Hi. I am new to H.U. I am a 69-year-old male in relatively-good physical health though a bit overweight, perhaps 20 lbs. In the Summer of this year, when still 68, I had my first episode of what was diagnosed as Afib after eating some chocolate that day, a Hagen Das dark chocolate and vanilla ice cream bar, and late-night sex. It happened in the middle of the night. Since then, I have had about 5 or 6 episodes, all of which "converted" to Sinus (normal) rythm on the second day. (Thank God.) My doctor did the usual routine of tests, including blood work, a Nuclear Stress Test, and Echo Cardigram. Those tests showed normal heart structure and no underlying heart disease. This was my first known "cardiac" symptom or event.
My doctor then put me on 25 mg daily of Metoprolol and a low-dose aspirin. From the first episode until now, I have calculated an average of 16.5 days between episodes although there was a 32-day gap between the 1st and 2nd one. I am now up to 75 mg. of Metoprolol and have discovered, due to the fact that ALL of my episodes happened at night, I have no underlying heart disease, and my symptoms also include digestive issues, and I haven't had the very rapid heartbeat experiences I hear about, I most probably have what is called "Vagal Afib" which means I am triggered by an imbalance in the vagal nerve rather than cardio issues. That would mean that Beta Blockers like Metoprolol are strongly counter-indicated for my condition as they can actually CAUSE arrythmias and cause paroxysmal Afib, which I have to become persistent or permanent. I have emailed my cardiologist about this but have not heard back yet. We had previously discussed that, if the Beta Blockers didn't sufficiently prevent my symptoms, we would move on to an anti-arrythmia drug such as flecainide which appears to carry more potentially burdensome and possibly dangerous side effects than the Beta Blockers.
So, that's where I am at present with this situation. I continue to try and stay healthy, performing cardio exercise and soon beginning a resistance program. I would like to hear the experience of folks with anti-arrythmic drugs like flecainide, etc. Thanks for reading this
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willec49
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All sounds pretty standard good pracice except for the aspirin which unless you have ischemic heart problems is of little value. Aspirin has been removed from the recommended list for AF here in UK since 2014 as not only does it not prevent stroke but can still cause harm in the form of degestive system bleeding etc. Anticoagulants would, be strongly recommended so I suggest that you re-visit this question with your doctor and investigate the CHADSVASC score to check how much risk you may have.
Do go to AF association main website and read all the fact sheets as knowledge is power and also investigate all the life style options such as weight loss.(BMI less than 25) no alcohol etc which have proved to improve quality of life for those of us with AF
Thank you for your reply to my post. I did raise the question of blood thinning drugs with my doctor. This was his response:
"Given your risk profile (1.5% risk of stroke at baseline from the atrial fib), it is acceptable for you to take aspirin as your blood thinner. At the same time, rarely, some people choose to take a stronger blood thinner for maximal protection from a stroke, albeit at a higher risk of bleeding. Based on the current data we have, with aspirin you are at a 1.2% risk of a stroke type event with a 1.1% risk of a major bleed. If you took a strong blood thinner such as pradaxa, you would be at a 0.3% risk of stroke event with a 3.8% risk of major bleed.
So for low risk patients, it is acceptable to take a weaker blood thinner but as our risk of stroke goes up then it makes more sense to take something stronger, even though the bleeding risk goes up."
I am and have made lifestyle changes. I haven't eaten red meat in over 30 years. I don't drink, smoke, or do any drugs at all. I'm doing more cardio and will be starting a resistance program soon and have moved my belt tighter by two holes, etc. All good advice. I appreciate the feedback and support here. Thanks!
Bob, I did read the AF Association main website which is a great source of info. Thanks! Also, I found that my CHADSVASC score is 1. Best Regards, Bill
With a score of 1 anticoagulation is optional in which case why take something that doesn't do the job yet can harm you (aspirin) . Aspirin is an anti-platelet like clopidergrol not an anticoagulant. Neither of course thin blood at all but sadly doctors think we are too thick to understand anticoagulation and use that dreadful missnomer.
Bob, can you say then what factors would carry the most weight in making a decision whether or not to take an anti-platelet or an anti-coagulant with a score of 1, which puts someone like me in the "optional" category? (Beyond the opinions and preferences of various doctors, etc.) Thanks.
For me it was simple - risk factors of stroke from AF episodes period. I am over 65 and my score of 2 is only because I am female and over 65 on anticoagulation and still had a TIA a year ago.
Risk factors of taking anti-coagulants - unintended bleeds - but as I no longer do high risk sports or a job which would be considered high risk - that risk would be much lower than the risk of having an AF induced stroke.
Individual risk:benefit is the only factor.
At our patient conference I was rather shocked to hear that only reason that the benefits of preventing stroke were set at a CHaDS score of 2 - was that there are no large studies looking at strokes in AF patients with a Chads of less than 2 - ie there are no stats! The advice given was that everyone who had suffered one AF episode would benefit from anti-coagulation.
I can not understand why in US aspirin seems to be so widely prescribed whereas in Europe it is such a different story. The potential to cause harm from affects with aspirin is much, much higher.and very well understood from arthritis patients who used to be prescribed daily aspirin.
To say that everyone who has suffered from one Afib episode would benefit from anticoagulation seems to me a bit like a mantra. Like the one that says that all patients with a cholesterol level over 5 will benefit from a statin. If you look at the NICE graphs for patient decision making it shows clearly that for 1000 patients with Afib with a score of 2 who do not take an AC , 25 will suffer a stroke in a year. If all were anticogulated 17 would be spared the stroke. Surely those 17 are the only people to benefit ( except of course the shareholders of the companies who make the drugs). The others will have not and might indeed have suffered side effects. Bleeds are not the only side effects of ACs. Warfarin long-term can cause osteoporosis and none of the NOACs have been around long enough for truly long term side effects to show up. Other side effects can severely impair quality of life for some people . There is too much one size fits all in medicine in general.
Whilst I agree 100% with your last statement & have been a sceptic for many years - 1 TIA made me realise I am playing Russian Roulette not taking one.
Risk : Benefit - very personal choice but hopefully a very well informed one.
I think the DOACS have been around long enough now to make an informed judgement - I’ve been taking one or other (they all have individual pros & cons) for 8 years with no long term ill affects & believe me I have complex needs & cannot (would not) take any other AF meds at all - all have had serious unintended long term affects on my health & I have a Red Alert in my medical file for any Beta or Calcium Chanel blocker.
I have not yet been totally convinced! But mainly because I tend to react badly to drugs. I have been poisoned by taking Cipro more than once and am still suffering the consequences . My first attack of afib came after taking it and I have widespread tendonitis and deterioration of rib cartilage as a result. The first vitamin k inhibitor I was put on Préviscan gave me terrible leg pain ( probably because it is fluorinated and fluorinated drugs are a no no for floxies) and I could not keep my INR stable. I have crap veins too so that did not help! I was relieved when my cardiologist said I could stop it after the Holter. I have tried Pradaxa and it gave me indigestion and loss of appetite. Both my cardiologist and GP say I do not need an anticoagulant. They are going by the latest ESC guidelines which say optional for Chadsvasc score of two as long as those points are for age and sex. I do worry about having a stroke and am leaning towards Warfarin with the self checking. I have read that if you take a vitamin k 2 supplement and match the Warfarin dose to that it is easier to keep the INR stable. I am sure if I insisted on an AC they would prescribe it. Have I misread your post or did you have the TIA despite being anticogulated?
Yes, but what had happened was that I had come off AC’s as I hadn’t had AF for several years after a successful ablation - then I suddenly started having AF again and my first thought was - Aaaah - I’m not anticoagulated - when previously I had pushed to come off them. The TIA happened a few months later. Anticoagulants don’t stop you having a stroke or a TIA - but they do lessen the risk. It is thought that AF’ers tend to have more micro-bleeds as dementia is linked to AF. There is some evidence that anticoagulants reduce the severity and the frequency of vascular dementia.
The DOACS are not Kit K antagonists so INR testing is not required which as I was travelling such a lot was the main reason I went on them.p but frankly, I had an immediate bodily reaction against the name of 2 drugs when they were suggested - Wafarin and Sotolol which made no sense, but I have learned to trust my own bodily instinct.
I think it takes a very long time for our body to come back after any antibiotic - I was very sick more some months after taking a penicillin based one for pneumonia earlier this year.
The fluoroquinolone class of antibiotic are particularly pernicious. They act like chemo drugs (actually they are chemo drugs in that they modify the DNA of the bacteria- but when they were developped the similarities between bacterial DNA and mammalian mitochondrial DNA were not well understood) and they can cause permanent disability. The German government requested the EMA investigate them and recently they have recommended much more restricted use. It is a typical story of doctor naivety and drug company greed. They were developed for truly serious infections like anthrax and plague but there's no dosh in that so doctors were encouraged to dish them out for all manner of banal intections and even to prevent travellers diarrhoea! With devasating and even fatal consequences for some poor people. Not much fun dying for a cough that was probably viral in origin and would have gone away on it's own anyway.
I take Mycophenolate, an immune suppressant, which doesn’t mix well with many drugs. The alternatives would be old chemo drugs or steroids which I’m trying to avoid. I have to be really careful with many antibiotics and there are several which could be lethal for me so I tend to do all my own research before agreeing to take anything as I have also experienced a lot of incompetent, inexperienced and dogmatic doctors. Thankfully I now have a team who are willing to talk to each other and an excellent primary care practice.
Unfortunately there are too many incompetent and dogmatic doctors. The two seem to go together! My cardiologist is definitely not a " take this drug because I say so and don't ask questions " type but on the other hand he is not very communicative and after the pro anticoagulation advice on this forum I am torn between following his ( and my GP's) opinion and insisting on anticoagulation ( which emotionally I don't want to take anyway). I wish you all the best with your complicated health problems. Have a great festive season!
I had this conversation with my doctor via email and he gave me statistics on probability of bleeding for both aspirin and drugs like Eliquis, etc. He is in favor of the aspirin for now. I see that aspirin is no longer used in England.
Hi CD. I'm with you on the aspirin popularity in the US. After getting off Coumadin, then Plavix after the Watchman procedure in January, the protocol is a baby aspirin (81 mg) daily for the rest of my life. I read about the post procedure protocol in the UK of no aspirin and it reasonates with me.
One theory I have is here (US) often guidelines are put in place out of an abundance of caution for doctors because we are such a litigious nation. People sue at the drop of a hat here and attorney ads on tv are very abundant. (Attorneys are sometimes called ambulance chasers here.) There are times when an accident victim goes through the E.R. and not long after being settled in their room is visited by an attorney wanting to represent them. Not condoned by hospitals but common.
Even I am cautious about answering healthcare questions for other seniors here. When I was still working as a nurse I carried malpractice insurance but no longer since I'm retired. I can still be sued if someone chooses. (No good deed goes unpunished!-sometimes).
But back to aspirin. I didn't like taking it as I feel long-term risks outweigh any benefits so I don't.
Fortunately I have a great, intelligent, think outside the box Electrophysiologist who I always level with and he knows how I feel. It's unofficial as I don't want to put him in an 'iffy' position re US Standards of Care. But not everyone is so lucky.
Sometimes we have to listen to our gut and do what we feel best and be wary who we share information with. Just my opinion but a year into this procedure things are working well.
Irina, thank you for responding to my post here. I'm very glad that you are doing well after your procedure and on the aspirin. I'm also currently on the low dose aspirin for now and will have a phone appointment with my cardiologist today to negotiate possibly weaning off Metoprolol and doing an anti-arrythmia medication as needed. I hadn't thought of the whole thing around legal liability which, as a Psychologist, I am always cognizant of. Best Wishes!
Thank you wille. Actually I am not taking the recommended aspirin. It's more of a precaution here after having an atrial anterior closure. But before my procedure I would have remained on a bonafide anticoagulant rather than just aspirin. And welcome to the A Fib Club.
I've had it since 2011 and am now very stable with no symptoms. I take no meds, have persistent AF, a pacemaker, 1 past ablation, and the Watchman device. At this point I have very little anxiety about my a fib. I'm hoping you reach this point soon. I saw my Electrophysiologist a couple of weeks ago and was told no further changes in my EKG in 2 years.
I believe a stable and comfortable life is possible with AF though it's a different journey for each of us and it takes a bit of trial and error to reach our own best treatment plan.
Hi Irina - Really pleased to hear that all goes well with you and I can understand your reasoning - I think it is mad, mad, mad. Unfortunately we are tending to follow but considering we don’t pay directly for our healthcare it is somewhat ironic that a few people get big cash handouts whilst others are refused treatment because of financial restraints.
The Guardian - Feb 2018
The group, which includes the chairs of the British Medical Association and the Academy of Medical Royal colleges, said the NHS spent £1.7bn on negligence claims last year and the annual cost has doubled since 2010/11.
They added that the estimated total liabilities, which is the cost if all current claims are successful, stands at £65bn, up from £29bn in 2014-15.
Now whilst some may be for severe negligence, I wonder how many are not?
Healthcare is such an emotive subject isn’t it? US has the best technological medical care in the world and the lowest level of Health in the general population. UK NHS refuses people essential, life saving procedures and drugs because lack of funding. It’s a mess.
You're right on the money, CD. And in my experience I would say most medical lawsuits are not warranted -and if they are- not for the money being asked for. I'd like to share some info I have personal knowledge about on the subject.
I'll preface by mentioning a wise surgeon I worked with years ago. I was a new graduate and I learned a lesson from him.He was excellent-someone who I would let operate on me. He believed that if we are honest with our patients, admit our mistakes, apologize, and try to be a part of helping them rectify the error patients would not be inclined to sue.
An odd notion in today's world. He believed most patients who had a bad experience didn't have money as their first object; they wanted to be heard, not lied to, and guided in how to become well again. He made a small mistake during a surgery once-easily rectified- and I saw him walk right into the recovery room and as soon as the patient was awake tell her what happened and that he would see her in her room as soon as she was awake enough to talk and discuss how the situation could be remedied. It all turned out well. She remained his patient and had further surgery by him. He was never sued. An unusual man as he was very transparent with her.
Health practitioners are human and even the most competent will sometimes make mistakes. I believe in lawsuits if the patient and damage from gross negligence cause injuries that will cost the patient financial struggles down the road that might be catastrophic. But these are not what most lawsuits are about.
Frivolous suits are so common here that one hospital I worked in referred to them as "suing for a new Toyoto". A patient would file a lawsuit for an enormous amount of money and then finally after it was almost ready to go to court and the patient realized he/she had a weak case would settle out of court for enough money to buy a new car.
Finally my own experience with lawsuits. I'm giving a few vague details because it happened in the late 70's, several key people involved are now deceased and no one can be hurt or identified by my sharing.
It was a holiday and I was working in the O.R. We were very short-staffed as several people had called in sick just to have the holiday off. We were very busy, it was a big hospital with lots of the 'gun shot wounds/stabbings' emergencies.
A patient was brought in who had tried to commit suicide by shooting herself in the chest. Long story short-her life was saved but as you can imagine there was a lot of blood and tissue damage. A sponge was left in the patient (yes things happen) and she lived to sue us several weeks later when pain she was having was picked up by another hospital and the sponge showed up on xray. It did not show on our xray when we checked after an incorrect closing count.
She sued everyone who was in the OR with her including me. The case went on for a year before being settled out of court. It was very stressful for me. I was very angry, scared, depressed during this time. We all did our best for this patient and sometimes mistakes can happen. She finally settled for a much smaller amount (Toyoto?) out of court. I almost left nursing but a good therapist helped me get through all my emotions.
Sorry to be so lengthy but when we are not honest about trying to get big money from the healthcare 'piggybank' we might not be entitled to, I hope there is karma for these people for what they have taken away financially from others who then have to do without.
I'm still angry revisiting this on paper almost 40 years later.
Ahh...bless you, You are welcome and I hope that relieved you of another layer. We do tend to hold onto these injustices and they can affect our own health. Some people seem to have to act out their own anger to deliberately hurt others, what a sad story. Thankfully I believe there is good in the world and hang onto the idea that good may balance out the bad.
Sorry for the delay but CDreamer has said most of it. Personally with a score of 0 and AF i would take anticoagulation and many EPs would agree. Many agree that AF should mean anticoagulation. Full stop. Antiplatelets like aspirin have no place in treatment of AF and should only be used where patients have other cardiac issues . Bleeding is far more likely on such meds than anticoagulation especially gastro intestinal bleeding which can be hard to spot and can and has caused death. From my own personal experience in fifteen years of warfarin I have never had any bleed problems even bearing in mind that I work with engines and machinery, yet when forced by other considerations to take aspirin had some really traumatic nose bleeds which forced a complete change of my hospital bed and an immediate cessation of the antiplatelet.
Hello and welcome. Do you actually have any symptoms that you feel need treatment with medication at the moment? Lifestyle changes would be a good first step.
To answer your question, flecainide for me induced atrial flutter. I took Sotalol for 8 years without any obvious side effects.
In the UK, if you were felt to need stroke prevention medication, you would be given an anticoagulant rather than aspirin. The latter is good for vascular disease but can cause blood loss from the GI tract.
Thank you for your welcome and response to my post. I don't have any symptoms of Afib until I DO have symptoms when an episode happens.
Interesting as I've studied all the pros and cons, side-effects, etc. of sotalol vs. flecainide and, according to all the studies and papers I've read, sotalol is strongly non-indicated for Vegal Afib which I appear to have. But, metoprolol, which I am taking, is also non-indicated for my condition, according to the research I have read. I've communicated all this to my cardiologist who is supposed to be back in the office tomorrow. I hope to have a productive conversation with him then. Thanks again!
Hi Willec! I was prescribed Toprol 5 years ago, after my first ablation. I stayed on a low dose until I became educated through this forum and Dr. Sanjay Gupta's videos about beta blockers not being so great for vagally-induced AF. No docs had questioned my continued use of Toprol, so I decided to.
I consulted with my EP and with his blessing, went off Toprol in August or Sept. There was a very short time of my HR jumping up a bit occasionally as I weaned off of it, but I made it through that phase and am vastly better off as a result. My HR tends to stay in the 60-70 range, up to 80-90 with exertion.
I came to see that the sluggishness I'd been feeling even on a walk in the woods that wasn't so intense hadn't been strictly from AF, but from medication. There was a lot during this year that I attributed to AF itself that was actually the influence of the medications that were taken too frequently or at too high a dose.
I now take Flecainide only as needed to stop an episode, as taking it daily brought on dreadful side effects. I've reached a good place with my EP, who acknowledges that I am quite sensitive, and so he's fine with me sorting out the right balance for myself with Flecainide. We reached this place in my appointment last week, a subtle but powerful shift that has been as healing for my heart as any medication. By that I mean that I feel understood and respected, that he trusts that I'll take his advice and within common sensical bounds, tweak the dosage to find what works for me.
A few other interesting factors have contributed this week, but since that appt., I have been in NSR for the longest stretch for a while.
Nella423, Thank you for sharing your experience with Afib. I am happy for you that you feel you have arrived at an arrangement regarding medications that works for you. I emailed my cardiologist to this effect, regarding the fact that Metoprolol is counter-indicated for Vagal Afib and I am on the highest dose before I would transition to an anti-arrythmia drug like Flecainide. Also of note, I have been on 25, 50, and now 75 mg. of Metoprolol and the average period of time between Afib episodes on each dose are not much different. We're supposed to have a phone appointment today before he goes on vacation. Fingers crossed.
I think that you're wise to discuss the issue with your doc. What I've learned from my own experience and from all the interesting stories from the forum is that there do seem to be many ways that AF affects people and many ways to treat it. I think that my doc just hadn't encountered many patients as sensitive as I am, so didn't quite register at first that the normal higher doses he prescribes are too much for me. Fortunately, he does listen.
There's a balance to strike between trusting the doc's expertise, yet advocating for oneself and becoming educated. Sounds like you are doing well with this.
Hi wille. It's me again. Just wanted to add to what Nella wrote. She's so right about having a doctor who allows you to participate in your treatment decisions and listens to your ideas. To me having a doctor that is not threatened by a patient's knowledge and desire to learn about his illness so he can be a part of the solution is key to living comfortably with a-fib.
Not always easy to find these doctors but worth the search.
Take care. irina
Hello Willec! Your gaps between one bout of AF and the next are very like mine and I usually wake to find AF has arrived. Gaps can be as long as 48 days or down to 10 and occasionally only 4 days. My average is 20.75 this year and was 18.25 last year. Whilst the lack of progression is pleasing, the sessions have been lasting longer.
I used to take 150mgs of flecainide twice a day - top dose - and am pleased not to be doing so now following two ablations. I currently take atenolol, losartan and rivaroxaban.
Hello! I have found Flecanaide very useful,but it did send me into atrial flutter after a week. I had previously taken just a beta blocker,blood pressure tablet.After a TIA,I was given flecanaide,and taken off the beta blocker as my hR is naturally low. This apparently caused the flutter! Long story short,now only take betablocker if my Afib goes fast,unusally for me as it normally just shows up as weird jumping about stuff.
I am on 100 mg flecanaide,and can take more if needed in a bad attack.
The most important medication for me is my anticoagulant..NOT blood thinners as some refer to them.
Wilsond, that's very interesting because I have read about people who don't take it regularly but just carry flecanaide with them in case of an episode which they then take and, according to their accounts, always convert. Have you had any more TIA's? So, it sounds like you are on flecanaide long term and Beta Blockers TID. (Kind of the opposite of the situation I am describing here.
Some peop!e like me take a maintainance dose,with the option to add more kick if need be,others just use as a pill in the pocket. No just the one TIA,and am on waiting list for afib and aflutter ablation.
Af is such a weird condition I think there are many different regimes to try and keep it under control!,
As a 25 year "vet" of this beast,I was very interested in your post. For about 20 years my only medication was low dose aspirin, not sure why, but I started off exactly the way you have, except my time between episodes was a bit longer.
It wasn't until I moved to Australia, and a different cardiologist that more medications were added ,mainly amiodarone as a "pill in the pocket" which worked very well for a while, but 18 months ago I became persistent/permanent, and I was taken off aspirin and put on Apixaban,
Ok.now one question, do you have, or have you been tested for sleep apnoea?
I don't read about it much in the posts on this site, but my cardio is of the opinion that a large percentage of Afib cases are triggered by sleep apnoea,which (apparently) is why so many people "wake up" with Afib.
Just a thought, if you don't have SA, then that's great, but if you do, get some advise on how to treat it.
I now have a chin strap ,which gives me a great nights sleep, In fact my wife is even considering allowing me within snoring distance which is a big plus for me!!!!! LOL
Cocup66, actually, I'd forgotten that one of the interventions my general practitioner gave me was a sleep test which revealed Mild Sleep Apnea. I tried sleeping with a C Pap but it didn't work because I have some intermittent asthma symptoms. I was doing Qvar 80 but have stopped. Sleeping on my side with "Breathe Right" seems to help. But, you are correct that there is an association between Sleep Apnea and Afib as well as other problems.
Good morning reading your post made me think there is hope for me. Nothing to do with you condition . I am a 55 year old lady with tbi whose ex husband divorced me to go to another women. I have not had sex for over a year and never thought I would at my age now. I thought I was incorrect wanting sex at my age. So I realise not the comment you wanted but you have given me hope. Unfortunately I have physical disability and am not allowed to drive so any suggestions how I can meet people of my age safely??
Hi Mufc. Thanks for sharing your situation. It's a brave thing to share personal information sometimes. And I'll bet you've helped a lot of people who have similar situations and questions but did not want to post.
You're never too old and many seniors have physical limitations. But where there's a will there's a way.
Your comment made me think about a conversation with a 70 year old female neighbour on the weekend. She said doctors recommended a CPAP machine and she said “No way, that would be the end of my sex life.” You’re never too old 😉
Oh sorry. It's a "CPAP" machine. "Continuous Positive Airway Pressure." They are used to treat Sleep Apnea by continuously forcing air into a person's nose/throat and respiratory system. Sleep Apnea has been linked to heart problems and other health issues.
Giving up Caffeine and alcohol has greatly reduced fluttering and irregular heart beat...I have had two incidents of AFib..Both appeared to be set off by lying on my left side...On 81 mg aspirin, reduced from 325 mg. But added Eliqus 2X a day
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