Managing Atrial Fibrillation: Concerns About Stopping Heart Medication

The doctor discontinued the medication despite the arrhythmia?

My father is 90 years old and has been dealing with arrhythmia for ten years.
He stopped his medication last year, which led to a ventricular tachycardia episode that required an emergency visit.
After being discharged, the doctor prescribed Dronedarone (200 mg) to be taken once daily in the morning, along with Amlodipine (5 mg) in half doses twice a day.
He has been on this medication regimen for about six months, and his heart rate has been controlled at around 65 bpm, with a blood pressure of approximately 100/65.
However, in recent months, he has experienced brief episodes of dizziness and blackouts lasting a few seconds.

Today, the doctor decided to discontinue Dronedarone to observe if this would improve his dizziness.
My concern is that my father previously experienced a heart rate of 150 bpm due to stopping his medication, which led to an emergency situation.
Now that Dronedarone has been stopped, what should we monitor? At what heart rate should we seek immediate medical attention? Should the doctor have discontinued Dronedarone, or could other medications be considered? Given my father's advanced age of 90, I am quite worried.
I would greatly appreciate your assistance in addressing these concerns.
Thank you very much.

Wu, 90~99 year old female. Ask Date: 2021/03/10

Dr. He Dongjin reply Cardiology

Hello, the doctor is concerned that the medication overdose may cause a slow heart rate, leading to dizziness and temporary vision loss.
If your heart rate remains above 100 beats per minute, please visit the outpatient clinic for medication adjustment.
Changhua Hospital cares about your well-being.

Reply Date: 2021/03/10

More Info

Managing atrial fibrillation (AF) and the associated concerns regarding medication can be quite challenging, especially in elderly patients like your father. Given his age and medical history, it's crucial to approach this situation with caution and a thorough understanding of the implications of stopping heart medications.

Atrial fibrillation is a common arrhythmia that can lead to various complications, including stroke and heart failure. Medications like Dronedarone (the drug you referred to as "臟得樂") are often prescribed to help control heart rate and rhythm. While it appears that your father's heart rate has been well-controlled at around 65 beats per minute, the recent episodes of dizziness and near-syncope (feeling faint) are concerning and warrant careful monitoring.

When a physician decides to stop a medication like Dronedarone, it is usually based on a careful assessment of the patient's current health status, potential side effects, and the risks versus benefits of continuing the medication. In your father's case, the decision to stop the medication may have been made in an attempt to alleviate the dizziness he has been experiencing. However, it is essential to monitor his heart rate closely during this period.

Here are some key points to consider:
1. Monitoring Heart Rate: After stopping Dronedarone, it is crucial to monitor your father's heart rate regularly. If his heart rate exceeds 100 beats per minute (tachycardia) or drops below 60 beats per minute (bradycardia), you should contact his healthcare provider immediately. If he experiences a heart rate of 150 beats per minute or higher, it is advisable to seek emergency medical attention.

2. Symptoms to Watch For: In addition to monitoring heart rate, be vigilant for any symptoms that may indicate worsening heart rhythm issues. These include:
- Increased episodes of dizziness or lightheadedness
- Shortness of breath
- Chest pain or discomfort
- Palpitations (feeling like the heart is racing or fluttering)
- Fainting or near-fainting episodes
3. Follow-Up Appointments: Ensure that your father has regular follow-up appointments with his cardiologist. These visits are crucial for assessing his heart rhythm and determining whether any adjustments to his medication regimen are necessary.

4. Alternative Medications: If Dronedarone is not suitable for your father, there are alternative medications available for managing atrial fibrillation. These may include beta-blockers, calcium channel blockers, or anticoagulants to reduce the risk of stroke. Discuss these options with his healthcare provider to find the most appropriate treatment plan.

5. Lifestyle Modifications: Encourage your father to adopt a heart-healthy lifestyle, which includes a balanced diet, regular physical activity (as tolerated), and avoiding stimulants such as caffeine and nicotine. Stress management techniques, such as mindfulness or gentle yoga, may also help in managing symptoms.

6. Emergency Plan: Develop a clear plan for what to do in case of an emergency. Make sure that you and your father know when to seek immediate medical attention and have contact information for his healthcare providers readily available.

In conclusion, while stopping Dronedarone may be a necessary step in addressing your father's dizziness, it is vital to monitor his heart rate and symptoms closely. Regular communication with his healthcare provider is essential to ensure that he receives the appropriate care and medication adjustments as needed. Your father's safety and well-being should always be the top priority, especially at his advanced age.

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