I have been recently diagnosed with atrial fibrillation, after I went into the GP with a fast heart rate (I hadn't noticed the irregularity) following anxiety after 2 eye operations for pressure, with several pressure spikes due to reaction to the steroid drops.
I'd never heard of atrial fibrillation before! I was prescribed Bisoprolol and put onto Warfarin straight away. I then had an Echo cardiogram which showed no structural issues, apart from what was described as a little leakage, which was 'nothing to worry about.' The 24 hour monitor apparently showed the longest period of palpitations of about an hour and something.
I had my appointment with a cardiologist on Friday and I am not sure what to make of it - can you help me interpret it please?
The ECG beforehand showed sinus rhythm. I had expected her to ask about my symptoms, and maybe have more tests and possibly be put on one of the drugs. Instead, she said she wanted to leave it for a couple of months, but didn't say why. Confused, I could only think to ask if she thought it would go away and she said it might.
As I has said it seems to come on mainly at night, she recommended an extra half strength Bisoprolol before bed. If, after a couple of months, I have the AF, she would arrange a stress test and perhaps 'a little' Flecainide.
She also said she thought she thought could see some enlargement of the aorta artery on the Echo, but it wasn't clear. As I am tall (6 ft 1 in), I might have Marfan disease, so she would arrange a scan of that. Having since looked that up, I don't have any of the other symptoms of this disease, such as the long fingers.
What do you think? Thanks very much.
(Background info - I am a 53 year old male, and have been on Losartan for blood pressure since 2008, but have closely monitored it. I am normal weight and do a reasonable amount of walking for exercise. A recent cholesterol test was good. My previous resting heart rate was 70, but now with the Bisoprolol is 55 according to my Fitbit. When I get the palpitations, it goes into the 90s. I don't get dizzy or anything, but I do get a strong ticklish feeling in my chest when I get the palpitations.)
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AlanAF
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Hello Alan and welcome to the mad world which is AF. This is a mongrel condition which no two people ever experience the same so you will learn to understand your version eventually but be warned that others may be quite different.
Firstly if you haven't already please visit AF Association website and read as many of the fact sheets there as you can as knowledge is power.
Secondly, AF is almost always progressive so don't put too much score on "it might go away". It may take a while before you get the next episode or they may start coming thick and fast.
Thirdly, life style changes such as avoiding eating late in the evening, reducing stress, stopping smoking if you do, reducing or avoiding alcohol can all help reduce the burden of AF but it won't cure it. If you have the pre-disposition to it you will find things that trigger it maybe but they are not the reason for it. You have it, end of, as they say.
It isn't life threatening although it has been said to feel like it sometimes and strangely many people with AF live longer than their peers due to the improved life styles they adopt so it isn't all bad news.
The other good news is that you are anticoagulated as AF makes us 5 times more likely to have stroke. Not everybody gets such rapid treatment.
Last point is that cardiologists are not always the experts on AF These are the EPs (electrophysiologists) who are the electricians to the ordinary cardiologists plumbers. If things do progress then there will come a time when you should see an EP rather than rely on the general cardiologist but it is probably a bit early to think about that now.
Ask any specific question and we will try to help.
Thanks very much Bob. I was a bit dubious about it going away, though I suppose there is always the remote chance. It comes pretty much daily. I think the beta blockers are having a good effect though, as it seems better in the day after I take it. I think I will ask for an increased dose to see me through the evening and night as a quick response, as it is driving me mad at the moment.
Thanks also for highlighting the AF Association. As it happens, I have sent off my membership form this afternoon! I am also doing all the lifestyle things, and that is going well enough.
I liked your point about it forcing us to live more healthily, so we may actually live longer, although I must admit I am very down about it all at the moment, so a bright spot is good to see.
I have already asked my GP to be referred to an electro expert, though they don't have one in my local hospital, they do in a near by one. I am also considering seeing a consultant privately. Any advice on that aspect would be much appreciated.
Costs around £200- for a consultation I understand but often worth it to get on the ladder of treatment (NHS after initial visit usually.) There is a list of EPs by area under patient information on the main AF A site.
Bob - Went into the GP surgery this morning and spoke to the receptionist about chasing the letter from the hospital appointment and also about asking for an NHS referral to Liverpool Heart & Chest Hospital, which seems to be very well regarded on this forum and elsewhere.
May I ask you if you feel there is there any consensus emerging about drugs vs ablation as an early treatment for someone in otherwise reasonable health? The drugs seem to have potential nasty side effects, whereas the op seems a more drastic but gives a more normal life. Both don't necessarily last forever, but healthy living will prolong benefit.
To me there is no argument. Many EPs believe that early intervention by ablation is the best solution to giving a greatly improved quality of life (QOL). If the ablation is successful then you should have a number of years drug free once the recovery period is over and even if partial success then drugs can be drastically reduced. AF almost always progresses so best to stamp on it before it becomes more persistent or even permanent and less treatable.
That said it may take more than one procedure to get on top of it, like me. Three till 2009 but no AF related drugs since. OK I do get some arrhythmias; ectopics and short runs of tachycardia occasionally but my QOL is 1000% better than pre-ablation and apart from warfarin (for life obviously) I take statins and mild BP medication but no nasties.
It must be remembered that there is a very small risk associated with ablation but there are risks in everything we do, even doing nothing! Uncontrolled AF can lead to cardiomyopathy and even heart failure after all. I always believe that risks became worse thanks to the litigious society we inherited from across the pond which means that you now have to be told even the most unlikely risk in case your relatives sue the hospital should the unthinkable happen. So far I don't think any doctor has been sued for not doing a procedure but it will come and then the risks will even out I'm sure. Cynic? Moi?
Thanks very much for your response and judgement - much appreciated. I understand NICE recommend patients try 2 drugs before an ablation is offered - how would you recommend trying to get an NHS ablation asap, or does it have to be the (presumably expensive) private option?
I really like this reply from Bob, especially the point that its a mongrel condition.
My cardiologist is 71 and HIGHLY respected here (South Africa) and the three things I have taken away from him with regard to A-fib are:
(a) We don't really know what causes A-fib - the only possible cause he has mentioned more than once is binge drinking (I like a drink, but I don't binge drink)
(b) The health risk of A-fib is blood clotting and the clots causing a stroke - so make sure you take your blood thinners.
(c) There is no need to change your exercise regime on A-Fib (unless you are not exercising, then you should start to). When i first got it (and it was not mild A-fib) I asked him whether I could mountain bike - his ONLY concern was that if i fell off my bike i would bruise and bleed more because of the blood thinners.
On the A-fib going away - I have read somewhere, could have been on this forum, that someone manages to get their A-fib to go away by spinning (on bikes) and doing intervals....they suggested the high heart rate got 'rid' of it....I am sure my cardiologist wouldn't have a problem with me trying that.
oh dear and top of your other problems must be tough , but youve made a good move in signing to this Forum. It seems a condition that confuses everybody,
Its one forum where nobody thinks there are stupid questions just the need to know more.
Thanks very much and thanks to everyone for the welcome. I have found this forum extremely useful.
I think my eyes are stable for the moment, and I am confident enough go to the opticians tomorrow to get some new glasses. I will probably need another operation at some point, hopefully not too soon.
It's easy to blame the Afib on the eye stress, but I was probably susceptible beforehand with hypertension and other anxiety. If only I could chill out!
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What do experienced members think of this?
Palpatations
Ectopics/Possible Afib
Flecainide maintenance dose with beta blocker
Blood Thinners and AF
