Advances in Atrial Fibrillation Therapies

Andrew Rubin, MD, Electrophysiologist and Cardiologists with Eisenhower Desert Cardiology Center discuss new advances in Atrial Fibrillation therapies.
(4-12-22)

Q & A
Dr. Andrew Rubin, MD, Zoom CHAT questions:

• I am taking Diltiazem and wondering if that compares with Warfarin?
o Diltiazem is a calcium channel blocker medication used to treat blood pressure and certain heart rhythm disorders. Warfarin is a blood thinner used to treat and prevent blood clots. They are two completely different medications, treating different issues.

• Are you familiar with taking metoprolol with Flecanaide to control Afib
o Yes, they are both great medications with a history of effectively treating and controlling AFib.

• Comment please on why AFIB drugs to control rhythm quit working.
o Any medication has the possibility of becoming ineffective over time as we age and our body changes. Sometimes medications that were once effective will become ineffective in the future.

• Is it possible to stop Amiodarone, or must it be taken forever?
o Yes, it is possible to stop Amiodarone. However, if it is effective and side effects are not a problem it may be continued long-term. If side effects are an issue, other effective medications may be indicated. This is a patient specific question and dependent on individual circumstances.

• Can you address the use of Soltalol?
o Soltalol is a reasonable drug used to suppress AFib.

• What about caffeine? Is it harmful?
o Caffeine in moderation is not harmful.

• What is the recommended timeframe to elect ablation vs a meds only regimen?
o This is patient and physician specific. There are a lot of factors that must be considered: effectiveness of medication regimen, tolerance to AFib, personal health history, ultimate goals, etc. This requires a conversation with your physician, there is no specific recommended timeframe.

• Why aren’t left atrial closure devices more common than blood thinners for stroke prevention.
o Blood thinners have been around for a long time. Left atrial closure devices have been around a little more than 6 years. More long-term research is required. In addition, currently, proof of intolerance of blood thinners for one reason or another is required to warrant the use of a left atrial appendage closure device.

• Is it possible for Bisoprolol/Metoprolol to be over-tolerated by the heart, not work? If so, what are the alternatives, drugs to take its place in the future?
o It is possible that any drug that was once effective may lose effectiveness overtime. As our bodies age we continuously change, that’s is why regular medical care is necessary to ensure that each person is on the most effective regimen for them as they age and the body and heart change.

• What are the differences between Metoprolol and Propranolol?
o Metoprolol is beta-1 selective and generally better tolerated than Propranolol.