What next?

[puppywalker]

This is my first post. I am a 73 years old woman and was diagnosed several years ago with paroxymal AF. At the time I had several brief episodes a day lasting just a few seconds. Over time I noticed that these brief episodes had changed to episodes lasting a couple of hours at a time and involving breathlessness and tiredness so, for example, I couldn't manage to walk the dog. These episodes became longer, lasting a few hours but only happened a couple of times a year. Then in September I woke up feeling absolutely exhausted. I had to stop and sit down twice before I could get downstairs. I managed to reach the kitchen and sat down on a chair with my head resting on the table. I couldn't manage to walk into the living room to lie on the settee as my husband wanted. He phoned for an ambulance and I was taken to hospital. They diagnosed slow AF with cardiac pauses together with low blood pressure. BP was 118/57 on admission to hospital. I was discharged the following day my heart having returned to sinus rhythm.

I have had a 24 hour ECG and an ultrasound examination of my heart.

My normal pulse rate is slow at 52 beats per minute and during my usual AF episodes it is very fast, usually over 120. I normally have high blood pressure and have been taking medication for this for the last 20 years.

The cardiologist stopped my blood pressure tablets and started me on Edoxaban.

Ten days later I was back in hospital with a nose bleed caused by high blood pressure and the Edoxaban! My GP has been really good and gradually reintroduced some medication to treat the high blood pressure. I am now in AF all of the time and my GP has prescribed 1.25mg Bisoprolol per day to reduce my heart rate from 120 to between 60 and 70.

I have an appointment to see the cardiologist mid January to find out the result of the ultrasound and 24 hour ECG. What sort of treatment might he suggest? What should I ask him?

[Hidden]

Hello puppywalker, welcome to the forum.....I need to be careful here, because you seemed to be pretty well informed!! You also appear to have some good medical support, sadly many here are not so fortunate. Unfortunately, it is a shame that they were not more pro-active when you had paroxysmal AF as that can be easier to treat, however, all is not lost.

Your situation is almost a mirror image to my own, so I will outline what happened to me. I was diagnosed with lone persistent AF, the only difference was I knew nothing about anything! I saw an excellent Cardiologist who carried tests much the same as yours. He then arranged for me to have a cardioversion. Simply, a way of stopping and restarting the heart to determine if it would return to normal sinus rhythm, which it did for over a year. He also wanted to know how this effected my symptoms. After 14 months or so, I had bouts of AF, but these were controlled using Flecainide as a Pill in Pocket. The frequency began to increase, so the medication changed accordingly and I remained mainly in NSR up to the time I had a Cryoablation last July. This, of course, does not mean that my experience will be the same as yours, because there are so many variables, but hopefully it will be a guide. One thing to remember, it is an EP (Electrophysiologist) who is a cardiologist that specialises in arrhythmias and they are the best sort to see if at all possible.....hope this helps, and good luck, John

[puppywalker in reply to Hidden]

Thank you Flapjack, that is very reassuring. Most of what I have learned about AF has come from this forum over the last week or two. Thanks again.

[CDreamer]

hi Puppywalker and welcome. Not much to add except that if you look at earlier posts today you will see a video by Dr Sanjay Gupta, well I think he posted 2 today actually, anyway one was on treatments and how cardiologists decide which treatment would suit which patient - I would suggest that watching them may be helpful as he explains the difference between risk management - mainly stroke risk and anti-coagulation therapies, symptom treatment and their principle treatments which are lifestyle changes, drugs, chemical or electrical cardioversion or ablation.

You may then want to read up on these treatments in which case go to the AFA website. Write down any questions or concerns that you have whilst you are doing your research which would then form the basis of your questions to ask.

Best wishes CD.

[puppywalker in reply to CDreamer]

Thank you, CD, I have watched the videos and found them thought provoking and reassuring. It was particularly interesting to see that treating the symptoms of AF using beta blockers to slow the heart rate down so the patient could function comfortably but remained in AF had a similar outcome to "curing" the AF by ablation.