I’ve not posted for a while but lurk quite often and I thought it was about time I contributed to this splendid and supportive forum. Cutting a long story fairly short. Quite a few years ago I was diagnosed with AF after a GP examination following a severe pain in the chest, I was electrically cardioverted unsuccessfully twice and then placed on a drug regime (Warfarin, Bisoprolol, Ramapril, later changed to Dabigatran and Bisoprolol was dropped). I was told by GP following a letter from the cardiologist I had seen as a follow-up to the final failed cardioversion that there was nothing more to be done since I was asymptomatic and treatment priority for scarce resources, understandably, would always be for those whose quality of life was much worse than mine. The years passed, I had a few wobbles and scares and a couple of visits to A + E as a result of severe pains in the chest and one following an incident of syncope. I left A +E last time having been prescribed Digoxin 125 mcg and my GP prescribed additionally Candesartan 4mg; the visit to A + E had revealed a concerning drop to my ejection fraction from the low 50s to around 25%. Still largely asymptomatic (although I still felt a little tired) I just got on with things putting down my increasing lethargy down to increasing age now 76 years.
Out of the blue, as it were, I received a letter from my GP practice inviting me to take up their offer for an examination by a visiting Consultant Cardiologist as part of their scheme to monitor all their patients experiencing heart failure. I spent about 20 minutes with him during which time he asked quite a few questions from which it was obvious that he had read my medical history very thoroughly, I was beginning to be impressed. He referred me for a cardiac MRI scan, requested a 72 hour Holter monitor and an echocardiogram. I left with a feeling that this chap was seriously “on the ball”! A few weeks passed and I had all the tests he had asked for and I received a copy of the letter this consultant had sent to my GP. Please bear in mind that I was previously resigned to just carrying on taking the pills since there was “nothing to be done”.
In brief he wrote: “ the cardiac MRI and echogram demonstrate a dilated left ventricle with an ejection fraction of 15% and hypertrabeculation demonstrating a diagnosis of LV non-compaction”. He then referred to the Holter monitor results: “showing AF with heartrate between 59 and 172bpm, mean of 94bpm and a short burst of non-sustained ventricular tachycardia. There were some symptomatic episodes which demonstrated uncontrolled AF with isolated ventricular ectopics. The ECG demonstrated a heartrate of 110 in AF with left axis deviation and a left bundle branch block with a QRS of145 millisecs”. He then went on: “ this gentleman has severe LV impairment due to LV non-compaction with poorly controlled AF”. He recommended up titrating my current meds and added Eplerenone 25mg daily. Then came the most unexpected recommendation that: “in view of the episode of syncope which I am now highly suspicious is related to an episode of ventricular arrhythmia” I should be offered an implanted bi-ventricular defibrillator!
My apologies for this rather long post but it does go to show that just putting up with things can be exactly the wrong thing to do and who you see regarding your AF is probably the most important variable in any following treatment. I am still quite stunned by his letter and shocked that none of this was previously noticed by any of the health professionals that have examined me over the years since my original diagnosis. Incidentally, as opposed to atrial arrhythmia (AF) ventricular arrhythmia is a killer (sudden cardiac arrest)!