AFib abd meds

I've written about this before - but still looking for ideas-
My wife is 76, not overweight and has had hypertension as long as I can remember, most recent readings were in the range 170/80. She also has permanent AFib. A cardioversion lasted a day. She is on Coumadin (Warfarin).
In attempting to reduce the BP her meds were changed to diltiazem 180 mg once a day (long ago) and Toprol (from ateno) 50mg. Her pulse rate seemed too slow so the doc reduced Toprol to 25mg (split from
50). She seemed to have less problem with Afib on the ateno.
She now has severe swelling in the ankles - supposed attributed to the diltaizem, and worse she has such hard heartbeats in bed that she can't sleep. Furthermore she is very tired and SOB - maybe from lack of rest.
She's due back at the cardio in a couple of days and we are debating what to ask - or do. We are seriously considering seeking out another doc, just for another opinion.

Sorry I mean Pulmonary vien ablation.
Listen to yur electrophysiologist. Ask he or she to expain your rhythms. Most of these physicians have written material that explains various proceduces.
Solotol is a drug of choice for your situation. Give it a chance.

let me guess: a) probably they considered your bradycardia as potentially more serious and urgent to handle than your other heart problems. And/or b) they believed that once your bradycardia got fixed by the pacemaker, they would be free to try any antiarrhytmic drug with no risk to worsen your bradicardia problem

well, your paroxysmal (intermittent) a/flutter and tachycardia now require attempts with some out of the of the various drugs that are today available. That generally require months. if not years. And later on, should those attempts prove ineffective, you may consider rf ablation.

Last but not least, I believe you mostly need to discuss your situation and perspectives with a cardiologist who is *really* capable of a) listening to you, and b) explaining things to you.

I apologize for my poor english (I live in Italy)

I'm not a doctor either, and have a pacemaker implanted (bradycardia and some other heart "bug".

To my knowledge, a pacemaker is ineffective against afib and aflutter arrhythmias (afib is another heart bug of mine).

Unless your pacemaker is actually a defribrillator, they must have implanted it to handle a type of arrhythmia other than aflutter (AV block? bradycardia?).

no, I don't.
I mean it may take that long to find the "best" medicine (or the bes association of medicines) "for you". For example, in my case it took years to find an association of medicines, i.e. sota and flecainide, that lookes *very* effective for me. And I'm aware that such effectiveness maybe a coincidence or may not last long

excellent !

Defibrillators are not used to control atrial fibrillation or atrial flutter.The are used to control the fast arrhythmias that are generated in the ventricule. Generally pacemakers do not treat this rhythms either. Pacemakers are used to treat the brady rhythms or heart block. There is a particular type of pacemaker that attempts to keep the patient with paroxysmal atrial fibrillation in sinus rhythm. This is accomplished basically by the device watching for premature atrial contractions and when it see's a certain number of them it is programmed to increase the patients heart rate for a short period of time. It then goes back to previous rate and watching and counting mode..The rate This is a very basic explanation. The actual algorithm is a bit more complicated. As for treatment with ablation. Atrial flutter yields pretty good results. Atrial fibrillation is really not so easy to control although with the newer pulmany view ablations and superior and well practiced electrophysiologist under certain circumstatnces can be effective. That would depend on the cause of your fibrillation and locating the pulmonary view sites.
In fibrillation there are multiple sites. Drugs are the most common treatment for atrial fibrillation. In most cases the treatment works well. The pacemaker with protect you from both your own bradycardia rates and the effects of the medications to treat the atrial fibrillation.
Hope I have helped.

I'm not a doctor, but there has been some limited success with Ablation for AFib. Might be worth looking into. Not sure about the pros and cons.