Advice please re af

[Icenae]

Hi folks. Not sure what to do. I am 67 grandmother. Take bisoprolol varying amounts and rivaroxaban

Have had paroxysmal af ( sick sinus synd of tachy/brady variety). for 19 years. 2 nd pacemaker has 18 months left. 3 ablations. 1st unsuccessful and massive haematoma. 2nd worked for 2 years. Last one horrendous. In hospital a week, Had effusions and oesophageal bruising. Put back into spasm and took months to recover. But did help rythmn a bit and kept tachy to max 120 pm mostly. Started magnesium and had a quiet spell for 6 months. Now I am back in af a lot. Running over 100 bpm much of the time. Resting hb 85. I feel ok really. Just got back from 5 weeks in Oz. Ambled around at my pace. Doc said to increase bisoprolol from 375 to 700 daily but doesnt seem to make any difference apart from making-me more puffed on any a activity. (I also cold sweat frequently). They recommend another ablation or the final cut of av node. Question is. If I just stay as I am and put up with af will it shorten my life much or should I have the av node ablation and be pacemaker dependent. Would that slow me down more or lengthen my life. ??? Any advice or experiences please.

[Hidden]

Hello Icenae, my you have been through the mill but it’s great that you have not allowed AF to spoil your life. I don’t have the experience to respond to your question but you sound like a gutsy woman prepared to fight your corner. There are a number of alternative betablockers available and if I were you, I would ask for a change. We get good reports about Nebivolol which for some, seems to control heart rate without causing the lethargy and breathlessness. Hopefully others here will be able to answer about an av node ablation. It’s my understanding that provided your AF is controlled, it will not shorten your life. Good luck....

[Icenae in reply to Hidden]

Thanks for your reply. I will research nebivolol. I have been on so many meds with side effects. Only left with bisoprolol now.

[Hidden in reply to Icenae]

I changed to Nebivolol. Brilliant.

Di

[Hidden]

In general a mean heart rate over 100 measured on holter monitoring, increases the risk of congestive cardiomyopathy.

In your situation, things to consider would be whether all medication options have failed or are contraindicated. Have you been given a therapeutic dose of digoxin combined with a rate limiting drug other than a beta blocker?

Would you need a new pacemaker set up with 2 or 3 wires, to give the best chance of a successful AV node ablation? My impression from reports here is that the majority who have had this procedure are helped, but a minority had no benefit.

A repeat AF ablation sounds potentially hazardous. What was your EP’s recommendation? The usual caveat, I am not a doctor and have not had an AV node ablation. I have had 2 AF ablations but would refuse a third, having had a possible TIA during the second and an emergent delirium from the GA.

[CDreamer]

Hi - I think you have been through a lot and I really feel for you.

I chose to go AV node ablation - I had a dual ventricular pacemaker which my EP advised but unfortunately the LV lead has become detached and I am still waiting to have it re-attached. I have to say that I have been feeling SO much better since the PM implant that I am wondering if I really need the AV node but I have had a few AF hiccups recently so on balance I think I am going to go through with it, as and when I can get the lead re-attached.

I was told that if AV node is done with a PM which only paces one side of the heart then the chances of HF from cardiomyopathy is much higher as your PM will be working 100% of the time and over time that means your ventricules can go out of sync, which causes other problems - so that may be a question to ask?

At this stage I think we need to be thinking of quality of life, benefits with less risk. PM’s have improved technically in the last few years and I have to say I am delighted with the improvement of my QOL, even without the AV node ablation so maybe that is something to explore with your consultant?

Let us know how you get on, Best wishes CD

[Icenae in reply to CDreamer]

Thanks for the reply. How long have you got to wait for the wire reattachment.?? Has it detached from the pacemaker. I am glad you feel better with it. I certainly did re the brady part. Is there a long wait for your av node ablation. Hope it goes well.

They say i have a lot of noise on one of my 2 leads and will put a new one in next time also maybe 3 leads. The existing ones stay there. Cant remove. My pacemakers helped a lot. (18 years ago) No more blackouts. But just need to get the af/tachy side down. The leads apparently cause a bit of regurg as the valve cant quite close. I am under the genetic cardio at Barts now as my brother had a similar condition and developed restrictive cardiomyopathy but I havent got cm yet thank goodness. But my appointments keep being bumped. Supposed to be February. Then April now July. They have offered me for years the av node cut but just worried I will be slowed down more. Seems a bit drastic. And is it still beating tachy but you just cant feel it. So heart still overworking in the background.

(Does anyone get cold sweats on exertion.

Or is that probably due to fibromyalgia).