Dangerously abnormal heartbeats require drug treatment

Dr. Keith Roach

Dear Dr. Roach: I am a 67 year old Caucasian female in generally good health. In 2022, I was diagnosed with asymptomatic atrial fibrillation (AFib). I underwent electrical cardioversion in the hospital, but the AFib continued intermittently throughout the past year, according to my heart monitor. Six weeks ago, a 14-day Holter monitor showed an AFib load of 65%, with my heart rate ranging from 34-192 bpm.

My doctor is suggesting Tikosyn, as metoprolol lowers my heart rate significantly. Unfortunately, my insurance will not cover the brand name Tikosyn, but will cover the generic version. Any concerns about the generic version?

— PS

Dear PS: AFib is a common electrical abnormality of the heart where the heart’s normal rhythm regulation is lost and the heart beats chaotically. Heart rate can be variable and your range is worrying, as 34 is too slow and 192 is extremely high for a 67 year old. Better control of your heart rate is essential.

Dr.  Keith Roach

If AFib recurs after an electrical cardioversion, medication is usually tried. There are several drugs, and clinical judgment by a cardiologist is essential in choosing the right one. I never prescribe these drugs; I leave it to the experts.

Tikosyn is a common drug. All anti-arrhythmic drugs have the potential, paradoxically, to create new rhythm disorders. About 3% of the time, Tikosyn causes a dangerous rhythm called torsade de pointes, which is life-threatening.

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