AF help sought

[Arbroathsmokie]

Hello, I am new to this forum and I must say I have found it a great help. I have been diagnosed with AF and have had five episodes since July 2013. I have a number of concerns and wonder if anyone can help. I was originally prescribed Bisoprolol 2.5mg and over a short period this was increased to 5mg. As a result my bpm dropped to 39 so was taken off the drug. Since then I have had an ECG and was fitted with a 24hr monitor that showed (to quote the report) "episodes of sinus bradycardia and of svt. Junctional rhythm and 1 slow ventricular couplet". The report mentions 'Brachy/Tachy syndrome. Without any other treatment or drugs being offered by my cardiologist, I am now on the waiting list for a pacemaker. Having read a lot of information on this site I am somewhat confused that I seem to have gone from A to Z in one swift moment without consideration of alternatives. Furthermore as I appear to be 'low risk' on their grading scale, I have not been considered for any anti-coagulants. I would appreciate any advice as I am returning to my GP in a couple of days to try and get some answers/explore alternatives before the pacemaker is fitted. Has anyone else had a similar story and diagnosis?

[johncb]

Make an appointment with an Electrophysiologist as soon as you can. I too had Bradycardia with my AF, had intermittent attacks which would last anywhere between 1 and 15 hours at a time and my BPM was very similar to yours and all the Cardio could do was give prescriptions for Beta blockers and Warfrin. When I mentioned seeing an EP she said it was too dangerous and I would have to wait till drugs completely failed. I read as much as I could about AF and made the decision to see an EP. Had an ablation in Feb and after a shaky first 2 weeks I have never felt better, AF has completely gone and even the ectopics that I used to get every day have almost totally stopped. I am off all meds except low dose of Blood Pressure Med (Karvea). Quite often the first ablation doesn't work so I was lucky to have success with first one, had it not worked, I would not have hesitated to do it again as the procedure is painless and very safe in the hands of an experienced EP. At least make some enquiries and look at as much literature as possible.

[Hidden]

You need someone with more knowledge than me to respond on this, but from what I read of your post you suffer from a slow heartbeat. To my knowledge, Bisoprolol slows the heart down!!! I had to stop taking it because it slowed my ticker down when I didn't need it slowing. My GP prescribes Bisoprolol as soon as you mention AF, but it is for me the wrong drug completely.

Maybe it's the wrong one for you as well? But wait for some better knowledge than me before taking what I say into account.

PS. IMHO, you need to see an EP, non-one else really understands especially a lot or even most GP's.

[Hidden in reply to Hidden]

PS. Just re-read your post and saw the bit saying you'd been taken off Bisoprolol because it slowed your heart down too much.

Sorry, must get some new glasses! Just ignore me.

Koll

[Varina8]

Arboathsmokie,

When I was 63 years old I was diagnosed with bradycardia and sick sinus syndrome with paroxysmal AF. No treatment was considered possible when waiting for pacemaker but aspirin for anticoagulation. After pacemeker I had bisoprolol 5-10mg daily. When the new guidelines for AF were published Marevan treatment was started and I was ready to accept it, too. Pacemaker doesn't help for AF, but makes other treatments possible. It functioned well for more than six years, as did bisoprolol. Now I have my second pacemaker since one year. PAF episodes once a month last 12 hours and disappear spontaneously. At present I have propafenone and Marevan of course. When reading this forum I am wondering when is it my turn for ablation?

[Hidden]

You definitely need to see an EP asap but certainly before any pacemaker is fitted. They are the specialists in this area and will diagnose your problem and the best treatment for you. I suffered from A/F for about 6 years, only being diagnosed 18 months ago. Drugs made little difference, so only after pushing was I referred to an EP, who gave me complete confidence in his ability to improve things for me. He carried out an Ablation for me one week ago and so far so good.Also, I was considered low risk on the scale for anti coag, so not prescribed it. Unfortunately I then suffered a TIA in May last year. My GP then said perhaps he should have put me on anti coag after all, but hindsight is a wonderful thing. If I had found this site then, I would have definitely pushed for it. The advice and support on here is invaluable. Good luck.

[rosyG]

Hi,

You definitely should have anti-coagulants as you have had several AF episodes- I have similar bradycardia and SVts etc and EP I saw recently, and cardiologist before that, both said pacemakers not needed at present but they were pleased I had stopped beta blockers myself when caused extra low pulse.

You need proper advice but I was told by EP that many of the drugs would be unsuitable because of bradycardia so do a lot of reading about ablation before you get specialist appointment so you are in a good position to make informed decisions.

[Arbroathsmokie]

Thank you all so much for your replys. I have written down numerous questions for my GP appointment tomorrow.

[moggdog]

hi mate . i started off with af .had an ablation and now ive got svt .and they say thats a common thing ? but anyway im no expert either . i hope your gp is better than mine cause usually they dont really know condition. i would say you defo need anticoags. and to get a consult with your cardio asap . but while your waiting .can you get the number for the arithmia nurses ? because they can answer your questions and help with your meds . oh and ask about ablation. good luck

[pip_pip in reply to moggdog]

Hi Moggdog,

Having bouts of SVT after ablation is common, and although it doesn't feel like it, is a positive move in the right direction. It means that the first ablation removed the irregularity of the heartbeat and now they can concentate on the speed only, which is much easier to treat, via ablation or otherwise.

I had this prob and the SVT was removed after second ablation, although my AF has returned 2!/2 years on. When I was hit by SVT I thought I was dying, for the first time in 15 years of these problems, but I was assured, far from it (so they said)

Be well

Pip

[pip_pip in reply to pip_pip]

Unless of course the SVT was of a very high rate 300 + then things might not be so cosy

[mumknowsbest Volunteer]

Hi

I have tachy brady syndome and the EP team put the pacemaker in as I still had AF. I had had a couple of ablations by this time which only worked for a short time.

As everyone else has said I would definitely ask to be anti-coagulated and from my experience I would go for the pace maker. I# didn't want it at first but they said to me AF wouldn't kill me but a pulse dropping below 30 could so ~i went for it. Don't regret it

Eileen

[CDreamer]

Hi & welcome to the site, I do hope you find the support you want.

Although I have had P AFib myself and have recently had a catheter ablation for that condition, I had what is termed Lone AFib, whereas my husband was recently diagnosed with exactly what you describe ie:- P AFIB with brady(slow)/tachy(fast) heartbeat and is also waiting for a pacemaker. He was completely asymptomatic and we would not have known about his condition had I not owned an AliveCor monitor which he used and took the ECG tracings to his GP so that it was diagnosed early, which we consider a great bonus as it leaves him ahead of the game, so to speak. Untreated bradychardia could lead to heart failure over a period of time. Given that he is 80 this month, but still very active, playing 18 holes of golf several times a week, there is an expectation that bits will start to deteriate but we want as active a life for him for as long as possible.

I would absolutely echo the advice others have offered here, please ask to see an Electrophysiologist, however it took me about 8 years to get to see one and when I asked my GP why he said because they are so thin on the ground. We live in the South West and the nearest is Bristol or London. If you don't get referred by your cardiologist to an EP ask to see a very experienced cardiologist with a special interest in electrophysiology - the specialties seem to split into structural and electrophysiology and there is often a cross over. I ended up paying privately and so wish I had found this site a lot sooner as I wouldn't have messed around for the last 8 years and gone to an EP way back, but because I didn't know until I found this site -8months ago I didn't ask and nobody in the NHS enlightened me.

My husband was told they would not offer a Beta Blocker to address the AFib - which is what Bisoprolol is -because it will slow the heartbeat and therefor it wouldn't be safe to treat the AFib medically without the heart being paced electronically. We were told the procedure is very routine these days, it is a day case if performed in the morning or overnight if in the afternoon - the need for monitoring for the 1st few hours following the procedure, performed under a local anaesthetic and normally takes less than 1 hour.

I know it may all sound very alarming but there are a number of people on this forum who have had these procedures and will assure you that although it is a shock to learn about a wonky heart, we do live and thrive, it is not open heart surgery, as it was at one time, and is now considered a routine procedure. Once fitted It won't stop you doing anything and it will protect you.

The things you may consider are what is the prognosis for you if you don't have the implant? I should think it unlikely, though I am no medic, that you would be considered for medical or catheter ablation treatment without this safeguard.

For my husband he has been told he must not drive until a week following the implant, although he has not had any blackouts, that may happen.

Sounds to me as though you need more information from your Doctors and reassurance as to what will happen and the risk / benefit ratio.

You mentioned anti-coagulation and being low risk, I am sure others have already, but I was very against taking any anti-coagulation until I looked at the risk profile for stroke relating to AFib sufferers. Even at 'low risk' you need to talk with your GP and ensure he is well enough informed as many GP's and cardiologists are ignorant of the strong relationship between AFib and stroke. Asprin is an anti-platelet not an anti-coagulant and is useless as protection against stroke. As my cardiologist said to me last week, that is one complication you really do NOT want to have to contend with.

Reading the other posts I think you may be picking up a theme? Hope this helps.

Do come back to us and ask any other questions concerning you and let us know how you got on.

Very best wishes .......

[bootneck3]

Hello Royal (I believe from a reply by your wife)

Seems your AF started just before mine as it was September 2013 for me, with 7 admissions in hospital up to and before Xmas. ( Meant that was a wash out and had to cancel the holiday over Christmas to Gambia).

I was started on Bisoprolol at 1.25mg and each time increased to max of 10mg. Now on that, Flecanide and Rivaroxaban which all make me feel ghastly. Constant chest pain, sensitive upper stomach, numbness down left arm. Was off work since start of it until last week (partime thank god) and off to see Consultant tomorrow for possible agreement on Ablation. Just come back from Drs and tested myself, BPM currently 159. Hope all is going ok with you.

I understand you served in several units. I was a club swinger!!!!!!! ( no not that type) and served between 1973 and 1985. My brother served from 1971 for 28 years and included 41 cdo whilst still in Malta.