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Do rate and rhythm drugs stop AF?

I'm at the start of my AF journey and wonder if Bisoprolol and rhythm control drugs stop AF or do they lower the impact of symptoms but the AF continues - and progresses from paroxysmal to permanent.

Is a point reached where the dosage has to be increased as the condition progresses?

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Bisoprolol just made me feel ill. EP said with my type of AF it was the wrong drug. I've had two rhythm control drugs that have worked to perfection even on an average dose. Originally Propafenone worked on me, but had a considerable effect on my mind/memory. Lately, Disopyramide has worked again to perfection but still yet to detect any meaningful side-effects.

These drugs just control the symptoms. I still have arrhythmia, but no symptoms.

Koll

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Hi Finvola

Oh gosh, I wish that everyone could answer that but it's almost certainly unanswerable in terms of certainty.

We all differ so much, and some will find that drugs will keep them under control, and some will need to go on and have an ablation. In general dosages are not increased hugely certainly for the rate control drugs such as Bisoprolol, but can be increased for rhythm control.

Can I just pick you up gently on "permanent" because that means untreatable, not for example like me persistent, I am in A Fib 24-7 but largely have few if any symptoms.

I am assuming that you have paroxysmal AF from the way you ask the question, and yes I suppose most people with PAF would only seem to get worse until they eventually have an ablation, some of course do get by on drugs alone. I've not seen any statistics on this, so my opinion would be formed simply from what people have said on the forum, and could be incorrect.

Those of us less symptomatic, or even asymptomatic, it's even less clear, some say it will only ever get worse, some say the heart is being damaged (but not my cardio) and some say have a really early ablation to deal with these. But then some say ablation is not so good for anyone in long term persistent AF (like me) and some say the quicker the better.

Sorry I am not making things clear for you, but I suspect no-one really can give you a definitive answer

Be well

Ian

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Hi Ian, I think you are spot on with the above comments. Keep the good work up!

I find that knowledge is power and this is what I gain from the thoughtful explanations that you offer.

The sun is shining today, enjoy and stay well.

Phyl.

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Hi Ian, didn't realise it before but it seems we are in the same boat! I too have been diagnosed (2009) as in persistent AF and to all practical purposes asymptomatic. I was on bisoprolol for most of that time and over time did begin to feel breathless and pretty tired most of the time (also white fingers). Recently, at my request, drug was changed to Adizem-XL (channel blocker), didn't get on with that at all. Stopped taking it, have yet to see GP though. I have been taking blood pressure and pulse daily on average 125/70 pulse around 75. I now seriously question whether I need rate control at all! When initially diagnosed an ultra sound test gave a pretty poor ejection fraction of 35% so I was prescribed Ramipril to deal with that.a further test showed the the Ramipril had done its job as my ejection fraction had improved to about 50%, back in the normal range. To get rid of the nasty dry cough I was prescribed Losarten which I still take along with Wafarin. I'm going to talk to GP about dropping the Losarten as well and just keep taking Warfarin (stroke protection) I wondered what drugs you are on and are you stable in general and have you thought about or ineed been to see and EP?

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Hi reedman

I'm on diltiazem (calcium channel blocker) warfarin, statins (preventative) and low dose aspirin which is for higher than usual "free calcium" in the heart.

I am stable, although I do get sharp pains under the heart at times, and really struggle walking up hills (I live on the top of one) but can walk on the flat for a relatively long way without challenges. Occasionally at night can really feel the flutter and am most uncomfortable, but almost symptomless otherwise. Usual BP is around 115/80 and a resting pulse of around 75 like yours.

No I have not yet seen an EP my cardio told me at my last appointment that he was a "heart valve disease" specialist, and that I probably knew more about AF than him, which was not very reassuring, so I will be asking to see an EP at my next appointment.

Losarten is usually for high BP isn't it? how is your BP now

Ian

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Hi Ian

Thanks for your reply. I assume the channel blocker is for "rate control"? I was on Simvastatin a while ago now stopped around a year ago, bad muscle pain right shoulder and arm began to affect finger movement not good for a clarinet/saxophone player! Took about a year to completely go away. I have totally controlled a high cholesterol problem by doing Michael Moseley's 5, 2 diet all diabetic signs have gone! I get the odd sharp pain under the heart but they are so infrequent that I hadn't associated them with AF. Walking uphill can be a bind but I put that down to the Bisoprolol. I had to abandon a bit of heavy weeding in the garden because of breathlessness a while ago. I intend to give it another go perhaps later today since it is about six weeks since I stopped taking it. As I understand it I was prescribed Losarten as a substitute for the Ramipril. It is confusing since a lot of these drugs, certainly the ones I have been taking are also used for high blood pressure which has never been a part of my symptomatology. I think I'm going to push for an appointment with an EP, or possibly go privately. My BP is fairly stable at around the 120 something over seventy something e,g this morning it was 126/76 heart rate 80.

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Thank you for the replies, they have been very helpful and my apologies Ian for mixing my terminology - I meant AF 24/7 in contrast to the paroxysmal variety.

I have been diagnosed with PAF with very short runs of both SVT and VT showing on a 24-hour trace. I'm trying to inform myself about drug treatment and, yes, heart damage from AF was something I thought of, especially if AF is present in the background and is progressive. I'm currently taking Bisoprolol 2.5mg and it has improved my QOL considerably in only two weeks - apart from my feeling like a walking deep-sea diver, that is.

I did suspect that only the symptoms are controlled, so that is useful information, Koll.

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At HRC last year we were told that early intervention by ablation held the best outcome for patients with AF over long term drug use. Now the BIG problem is that Long Term in AF is a very loose description and basically means about three to four years. according to the EP who I cornered.

On the subject of HRC I would really urge all members to try to make the trip to Birmingham in October as there is so much useful information you can gather. For those arriving on Saturday before the event I organise an informal supper and get together and we have had friends come from all parts of UK includng Eire and NI,

Bob

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Bob, your first sentence is clear cut - but does that mean that after the 4 year marker that drugs become a better prospect or that ablation after 4 years on drugs is not so good?

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Yes that is right or it might be Heart Rhythm Congress. Dates on AFA website but patients' day is Sunday 5th October. You need to book via AFA office. Look up the details on the website. Previous two years I and a few others have stayed at Hyatt Regency just across the road from ICC where it happens but it is eye wateringly expensive. There is a Premier Inn not far away which is cheaper. I will wait till nearer the date and see how many can come to the supper before I book anywhere for that. we normally get between 6 and 10 with about four regulars.

Re the results post four years the problem is lack of data for ablation. There seems little argument amongst experts that AF begets AF so it will usually get worse over time unless successful ablation and many drugs do cause unwanted side effects. e g Bisoprolol and tiredness. I had three ablations over four years and have been AF free for six now but I do still have some arrhythmias, just not AF. For me the improvement in QOL (quality of life) has been immeasurable and I would do it again in a nano second if needed.

It is a personal choice but also important to make that choice with all the facts as known at the time.

As far as effectiveness of drugs goes, there are no receptors in the body for these drugs like there are for narcotics so it isn't a case of taking more and more of any given drug. There is always a poison limit above which the drug will do harm so in most cases if a drug fails to alleviate the symptoms it should be stopped and another tried. Too many doctors will jump straight to bisoprolol and when the poor patient's heart rate drops dangerously low they start talking pacemaker. Hello!? It seems that GPs will not normally prescribe rhythm control drugs like flecainide or propafanone whilst amiodarone, known in the trade as domestos (Kills all known arrhythmias) is normally only used in hospitals under emergency conditions. Dronedarone(Multaq), much vaunted a few years ago when it was first licensed sadly failed to live up to early promise and seems to have fallen through the cracks recently unless anybody can tell me they are on it.

Bob

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Thanks Bob- just looked up the Hyatt regency and it is expensive but looks very convenient for the ICC and also has pool ! Will you let everyone know re the supper nearer the time- a few of us have been meeting in London and it is good to swap stories

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Yes, I like the idea of going too, I will have to look up the prices for the Hyatt Regency and see how much they make me cry... Really looking forward to meeting everyone.

Lis

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Super answer, Bob - thank you.

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Hi Bob - I've been taking Amiodarone for almost 18 months and it doesn't stop my AF. In fact I've had two periods of AF that each lasted 6 weeks (when I had cardioversions to put my heart back into rhythm). During a PAF attack it does keep my heart rate down to about 130ish. Amiodarone is bit of a failure for me and I hate taking it, but I'm told it's the only thing left for me to take. I've been having a bruised feeling in my back and have been unable to lie on my back in bed, it also hurts if I lean back into a chair. On top of this, since last Christmas I have developed an annoying morning cough - never had a cough in my life before. My GP is wondering whether the Amiodarone is affecting me and I go for a chest X-ray next Monday. I try not to worry but there's that little voice in my head that says, 'What if it has damaged internal organs'.

Jean

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Hello Jean again and I wouldn't want to be on amiodarone long term as yoo obviously don't either. I guess it is a judgement call but under ESC quide-lines it is the drug of last resort. Good luck with the EX ray as that cough sounds like it needs looking at soonest.

Bob

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I was on amiodarane, which is very toxic drug. I do not believe there is nothing else. I would suggest you research this drug. it gave me stomach pains and nausea, they told me best drug for cardiac bypass with afib. now I'm on a rate medicine carvedilol which has been controlling my afib. good luck

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Hi Grace, this post you answered was put on the forum 4 years ago. Amiodarone damaged my thyroid I will now need to take medication to support it for life. I never know what to say to people when they say the have been put on this toxic drug!

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Hi Bob, do you have info re; accommodation on the Sat night, Thanks Chris

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Where do you stay Bob?

Rosemary

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And can you buy tickets on the door or do you book them in advance?

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Buy the tickets now, only £20 for early birds

From the 1st August they go up to £30 and on the door £50

Ring the AFA 01789 451837

Ian

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Thanks.it's worth getting them in advance then.x

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I have been told by the EP and cardiologist that I have permanent AF but they are still trying to give me relief as I am very symptomatic. Hence my 4th ablation in Sep. My first was in 2011 when I had already been in permanent AF for nearly 3 years. There is no cure just temporary SR for a better quality of life. I don't know what happens when they won't do any more ablations.

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Hi Finvola

My own experience with paroxysmal afib has been that it has stayed as paroxysmal - never been in permanent afib, always cardioverted with drugs when admitted to hospital. I've had a variety of drugs over the years, for the last 4 years, been on bisoprolol. As each episode occurred, the dosage has gone up. I was on 10mg last year prior to my second ablation and am now on 7.5. Disappointing, as I had hoped to decrease altogether but each time I try to drop, it doesn't work out.

So, to answer your question, yes drugs can drop the rate and control the rhythm (two different types of drugs as I understand it). I believe bisoprolol is a rate control drug. The only time I have had a rhythm control drug is when they are trying to control things during an episode.

It's my believe that as things progress and if one continues to have episodes, drugs will be necessary and more than likely increased, to keep things under control. At least, that has been my personal experience having PAF. However, everyone's journey is different and you just need to find out as much about afib, available drugs and treatments etc so that you are well armed with information and the questions to ask when you see your EP specialist.

Anneliz

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Bob, I appreciate your great knowledge. I was put on amiorderone in the USA 8 yrs ago. I was in the hospital with conjestive ht failure and cardioversion didn't work, so after 10 days in hospital with amioderone it went back into rhythm and the Dr said I would need amiodorone the rest of my life. I seemed to do well on it. But then I had pneumonia twice in 2013, and I didn't want to risk damage to the lungs, plus my ht was having more irregularity and racing. I had new doctors due to relocations. I had my 1st ablation in July 2013, stopped amioderone, still had problem. Put on propafanone, in 2014, ht raced. Just had 2nd ablation a week ago. I have a moniter to ck for afib under my skin for 6 mo, or 3 yrs if needed. I'm not scheduled to see EP for 3 mo, but with ht still approx 120 bpm and when I take Coreg I'm so weak with low BP I can hardly function, I think I will try to see him. He didn't plan for antiarthymia med for 3 mo. So far I see no improvment, maybe I'm impatient a week from the ablation. But my PB moniter says IHB most of the time. We will see what the Reveal LinQ moniter says. Since ablation my ht pounds when I lie down, subsides some in the nite..didn't have this before. Do you have any antiarythmia suggestion to try? Since amioderone worked so long, what might be best to try now? My meds now are coumadin, lasix and Coreg. Thanks so much for any advice.

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There is no cure for AF MY consultant good as told me.

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