Avoiding permanent atrial fibrillation: treatment approaches to prevent disease progression.



in this article entitled, "Avoiding permanent atrial fibrillation: treatment approaches to prevent disease progression".

"AF is a progressive disease, and persistent or permanent AF is associated with greater patient morbidity and mortality than paroxysmal AF. Results from randomized controlled trials suggest no mortality benefit of a rhythm-control strategy for management of AF in comparison with a rate-control strategy. Nevertheless, use of a rate-control strategy is associated with more rapid progression of AF to persistent or permanent AF, partly due to morphological changes in the atria that facilitate maintenance of AF. Thus, for younger or highly symptomatic patients with AF, the benefits associated with a rhythm-control strategy should especially be considered and implemented as appropriate. In select patients, catheter ablation provides greater success for prevention of progression of AF than antiarrhythmic drug therapy, although a need for an individualized approach for rhythm control remains essential". From above article.

I wonder if my Atrial Fibrillation became so frequent because I was on Bisoprolol for over a year. Sotolol did not work for me either but then I only took it for a few days. Then when I saw my EP he put me on Amiodarone and weaned off the Bisoprolol which worked.

27 Replies

  • I think the phrase "a need for an individualised approach" says it all.

    Some of us have had side effects from Amiodarone, arguably as bad as AF itself.

    Note also the use of "select patients", i.e one size doesn't fit all. Hard to tell what might have happened if a different course of action had been chosen in any set of circumstances.

  • No,it doesn't. My husband has to keep adjusting his meds in order to stay as healthy as possible. He doesn't eliminate the build-up very well, so at times his system becomes overloaded and has to back off. He has his ups and downs but does his best to keep it under control. There is no "one size fits all" because everyone is an individual and all humans process drug therapy in different ways.

  • @harmonykm To determine which meds your husband can take there is a blood test for genetic polymorphisms of the P450 cyp detox system in the liver--through which most drugs pass. doctors do know about this.

    There are 2 other tests for underfunctioning of 5MTHFR and for CO

    MT--which can show slow methylationl. The 5MTHJFR can be remedied by taking reduced bioavailable B's and the COMT can be addressed by avoiding epinephrine, noradrenaline and dopamine, as this genetic glitch breaks them down too slowly (ex. novacaine contains epinephrine-carbocaine can be used instead, and quinolone antibiotics raise dopamine levels--all these genetics things can cause afib to kick in. 5MTHFR is an enzyme that breaks down Magnesium. To counter this problem the reduced B's ( are uin a form past the point where the f malfunctioning metabolism occurs).

  • "AF is a progressive disease, and persistent or permanent AF is associated with greater patient morbidity and mortality than paroxysmal AF."

    I think (hope) what they mean is untreated AF. Please tell me if I'm wrong. Every time quotes are made from the medical profession, they omit the work "untreated".


  • PAF is supposed to progress slowing towards persistent or permanent AF. They were surprised my PAF progressed rather quickly.

  • guyhaywood.co.uk/Plymouth-E...

    In the above link there is a graph on page 7, showing progression from PAF to Persistent AF. In another research paper the result may be somewhat different. However, Plymouth Hospital specialising in Heart matters is supposed to be one of the best.

    The Arrhythmia Nurse newly from London was also of the same opinion so it appears this is the standard theory from other researches.

  • Heather, I can't get into your link. I'm interested as Guy Haywood did all three of my ablations.


  • See below.

  • Seems published 2011 so may be out of date?

  • I couldn't get the link on this forum either. Hence, I sent this as an attachment to my email address and it worked. If you would like me to send you the PDF information I will send it to you. Whether you can send it to me somehow via this forum I don't know.

  • Try this to take you to his home page.


  • That's because an i has been added after pdf so it won't work.

    Here is actual link for jeanjeannie50 and others!!

  • I went from PAF to 24/7 AF over a short period too. I can't put a timescale on it, but more like a few months rather than years. I wasn't on any drugs at all at the time as I wasn't diagnosed till it was round the clock. My ablation for it worked.

  • As a "younger" paitent, this was the reason I chose ablation as early as was possible in my treatment, to give it a good shot at nipping it in the bud

  • I'm sure you understand how I agree with your there Juggsy. I chose ablation when 60 and not so young because I intended to be around a few years yet. As I say many times, many EPs feel that early intervention with ablation is the best course of action for some people.

  • This begs the question why we aren't all sent off to a consultant by the GP (at least once) as soon as possible?

  • Obvious. Money! If everybody with AF wanted ablation it would bankrupt NHS is six months. Agreed not everybody is suitable anyway.

  • @BobD Dear Bob This is shy a single payer system is not good.

    Necessary medical care is not available.

  • Omniscient1-If you have afib you need to see an EP--immediately. Your GP and even a general cardiologist do not know how to treat afib or interpret the ekg. I have a very good GP- she told me immmediatley I should be on warfarin--as my afib gives me a 5 timjes greater chance of getting a stroke and I need t o see anEP for an ablation.


  • Hi Traveller, Thanks for your note. I was diagnosed with (permanent) AF about 7 years ago, I had probably had it for up to 5 years before that. To access a consultant in the NHS you have to go through a GP first, if the GP isn't minded to do that (like mine, unlike yours) then you don't. As a newly diagnosed patient I took him at his word. However medicine is financed you are at the mercy of the people delivering it.

  • @Omniscient1 I am so sorry that you are in this situation. The gp I mentioned who said I need an ep was not being seen for afib. I was seeing her for a sinus infection and needed an antibuiotic rx. I had already seen an ep and had an appointment for an ablation. The ep I was was referred to me bymyself after having great dissatisfaction with doctors I had seen-- 1 cardiologist wanted me to seee an ep -- 1 did not. The one who referred me to her favoriet ep---after I checked out that ep, I decided he was not so good---so I researched and found one I thought had greater expertise and experience based on his previous residency at Cleveland Clinic and his published research, and his current job in the electro physiology lab at Strong Memnorial hospital in rochester ny lab. To get him to see me I had to fax him evidence---0 so I faxed all copies of all my abnormal ekg's--- some of the previous cardiologists secretaries did not want to fax the copies until I told them theywere legally required to do so. There where so many pages the fax cost me about $100 --(his area code was long distance form where I am so it was double the price per ;age)--then I had called for an appointment and said I MUST see this doctor--he specializes in exactly what I need and they told me to fax the copies. I was not in permanent afib--but about 50% of the time. When the ep saw me for a consult and he did a physical exan, ekg, and verbal questuionuing and medical record he said he thought I would need at least 2 ablations and meds and he could not guarantee it would work because my ekg looked so abnormal--I had 5--6 different kinds of abnormal cardiac rhythms at the same time. I told himk to do his best and I would take care of the rest as per Tai chi, music, supplements, food, and avoiding the afib triggers. I only needed one ablation and I am fine due to the other things I mentioned. What your gp did was terrible. A gp does not know about afib. Too bad you did not have access to a private gp, a private cardiologist and a private ep--at least for the consults. I know this is expensive in the UK.

  • Unfortunately, my ablation at age 60 did absolutely nothing!

    The only way to feel positive about my condition is to believe that my increased mortality (if this report is correct) means less chance of developing dementia before I depart to pastures new.

  • @mycallc did your ep give you any drugs to take after the ablation (such as warfaruin and sotalol)? did he tell you to make sure that your magnesium and potassium did not fall to low since the meds, and all the meds used during the ablation deplete your body of these minerals? Did he tell you to take Co Q10 and magnesium glysinate and magnesium taurate? Did he tell you to avoid the triggers of afib? Did he tell you what the triggers are?( processed food, alcoholic beverages, salt, sugar, chocolate, quinolone antibiotics, large macrolide amntibiotics, candida, viral infections, excess inflammation)? If no one gave you this info, you are missing alot thqat would help you Also TaiChi will improve your situation 1000%, as will certain kinds of music (Mozart symphony #40 ion G minor-scientifically proven), zen meditation, a long moderate walk.

  • traveler65.......... of all the things you mention, I was prescribed none. I was put on Amiodarone for far too long until it affected my thyroid. Only then was I taken off it !

    I had a second ablation followed by a cardioversion, both to no avail. Following those failures I was put on Warfarin and Bisoprolol. Basically, I'm doing fine with permanent AF and do a great deal of walking and play tough badminton weekly.

    My bigger concern now is my leaky mitral valve !

  • Same here.

  • @heatherfriend Hi You need to control both the rate and the rhythm. An ablation plus low dose sotalol and warfarin would be useful . amorodiane is a dangerous drug. Keep your blood pressure at 120/80 or 115/75 approximately because above the 120./80 changes the architecture of the heart--leading to afib and other heart diseases.. Avoid all the triggers. salt- sugar- processed foods-chocolate-alcoholic beverages-large macrolide antibiotics-quinolone antibiiotics- viral infections- excessive inflammation.-excessive levels of candida in your gut Keep your levels of magnesium and potqassium high enough but not too high ( every 4 months do a blood test called comprehensive metabolic panel and also one for red blood cell magnesium (You and your doctor do not have to do this of course but if you wqant to be alive and well this will put you in thqt direction ) Whoever thought that contgrolling either rate or ryhthm only was a good idea??

  • Thank you I will bear what you say in mind.

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