Comments are appreciated re. my AF observations/ comments.
Have been in PAF getting on for a year now. Aged 68 with no comorbidities. Found out that I am adrenergic with triggers from stress/ exercise and have an episode about every 10 days. They last from a few mins to 24 hrs. Echo was structurally ok. I was prescribed bisoprolol (2.5mg/day) six months ago as a weak anti- arrhythmic. Felt pretty tired the first few months but wanted to give the medication a good chance. Really feeling the cold these days in my hands/fingers. My BP has always been on the low side (100/65) but hasn’t been a problem. Not on anti-coagulants at moment due to my low Chads2 score.
I sense the medication has reduced the frequency of episodes and also takes the peaks off the initial pulse rates when in AF. It hasn’t eliminated AF however (You can but hope…) which I check on my hand held ECG monitor. I am keeping well hydrated, drink coconut water and have a high Mg diet with taurate supplement. Have given up alcohol.
I’m getting more used to the episodes now and learning to relax as much as possible with Meditation/ Entrainment (listening to slow heart beats) whilst having an episode. I find I have to get my pulse below a particular threshold (70 bpm from an initial high of 120/100 bpm) before I can flip back into NSR. I normally use moderate exercise (a 30 min walk up a small hill locally) to do this: it works 80% of the time. Occasionally, I can flip in minutes just listening to slow heart beats.
I discussed with my doctor increasing the dosage of bisoprolol to 3.75mg/ day but she was very reluctant as my pulse rate has dropped from 65/55 to 55/45 and she doesn't want it to go below 40bpm. I feel I am coping ok with the AF as I am still keeping active playing golf several times a week and walking a lot in between games. There’s the worry that things won’t improve and will only get worse…
My cardio didn’t arrange any further appointments with me, but I’m thinking of seeing an EP privately to get an in-depth review of all possibilities as I guess ablation may be a possibility in the medium/long term. Is this chat recommended? Is there any other medication that I should be considering instead of bisoprolol? Anything else I should be doing?
Thanks in advance!
Vince
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Vince1001
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I would agree that an EP appointment would be a good thing BUT it is important to understand that any and all treatment for AF is only ever about quality of life (QOL) and preventing future damage to the heart. So long as rate is well controlled the main thing is the burden any AF produces.
Bisoprolol being a beta blocker is primarily a rate control drug so there are anti arrhythmics available which will l have less effect on lowering heart rate.
Life style play a very important part in AF control, with weight loss (BMI 25 or lower), healthy diet, .less meat and processed foods and a more plant based diet all having shown real benefits. Hydration (water not tea or coffee) and of course little if any alcohol plus a sensible exercise regime all have parts to play.
You are doing all of the correct things & sounds as though you are adapting to life with AF. Well done!
My own view, having done the gamut of treatments for 15 years, is that use the minimum of drugs you can get away with as they all have affects and they really aren’t nice affects but you need to balance that with QOL. Sounds as though yours is middling at present, so keep on doing what you are doing.
There may be a case for ablation but accept its not a cure all and several may be required and even when it works, it may return. Recovery is very individual but many find it takes months rather than weeks.
Certainly discussing options with an EP with a good reputation will offer the specialist knowledge which will help you to work out what would be best for you. Keep a very detailed symptom/Med/lifestyle log - if you have iPhone the Health App works really well so you can se if there are patterns as the more data you can present to EP, the more of an overall picture you can present which will help establish your best options.
Many thanks CDreamer. I hadn't considered the App but on reflection consider such info vital for the EP. I checked on the Iphone and in search it comes up with Health View. Assume its this one unless advised otherwise. Vince
Some good advice from others and clearly you have a good grip on what you should and perhaps, shouldn’t be doing to keep your AF under control. Also helpful to have a supportive GP. In terms of moving forward, I would certainly suggest that you have a discussion with an EP. If you can do it privately, so much the better especially if have access to your test results, especially the echocardiogram as these can be expensive if done privately. I would also suggest you take a look at the Kardia mobile device. The single lead variant is normally sufficient to maintain an accurate record or episodes and the reports are accepted by most medics. The main benefit is that as soon as you sense something untoward, you can check it for yourself within minutes. The risk is getting obsessed with taking readings!!
Many EP’s can be enthusiastic about doing an ablation because that’s what they do, so make sure they explain the downsides (of which there are not many). They generally prefer to carry out an ablation sooner than later and that’s because success rates tend to be better but under the current climate, waiting times can be long which also gives you time to change your mind, but few do!
The only other thing is anticoagulation, clearly you have done your homework but make sure that it’s on the agenda should you decide to see an EP.....best wishes.
Well done Vince you have done a lot of the right things in just a year!
However, my view is that the AF episodes need to be stopped completely (or almost completely) starting with a private consultation with your cardiologist not your GP or EP. I always find it surprising that the medics are so diverse on their approaches to similar cases e.g. my overall circumstances are close to yours and my cardio put me on just Flecainide (a strong but relatively tried & tested drug) without Biso/BB/CB 7 yrs ago (due to my HR/BP on a par with yours) because as he said the latter "would make me feel unwell". That said it still took 3 months before my body got used to the medication but no AF to speak of since.
Also, I suspect you still have a number of lifestyle issues all of which need to be corrected by yourself - reduce all stress, moderate exercise, change diet & ensure your sleep is optimised. Plenty to read up about these and more aspects on this forum.
At 67yo also with Lone PAF & contrary to advice to start anti-coagulants (despite AF episodes stopped for years) I am postponing taking them. However, with your history I would either take action to stop the episodes or carefully consider starting ACs. nb I posted here yesterday the chances of a clot being 1 in 20,000. source: see link & coupled with much quoted x5 factor if you have AF nationwidechildrens.org/con...
As you no doubt appreciate almost all comments here are based principally on individual patient experience not trained medical knowledge.eg I don't recommend an EP visit simply because I had two and didn't learn anything to help at my AF stage.
Thanks Secondtry....and congrats on getting a medication that worked for you! I shall certainly consider Flecainide once I see a Cardio/ EP in order to try and put a stop to the episodes once and for all.
I think I'm doing as much as I can healthwise. BMI of 23. Given up alcohol and moderate exercise every day. Diet is very good with no processed food. i.e. plenty of spinach, avocado, etc. Always willing however to improve...
All sounds very positive. I believe a 'blanket' i.e. cover all approach to AF gives you the best chance as none of us knows what is our individual cause(s). Re diet where I include supplements, this is probably the hardest to optimise. Ten years ago I would have said we were on a good diet, now I would say we are on a much better diet but not the best. On food I regard suppliers as important as the product itself.
Sorry that link I copied from where I posted it on the Apixaban thread doesn’t seem to be working. Two links there about taking anti coagulants on a pill in pocket basis for certain patients . Could be of interest to you and Vince
Thanks Peony..... My Chads2 vasc score is 1, and both the doctor and cardio say no need for A/C just yet. Lots of stuff in that article that needs a thorough review. Thanks!
Sorry Maddie am not technically brilliant . I posted two links to those articles on the Spangles thread on apixiban that work , you can find the info there
Excellent advice here and you're doing all the right things! Definitely worth paying to see a good EP in my opinion. Research the top names in Scotland is my advice and go have that chat. We're all put in Bisoprolol to begin with but there are other options. Flecainide has been mentioned above and it tends to suit active people us my understanding. However, your GP is not allowed to prescribe it. May I ask re you converting to NSR through moderate exercise - do you deliberately take your BPM up to a higher rate and then wait for it to lower, in which case it converts? I ask because my own AF when it kicks off is always 110BPM+ and though I've managed to get it down to the 80s with slow breathing, I can never get it down further. I've the sense that if I COULD I would convert. Thank you!
Thanks Singwell. Very interesting comments on flecainide/EP which I shall consider. To answer your question, yes that exactly what I do. I have found there are 3 stages from when I get an episode. The readings below are pulse and min/max from measuring the peaks of my hand held ECG unit. I find the differences in the peaks just as important as the pulse rate (hope that makes sense). Here's some typical readings:
Phase 1. Trigger. Pulse 100 ish Variation 60-140
Phase 2. Cool down. Pulse 85. Variation 54-120 (usually after 30 mins entrainment/deep breathing)
Phase 3. Threshold Pulse 69. Variation 40- 115 (can take another 30 mins)
I invested in a really good set of headphones that cuts out noise when I listen to slow heartbeat sounds. Hence I can really relax oblivious from house/ traffic noises and find these help enormously. Sometimes I use a footbath of high grade Mg salts. Not sure if any good but makes me feel better!
Once I meet the threshold I often do the walk up the local hill. (depends how busy I am and time of day). Also I have a work out session using resistance bands that can also work. Resting pulse after cool down is ~ 70 bpm with variation as above.
I then go about my normal business ignoring things. Within an hr or two it should then flip (80% of the time) into NSR of 60bpm.
Note that I've found doing the moderate exercise in stages 1, 2 is a waste of time. I must be in stage 3; below the threshold of around 70bpm.
Not quite sure about methodology but it works for me...but as Secondtry says I need to cut out the episodes completely.
Hi VinceI am a great believer in regular walking, mostly on flattish paths, using a fitbit to record what is going on . In this weather I usually go out with about 6 layers on. A few years ago I managed to chop the end of my left thumb off and consequently feel the cold very keenly in that hand.
I have a small hand warmer which makes a great deal of difference. It runs off lighter fuel and there are 2 different sizes available. The larger on is a bit of a tight fit in my glove, but runs well in my pocket as it needs a reasonable supply of air, so it is just a matter of transferring it backwards and forwards. The one I use is sold by warmawear, with the smaller one made by Zippo.
I have been taking warfarin for quite a few years now. Once the dose is established they don't need to see you very often, but the protection against clots and strokes is vey vital.
Strongly recommend appointment with EP. I would have a conversation with EP about continued use of Bisoprolol due to its impact on your system, for many people it makes them feel really sluggish.
My GP put me on Bisoprolol when I was first diagnosed with AF I discussed this with my EP, and as my heart rate seldom went above 80 I questioned why I needed it. He agreed that I should stop taking it, as people have said above it is just rate control.
With regards to CHADS score, my understanding is that if you are over 65 and have AF, you have a chads score of 2 and the recommendation is that you should be on anticoagulants (that’s my score due to my age and having AF). I might be wrong, but perhaps you may wish to check that out. Once you are over 65 you have one added to your score (I think).
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