Question: I have tried four different heart rhythm medicines for atrial fibrillation and none of them seem to work. Is this common, and why does this happen?
Answer :It's important when you're diagnosed with atrial fibrillation or when you're started on an anti-arrhythmic drug to have realistic expectations. And the treatment of atrial fibrillations is sort of like the game of baseball where it's very hard to get on base in baseball and it's hard for medications to completely control atrial fibrillation.
If you look at most medications, they have about a 40 to 50 percent success rate at a year -- meaning if your doctor starts you on medication for your atrial fibrillation, there's at best a 50/50 chance you'll remain at normal rhythm for 12 continuous months. And it's certainly, there's certainly a 50/50 chance that atrial fibrillation will come back at least some of the time. Now once a first medication is unsuccessful and fails, it's less likely that the second, or the third, or the fourth medication is going to work.
So typically, we'll try perhaps one or two medications. There's one medication called amiodarone that's more powerful than the rest of the medications, it also has more side effects that's generally reserved for last. But even with amiodarone, there's only at best a 70 percent chance that might work. So I think the message you should take home is that anti-arrhythmic drugs are commonly used, if you're lucky they'll work. And they may work for a year, they work for two years, they may work for five years. And occasionally they will work for the rest of their lives. But it's very very common that they won't work completely or won't control your atrial fibrillation completely, and you'll have to pursue other options.
I think the other point to remember is the reason we treat the atrial fibrillation with medications or with procedures is to make a patient feel better. So if you're started on anti-arrhythmic medication because you're having we'll say, five episodes of atrial fibrillation a day, and on that medication you have one five minute episode of atrial fibrillation in three months, you'll probably be happy and even though that medication's not completely successful, it's successful enough to make you feel better, and at the end of the day, that's what we're really shooting for.