Can anyone help about the transition from paroxysmal to persistent AF?

[Tobw]

Hello everyone, I have only just registered on here and would like some opinions on what I was told this morning by my GP. By way of background, I was diagnosed with paroxysmal AF in 2008 (I had been having episodes for a year or more beforehand though) and am currently on Bisoprolol and Warfarin to treat it. Although my GP didn't think it was one, I may have had a mini stroke six years ago (it happened the day after an AF episode) and it was this incident which eventually led to my AF being diagnosed. At that time I had all the relevant tests and at the end of them I was basically told I was free to live a "normal" life as long as I kept on taking the tablets.

That's what I've tried to do since then - I've had between two and six episodes a year lasting anything between forty minutes and thirty one hours and because I seem to be lucky compared to other sufferers with the only symptom I get being the erratic heartbeat, my AF has not been as life changing as it has been for others.

However, I'm now thirty six hours into my latest episode and although, once again, I have no what I would call serious symptoms, I decided to see my GP as a matter of urgency this morning because it was hanging about so long. He confirmed my impression that my heart rate was in the 70/85 beats per minute range (the medication I'm on means it tends to be in the 50/60 area when I'm in sinus mode) and he told me that my heart was beating at what he called an acceptable rate, it was just that it wasn't a regular beat.

After consulting with a colleague, they agreed that a non urgent appointment be made with a cardiologist - I was told my AF was probably becoming persistent in nature, but that there was no need for anything else to be done now as long as I didn't develop more serious symptoms.

I'm happy to accept this because I don't really feel any different to how I normally do, but it did surprise me a little because I had formed the impression that it was a priority that people with persistent AF be restored to sinus mode as soon as they could if possible. Am I mistaken in that point of view? Is it normal practice for people with persistent AF not to be ablated if their heart rate is within acceptable limits and there are no other serious symptoms?

[BobD Volunteer]

I feel that you should ask to see an Electrophyisiologist as soon as possible, Cardiologist seldom have the most up to date information and GPs most definitely not with a few exceptions. Great you are on warfarin for stroke prevention but there are many other medicines which can help. So far you have been on rate control only but there are several rhythm control drugs which may keep you in NSR . Then there is the possibility of ablation and there should be no bar on this even if you are persistent.. To be honest many EPs feel that early intervention by ablation has more chance of long term benefit that waiting till the AF has become permanent. Ask to see an EP asap.

Bob

[Tobw in reply to BobD]

Thank you all for your replies. As it turned out, my episode ended within about a quarter of an hour of me typing my original message (I'll have to remember that for when I have my next one!) and so the vision I had of possibly being in AFib for an indefinite period did not materialise.

Nevertheless, my episodes are becoming more frequent (albeit at a pretty slow rate) and I feel as if I am on a gradual journey towards persistent AF.

Bob and Beancounter, the research I have done tends to back up the theory that ablation has a better chance of success if it happens sooner rather than later.

I'll definitely ask about seeing an EP given what you all had to say.

[Beancounter Volunteer]

" Is it normal practice for people with persistent AF not to be ablated if their heart rate is within acceptable limits and there are no other serious symptoms?"

Yes at the moment, but there is also a lot of evidence that the sooner the ablation the more chance of success, so people like me with peristent AF but almost no symptoms are in a quandry, do we ask for the ablation? knowing that we shall probably feel worse initially certainly, or hold on until the symptoms get worse and then have an ablation with less chances of success? Opinions differ, certainly on this board, and apparently even with some eminent EPs.

But I do fully agree with Bob ask to see an EP not a cardiologist, difference between a plumber and an electrician

Be well

Ian

[Hidden]

Don't know whether this will help but I went from PAF gradually to 24/7 AF. I reckon I was in 24/7 mode for maybe 6 months, I really don't know, it was a gradual change not like throwing a switch. That was over a period of years, starting slowly, and then accelerating in the last one-two years. I didn't know it was AF back then.

Eventually I collapsed, and was put in a coronary ward where they tried various drugs to find the one that worked for me, whilst being monitored. That drug completely removed my AF. Two years later I had an ablation so I could stop the drugs, because it had side-effects I didn't like. That ablation worked really well for 8 years. Now got something happening again but not sure what yet.

IMO, an EP is a must, they are the ones that specialise in electrics.

Regards

Koll

[rosyG]

Totally agree with what has been written so far- at least if you insist on seeing an EP you will then be able to make an informed choice of treatment in the light of your individual needs,

best wishes

[Lenana]

I have had AF for a year now with no other obvious symptoms except an irregular heartbeat but reasonable beats per minute. I am on Pradaxar and Digoxin but do not need to have regular check ups for my AF. At 87 I do try to take things easy but, apart from that, I lead a normal life. Good luck Lenana

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