Change in AF perhaps

[Thomas45]

I read somewhere on here that Paroxysmal will in time become Permanent. I had my annual hospital check-up yesterday (wth a Cardiologist, not an EP). In the past whenever I've had AF it's my neck which has alerted me, without me checking for my pulse there. Yesterday at 9.15 I didn't feel that I was in AF, but I was, and that was confirmed by an ECG. It's AF which I'm not aware of, except when I see beating on my right wrist, if I have my hand in a certain position, to the left of the left-hand side vein. I've also felt it in my pulse. I've had paroxysmal AF for about 21 years, but only diagnosed 12 years ago, I'm nearly 72. I take 150mgs Flecainide twice a day, and Warfarin. I also have Chronic asthma, and wear compression socks to combat lymphoedema. I also have an enlarged prostate and the medication for that doesn't seem to be working - it's being investigated. I'm 6' 7", overweight, but not obese, don't drink coffee or eat soya, which have been triggers in the past. I'm active, although not good at running. I'm trying to get weight off.

I'm still in AF, although I can't feel it, pulse about 66 resting. The question is, should I do anything about it? I feel I spend far too much time at my local medical centre, although one doctor told me that I never waste their time. Specialist says I shall be put on a 24hr heart monitor. How long should I be in AF before I ask for medical help? I've never had an ablation. Sorry if this is a daft question.

[BobD Volunteer]

Brutal facts here. ANY treatment for AF is ONLY about improving quality of life.

If you are asymptomatic and provided that your heart rate is controlled then why risk messing about with things. OK I am a great fan of ablation but it is not without risks however small. Whilst one may say that you have not been best treated not having seen an EP in all this time you may now need to be a little proactive about your treatment if you are not happy with what is being done for you.

[Thomas45 in reply to BobD]

Sorry, I can't have written my post well. I'm not looking for ablation, just some advice. As for Flecainide it's stopped me getting the awful episodes I used to get. It was a shock to me to find I was in AF as I can't feel it. The consultant suggested 24 hour moitor and depending on the results Diltiazem. I've read today that Beancounter has permenent AF, so I shouldn't worry that my AF might go on for days, or more. I am sure that the Arrythmia specialist at my local medical centre would sort out seeing an EP if I felt I needed one.

[BobD Volunteer in reply to Thomas45]

Would you ask a plumber to re-wire your house?

[Thomas45 in reply to BobD]

I totally agree with that point BobD, but that wasn't the point of my question. I stated, only as a matter of fact that I hadn't had an ablation. I have discussed AF with an EP but not consulted an EP. Flecainide has kept me free of AF except for 1 or 2 short (less than 20 minutes) episodes per year in 11 out of the last 12 years. The other year I was on amiodarone, for me an awful drug.

I posted, perhaps before I'd thought about it, really seeking assurance that there's no risk in being in persistent AF, as long as you're on the right medication. Diltiazem has been mentioned after I've had a 24hour monitor, subject to the results. Thinking about it now there are people out there walking around, going to work etc, with unknown asymptomatic AF. The difference between them and me is first I take warfarin, and have my own Coaguchek tester, and I have good medics. Personally I've never liked the idea of ablation for me, but that isn't the current issue.

So thanks for your comments, Bob. They're appreciated.

[CDreamer]

Totally agree with Bob, my only comment would be that if you are in AFib most or all of the time - the monitor will confirm the nature of your AFib - I would seriously question why you are taking Flecainide, which is a very toxic drug, if it isn't controlling your AFib?

Beta blockers I could understand but Flec is a rate control drug but I suppose you need to be very careful regarding the asthma with beta blockers.

In my book the fewer the meds we take the better.

Hope you get some answers - in your shoes I would be looking at priorities and risk:benefits regarding meds.

Best wishes.

[Bagrat in reply to CDreamer]

I always thought flecainide was rhythm control although it does drop some peoples' rate and of course can cause other arrhythmias.

[Thomas45 in reply to CDreamer]

Thanks, CDreamer I'm taking Flecainide at the moment, and for the last 11 years, because during those years I've only knowingly had Paroxysmal AF, on one or two, or no episodes a year. I could feel those episodes in my neck. I could see them in my wrist.

I'm asthmatic and although there may be Beta blockers now that work for asthmatics, there haven't been for long, and Flecainide has worked for Paroxysmal AF.

I agree with the point about medication. The side effects I had from one NOAC were terrible, and in my view were a trigger to me getting Polymyalgia, which thankfully left my body after three and a half years.

[RiderontheStorm]

Everything is RISK management related. I would think being on blood thinners for stroke protection is the most important element here and if It were me. Sounds like you are not unduly affected by the AF I would be careful with undergoing procedures as you age.

[Thomas45 in reply to RiderontheStorm]

Thanks. I've never been keen on ablation, which seems to be not a good return on the money it costs. I'm sure it helps some people, and as more ablations are done the EPs are becoming more knowldgeable, but there is no "standard" human. Our bodies and lives are all different.

[eleanor--1941]

Hello Thomas,

I have PAF 18yrs coming.I take medication as PIP only when an episode comes on. 300mg of Flecainide.I was told by Consultant it can take up to 8hrs for Flecainide to work,if it doesn't ,go to A&E.Hope this helps,should check with your Consultant.Keep well.

Eleanor.

[Thomas45 in reply to eleanor--1941]

Thanks, Eleanor

[Meeko]

I know a guy who at 90 has had a successful ablation 6th. Down to the skill of the surgeon and your baseline health imho

[RoyM]

I am in persistant AF and have been for 13 months now. I take Bisoprolol and Apixiban I am pretty much symptom free with a resting HR of about 75. Because of this my EP considers the risks surrounding an Ablation out weighs the possible benefits to me. So at this moment in time I simply plod on. I must say I do worry what the long term effects on the structure of my heart will be. Only time will tell.

[wilen]

Hi Thomas45. I too am in persistent/permanent AF and have been for around 3 years. Because, like you, I`m virtually symptom free, and because my resting HR is about 60, my cardiologist told me that rather than have ablation, which was not guaranteed to work, my system would adapt to the perm. AF and I should be able to live a near normal life, which has been very much the case. The key to this of course, is being asymptomatic with the AF.

However, there is a sequel to this story which a considerable number of a fibbers may find very interesting. When I get a moment, I`ll be posting it as a new post on this website. Look out for it - `A "cure" for AF??`

wilen.

[Thomas45]

I saw a very knowledgeable (on arrhythmia) GP today, as part of World Arrhythmia Week. I had an ECG which showed I was still in AF, but the GP put my mind at rest. I had been very worried about it but am no longer.