Pumping Marvellous

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Cardioversion here we come

Just had my initial consultation with Angela Graves my Heart Failure Nurse and Dr John McDonald my cardio consultant who has just set the date for for my Cardioversion.

Can’t say I am completely looking forward to it, I still have an aversion to needles when I have my general anaesthetic but I realise that it could take me out of AF and back into Sinus Rhythm so I suppose this is a really good thing. The only big decision I had to make was taking Amiodarone.

Amiodarone is an Anti-Arrhythmic drug that has some quite perturbing side effects and I will let you investigate that. It has a half life of 45 days which means in layman’s terms it doesn’t get into your body for 45 days and therefore takes a long time to exit as well. Therefore John McDonald and I have agreed that I start off on 200mg of Amiodarone and continue this until I get my Cardioversion on the 25th November, if I don’t make it into to Sinus Rhythm and stay in AF then I will come off Amiodarone or if I go into Sinus Rhythm then I stay on Amiodarone for 90 days and no more. This is to enable my heart to have the best possible chance of staying in Sinus Rhythm. The reason for taking the Amiodarone before Cardioversion is that it increases the chances by 15-20% of the heart going into sinus rhythm from an electrical Cardioversion. It then keeps the heart stable by trying to prevent a flip over to AF again.

So lets give it a go and keep abreast of my shocking performance!!!!! It reminds me of that Carry on Film Carry on Screaming when Kenneth Williams says the famous line “Frying Tonight”

What I will stress is that to have these levels of discussion you need to have the right relationship with your Consultant and Nurse. Both John and Angela are very supportive but probably think I ask too many questions. Because I challenge my clinicians I am an expert patient – you should try it.

AF and Dronedarone

This is a recent press release from NICE (National Institute for Health and Clinical Evidence). It talks through it’s recommendation of Dronedarone which is a derivative of Amiodarone which is an antiarrythmic drug. It is quite technically but is an interesting read.

“In guidance published today NICE recommends the use of dronedarone as a second-line treatment in people with additional cardiovascular risk factors whose atrial fibrillation (AF) has not been controlled by first-line therapy (usually including beta-blockers). The guidance recommends dronedarone as an option for the treatment of non-permanent atrial fibrillation only in people:

Whose atrial fibrillation is not controlled by first-line therapy (usually including beta-blockers), that is, as a second-line treatment option, and

– who have at least one of the following cardiovascular risk factors:
– hypertension requiring drugs of at least two different classes
– diabetes mellitus
– previous transient ischaemic attack, stroke or systemic embolism
– left atrial diameter of 50 mm or greater
– left ventricular ejection fraction less than 40% (noting that the summary of product characteristics [SPC] does not recommend dronedarone for people with left ventricular ejection fraction less than 35% because of limited experience of using it in this group) or
– age 70 years or older, and
– who do not have unstable New York Heart Association (NYHA) class III or IV heart failure1.

In recommending the use of dronedarone as a treatment option for some people with AF, the independent Appraisal Committee noted comments from patients and clinical experts received during consultation on the draft guidance that all current anti-arrhythmic drugs have side effects which can have a significant impact on quality of life with long term use. It heard from patient experts that some people with atrial fibrillation might prefer to take dronedarone because it has fewer side effects, despite it being less effective than other antiarrhythmic drugs in preventing recurrence of atrial fibrillation. The committee also accepted evidence that the drug did not lead to an increase in the risk of mortality, unlike the anti-arrhythmics with which it was compared.

Atrial fibrillation is one of the most common heart rhythm disturbance conditions. It can cause symptoms such as palpitations and tiredness and is associated with an increased risk of thrombus (blood clot) formation and thromboembolism including ischaemic strokes. The prevalence of AF increases with age and in the UK nearly 50,000 new cases of AF are diagnosed each year. Standard baseline therapy for AF may include drugs to maintain sinus rhythm, where beta-blockers are usually the first choice.”