Symptoms worse than last time I was in AF

[heekle]

In May 2016 I became unwell on holiday (heart rate 150+) and ended up in A&E, where they confirmed I was in AF. I had a cardioversion in Sept 2016 and felt great until Dec 2019. (In those 3 years, I was cycling regularly and generally looking after my health).

In mid-December last year (2019) at our annual cycling club dinner and 'out of the blue' I collapsed and ended up in A&E (a bit put out as I'd only eaten my starter); it was confirmed that I was back in AF. Put back on Bisoprolol 1.25mg.

My consultant feels that as the CV was successful for 3 years, it's worth trying it again before looking to an ablation.

CV date expected within a couple of months. However, this time around it seems different whilst I'm waiting. I feel absolutely 'wiped out', every day - tired, lethargic, and sometimes a headache - from the time I get out of bed. Some days it gets easier late afternoon, but generally, it seems as if my days are wasted just sitting around. Roll on the procedure!

Is this normal with AF? Is it the bisoprolol? Any advice appreciated.

Many thanks

[BobD Volunteer]

All sounds typical AF to me and your bisoprolol dose is about as low as it is possible to go.

Regarding the proposed cardioversion yes this may return you to NSR but as you know this is not really a treatment for AF , just a hope that it will stay away for a while. What it does do is find out two things. Can you be returned to NSR and do you feel better in NSR. If yes for however short a time then ablation may be offered. If no to the first the chance of success is very low and if no to the second then the benefit may not exceed the risks. All and any treatment is only for quality of life after all.

[heekle in reply to BobD]

That's an interesting summary BobD. When I saw my consultant early March, he confirmed (as you said) that a CV is generally a short term measure, but as I'd had what he considered to be good result (Sept 2016 to Dec 2019) then it would be worth another go.

If my CV is further delayed then perhaps a higher dose of bisoprolol is needed?

[Hidden]

Given that your CV was relatively successful, instead of waiting months for another one, I wonder if it would be worth discussing the possibility of trying a PiP (pill in pocket) with your Doctor. Usually, this would mean taking a one off, substantial dose of a rate controlling drug such as Flecainide which, if deemed suitable and was successful, would return you back to NSR in days rather than waiting months. The longer you remain in persistent AF, the more established become the rogue impulses which causes the AF. I’m not medically trained and this treatment is not suitable for everyone and would need input from a Cardiologist or EP but I would have thought it was worth exploring especially given the delays caused by Covid-19.........

[heekle in reply to Hidden]

Thanks - one of the cardio team is due to phone me on Monday to discuss things so I’ll raise the PIP then - sounds like a good idea.

[heartmatters1 in reply to heekle]

This is my choice of treatment, as my episodes are so few & far between. PIP (Flecainide) reverts me back within a couple of hours. Of course this could change & I would then go to plan B.

Best wishes Ally

[heekle in reply to heartmatters1]

Thanks Ally - I'll ask on Monday why that hasn't been suggested as a temporary measure.

[AFCyclist]

I am a regular cyclist and have found overdoing it on the bike can trigger my AF. An electric bike has made a huge difference. I have had 4 CVs and a cryoablation. I have also developed a trick to get out of AF by cycling up a hill.

[heekle in reply to AFCyclist]

Thanks AFCyclist.

When I went into AF again last December, I bit the bullet and sold both my road bike and my mountain bike and bought a Scott electric - fantastic machine which meant I could still ride with my mates!!!!!

Unfortunately I’ve ridden it twice as I feel continually exhausted and light headed. I reckon I’d be a danger on the roads - so wanted to know what other people feel like when they’re in AF. My symptoms are there from the wake up - I’d understand it if it came on after some decent exercise

[heekle]

Never heard that name before, ectopic1.

I take a few other heart meds....

Losartan 100mg; Atorvastatin 80mg ; Apixaban 5mg x2; MonomilXL 30mg; Amlodipine 5mg; Bisoprolol 1.25mg

I thought that bisoprolol was for controlling the rhythm??

[BobD Volunteer in reply to heekle]

No Bisoprolol is a rate control drug Flecainide is a rhythm control one.

[Hidden]

I guess I just do not understand your system in the UK. When a person goes to the ER here at my local hospital they try to convert them in the ER using medications. If it works you can go home in a few hours with prescriptions,

If we fails to return to sinus rhythm within a few hours, we are admitted to the hospital. During the hospital stay the patient is in a telemetry unit with 24 hour monitoring. They also run other tests to look for any other heart problems. While being monitored they try other drugs to convert the patient. If there is no chemical conversion, they do the electro-shock. It has been that way at every hospital I went to since 1986, and at my last appointment I discussed with my new doctor which hospital to use if I could not convert myself with my PIP, and what the protocol is. He assured me that it has not changed since my last hospitalization in 2003.

My last hospital stay for A Fib, I had already used Verapamil, which at that time was my PIP. The ER doctor called my cardiologist at 4am and they discussed the fact that Digoxin and Quinidine didn't work for me, based on past experience. So, they decided to try Flecainide. The ER doctor gave me one 100 mg tablet of flecainide and it did not work, so I was admitted.

Around 7am my cardiologist came to my telemetry unit room and said they were going to give me another 200 mg dose of Flecainide, but if it didn't work, I would have an electro conversion scheduled for the next morning. Thankfully, it was enough to put me back into rhythm within about 2 hours. I was monitored for another 24 hours to make sure I stayed in rhythm, and did not have a bad reaction to Flecainide. Then I was sent home with a prescription for 100 mg Flecainide daily. It was too high a dose for me and within days it was changed from a daily dose to a pill in a pocket.

I have not had to be hospitalized for A Fib in 17 years and I have never had to have an electro conversion with any incident and I joined the A Fib Club 34 years ago!

[heekle]

Interesting ectopic1 .....prompts another question - is it the case with AF that you have it or you don't or is it graded by it's severity. So, perhaps I have not been given a rhythm control drug because my AF is what they consider mild for example??? (It certainly hasn't felt mild this time around!!)

[heekle]

Thanks Mollybear - very interesting to hear how you get treated in US (I assume). Very different to timelines here in the UK.

I went to A&E on 18th Dec - always a long wait; this time around 6 hours. After the usual tests, I saw a Registrar from the Cardiac Centre who confirmed I was back in AF and the next step would be for a 3 day ECG - which was fitted on 14th Jan.

Waited to see someone at Cardio until 18th March (just as Covid was coming to the fore).

Had an ultrasound scan on 9th June - this seemed an indication that things (other than Covid) were at last moving again. So now it's just waiting for the next step - hopefully the CV!

However, despite the protracted waiting times - and this may seem strange to someone outside of the UK - I absolutely love our NHS and the great folk who work in it!!!

[Gowers]

I was put on Flecanaide after my 1st ablation but according to my cardiologist it caused the af flutter. Some folk don't have this problem - we all react very differently to the various meds as can be seen on this forum