I have been told I have PAF is this only treated with drugs

[peterjames]

[BobD Volunteer]

Hi Peter, there are three possible treatment strategies but NICE lay down a pathway. The two drug options are rate control or rhythm control. Beta blockers such as bisoprolol are often given as a first line to slow the heart during attacks but these tend to cause problems for people with asthma so need to be used carefully. There are a number of rhythm control drugs which attempt to keep the heart in rhythm including flecainide, propafanone, and the old favourite amiodarone, the last tending to be a last resort due to side effects. Many patients will be given a beta blocker and possibly flecainide as a pill in pocket to take during attacks.

The alternative treatment which under NICE guidlines can only be used after two drug strategies have failed is ablation. Many of the rogue electrical impulses which cause the AF are thought to come from the fours pulmonary veins where they attach to the left atria. By isolating these areas by burning scar tissue around them either by RF energy or cryo balloon it is hoped to stop the impulses and ditto the AF. Many specialists believe that early intervention by ablation has the best long term outcome. but it must be remembered that this is all very new science , within the last twenty years for sure.

I was diagnosed with PAF in 2005 and had three ablations in 2006,.7 and 8 since when I have been AF free so obviously a big fan of the procedure.

I must mention that while AF is not life threatening (it may feel like it sometimes) it does increase your risk of stroke by a factor of five so patients need to be assessed for risk using CHADS2 or CHADS2VASC2 score system (look it up on the main website) If your score rates it then you MUST be on anticoagulation and I don;t mean aspirin which is about as useful as a chocolate fire-guard where AF is concerned. We are talking warfarin or one of the new oral anticoagulants here and don't let any GP put you off. Many are still in teh dark ages about AF so you need to become your own expert. You should also get to see an electrtophysiologist, that is a cardiologist who specialises on rhythm disorders ad there is a list by area on the main website as these are the guys and galls who actually understand your problem . Many main stream (plumber) cardiologists are not up to speed and still consider it a minor inconvenience.

There are many useful fact sheets on the main website which I commend to your attention as knowledge is power. Ask any specific question and somebody her will be able to answer.

Bob

[peterjames in reply to BobD]

thanks very much for the info..peter

[Hidden]

Hi Peter

Excellent post from Bob, can I just add my penny-worth. I'm just a patient, had AF for 20 years, diagnosed 10 years ago. Had an ablation which kept me clear for 8 years without drugs.

GP's are not up to scratch generally on arrhythmias and (mine at least) cannot prescribe the drugs I need (rhythm control drugs), so be aware of that. Mine will automatically prescribe beta-blockers which are completely wrong for me, may be right for you though? Do listen to Bob and see an EP if you haven't already, they are the only ones who really understand what they are doing. I would insist on being referred.

Also be aware that different drugs work differently for each of us. It's not like taking headache pills. I've just had to go through three different drugs to find the one for me. One caused the problem I was trying to get rid of, the second did the job but gave me unacceptable side-effects, and the third seems to be working. So if something doesn't work out with what they first prescribe, ask to change but ask on here first because you'll get some detailed replies and experiences.

Best wishes

Koll

[rosyG]

Hi Peter,

Bob has given all the information needed- just want to say read as much as possible so you can ask al the right questions when you get EP appointment. best wishes

[Hidden]

Hi Peter, welcome to the community, though I expect you'd rather not be here, like all of us... Bob's information is always good and is about everything you need to know. If you ever have a question there are always people here who will help, who've been through the same experiences, and will be able to provide support.

[peterjames]

thanks for all the information from you all regards...peter

[bootneck3]

Well explained Bob and I' sure anyone new to AF will probably it find it very useful. My own experience only started in September 2013 and recently joined the Forum after 7 visits to A@E and numerous episodes of AF.

Things have progressed in the past few days. Following my last visit in December with a rate of 225 and maxed out on Bisoprolol, Rivaroxaban and Flecanide, saw my Consultant on Thursday. on arrival had the customary ECG and running at 150, which shocked the nurse a bit. Consultant great, stayed in overnight on Amiodrone IV and brought back into normal Sinus rate. Consultant stated ablation the way to go, and as the nearest hospital in Bristol has at least 9 months waiting list. So he rang Harefield in London and has got me in next month. Hopefully things will then be on the up.

Good luck to everyone looking for the best course of treatment, we are all different.

[Hidden]

G'day peterjames,

BobD's comment says it all. Personally though, I have only ever been treated with drugs, and now 4 years down the track I still am - and highly successfully. However as my paroxysmal AF seems to be Vagal related I've had professional nutrional advice on dealing with a series of digestive issues which seem to be a major trigger and have a significant bearing on my AF and this has worked hand in glove with drugs. So now I hardly ever have an AF event, occasional palpitations and that's it. Before AF I was on Ramipril 10mg (for high blood pressure) and Simvastatin 40mg (for cholesterol). After AF in addition to what I was on, I was put on Warfarin (averaging about 5.5mg a day to stay in range) and Bisoprolol 5mg. End of ! Guess I'm lucky.

Good luck in your journey.

Cheers

Aussie John