I've never posted to this board before, but I'm hoping I can get pointed in the right direction. My Mom is 65 and has Graves' disease. She has had bouts of AF on and off for the last year or so, and this time she's been in to the ER three times in the last week and was admitted yesterday. Her heartrate goes up to 170 if she moves at all. If she lays flat on her back it stays somewhat stable, but still high for her (around 120). She had this happen about a year ago, and they shocked her to get her heartrate to convert, but apparently in AF patients it doesn't typically last. So here's my question: The cardio's plan is that they are going to try to convert her with meds (she's been on rhytmol this whole time) and try to get her TSH level under control, since it's double what it normally is. If they can't convert with meds, what's the typical next step? In all of this, they have not talked about a pacemaker, and Mom says that when she first started having AF they told her that she wasn't a candidate, but she doesn't know why.

I dont know alot about afib. Maybe they could do an ablation to destroy the cells causing the afib. I have also heard of a maze procedure for afib. Hopefully the meds will do the trick...Good luck to her

texcat,

Is her GRAVES fully controlled. With raging thyroid hormones, I would imagine the incidence of tachycardia is MARKEDLY increased?

Zip2Play - She's been treated for Graves for years, but as to how 'controlled' it is, I don't really know. I know she's had some instability in terms of her TSH levels, and they are currently double what they are normally right now.

first the Graves needs to be controlled.
She does Not need a MAZE or an ablation. Those would be extremely drastic steps for her problem.

I just got an update from Mom, she's still not able to get up w/out being very dizzy and she still hasn't converted. The docs are planning to do the eletrical cardioversion on Friday afternoon if she hasn't converted by then. She's been told by one of the nurses and a friend who has this same problem that they don't like to do the cardioversions unless they have to because it damages the heart, but I haven't been able to find any info that confirms this. Is this true?

It does not damage the heart.

Texcat:

For eight or so years, I have had afib episodes. These have occurred with increasing frequency.

I've had two cardioversions. They do not damage the heart as far as I can tell.

There were only two weeks between my last cardioversion and a new onset of afib. I felt worse than discouraged, because I simply can't function in afib because of a combination of problems caused by an earlier (1974) severe heart attack and congestive heart failure (ejection fraction is 35%). My heart can't get sufficient blood supply in afib.

At that point the cardiologist put me in coronary care and started me on sotalol (Betapace). This medicine requires close monitoring for 48 - 72 hours to make certain it doesn't induce other severe problems which would need to be acted on immediately.

That was nearly a year ago. I have not had any afib episodes since, and give grateful thanks for that fact. I hope it continues. The cardiologist tells me that if afib returns, he can up the dosage of sotalol.

At this point, I can work hard without distress or angina.

I hope your mother's afib responds well to treatment.

Bill

I have a friend who does pretty well on sotalol. He's had afib/flutter for about 2 years now and they don't want to do an electro-ablation til they have to.
He's had electroversion TWICE. The first was unconscious and went fine; the second was awake and caused him so much pain that he is DREADING the next.

But he SWEARS by the sotalol. It doesn't completely prevent all episodes of a-fib but helps enough such that no bouts have lasted long enough or been severe enough to cause another run to the ER in the last 6 months. Other beta blockers didn't help him at all.

I talked to Mom last night, she said that they took her off of the Rhythmol and on Digoxin, and she had an episode of crushing chest pain/jaw pain/left arm pain - classic heart attack symptoms, but the cardio came in and looked happy, saying she had converted to normal rhythm. So she didn't get have to get the electrical cardioversion today, but I'm a little confused about what just happened.

Your mother's chest pain with what seems to be typical angina is odd, Texcat. But if she converted to normal sinus rhythm and the cardio is on top of the situation, it would appear that things are going along all right.

Let us know how your mother does.

Bill