3rd time in A&E with paroxysmal AF

I'm getting a bit concerned just spent a 3rd occasion in hospital due to my AF/flutter

First time that reverted to normal sinus rhythm after few hours, second time they put me on magnesium drip and extra bisoprolol and it reverted - told me not to come back unless it had been going 24hrs or more... I had a 3rd occasion art home lasting 20hrs, no A&E, the 4th yesterday was severe arrhythmia causing breathlessness then seemed to speed rhythm even though I'm on sotalol now.

My concern is this is happening every 6-8 weeks; ever since my levothyoxine dose was raised to 175mcg. Could my thyroid be causing this? Cardiologist thought it might be gastric related but I've been on omeprazole since these stared.

It's this going to involve having ablation in the end?

42 Replies

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  • Probably. AF almost always is progressive. Don't wait till it is too late and you are persistent. You have AF now regardless of any triggers and whilst the vagus nerve may be involved it is just a trigger. Get to see an electophysiologist rather than an ordinary cardiologist. By the way, Sotalol is no longer approved by NICE for treatment of AF.

    Go to AF Association main website and read all you can of the fact sheets available as knowledge is power.

  • Very much agree with Bob to see an EP before it goes to the persistent AF stage. Very important you keep a written log of all events and treatments as you go along. Also separately a list with dates of all medicine changes.

  • Thanks for that. So sometimes people have paroxysmal for all their lives as well as progressive forms? I agree knowledge is power to make decisions in your own circumstances. Of course an electrophysiological is going to advocate ablation, that's his job. I'm sure my cardiology guy will refer me when he thinks it appropriate. I would have thought finding the trigger or root cause would be preferable to reduce, prevent recurrence is preferable rather than jumping into surgery straight away.

    Sotalol may not be approved by NICE, but that doesn't mean it doesn't have a place in treatment. NICE's remit is cost v benefit don't forget lots of effective cancer drugs aren't approved by NICE after all.

  • Sorry Sotalol has high risks attached which far outweigh any benefits FOR PATIENTS WITH AF. It is nothing to do with cost in this case. I don't agree that all EPs will go straight to ablation which of course is not surgery at all. It is a procedure. Cardiologists are basically plumbers and you wouldn't ask a plumber to re-wire your house so why not go to an electrician. He may tell you it doesn't need re-wiring but at least he is the expert.

    Triggers are just that and many people have none or hundreds. They are not the root cause of AF which is often genetic although binge drinking, high endurance training and similar acts have been blamed for starting it. Once there it seldom goes away on its own thanks to changes in the atrium which tend to be self propagating. Changes in life style. eg stopping drinking, reduced caffeine, better diet, better exercise regimes etc can all bring benefits in QOL for some people but not all.

  • Well it was prescribed for me after my Afib broke through bisoprolol with a 20hr episode. This on on sotalol lasted 12hrs, as they upped dose a bit.

    Interesting analogy, question is why do we get referred to a 'plumber' initially not the 'electrician'?

  • Probably because there are very many more ' plumbers ' around than there are ' electricians ' for starters!

  • I also think that many GPs do not understand about AF and did not cover it much, if at all, in their training. The first catheter ablations are a relatively new medical phenomena. Fortunately I had a very enlightened GP (in her 40s) and she referred me straight to an EP and said she didn't want to refer me to a general cardiologist. At that time I had no clue about AF or cardiologists or heart specialists. A few months ago my GP had a medical student shadowing her and my GP explained to the student that I had AF and my GP said that I knew more about AF than she did!!!

    A few months earlier a locum GP at the surgery (who was in her 20s) called me in to the surgery to see her because of a letter received from me to Barts. She asked a lot of general questions and also about the AF and treatment, etc and she told me that she had learnt some new things about AF than she had done in her training. Also she didn't know about the AFA website.

  • I don't believe at all that EPs will recommend that a patient has an ablation when the person does not need one. In fact I suspect that they err on the side of not doing one!! Ablations take a lot of time and a lot of resources. On the day I had my ablation before me at 08:30 there was a fellow who had a simple touch up ablation which took about 2.5 hours and then they had a half hour break before starting on me and I was in the cath lab for 6.5 hours and then that was there lot for the day at 6pm. If the waiting lists were very short (from info on here some areas the waiting time is 1 year) then there might be some justification for feeling that. In any event medically they are trained / guided / ? ethically ? not to do unnecessary operations.

  • I went into fast AF after my levothyroxine dose was increased. Was admitted & cardioverted electrically. Iwasvthen put on lower dose. I would have thought that the hospital would have queried your recent dose increase?

  • The tone of your last sentence is interesting Roobdog. "Is this going to involve an ablation in the end." Oh no! not that 'final solution?'. The reality is that nothing else really works in the long term. Drugs will help of course, they'll relieve some symptoms (though probably give you others), they may keep you in sinus rhythm longer but all the time your AF will get progressively worse and eventually, you will probably end up in permanent AF with options closed.

    Too many of us, I believe, see ablation as the last resort. I know I did for a couple of years. Alternatively we can see it for what it really is. The only thing out there that offers anything like a cure for AF - and why would you not want that as soon as possible?

    Something to think about eh? Good luck.

  • I definitely consider ablation as a last resort! If I could be confident that it would involve just one procedure I wouldn't be so sceptical but it seems that many people have repeated ablations and that thought freaks me out!

  • Marilyn. .. My thoughts were the same as yours. When I finally decided to ' bite the bullet ' & attended a pre- ablation talk with one of the EP consultants at The Heart Hospital in London , he said that with my record I could expect to need 3 attempts ! I thought ' crikey ' ( or words to that effect ) this can't be happening, surely one will do it. Anyway, 3 ablations down the line - not anywhere as bad as I had anticipated ,by the way , and I still get AF! Another story......

    Sandra

  • And are you still where you were at the start or are you better than you were? Or worse?

  • Rellim, I am better than I was. My history goes back to 1992 with periods of remission . It was a bout of heart failure - pulmonary oedema - which helped to make my decision. I am refractory to most drugs apart from Disopyramide which has kept me in NSR for 6 months now.

  • Oh, long may that last!

  • Are you advocating ablation as the way forward? Sounds like you aren't if you've had 3 and still have afib

  • Roobdog. -- see my reply to Rellim. We all have to make our own decisions in the end as we are all affected differently. I would have been foolish not to have gone down the ablation route. No,we have not stopped the AF but I am considerably improved & ever optimistic that the worst of it is behind me.

  • Why? You go to the dentist regularly do you not?

  • Not wishing to be critical but your view means that you are pushing down the road to it being almost 100% certain that ablation does NOT work first time. Look at the success statistics for ablations. They are very much better it you are in paroxysmal AF (not just the first ablation but subsequent ones) than if you have progressed to persistent AF. If in persistent AF the chances are very high that someone needs two or more ablations. I think that in persistent AF the chances are around 30% or so first time. As I understand it the longer you delay the more the AF develops and is encouraged to develop and as BobD says AF begets AF. Also sometimes the heart gets "used" to being in AF.

    In my case I was in persistent AF when diagnosed. I had had some symptoms for a few years but not excessive and had carried on with life without fully realising that I had been gradually going down hill. My nature was Go, Go, Go and live life at a hectic pace!!!

    After I had a cardioversion and reverted to persistent AF in less than 24 hours I saw my Consultant EP. He told me (to face and in letter) only realistic option is an ablation. Took me off Flecainide. When he said that I asked what the chances of success were in my case (I had been doing research on AFA and other sites - but had not seen this forum at that point. I asked him to be 100% open and he told me that in MY case there he thought that there was 0% (zero %) chance of success first time and about 30% to 40% success second time and quite possible I would need three. He said that for the first one he could not predict how long I would stay in sinus rhythm for but max was weeks. His HOPE was that I would last 6 weeks so that he could see the effect of not being in AF had on my leaking heart valves (moderate to severe leakage in the tricuspid valve and minor leakage in mitral valve) - 6 weeks was the minimum stabilisation time. He arranged for my ablation follow up appointment to be at 6 weeks rather than the normal 3 months (so you can see he didn't expect it to last). However I lasted less than 72 hours in sinus rhythm before reverting to persistent AF (and where I remain 6 months later). All verified on my AliveCor.

    So my recommendation (and I am not medically qualified) is to go for an ablation as soon as they are willing to do one.

    Good luck.

  • Ablation seems like using a sledge hammer to crack a nut to me. If the root cause is inappropriate thyroid hormone treatment then surely modifying this is to cure the AF is preferable? I'd like to explore non-invasive treatment first and find a root cause if there is one.

  • If you have a thyroid problem which is thought to have brought on the AF episode, then of course it must be sorted out. And if you never have another AF episode - fantastic! No ablation required.

    But......it's unlikely to be your last AF episode I'm afraid. That's the nature of AF - there's unlikely to be a 'root cause'.

    Pass the sledgehammer please......

  • The only reason I think it's possible that thyroid hormone may be root cause it that these episodes coincided shortly after an increase in my levothyroxine. I was originally diagnosed with underactive thyroid after having palpitations 10 yrs ago. The doc then thought excess thyroid hormone was causing them.

  • Could be Roobdog.

    The night before my first AF episode I ate, for the very first time in my life, quinoa.

    Guess what I blamed my AF on for weeks afterwards....

  • Good one! At least at least thyroid hormones do effect heart rhythm!

  • Ah! But we didn't know then that quinoa didn't.

  • Good point

  • From my experience thyroid checks are amongst the first tests done when you present with AF.

  • Yeah but they don't always check T3 levels

  • I am normally on the Thyroid UK site of HU but was diagnosed this year with AF and so am reading and leaning. When I was diagnosed my thyroid blood results were over the reference range and I am convinced this is what tipped me into AF.

    You should ask your GP for a full thyroid blood test and this must not be just TSH which is what all doctors rely on and which is hopeless . You also need Free T4 and Free T3. Only these results will give a true picture of what is going on. T3 is the active hormone and your Levothyroxine is T4 but is just a storage hormone that is converted by the liver into T3. Management of thyroid here and across the world is a scandal and you need to look out for yourself, because GPs generally do not have a clue. They are simply taught to look at lab results of blood tests. If you ask most GPs "what is T3"?, they will not have an answer, yet it is what the body needs to survive every minute of the day. Neither of these hormones should be over range.

    Hope this helps and I recommend the Thyroid UK site for help and knowledge. Ask away if you have any questions.

    Good luck!

  • You are right |Hennerton about T3. Mine is a very long story about T3 and Thyroid Uk but I am so glad I found Dr. Barry Durrant Peatfield some years ago who suggested T3 and took me off Thyroxin.I was so hyperactive on it.....then bingo.....my TSH and T4 adjusted and I am now near normal.It took 6 weeks for the change to happen and for me to feel human again. My GP was amazed.Local hospital had written me off...'yes, you're not very well....an understatement... but we cannot help you'!!

  • It is truly a minefield of lack of knowledge by doctors and a willingness to test for almost any disease except thyroid and even when they do a blood test, they still rely on just the one marker of TSH, which is something managed by the pituitary gland and not the thyroid.

    So pleased you discovered T3. It is a bit like a best kept secret and I have no idea why. Do you get it on prescription or only via Dr P?

  • For Hennerton.....My then new GP had been struggling to get my Thyroid sorted with no luck...previous GP had 'near killed me'....when(another long story) I 'came upon' Barry Peatfield. My GP was quite prepared, and still is, to prescribe T3 because Barry P is a 'real doctor' trained at Barts. He would not have been so accommod. if the 'doctor' had been e.g. a naturapath or similar. With effort from my GP I can now get occassional blood T3 testing along with the rest of 'the gubbins' of blood tests processed at the local hospital....I do not take T4.......thyroxin. B. peatfield was convinced I had enough of my own and that if i took T3 it would 'chase' the T4 in my body into the cells. It seems to have worked and his 'theory' appears to have been correct.

  • sorry you are having difficulties. It is thought there is a connection between gastric reflux and AF but whilst omerprazole is thought to help reduce this, and therefore arrhythmias, some studies suggest it can cause them too. I have just been diagnosed with reflux so was looking at this before going to see my GP. When I saw your post `i searched again and it's interesting that this study( below) seem to suggest it's because proton pump inhibitors ( of which Omerprazole is one) lead to low magnesium levels!!

    I stress I am no medical expert but copy a section below so you can discuss with your doctors- it may be they will suggest same medication but extra magnesium but that is definitely something your doctors would need to decide in the light of your medical history.I think it's worth raising with them in case these extra episodes are connected with the change in medication

    This is the quote from an online study

    "Patients receiving PPIs should be followed closely for magnesium deficiency, especially if they experience acute cardiovascular events, because this may contribute to worsening arrhythmias and further complications."

  • There is still something that you can do but it's a desperate turn.....

    if you are overweight you can try to loose weight becoming a sort of

    vegetarian with very few meat.

    Clean completely your diet ....water not coffee not alcohol fruit juice ( with juicer ) not smoke. Apparently this sudden change in your life style can improve drastically your AFib. You can try that "" Very Seriously "" or see an electro fisiologist and make sure is the best !!! good luck my friend.

  • drjohnday.com/get-rid-atria...

    Have look this article from Dr John ...copy and paste on Google bar

    Or look on internet for ........ HOW TO GET RID OF ATRIAL FIBRILLATION ONCE AND FOR ALL by Dr John I'm currently follow it with very small but steady results.

    I reminding you I'm on Bisoprolol 2.5 mg and 100 mg x 2 Flecainide

    But when I'm dieting it's 300 time better you feel relief from all the tensions that a preservative salty food can give you ; )

  • You can still loose weight without becoming a vegetarian!!!

  • OK......the point is not to become vegetarian the point is to create such condition were the body feel "RELAXED" all the time lets saying like you just finish a meditation.

    this is possible with vegetables and few meat .

    I also suggesting you to buy a pedometer ( do not RUN ) and start to do 10.000 step a day at list...eat garlic EVERY day drink WATER..try to clean your diet as much as possible.

    You'll after a month start to feel different Better like your heart thank you for that. Your body will feel more light like you have no tension , you'll not feel the energy of the carbohydrates like pasta or pizza or bread "" that create that sort of energy that going to tense your heart"" ...you'll feel less energy but also less tensed ...less energy but not TENSION in you MUSCLE in your HEART...more relaxed that will bring relief to your body and heart and according to me will slow your Atrial fibrillation + your BLOOD PRESSURE WILL GO DOWN mine is 106 / 75.

    So ..not bread and very few carbs ( Jacobs biscuit are good choice )

    Plenty vegetables Boiled or steamed and a FIST of meat .

    Avocado....beetroot is excellent !!!!!!!! ...buy Spirulina in tablets it will remove chemical from your system like lead or mercury.

    When I started I was on Feclainide 100 mg and Bisoprolol 2.5

    now only on Bisoprolol my GP watch me surprised .

    I do not want go for a.... Catheter Ablation.... and I do my best to avoid it like a PEST it must be MY last RESORT ...good luck..take care.

  • Mexicono

    I couldn't agree more with you. I am 68 been a vegetarian for over 15 years. I am also living proof that you can eat to much even as a vegetarian I ate to much bread and potatoes. I am type two diabetic and was diagnosed with AF at the beginning of the year I was having episodes of AF everyday. The medical profession where more invested in treating the condition than looking at possible causes. I recently was enrolled on a trial diabetes programme that was designed to see the effects on blood sugar levels in patients in different control groups. We had tests every couple of months at one test in May blood was taken and 24 hours later I was called by my GP because blood suger readings were very very high. For me that was a wake up call, I immediately starting to eat sensibly cutting out potatoes and bread and walking instead of diving in the car to go for a paper. I am still a vegetarian but I am eating sensibly. I have now lost two stone and equally important my blood glucose levels are back in the normal range AND I have not had one single episode of AF. I am on 1.25g of Bisoprolol. I will when I have lost more weight visit my GP to reduce or even stop the 500g of Metformin I take each day. I remain hopeful that everything remains as it is today...fingers crossed

  • I'm so proud of you and your determination keep calm and carry on you doing an excellent job.

  • Bit of an update, I also suffer from indigestion heartburn for many years, been having issues with this too lately hence why I was on omeprazole shortly after beta blockers.

    Been having a particular area of my oesophagus burning lately too am booked in for endoscopy to see what the damage is and unfunny thing is had small short episode of fib during burning phase of what I think is oesophagitis. Going back to docs on Monday to see if can speed up endoscopy appointment as think it's the trigger for the Afib.

  • One great thing about beta blockers - got rid of my debilitating migraines :-)

  • hi I have the some problem it could be gastric that cos the AF , it happen to me 2 weeks ago iam in sotalol , 6 yers and its ok but the gas cos that

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