Succumbed to A/C

[Alan_G]

After putting it off since I was first diagnosed 5 years ago I've finally succumbed to anti coagulation and selected Apixaban. I now await to see how I take to it. I was 65 at the end of last year but have no comorbidities and so score 1 on the CHADvasc2 scale. Previously, the GPs I had seen advised against starting on ACs but my latest GP who seems much more in the know about AF strongly advised I went on to them and so I took his advice. I've not had an episode in 4 months and I tend to think why should I be on A/C but I guess it only takes one AF episode to hit you out of the blue to get you worried again.

He also suggested I come off bisoprolol. I am on the smallest dosage of 1.25mg but my ECG showed a heart rate of 54 which he thought implied it may be time to come of bisoprolol. I have taken it under advisement but as I am AF free at the moment I'm inclined to leave things as they are. That said, last night my fitbit recorded by pulse at 43 and so I am going to have to give it serious thought. He seems to favour Sotalol as an AF medication.

[BobD Volunteer]

Hi Alan and well done on the anticoagulation. The number and intensity of AF events is not related to the dangers so best protected I say.

Although I am not medically trained I always feel that you only take things which make you feel better or protect you. Your GP seems to think that you may be better off trying without the bisoprolol and this does make some sense with such a low pulse. On the other hand I don't like his idea of sotalol as in UK this is no longer a recommended drug for AF due to possible unwanted and dangerous side effects. True some EPs (electrophysiologist) may decide to use it but after due consideration and a general check of other cardiac health functions. I would, personally, not accept a GPs recommendation of this drug.

[Alan_G in reply to BobD]

Yes Bob, I did do some research on Sotalol and it's effect on the QT Interval seems to be a risk. My GP didn't suggest I went onto it, he merely stated he has a number of patients on it but agreed that while my AF is as it is there is no reason to change anything other than maybe coming off the bisoprolol. That only concerns me because it means I am on NO medication for my AF. He did suggest it as a PIP though. Basically, he said he'd only consider other options if the regularity or intensity of my episodes took a turn for the worse.

[DK81 in reply to BobD]

"The number and intensity of AF events is not related to the dangers..........." It would be helpful to have some justification for this statement, as it seems to me that this aspect of AF is rarely discussed, and may not have been the subject of much research.

[Alan_G in reply to DK81]

Agreed. I thought you were only at risk during and immediately after an AF episode. If you are AF free for months I believed you were not as risk at all. One GP told me that, yet another said it was irrelevant how long your episodes were and what the frequency was. I guess now that I'm taking A/Cs it doesn't matter, but it would be nice to know.

[lis56beth in reply to DK81]

Hello DK81. I was not aware of this. It would be good to have some evidence for this statement. Can anyone help please?

[DK81 in reply to lis56beth]

I was quoting BobD, who made the assertion, so it is I who was looking for the evidence. Unfortunately, he has not provided any, so we may now be dependent on the views of others.

David

[Alan_G in reply to DK81]

One of my GPs made the same assertion. I think he was implying though that you could suffer 'silent' episodes that you were not aware of.

[lis56beth in reply to DK81]

Oh yes David Was just wondering if anyone had any links etc I suppose in a way it's quite reassuring if it's true That's if I have interpreted it right ie as long as you are on anti coags

[DK81 in reply to lis56beth]

I have done some hunting around for you, and found the (very long) url for some material I accessed previously. The text suggests Afib has different attributes.

heartdisease.about.com/od/a...

As far as anticoagulation is concerned, you may like to refer to my contribution (search for DK81):

healthunlocked.com/afassoci...

I hope the above is helpful.

David

[lis56beth in reply to DK81]

Thanks so much David. I appreciate it. Lis.

[Alan_G in reply to DK81]

One interesting fact/comment in the article is that it says blood clotting only starts to occur after 24 hours in AF. I've never been in AF that long and this does not appear to come into the equation as to whether you should be on A/Cs or not.

[DK81 in reply to Alan_G]

Your comment highlights one reason why I do not take anticoagulants.

[Hidden]

Hi Alan, just to say that I'm pretty much the same as you, male, 67, chads score 1 just because I'm over 65, no other comorbidities etc. I've been on Apixaban for a couple of years, and prior to that on warfarin. I've had no problems on either. My EP chooses which drugs I take.

Koll

[Meeko]

I use bisprolol as a pill in the pocket. If I wake up with a pulse over 70 I take it. Also if I get a racing heart I take it. I'd rather take rivaroxaban than have a stroke.

[Yachtgirl]

Sotalol caused my pulse rate to drop to a point where I collapsed. I was not keen to go on it as my pulse was slowly going down but persisted with cardiologist quite firm about me taking it. I was taken by ambulance to hospital where they stopped the sotalol. I am now not on any rate or rhythm control drugs and just put up with ectopics when I get them and I am happy with this. Sotalol is a dirty drug ( google for info).

[Pam296]

Hi Alan. I was diagnosed with AF earlier this year. I was initially prescribed with Flecainide, then Bisopropol but found it hard to work with the side effects. At present, I have very few episodes, all lasting less than 2 minutes. My cardiologist agreed I could come off all medication apart from Apixiban. I know it will get worse in time but I'm using this time to make significant lifestyle changes which I hope will help. I couldn't see the point in feeling dreadful for no reason!

No side effects from Apixiban so far.

[Alan_G in reply to Pam296]

I have read about many people who have all but eliminated their AF and so I do not believe it is inevitable that it will get worse. If you do nothing, then maybe, but if you make the correct life style changes and take the right supplements I'm hoping it can be held at bay until the new treatment comes out to replace ablation that is non invasive and takes about 5 minutes. I gather it is being researched at the moment but I don't how far off that is though. I am quite happy to come off bisoprolol as my GP has suggested, but I just worry about being on NO medication at all for my AF. Psychological worry I know.

I've only been on apixaban for 3 days but so far I feel no different than before.