AFIB rtn's with Vengeance 45 days pos... - Advanced Prostate...

Advanced Prostate Cancer

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AFIB rtn's with Vengeance 45 days post Valentine days Cardioversion - blame points to Abiraterone? maybe?

depotdoug profile image
19 Replies

Yes, Depotdougie, me, returned to AFIB code status 21/22 March. Not fun, Not a happy camper, Not much excitement in Ft Wayneville for Doug. Yes, I confirmed AFIB status by my Merlin @Home Remote ICD/pacemaker Xmit to my Cardiac Device Clinic this Monday. Verified with my KARDIA EKG mobile plate.

Got call today from my MO's RN, while I was trying to exercise my AFIB out. She says that Dr A says sure, my "Abiraterone 250mg daily could contribute, knock me back in AFIB. He gave me the option to stop Abiraterone. I'm not doing that yet. Not gonna happen.

I see my Electrophysiologist Tuesday next 11:00. Got my (5) bullet point Concerns & Questions already hot off the press for Tue. Probably send them tomorrow. A catch 22, take Abiraterone/Lupron/Prednisone to squash cancer cells, and Cardiac Rhythm goes crazy. The good news my EP guy is extremely cognizant about cancer meds messing up cardiac Normal Sinus Rhythm signals.

~ 96 hours till EP visit unless I divert to my fav hospital ER 1st.

Doug

19 Replies

God be with you Doug🙏🏼

timotur profile image
timotur

For about twenty years, I've have an atrial flutter condition that feels like the heart can't synch up the beat between chambers. It happens rarely, maybe two-three times a year. Usually it goes away if I lay down and rest and drink water. My EKG's are normal, and I attribute it to caffeine or stress. But last year, when I was on Zytiga, I had an episode that was scary, instead of a flutter, it felt like the atrium was pounding sharply, and when I laid down, it wouldn't go away for about an hour. I attribute it to high blood pressure as a result of Zytiga, possibly worsening the signaling issue with atrial flutter. At the time, I was doing 250mg with yogurt, and possibly the absorption of Zytiga too high. I would suggest reducing the food intake with Zytiga, or wait about 10 minutes after food to take it, to reduce absorption, and see if it the AFIB abates.

depotdoug profile image
depotdoug in reply to timotur

March 10th labs: PSA stuck @ 1.032ng/mL T levels <5.

We both are kind of alike. Abiraterone 250mg. I take mine to with yogurt or muffin with avocado. Sometimes an hard boiled egg. Just my MO prescribed with breakfast. (and an Apple a day)

My BP is controlled by 3 meds. Plus HCTZ 12.5 water pill. Plus Xarelto since Feb 14th Valentines day.

My AFIB rhythm feels actually much better when i exercise, yeh workout 2X daily. But my 2 Fitness places are closed.

Honestly think my ICD/pacemaker(at least pacemaker is working overtime) since AFIB returned 03/21 and now. I'm just trying to quit thinking about the pounding racing pressure in my right atria chest and Stay out of my local ER, again.

News of the day. Called my EP office after lunch today told them again my symptoms, they upped my appointment to this Monday 13:00. 2.5 days till I get my questions answered and a plan forward.

My AFIB history goes way back to April 2013, 2 years post Sudden Cardiac Arrest.

So looking forward to seeing my 4th EP doc soon. Plan on staying out of the ER this weekend.

More news Monday.

Thanks timotur.

Doug

timotur profile image
timotur in reply to depotdoug

Doug: with regard to atrial flutter, several years ago before my PCa, on a day when I ran a few miles in 90+ degree weather, I had my worst flutter event caused by dehydration-- it was a situation where the flutter kept occurring every two hours over 4 cycles, and I couldn't get it to settle down, and wound up in ER. Thankfully it wasn't a heart attack, but being dehydrated caused my electrolytes to get out of whack and the atrium couldn't synch up properly. So in working out 2x/day, be sure to hydrate and keep your electrolytes up.

Back to Zytiga-- it put additional stress on my cardio by increasing BP to about 165/100. When I had the flutter episode last summer, it was sharply, more intense that the event above. I took this as a warning along with the high BP and dropped Zytiga after five months, and continued on Lupron, now 12 months total.

depotdoug profile image
depotdoug in reply to timotur

Wow, Zytiga does cause my BP to increase as well. I’m having difficulty 1) taking my BP because it’s going up and down(maybe Abiraterone induced) plus I take my EKG with my KARDIA Mobile plate and Apple S4 watch. I’ve never had a problem taking reading my EKG’s but the last week has been a disaster. Most all EKGS came up unreadable or inconclusive. Yeh, my HR is all over the place.

One EKG taken March 26th I sent in for cardiac clinical analysis just came back: 122BPM SINUS RHYTHM W/single PVC’s. It sure looks like AFIB to me! Or maybe Atrial flutter.

I’ve been up awake since 03:30 today.

Anxiously waiting for my EP’s moved up appointment Mon 13:00.

Will watch my BP and maybe exercise once the thunder rainstorms stop. Thanks

Doug

timotur profile image
timotur in reply to depotdoug

Doug: if you have SINUS RHYTHM W/single PVC (premature ventricular contraction), I would ask the Dr if Zytiga is causing it or making it worse. A pulse rate of 122 seems high (maybe you were exercising), but what happens with PVC is the there is a premature contraction in the ventricle, a slight pause, then a stronger-than-normal beat. The heart fills with more blood during the pause following the PVC, giving the next beat extra force, and consequently higher blood pressure. Good you are on top of it with the monitoring equipment-- nice to know, may look into this setup in the future.

depotdoug profile image
depotdoug in reply to timotur

That EKG reading was Thursday eve, not exercising. Inside confined to home without leave. But had no idea PVC’s did or contributed to that. I’ve had lots, way to many Heart monitoring machines tethered to my 68 yo body.

Fact is Sunday when I was feeling terrible and BP was erratic and could not even take an EKG with my KARDIA mobile or Apple S4 watch EKG functions. I had enough. I sent a Merlin@Home remote monitor XMIT from interrogating my ICD/Pacemaker. I can manually do that. Response back from my Hospital Cardiac Device Clinic Mon after Lunch was a positive occurrence of Atrial Fibrillation and some Vtach contractions. That recording goes on 1] the hospitals cardiac device clinic St Jude Medical (now Abbot Medical) and direct easy access to my EP doctor. My EP was on vacation this week. His RN’s said he was staying at home, good idea.

Yes, absolutely my Abiraterone could probably cause AFIB or PVC’s.

I would prefer one more CARDIOVERSION to my heart, but do to hospital circumstance now, COVID-19 is Pri #1. Cardioversions I think are elective procedures and a No No now. Unless it turns out to be an Emergency, Trying to avoid that again. Today was not a good morning after a trip to Kroger’s home an got dizzy real dizzy. So laid down, staying hydrated and resting. You probably get the idea I’m trying to stay out of m favorite ER. Next Monday is getting close.

timotur profile image
timotur in reply to depotdoug

Ok Doug, very good, thanks for the info on KARDIA, going to look into that... good luck on your upcoming appointment.

Here's some more info on PVC events:

ncbi.nlm.nih.gov/pmc/articl...

tango65 profile image
tango65

The Cabana randomized control trial showed that 20% of the patients treated with ablation started with AF again at 3-4 months and 50% at 36 months. It is a procedure with a significant failure rate, in my opinion. Look at figure 6 of the study:

ncbi.nlm.nih.gov/pmc/articl...

depotdoug profile image
depotdoug in reply to tango65

That is an excellent article tango65. CABANA trial. Figure 6 facts.

My 1st Cryo-ablation was April 2014. It lasted ~ a year 2015. I was not on any ADT Lupron meds at that time. Now since Sept 2019 re-started Lupron now 3 90 day injections in March 10th. Now since Dec 10th 2019 I've been on Abiraterone 250 & Pred 10mg daily.

1. I've got my EP doctors appointment upped for this Monday 13:00.

2. Got call today from my MO's RN, while I was trying to exercise my AFIB out. She says that Dr A says sure, my "Abiraterone 250mg daily could contribute, knock me back in AFIB. He gave me the option to stop Abiraterone. I'm not doing that yet. Not gonna happen.

I've got, i think a skilled, my 4th EP. He's aware of advanced Prostate Cancer med's contributing maybe probably to my AFIB return with a vengeance.

I will digest the CABANA article this weekend. Another Cath Ablation may not be on my radar, Cardioversion again yes, Medication control maybe.

Besides don't think there is any elective procedures being done in hospitals now.

Bring on one more Cardioversion.

Oh, there is a newest type of ablation in trials now, in France and starting in US.

It is called Pulsed Field Ablation.

escardio.org/Councils/Counc...

Patiently waiting for next Mondays visit with my 5 bullet point questions comments.

Thanks for pointing me to that article, tango65.

DOUG

tango65 profile image
tango65

Best of luck!! Try to discuss the possibility of being medicated with flecainide or sotalol. It is possible these medicines could put you back in sinus rythm and keep it for a while and extend the time between episodes of AF.

IMHO, I would not stop the abiraterone if it is controlling the cancer.

depotdoug profile image
depotdoug in reply to tango65

I’ll put Sotalol on top my questions list for EP Dr V Monday. I’ve heard of both. I’m not taking Amiodarone!

Not stopping Abiraterone

, although my MO says it’s a possible cause of AFIB or High BP or PVC’s.

Thanks for update. Yes I’m staying hydrated well, lots of H2O going in.

tango65 profile image
tango65 in reply to depotdoug

Best of luck!!

mikiesan profile image
mikiesan

Have been in AFIB (pulse rate controlled with medications) for almost 20 years after several failed Cardio-versions.

Currently taking Zytiga 1000mg (4x250mg) daily for my Prostate Cancer.

Notice in reading the replies that several folks are taking their Zytiga with food. The Integrated MedFacts Module that comes with each prescription clearly states "Take this drug on an empty stomach. Take at least 1 hour before or at least 2 hours after a meal".

This was emphasized by my MO at time of prescription.

Maybe taking the Zytiga as recommended would help with some of the problems mentioned?

depotdoug profile image
depotdoug in reply to mikiesan

Thank you for your encouragement. Maybe hopefully Pulse Rate medications will be my answer as well. That's an excellent ? to bring to the Table Monday @1300 with my Electrophysiologist. I I've been in AFIB, in and out, since 2013. You've got me beat by 13 years.

1. I am one only 250mg Abiraterone 1 tab daily since Dec 10th.

2. My March 10th birthday PSA was down and holding @ 1.032ng/mL

3. My IU Health Simon Cancer Center MO is fine with 250mg Zytiga for now primarily because of my major past Sudden Cardiac Arrest history May 2011, 12 days in CICU, and a host of other cardiac issues. Plus I'm on my 2nd ICD/Pacemaker St Jude device.

4. I just re-looked at my 4th bottle of Abiraterone and it says "Take one tablet by mouth every day with a low fat breakfast". I did confirm that with my IU Health University Pharmacist director March 10th in person. I truly realize that there will be a time sooner , hopefully later, that i will have to up my dose to 500mg or 1000mg.

First thing I'll ask my EP doctor; after the due an EKG and interrogate my ICD/pacemaker Monday is "AFIB control with pulse rate controlled medications" my anti-AFIB solution??

I do exercise 1 to 2 X's daily so that may be a factor in pulse rate control, plus my pacemaker my control more than I understand.

I will post updates soon.

Thanks miskesan.

Doug

WSOPeddie profile image
WSOPeddie

I got atrial fibrillation ablation surgery on Feb 25th. One thing I can mention is that I believe taking vit D3 aggravates a-fib. I stopped it and my occurrence rate dropped. This was before the surgery.

lifeextension.com/magazine/...

diabetesincontrol.com/exces...

Here's a study that suggests the opposite -- that vit D deficiency can be the culprit:

nutritionj.biomedcentral.co...

depotdoug profile image
depotdoug in reply to WSOPeddie

Thxs I will look up those info link tonight.

Doug

depotdoug profile image
depotdoug

UPDATE: - 15 hours countdown till EP visit. My notes synopsis for Monday.

** AFIB 2nd X in 45 days - QOL vs Med’s -

I Chose QOL. "Not curable but controllable".

Kind of like my advanced PCa Cancer.

I'm looking for all the right answers in some of the places.

It will be an interesting OV @ 1300 Monday.

Saturday was a bad AFIB day for Doug. I went Kroger shopping early, groceries home, Doug home and got extremely dizzy sitting down. Decided to return to bed. Slept 2 hours, I know it's my atrial fibrillation symptoms. Irregular HR, pressure in right atria chest area, dizzy because HR is pulsing all over the place. But my pacemaker section of my ICD/ device was working OT, I think. Mr Doug's 2nd ICD/pacemaker is primarily set to maintain HR at 70 BPM, and it does that if heart is electrically functioning nicely. It is not since a week ago, again.

Good news no SOB(shortness of breath).

I just sent my EP my questions/comment concerns which i will take my own copy in with me.

Like all of us complicated complex patient patients, we go in loaded with our concerns/?'s.

I'm trying to take the same approach w/my AFIB re-occurence again, in 35 days, that I'm trying to take with my PCa tagged Adv/Metastatic. Controllable not curable.

What's going to happen Monday after lunch? Do not know, yet. Back in hospital is not an option under today's crisis. I think.

Doug

WSOPeddie profile image
WSOPeddie

One other thing about a-fib -- sleep apnea can aggravate it, as well as cause other problems like fatigue during the day. My a-fib surgeon had me take a sleep study test prior to surgery. Sure enough, I had sleep apnea. I can add that almost all of my a-fib episodes occurred during the night while sleeping, which is consistent with sleep apnea. So if you haven't already been tested for sleep apnea you may want to do so. I'm not obese so maybe not fitting the typical profile my GP never thought to have me tested. I had complained about fatigue many times. I've been using a CPAP machine for two months now.

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