After 3 months of symptoms have finally been diagnosed with PAF and started bisoprolol 2.5 mgs today.

[Scorer]

Started with 2-3 episodes a week but over the past 3 weeks have only had 2 episode free days. Last Monday was the worst when had 3 episodes and spent the whole day in a state of exhaustion. After taking my first beta blocker this morning I have had my best day for 12 weeks. No palpitations, heart rate irregular but not racing, no coughing, no nausea/light-headedness, no fatigue. Didn't expect such a dramatic effect. Will it last?

[Drounding]

Bisoprolol works well for many people. I've been taking it for 5 years now since my first cardioversion. I still pop into af sometimes but it's a great help.

Glad to hear it's helping for you.

[Beancounter Volunteer]

Hi Scorer and welcome

It's really hard to give your a definitive answer, as you've probably discovered AF is a very mongrel condition and just about different in all of us, and we all suffer differening but similar symptoms, to differing degrees.

Getting a drug regime which works can take a little time, often having to change drugs and dosages until one finds the combination which works best for any individual, and most of us will have been through, or be in that phase. You could be very lucky and have hit on the right combination first time, but you might also find that you need to try other things before all the symptoms settle down.

Hopefully you are also anti-coagulated, I am sure you have read enough here to understand why we all consider that so important. We are here for any questions, comments or even just letting off steam which we all need to do sometimes

Be well

Ian

[Hidden]

Hi Scorer

It's great that the bisoprolol has made a difference straight away, that's hopeful, it did for me too - it works well for some people. I would also recommend that you read through the AFA website because there is a ton of useful information and you can work out your Chads2Vasc score, which tells you your risk of stroke - based on which doctors should make decisions about anti-coagulation (very important).

Lis

[AnticoagulateNow]

Yes, Bisoprolol works for many of us. I have no noticeable side effects from the drug and I have really got used to a nice relaxed heartbeat around 55-60 at rest. Even during AF episodes it's rarely above 80 (pulse taken manually as 'machines' don't work when beat is irregular). We can't stress enough the need to be anti-coagulated though. With all due respect to Eatsalottie, never mind the Chads scores to assess stroke risk. YOU HAVE AF and while you remain unprotected, that on its own, brings risk factors of 5x to 9x that of the average man/woman on the street. If you don't take anti-coagulants because your Chads is "only 0 or 1", then what you are actually doing is waiting for your first stroke to bump your score up! Very scary thought as you may not need warfarin, or anything else for that matter, after your first stroke.......

[Scorer]

Thanks for responding to my post. Finding this site invaluable for information and support. Have not been prescribed any anti-coagulation yet as the bisoprolol is a stop-gap measure treatment by my GP due to the increasing severity of attacks. Am due to see the cardiologist at Papworth in 10 days to receive feedback on all the investigations and no doubt further treatment/medication.

By the way, have woken this morning feeling great more, like my old self.

[rosyG]

If you have worked out your Chads Vasc score and you find you are at risk, your GP will start you on anti-coagualtion- don't wait if it's needed!

best wishes

[AnticoagulateNow in reply to rosyG]

So if your Chads score is 0 or 1 Rosy, you're not at risk of stroke and anti-coagulation is not necessary? Please...irrespective of Chads, we have AF and we are all at significant risk of stroke if not protected.

[Hidden in reply to AnticoagulateNow]

I was diagnosed with PAF in 1998, it was only last year when I was approaching 65 when I was told I should be taking Warfarin, and then they seemed to be putting the ball in my court so to speak as I was asked if I really wanted to start taking it before it was prescribed. It never occurred to me that I should be on anything but Aspirin and I am simply amazed that my GP never suggested it. I wish I had known about this site, I only came across it after I had my 1st Ablation in March 19th, note I said 1st as I am still getting episodes.

[AnticoagulateNow in reply to Hidden]

The prime rationale behind Chads is that while too little or no anticoagulant will leave the patient at risk of stroke, too much could induce a bleed. So Chads attempts to weigh up and balance the odds. However it fails, because the reality is that provided INR remains in therapeutic range - or even a little higher, the risk of bleed is very small. The risk of stroke on the other hand is much, much higher. The risks are far from equal and you'll almost certainly survive a bleed anyway.

At the moment too, there is no comeback for the medical profession. Few widows/widowers are going to query why their partners, struck down with a stroke, were not on anti-coagulants. And even if they did, medics can hide behind Chads. Frankly, with warfarin so cheaply and readily available, this is shameful and It's time we all moved on, recognised the very real risks associated with unprotected AF, whatever one's profile, and dumped Chads where it deserves to be - in the bin.

[angiek in reply to AnticoagulateNow]

It is such a location/GP practice lottery as to how we are treated in the UK- I had my first (and quite severe) AF 'episode' on March 29th, and after a day in A&E I was given 7 days of Bisoprolol and told to see my GP for follow up. I had never heard of this condition so spent hours researching it - most of my best info has come from this forum, so thank you all!

I was already booked to travel to USA to visit my son on May 1st, so saw the Senior partner at my surgery to get more meds and asked what I should do about anti coagulation, and tried to hurry along any tests/treatment so that I could sort out my travel insurance (the company I had already bought from wanted a huge excess to cover me for AF so I had to cancel that and lose a large chunk of the premium).

The GP was less than helpful in all ways. He said I didn't need anticoagulation as I was not in permanent AF. Who am I to argue, right? Two weeks later I had 24hr holter ( sp?) and echocardiogram and with lots of chasing and phone calls I got the results literally the day before I travelled, diagnosis Paroxysmal AF, with recommendation that I change to Sotalol and see a cardiologist if problems persist.

I researched Sotalol, and was worried about changing onto it as there are lots of warnings about being under direct medical supervision when starting it, which could not happen if I was to take my trip to USA. I tried to see my own GP, ended up as a phone consultation as she too busy to see me before I travelled. She agreed with me that I should stay on Bisoprolol until I returned. And again said she did not think I needed anticoagulant. Almost without exception people on this forum warned me that I did (female, high blood pressure, AF) So I started myself on aspirin and have continued with that.

I returned from holiday last Tuesday, called to make an appointment, locum GP called me back (and again was a telephone consultation!) Although he was very willing to discuss everything with me he was not overly familiar with the condition and looked everything up whilst we were speaking. He again suggested I should change to Sotalol, as it was recommended by the consultant and was surprised when I pointed out to him that this was Rheumatologist - as he was the duty consultant when I was admitted to A & E and he ordered the follow up tests- I have not (yet) seen a cardiologist! I asked again about anti coagulation, he looked up the info for the scoring and agreed that my score is 2 -but he too said I do not need it as I am not in permanent AF. And then he also said that my last BP reading was ok (135/? (I can't remember) but that was after 4 weeks of Bisoprolol which surely does reduce BP as well? So if it is reduced by medication that means I no longer score for high BP on the CHADSVACS ??? He said the danger from a bleed if I was on warfarin was higher than the risk of a stroke.

I asked again to be referred to a cardiologist and was told to see how I go this month, and see my GP next time. 'My' GP has now left anyway, so I have no idea who I will see, and going on past history it seems like my practice tries hard to fob patients off with phone consultations when they can! I consider myself to be reasonably intelligent and able to stand up for myself, but have really struggled in the face of GP's who don't seem to be 'on my side'!

Prior to this I have always been in good health, only visiting the doctor very infrequently for usual 'women's stuff' - smear tests/menopause etc. The high BP came as a shock to me, let alone the AF. And incidentally no one has discussed with me how I could try to reduce my BP other than with medication- that seems to me to be one of the first things I could do!

I am so confused and the struggle continues! I have told my sister where I have kept all the notes of conversations with my GP's because I imagine if I do have a stroke I may not be able to talk for myself!

[angiek in reply to angiek]

p.s. anyone in Suffolk have recommendations for the nearest/best cardiologist, it appears there are no Electrophysiologists in Suffolk or Norfolk, but as I believe I am usually in normal sinus rhythm with two or three short 'episodes' of AF a week maybe I do not have such an urgent need for an EP?

[AnticoagulateNow in reply to angiek]

Only two or three short episodes a week? That's pretty frequent angiek. I do understand one's hesitation to thump the table, particularly in the early days of the condition when you don't know too much about it. But as your knowledge increases you will very quickly know more than your GP and as much if not more than your cardiologist. I don't know how GPs coped before Google came along - mine spends most of my consultation time checking online that what I'm saying is right! Now you're back from holiday, get anticoagulation sorted out and if anyone says no, break down in tears and say that you are terrified of the prospect of a stroke and, if the worst should happen, your sister will sue the pants off the next medic that says no. They'll prescribe.

[AnticoagulateNow in reply to AnticoagulateNow]

If AF is the worst thing that ever happens to us in our lives, we should shout with joy. There's a lot of people of our age with a whole lot worse. However if you have AF there is one big fly in the ointment. Without the ongoing protection of anticoagulants, we are all in mortal danger. It makes perfect sense then to almost eliminate that risk if you can. And you can....Anti-coagulate Now.

[fallingtopieces]

I have paroxysmal AF and have had an EP as my consultant for the past 2 years.

I have seen cardiologists on and off for the past 15 years, all trying to get to the bottom of my 'palpitations'.

It is suspected now that I have had episodes of AF, perhaps 2, before 2012, but in 2012 I was diagnosed with PAF as my first really scary episode was caught on an ambulance man's ECG. I've not had AF since. I'm lucky that I am in sinus rhythm but also have several ectopics and sometimes the odd 'gallop' of a short run every day. No day goes by without a few palpitations.

I'm on no meds just PIP flecainide which I am yet to(too scared to) take.

I have had echocardiograms, ecgs, holter monitors(just finished one yesterday) and stress tests but these are always normal except for some bradycardia.

My EP tells me I don't need warfarin nor the mini aspirin I chose to take myself.

Why would my EP not want me to take warfarin?

Pat.

[AnticoagulateNow in reply to fallingtopieces]

And what was his reply to that question?

[AnticoagulateNow]

And what was his reply to that question?

[fallingtopieces]

My EP's reply to that question was something like, 'Warfarin isn't something you would take if you don't need it and you don't need it.'

As he is an EP at a specialist heart hospital I took him at his word but reading so much on here of the dangers of not taking warfarin even for PAF alone with no other conditions has me worried.

I genuinely am baffled as to why he wouldn't want to prevent me from having a stroke as I'm sure he must be fully aware of all the statistics. : /

This is part of his profile on the hospital website;

'' [..............]is responsible for training and the appraisal of junior doctors specialising in electrophysiology at the Trust. He regularly teaches final year medical students from Imperial College on the management of arrhythmias.

He has been invited to speak at regional, national and international meetings and to provide specialist training in electrophysiology to doctors in developing countries.

The Royal Society of Medicine has also invited him to lecture on a variety of topics including management of atrial fibrillation and implantable defibrillators.''

[angiek in reply to fallingtopieces]

It is just so frustrating (and worrying) when the 'experts' don't even agree on the basic principles of how they should be treating us! How on earth can we make informed decisions when all the information we get is challenged? As I said before, it's a lottery, let's hope we are the winners!

[Rellim296 in reply to angiek]

I think part of the trouble may be that we walk a tightrope between bleeding and clotting and a crystal ball is required to tell who is going to come to grief which way. I believe there are far more clotters that bleeders. I have the suspicion that I'm more likely to be a bleeder but, to my mind, a fatal bleed may be better than having a major debilitating stroke and being unable to function. Thus I take warfarin - but unwillingly.