PAF and rhythm medication

[NiceNana]

Last night I went into A-fib again. It happens about every two weeks. I am on Bisoprolol which reduces my normal pulse rate to between 50 and 60, and 130 to 140 when in A-fib. Has anyone been given tablets to control the heart rhythm which has actually stopped these episodes occurring, or is ablation the only answer?

[jeanjeannie50]

I use Flecainide as a 'pill in the pocket' and within hours it usually puts a stop to my heart playing up. Before I took these pills my heart would race for weeks and would only be returned to normal after a cardioversion.

Jean

[Buffafly]

I take Propafenone but Flecainide seems to be the first choice for rhythm control. It has worked very well until recently (6 years).

[BobD Volunteer]

Bisoprolol seems to be the fall back drug for most GPs and some cardiologists as it tends to lower heart rates and help control it when in AF. It does not , however prevent AF or do anything to stop it . It is known aas a rate control drug.

Rhythm control drugs such as Flecainide, Propafanone, Dronedarone or Amiodarone attempt to keep the heart in NSR by controlling the way that the electrical cells operate . Rhythm control drugs are seldom prescribed by GPs and often not by cardiologists but by Electrophysiologists who are the rhythm specialists. Beta blockers such as bisoprolol should not be given to people who are asthmatic.

Many people do get relief from symptoms taking one or other rhythm control drug, often in conjunction with a beta blocker and some manage with the so called Pill in the Pocket method, taking the drug only when they have an event. Experience is that few actually last forever as AF begets AF

Under NICE guidelines if two or more drug regimes fail to help symptoms and those symptoms are debilitating then ablation may be offered. Many EPs feel that early intervention by ablation is a better strategy since AF almost always progresses and the longer you have it the more difficult it is to stop .

Bottom line is that if your drugs are not helping then you need to try something different and if you haven't yet seen an electrophysiologist then that is your nest move.

Bob

[teach2learn in reply to BobD]

As always, spot on, Bob. It's so great to have your consistent, knowledgeable input on this site!

[Uttled00]

I have both Bisoprolol and Flecanaide as a PIP, however when I saw my EP earlier this week he did say to use the Bisoprolol to help ease my symtoms it's the Flecanaide that will put my heart back in nsr.

[NiceNana]

Thanks for all your replies. I've had all the usual tests requested by my cardiologist when I saw him on 23rd January. He said he would see me again in three months - still waiting for appointment! Guess it is back to GP for referral to EP.

Lynn

[wendicarro]

Hi NiceNana,

I was started on Flecanide for rhythm problems and this did seem to work initially but as AF gradually became worse and more frequent they did not seem to have the same effect and I was at my daily limit?? Went on to have ablations, you need to have a chat with your EP or arrythmia nurse if you have one as they are easier to get hold of in my experience.

good luck

Wendi x

[alrk]

In the UK (in particular on wales) can your GP refer you to an EP rather than a more general Cardiologist?

[Arkwight in reply to alrk]

Your GP can refer you to whoever you ask him to refer you to. I recently found an EP I wanted to see and asked my doctor to out in a referral which he duly did.

[alrk]

In Wales it appears you can only be reffered to a consultant WITHIN your own health area and if you cant find an EP in that area then tough

[Uttled00 in reply to alrk]

Pay to go private (£150)and you can select whoever you want in whichever area you want.

[titchx]

I was diagnosed with AF in May 20013 and placed on Atenonol and Coumadin. My PC did not think I was a good candidate for cardio-version, being 76 yrs. old. One year later, I asked for a 2nd opinion and was referred to Tufts Medical in Boston where the procedure was done, in June 2014. Tufts' physicians did not feel I was a good candidate, having been in AFIB for over one year. Happily, they were wrong. The moment I returned to my room, I no longer had any episodes. Now at age 78+, I am no longer on Coumadin, but on Eliquis. I walk several miles weekly and have not had a single problem (one year later). The prescribed Flecainide has maintained the rate and my pulse has been steady at 60-65.

[destept in reply to titchx]

I live in Boston and go to Brigham or BI for cardiology.Never went to Tufts.Please, elaborate on referral.

[Thomas45]

I've been on Flecainide for about eight years, on 150mg twice a day and now only have AF episodes if I forget to take it.

[Sam16]

I was initially prescribed Bisoprolol which did reduce the episodes, but didn't stop them altogether. I was eventually prescribed Flecainide, but only after I had had an echocardiogram as I was told by my cardiologist that it cannot be prescribed if there are any heart defects. I have been on Flecainide, prescribed by my cardiologist, since August 2014 and (fingers crossed) I haven't had any AF episodes since.

[NiceNana]

Thanks for all your replies.

Lynn