What to do next

[NannyChickens]

I have now been in AF for 10 days having not had an episode since May when it lasted 8 days, the longest period up until then. My pulse is not particularly high at 78, usually 60 as on bisoprolol. I am also on warfarin and atorvastatin and 2 BP lowering drugs. My symptoms are not too bad but fed up with feeling whacked. I do have an appointment with Cardiologist in December but is there anything I should be doing now?

[Hidden]

I'm not medically trained but as long as your pulse rate remains below 100, I think you should just ride it out until you see your cardiologist. If it rises to 120ish, or you get chest pains or any other symptoms which give cause for concern, it's a trip to A&E or ring for an ambulance if necessary. In the meantime, try to keep calm and hopefully it will soon revert back to rhythm..........best of luck

[NannyChickens in reply to Hidden]

Thank you. I spoke to my GP this morning who was very supportive and suggested the same

[Lee-J in reply to Hidden]

Don’t panic I have been in A/fiib and flutter doing anything between 115 to 145 bpm for six weeks non stop now. Echo was fine and told by EP don’t worry it’s not doing you any harm. Will probably need cardio version soon if it carries on as after a while the ventricles May suffer. Point is I have been doing periods of six and eight weeks before reverting to sinus rhythm for four years now. Also on 240 mgs sotalol but not having much affect though would be a lot faster if not on it. Going to try another one after cardioversion. Good luck

[NannyChickens in reply to Lee-J]

Thank you. It is so reassuring to know that people have gone through similar and worse

[Jong1945]

Sorry to hear that.

Can I ask if you don't object, what age are you, what is your normal resting heart rate, and have any of your consultations in the past identified any cardiac abnormalities, or have they said yours is a "lone" AF (no apparent cause)?

[NannyChickens in reply to Jong1945]

Hi John. I am 69. Have left bundle block and a slightly leaky mitral valve. I have had high blood pressure for 20 years or more and have bendroflumethiazide and Candesartan for that. It is well controlled. Resting HR is usually 60 but mainly because I am on 10mg bisoprolol per day. I am also on warfarin 10mg and Atorvastatin 20mg. The afib however does not appear to relate to the electrical issues but who knows. Am interested to hear your thoughts

[Jong1945]

OK, thanks. I am always aware that younger (30-55 onset) "fibbers" with typically a low heart rate and no heart disease (and surprisingly often they have digestive problems too or are athletes) need different strategies than older-onset sufferers. "I am not a doctor" but from what you say you may well not fall into that category.

[Polski in reply to Jong1945]

Please elucidate! In what way do younger AFers need different strategies from older ones?

[Jong1945 in reply to Polski]

Polski - the reason is that younger patients with no "heart disease" are more likely to have the "Vagal" type of AF - see the thread healthunlocked.com/afassoci... and in particular Dr Gupta's video. He states it's not well-understood. I would re-phrase that and say that it is not well-enough known about, certainly by many GPs, and also by too many Cardiologists. It does feature in the European and American AF guidelines, so it is definitely "a thing"

[NannyChickens]

You’re right 😂😂

[momist]

BobD on here has a saying: If you go to see a carpet salesman he will sell you a carpet. One thing you will not get is a GP or a cardiologist recommending an ablation. Have you seen an EP?

[NannyChickens in reply to momist]

No I don’t think there is an EP in Inverness. I was told I couldn’t have ablation because of my other health issues???

[momist]

That's good to hear Hidden . I'm afraid my experience with a cardiologist at the local hospital was less positive, and that's all I had to go on. He was definitely a 'plumber' first and foremost. He seemed to ignore the AF part, and only concentrated of the 'health' of my heart, although he gave me a very good looking into (echo (twice!), followed by MRI, followed by Bruce Protocol stress test).

[Jong1945 in reply to momist]

There's a degree of truth in that saying of Bob's. My version is "whoever has a hammer tends to see everything as a nail". I think however, that the issue is whether the Cardio is up to speed with AF as a condition. EPs will tend to be up to date anyway as that's their sub-speciality. There are plenty of Cardios who are up to date (Dr Sanjay Gupta being one excellent example), but regrettable too many who aren't. I was a professional engineer and it was in my institution guidelines (or maybe the Eng Council's) that if someone consults you about an issue which you aren't fully competent in, it is your duty to make that clear.

[MS444]

Some GPs know as little about AF as your average carpet salesman.

[Hidden in reply to MS444]

I see your point but EPs and cardiologists may know relatively little about areas of medicine outside their own field.

Being a GP must be very demanding, in part because there is so much to keep up with, but also because many hospital departments discharge many more outpatients now.rather than give annual follow ups as in the past.

We should be grateful I think that at least we still have GPs, Geriatricians and psychiatrists who are trained to take a holistic view of their patients.

[MS444]

I like to be positive but warn everybody not to trust doctors in general. My GP had a letter from a cardiologist I visited in 2006 about PAF. I never saw the letter, but repeatedly visited the GP explaining concern over increasing frequency of PAF. No treatment options were discussed or recommended. In 2014 I finally instructed the GP to refer me to an EP I found through a friend. That was 8 years and over 100 PAF episodes each lasting around 12 hours.

The letter from the cardiologist, which I later requested directly from the cardiologist, categorically stated that if the PAF became more frequent medication options needed to be considered.

The EP performed an ablation.

So I endured a GP who for 8 years ignored and did not disclose the contents of the letter from the cardiologist, and knew nothing about the most common heart rhythm problem affecting humanity. There is no need to defend poor GPs due to their difficult jobs. It is better to be brutally honest about the fact that they cannot be trusted. Get a second opinion even if you think your GP seems competent.

[NannyChickens in reply to MS444]

I’m seeing Cardiologist next week for my annual review and I intend to ask him about referral to an EP

[Hidden in reply to MS444]

That is certainly not satisfactory. I have had good GPs and GPs I had no confidence in. I have rarely been back a second time voluntarily if I wasn't happy.

I also feel we have to keep on top of chasing up our own results and hospital letters. The NHS Is under-resourced, clinical staff are under pressure and administrative backup could be better.

I usually ask for the consultant letter to be copied to me.

[MS444]

Sounds good! Best of luck!

[wilsond]

Sounds very similar to my recent experience,look at my posts? Rule out going into atrial flutter...no need to panic though,its very sortable,it seems.worth enquiring

[drdang_20]

Try taking 2 tab of flecainide stat. It is also generally known as pill in pocket.

If it doesn't work then inn cordarone infusionunder medical guidance.

The last resort is electroconversion.

.......Dr Sharma