Hi everyone,I was wondering if I should be overly concerned by being in persistent Afib. When I called my heart specialist earlier this year he said he knows. I am on Bisoprolol 2.5mg ,digoxin 125mg, and rivaroxaban 20mg once a day, which I take in the evenings after a meal. I was never offered an ablation or anything else to regulate it. My resting heart rate can go from 55 to 70s, but I notice from my Apple Watch it has gone as high as 112 on one occasion. I am a 72 yr old and have discovered Afib about 3 yrs ago. At my last visit to my heart specialist he said the good news was that my heart was strong. I am on just 5mg blood pressure as my pressure is good and my cholestrol was once found to be 1 above the range so I am supposed to be on 2.5 every other day, which I hope to stop entirely after a recent fasting blood test. (the other test was not a fasting test). I also am hypothyroid, but that is controlled. Just lowered my meds for that as well. I don’t feel my Afib usually but have had the occasional chest pain if I get stressed and my Afib goes crazy. Stress is obviously my trigger. Should I ask for an ablation to control my afib as I am worried it would damage my heart. I am fairly active and walk, bike and do yoga and weights. I struggle with weight issues, but lost 12-15 pounds recently and am fairly fit.
Thanks for any feedback on my concerns.
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Adasian
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Any and all treatment for AF is only ever for symptom control and quality of life (QOL) so if your rate is as well controlled as yours is (normal rate is anything between 60 and 100 ) and you are anticoagulated (rivaroxaban) then I tend to agree that ablation is not a sensible option in your case.
Good diet (less meat and processed foods and a switch to a more plant based diet), no alcohol or caffeine etc and aim for a BMI of 25 and you will be fine .
Thanks. I am also scared it could accelerate any issues I have. I probably should leave well alone.
I think most people here would say that any treatment is about symptom control as at the moment, there is no cure for AF. From what you say, you seem to have your symptoms pretty well controlled with a resting heart rate generally well within normal rates. Persistent/permanent AF is often easier to live with too, rather than having the anxiety of worrying when the next episode will kick in. Although personally I favour the ablation route, I would try to deal with anxiety first which as we all know, is easier said than done. Here in the UK, most folk in persistent AF are encouraged to have a cardioversion first to see if their heart can be reverted into sinus rhythm and to establish whether or not this makes the patient feel significantly better. If it works, then there can be a long wait for an ablation and more than one may be necessary. Even without COVID-19 this can take a while so there is nothing to stop you from pursuing ablation treatment with an Electrophysiologist even if you decide to cancel the procedure at a later date. So, lots of options to consider and I’m sure others here will be sharing their opinions too, but in the meantime, take comfort from knowing that your current levels of AF are not restricting your activities.......
Thanks. In February I did have some concerns with tiredness. Some chest pains and breathing issues as well, but it went away just as suddenly as it came. I find this forum so enlightening as I realize these symptoms go with the territory as many of you have had similar experiences.
A combination of Bisoprolol and Digoxin is likely to cause tiredness and if your resting rate remains low, it may be worth asking your doctor if the Bisoprolol dose could be reduced. You can always return to the original dose if your heart rate or blood pressure gets too high.
Thanks for your reply. I am thinking of asking my doctor to change Digoxin anyway as I read on this forum that many experienced forgetfulness. I noticed it too but mildly on occasion. It could just be an age thing but since I have Alzheimers in my family I certainly don’t want to take anything that could contribute unnecessarily to it. Scares me to death!
Good idea, we are not medically trained but from what we hear, Digoxin is not now commonly prescribed for AF unless the patient follows a sedentary lifestyle and you don’t seem to fit into that category. Also, there are alternative betablockers to Bisoprolol which some say causes lethargy and many here say Nebivolol is worth considering but I have no personal experience......
Your HR sounds just fine. Just one thing (and I could be totally wrong here).
You wrote
"I am on Bisoprolol 2.5mg ,digoxin 125mg, and rivaroxaban 20mg once a day, which I take in the evenings after a meal"
If you take the med's after a meal it slows down a "quick fix" so to speak. For me I always take my Flec at least 30 minutes before eating for the full effect to kick in.
It's worth checking with your doc about taking the Digoxin before you eat. Like I say I could be totally wrong but asking about anyway the next time you see the doc.
"If you take the med's after a meal it slows down a "quick fix" so to speak. For me I always take my Flec at least 30 minutes before eating for the full effect to kick in."
You can't generalise re how to take medicines. Read the patient information leaflet that comes with the drug.
I know - that why I suggested the OP check with her doc. It was Digoxin I mentioned (not Riveroxban). I'm not medically trained and not in anyway trying to 'generalise' how med's should be taken. The OP asked a question on a public forum and I simply gave a suggestion to speak to her doctor about.
Thanks so much for your feedback. Will speak to the doctor when I get an opportunity to do so. Question. Do you think persistent Afib more dangerous to the heart? I do watch what I eat as I forgot to mention I am gluten and lactose intolerant and get very mild psoriasis when I eat wheat. (Glad I know my trigger). These are all autoimmune diseases that seem to go with Hashimoto thyroditis. I take pre and probiotics most days and manage to keep everything in control. I feel okay and try to focus my diet on gut health and stay away from junk food as much as I can. Though I admit it gets harder in the summer. I am a social drinker so just partake one or two. It seems getting older (though I don’t want to admit it) brings on various things.🤪
Provided rate is well controlled (which your's generally is) there is little additional risk from permanent or persistent AF. Uncontrolled rate can lead to other cardiac issues but dismiss this from your mind as it doesn't appear to apply to you.
I have been in Permenant AF for over four years. I take 1.25mg Bisoporol every other day and Apixiban. My resting HR is 69/72 and rises quickly when I cycle, swim or chase my seven year old grandaughter around but also returns to normal quickly too. I have 12 monthly checks and my heart structure is still normal and causing no concerns to my EP. I was offered an Ablation at the beginning of my AF journey but decided with advice from my EP not to go ahead. For me it was the right decision and don't regret not having an Ablation. I am a 73 year old male. Regards. Roy
Thanks. Such a relief. I have become so much more educated on this forum as I love my heart specialist but he didn’t tell me much. I see him once a year. Also forgot to mention my Dad died at 60 from a coronary thrombosis back in South America where I am from though I have lived in Canada for more than 40 years. Interestingly my 50 yr old daughter found out she has Heart Block. She was told it could lead to Afib in later years but hers is mild. Could be inherited. Hence my over concern about it. Thanks for your reassuring feedback.
I’d be pretty happy if I were in your situation. My understanding is that the longer you are in persistent AF the less likely it is that a first ablation is successful. The only thing I would query is why you are on digoxin as I was told it wasn’t suitable for me because I am active (not really, tbh). Still it doesn’t seem to be cramping your style. If you haven’t mentioned the chest pains I should, especially in the light of your cholesterol result.
I went into permanent A.F. about 2 years ago, after many years of living on the knife edge that is paroxysmal A.F., and I too am very well controlled
on Bisoprolol 2.50mg alternating days with 3,75 mg, also Apixaban,
I enjoy a healthy life with a feeling of peace that I hadn’t felt for many years. I have never had an ablation, but on 2 occasions had cardioversion in A&E. I am very active at 76years , walking at speed each day, exercising for Spinal Stenosis, and Cervical Spondylosis.
I wish you well, you too seem to live a full life with enjoyment.Dee
Have you been offered a cardioversion? Perhaps you don't feel the need if you're not hampered by symptoms.
At only a few years younger than you, and overweight I had a cardioversion after 9 months of persistent AF, and have remained in normal sinus rhythm for 6 months so far following that.
I had no stamina at all on Bisoprolol, digoxin and rivaroxaban
(I was put on digoxin because I hesitated about taking amiodarone when told of the side effects, and found I'd been prescribed digoxin, when all I wanted was time to consider the options.)
After the cardioversion I was told stop the digoxin straightaway. My energy came back - I think because of a combination of being in NSR and of being off the digoxin.
I ask because the longer you have AF the more intractable it becomes.
Personally I would be concerned if there was no ongoing plan to eventually get me back into sinus rhythm, for me it is the difference between having energy and having none, but it affects us all differently.
My energy level is not too bad now. I do go for a 45 min walk or bike ride 2-3 times a week and am always gardening, or maintaining the general household, cooking etc. I do painting as a hobby if I can find the down time. Just wish I could keep up with my more energetic friends who seem to have energy to burn😀 They consider me to be active but I burn out after a hike. Got so much against me, first the thyroid, age and now Afib. I am nevertheless thankful for small mercies.
My EP advised me against ablation. He said there is always a risk with ablation even though it is small. If you are in persistent AF without serious symptoms, it is not worth taking that risk unless it would significantly improve your quality of life. If you've been in persistent AF for some time, ablation is unlikely to be successful.
Studies show that mortality rates from rate control (which is your current treatment regime) and rhythm control (ablation, flecainide or amiodarone, etc.) are not significantly different.
My cardiologist told me last week that he’s glad we’re going for a 3 rd cardioversion as recent studies show that repeated ablations weaken the heart due to more an more parts of it being put “out of action“ as he put it... just telling you what my cardiologist told me.
I have persistent/permanent AF and have decided that I just have to accept it and live with it.
I have had one cardioversion which lasted two days and two ablation procedures. The first one lasted for just two days and the secound one worsened my condition. I was also on Flec’ and Bisoprolol for a while but that didn’t really improve matters and made me feel unwell.
Now I just take an anticoagulant.
Although the AF obviously does effect certain parts of my life, walking or cycling up hill are much more difficult for instance, I have found that acceptance has it’s positives. I just don’t really notice it so much anymore.
I have been in persistent Afib for over 3 years,after having intermittent for nearly 30 years. Ive just turned 71 with HR 70-80 BP 130/70.
The only meds I currently take are Rivaroxiban and Aspirin (had a stent put in my RCA in January) Ive tried heaps of others but I got tired of feeling sick!!
At present,I would say 95% of the time I dont even notice Im in Afib,in fact I sometimes check my pulse "just in case" LOL.
I have had 2 cardioversions,1 lasted 3 days and the other 2 weeks.
My cardiologist at the time was firmly against a an ablation,in his words..."If you can live with the symptoms of Afib,why go through such an unpleasant,and potentially risky ordeal,it wont make you live any longer"
For me Im very happy just living with Afib....no more anxiety waiting for the next "attack" to start and then worried sick waiting for it to stop. I FIRMLY believe the anxiety you go through with this beast is responsible for so much "wasted life"
I just get out there,delivering Uber Eats,which gives me plenty of exersize,especially walking up steps and down long driveways ( I live in Covid Free New Zealand)
I eat every type of(non spicy) food,have a beer (or 2)when I feel like it,and just enjoy life!!!
Happy to talk further with you Adasian,so good to read your story,
Good luck to you and hope you find my history reassuring.
I spotted a red flag in your post, one that I'm very connected with. Thyroid. You said you lowered your dose of thyroxine. Why? Why did you do that? There is so little understanding of thyroid treatment in the UK medical community. You shouldn't lower your dose on a whim.
AF can be caused by high levels of T3 in the blood. But it won't be caused by a low TSH or high T4. Only T3 is active and only T3 drives any kind of heart response. And in the UK it's rare to find a GP who is willing to test T3 and who understands the results. I have low free T3 and AF. I think my low free T3 is directly linked to my AF and there are medical papers out there that talk about this but they are harder to find than the papers that blame thyroid treatment for AF.
My advice to you would be to learn all you can about your thyroid condition. Join the thyroid community here on HealthUnlocked, it's very good. But learn and then do your own tests and get help with the results and how to interpret them in the group. The last thing you want to be with AF is hypothyroid. TSH is pretty irrelevant because it's a pituitary hormone not a thyroid hormone and all sorts can affect it. Sadly we live in an age where medics have been told it's the gold standard thyroid test. It just keeps people ill for decades in some cases.
Use a lab like Medichecks to run a thyroid blood test. Do the blood draw first thing, before 9am and don't eat anything or drink anything but water from the evening before. Always retest under the same conditions and you have a good way of monitoring what's really happening. TSH levels drop during the day so having a blood test at 11am and another at 3pm etc is just not comparable.
My persistent AF is much more tolerable than the random violent horrors I had before and so now I'm concentrating on my thyroid. I have added complications with it, but I'm not about to give up.
Thanks for your advise. I see a heart specialist. I also see my GP and an endocrinologist for my thyroid. My thyroid is now within the range as confirmed by Tests and both my GP and endocrinologist. My T3 dropped for awhile and T4 went up and Reverse T3 was all out of order. Now that I lowered my dosage it is all good. I agree your thyroid can cause a slew of other problems.
AF begets AF. The more AF you have, the more you will get. You refer to heart specialist, but you do not specify whether you saw a cardiologist or an electrophysiologist. An answer of "he knows" is meaningless and would be unacceptable to me. It sounds as if you saw a cardiologist because they love to hoard a patient keeping them on pills rather than sending them to an electrophysiologist for accurate diagnosis. To have AF with no discussion of ablation is also not acceptable, especially since you are worried that an ablation would damage your heart. It sounds as if this heart specialist made the decision for you to live in AF without your input as to what you want to do. I would suggest a second opinion.
You need to know how long you have been in persistent AF to know exactly at what stage of your AF journey you're at. The longer you are in persistent, the more ablations you will need to get to sinus rhythm and remain there.
Quality of life is a moot point, but sinus rhythm is highly superior to AF.
Sadly you are in Canada, and I would bet British Columbia which has an inferior methodology in handling AF patients compared to Ontario. From Canada myself, specifically B.C., I am fully aware of the shortcomings of the province in treating AF. My North Shore friend's case is similar to yours. Her North Shore cardiologist has now got her to long-standing persistent AF, refusing to send her to an electrophysiologist even when she asked. He has doomed her to remain in AF.
Since I am also in Canada, do feel free to contact me.
Had persistent AFib for over three years, picked up while on oral steroids which I still take. Couldn’t beta blockers so on diltiazem, forosomide and lisinopril for BP and doses just adjusted for afib. Also on warfarin.
Sadly while on two different osteoporosis (likely caused by the steroids) drugs I became so much more aware of the affiliation which normally only really noticed if checked pulse. Rate didn’t rise it was just more pronounced. Seems back to normal now off them.
Thanks for your help. I am actually in Ontario and plan to have an online chat with my cardiologist later this month. His name is Dr Maingi he works at One heart care. You can look him up. So far I am happy with him. I just wasn’t well informed to ask the right questions before. He knows I am hesitant to take drugs unnecessarily, but prefer to make lifestyle changes. I am trying to loose weight, work out and eat a balanced diet. Unfortunately, this alone may not work if there is a family history, thyroid problems, etc.
I too have Persistent AFib. I was diagnosed about ten years ago with intermittent AFib and it has slowly moved to Persistent. I have a similar drug regime, and like you, a very good quality of life. Since my rate is controlled and QoL very good, I just live and don't worry about it as best I can. I have a question for you though. You say you doctor says your heart is "strong". How does he know? Have you had a nuclear stress test to look at structure, blood flow and ejection rate? I found the reassurance I got from having one, and the positive results, very supportive in reducing anxiety about my AFib. You might consider one.
have you amy recent thyroid bloods. you could post on here with ranges. Why was your med reduced? TSH (thyrpid stimulating hormone) needs to be below 2_ for most people to feel well? When you say thyroid well controlled do you get printouts from your doc which you are entitled to or does he just say they are normal?. If anything over 2 they may nor be.
Have you had T4, T3 and TSH tested or just TSH? If your medication is too low or too high this can affect the heart too and cause palpitations. Docs tend to keep people on lower doses especially when older patients when in fact they might need need higher dose.
also what are your vitamin levels like. You should be tested for Vitamin D, B12, fereitin, folate snd these should be optimal, another thing docs rarely check due to cost! Also TPO and Tgab antibodies would be useful. Ot might be a gppd idea to get private test done if you can afford to.
I agree about Bisoprolol. I had to come off this as I already had low HR which was due to being hypo and it made me worse.
If hypo symptoms are not controlled it can affect the heart too. If it is hypo symptoms its best not ro overdo the exercise until levels are stabilised but Im so pleased you have lost weight.
Thanks. I am in Canada and we do get print outs if we ask but I can access my own files through Dynacare. You are told the range and where you fall within the range. From my research in the past I gather the range in the UK or US can be slightly different. My tiredness was when my I fell slightly outside of my normal range and my T4 was a little high and T3 low for me. Back in January. There are many things that can throw this off But I suspect my tiredness had more to do with AFIB and not my thyroid. This has since been Corrected and resolved. I feel fine now . Just had a battery of tests and CT scan as I had to go to emergency for a diverticulitis attack. My blood work is fine. I only take 1/2 a pill of Bisoprolol in the evenings. I don’t really feel my irregular heartbeat unless under stress.
Sorry about my statistics but I would have to go into another app to find it. I do a T3, T4 and T-SH test annually. I have not done a TBO or TGAB ( not sure if it called something else here) but as mentioned below had several tests for infection as well as a CT scan before they confirmed I had diverticulitis and put on antibiotics.
My Dr called today and said I have had 372 episodes of A Fib in the last 5 months. I’m very concerned. Is this way to many times. What can I do so that this number goes way down?
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