There is more than one approach to atrial fibrillation
DEAR DR. ROACH: I am trying to decide if it would be beneficial for me to get a second opinion about atrial fibrillation treatment.
I was diagnosed in May after my doctor discovered that I was in atrial fibrillation while taking my blood pressure and heart rate at a routine appointment. I was given Xarelto in the emergency room and cardio-converted with flecainide. I was sent home with a prescription for Xarelto to be taken daily, and instructions to return to the ER if I felt dizzy or had fluttering, pounding, pressure or pain in my chest.
Eleven days later, I was out of state and felt many of those symptoms. At that ER, the doctors were incredulous and shaking their heads about the fact that I was not prescribed metoprolol the first time; they gave me a prescription to take daily. At my follow-up appointment with my cardiologist, he said it was fine to take both, that Xarelto is a new blood thinner and metoprolol is an old-school treatment, a beta-blocker for regulating the heart rate. He also said not to go to the ER unless I felt like I was having a heart attack, with very strong symptoms, since I was taking medications. If I felt uncomfortable, I should call his office and wait several hours to do so, if I felt them in the middle of the night.
Several days later, I felt dizzy and my heart rate was clearly erratic, so I called his office. He called in a prescription for flecainide and told me to take three pills right away and if I didn’t return to normal in a few hours to go to the ER on an empty stomach and get the paddle treatment to restore my heart rate. At a follow-up appointment he explained that I should carry the flecainide with me to take as needed. If necessary, he would adjust the dosages so I would take all three medicines daily, and if that failed, the next course of treatment would be ablation. Should I get another opinion? — P.D.