Dr. Keith Roach DEAR DR. ROACH: I am a 67-year-old Caucasian female in generally good health.
In 2022, I was found to have asymptomatic atrial fibrillation (AFib). I underwent electrical cardioversion in the hospital, but the AFib continued periodically throughout the past year, according to my heart monitor. Six weeks ago, a 14-day Holter monitor showed a 65% AFib burden, with my heart rate ranging from 34-192 bpm.
My doctor is proposing Tikosyn, since metoprolol significantly lowers my heart rate. Unfortunately, my insurance will not cover brand-name Tikosyn, but it will cover the generic version. Are there any concerns about the generic version? — P.
S. ANSWER: AFib is a common electrical abnormality of the heart where the normal regulation of the heart rate is lost and the heart beats in a chaotic fashion. The heart rate can be variable, and your range is concerning, since 34 is very slow and 192 is dangerously high for a 67-year-old.
Better control of your heart rate is essential. 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 correct one.
I never prescribe these drugs; I defer to the experts. Tikosyn is a commonly used medicine. All anti-arrhythmic drugs have the potential, paradoxically, to create new rhythm disturbances.
About 3% of the time, Tikosyn causes a dangerous rhythm called torsade de pointes, which is life-threatening. Most of the ti.
