2023-10-05 07:28:56
by Fabrizio Tundo
Transcatheter ablation is more effective in preventing relapses and safer than taking antiarrhythmic drugs, due to the possible adverse effects which in the long term outweigh the small risks of the operation
A few months ago I had several episodes of atrial fibrillation, once a day for five days. In the emergency room they gave me an amiodarone drip. Now I take one tablet of the same drug a day. Some cardiologists recommended ablation to me, because amiodarone is considered a toxic drug and can cause problems; others tell me to wait. Furthermore, some doctors suggested the drug edoxaban (which I am taking) and others the combination clopidogrel/acetylsalicylic acid. I would like to know if there is an alternative therapy to amiodarone, with fewer side effects, and if I should take other drugs. I am 62 years old and have had a pacemaker for five; I have had a few angioplasties in the past.
Answered by Fabrizio Tundo, Department of Arrhythmology, Monzino Cardiology Center, Milan (VAI AL FORUM)
Atrial fibrillation is a very common arrhythmia, which increases in incidence with increasing age and can be favored by clinical problems such as hypertension, diabetes, ischemic heart disease. Amiodarone is very effective for the treatment of different types of arrhythmias, certainly including atrial fibrillation. Unfortunately it presents a number of non-negligible side effects, the most serious of which are extracardiac. It cannot be considered a toxic drug, because it still maintains a fairly high safety profile (otherwise it would be withdrawn from the market) and the benefits generally outweigh the side effects.
Thyroid dysfunction
However, it is necessary to monitor the appearance of side effects, the most frequent of which is interference with thyroid function, both in the sense of hypothyroidism (more easily correctable) and in the sense of hyperthyroidism, a more difficult condition to treat which almost always determines the need for suspension of the antiarrhythmic drug and taking other drugs to stabilize the thyroid function and make it work properly again. The dysfunction is therefore temporary, although it may take a few months to return to euthyroidism (the correct secretion of thyroid hormones). Unfortunately, his history of ischemic heart disease (he reports several angioplasties in the past) represents a contraindication to the use of widely used alternative antiarrhythmic drugs, such as class 1C drugs (for example flecainide or propafenone), which are generally well tolerated and have a lower risk of extracardiac complications.
Transcatheter ablation
Also for this reason I would seriously consider performing a transcatheter ablation procedure for atrial fibrillation. This operation has now become routine for many years and in recent times new techniques have been developed which have made the operation quicker and safer for the patient. We certainly have a lot of scientific evidence, derived from multiple studies on tens of thousands of patients around the world, which have demonstrated that transcatheter ablation is more effective in preventing relapses and safer than taking antiarrhythmic drugs, precisely because of the possible side effects. drugs that in the long term outweigh the small risks of the surgery.
Anticoagulant therapy
There are now superspecializations within each medical specialty and in the branch of cardiology the arrhythmologist is the doctor specialized in the care and treatment of arrhythmias. I would therefore advise you to carry out an outpatient visit with an arrhythmologist to carefully evaluate your case and possible confirmation of the indication for ablation. Finally, as regards anticoagulant therapy, it is certainly advisable to continue the drug you are taking (edoxaban) or a similar one, while I would not consider the advice to continue with the double antiplatelet therapy (clopidogrel/acetylsalicylic acid), which is not necessary if more than a year after the last angioplasty and does not cover the thromboembolic risk associated with the presence of atrial fibrillation.
October 5, 2023 (modified October 5, 2023 | 07:28)
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