Hi I am new to the group a friend told me about this group. My story is that I have had 4 episode of AF that seem to be 2 years apart which is so very strange. My last one was about 4 weeks ago and as the others ended up in A and E. The doctor was brilliant did bloods ext and never had to have anything to stop the AF after a couple of hours seems to go back to normal. I was sent home to have my gp follow up. After 2 weeks of hearing nothing I got in touch. The doctor in A and E says I should see a cardiologist but my gp says no and put me in edoxaban 60mg and 5mg of Bisoprolol, he said only if these tablets don't suit will he send me to see one. I had to ask for a heart echo which I am waiting for. Just received tablets and of course read all side effects!!! So I am scared. I was wondering how others have been on these meds ? I cannot understand why I could not have tests before taking tablets?
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Rhoded
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Usually it is what the hospital docs say goes. So you should be refered to a cardiologist.If you have Afib and no antiagulant you are more liable to have a stroke so they are being cautious.My view as a non medic but fellow sufferer which is what this group is all about.
Hello Rhoded and welcome to the forum. Your AF experiences so far, are sadly quite common but it is good that you have received support from your hospital and your GP. From what you are suggesting, your AF burden so far is fairly low and steps have been taken to try and keep it under control including prescribing an anticoagulant (Edoxaban) to help reduce the risk of stroke which is unfortunately a risk associated with AF. I’m not medically trained but as I understand it, all that is required to determine whether or not you have AF is an ECG and the medication you have been prescribed is what is commonly used for AF patients so try not to be over anxious about that. However, it is important that you press your GP for a referral to see at least a cardiologist or preferably, an Electrophysiologist who is a cardiologist who specialises in arrhythmias. If it’s appropriate, consider making any appropriate lifestyle changes to reduce weight, avoid alcohol, improve diet etc which are known to make significant improvements to reducing problems associated with AF. Whilst some GP’s are quite knowledgeable about AF, specialist knowledge is key to determining what is the best treatment plan for you.
Improving your knowledge and understanding of AF is also important because it will enable you to have more meaningful discussions with medics, so I suggest you click on the link below and slowly wade through all the information available from the AF Association and other sources.
Don't be scared sweetheart - there's no need. I completely understand why you are though.
Now let's run through this. You have had 4 afib attacks in two years and are on an anticoagulant. You really have no concerns to worry about. As for reading possible 'side effects' of these med's - the pharmaceutical companies have to cover themselves legally. As a law graduate I know this. As for seeing a cardio - your doctor has no right to refuse you to be refered at all. I think you should ask to do this - in fact you should insist. Being nice doesn't always work in this world. You have every right to be refered - please do so.
I'll say it again - don't be scared as you have no reason to be. As for your med's - you won't even know your on an anticoagulant. Bis can make you feel tired - this is my take. I was put on 5 mg too but they dropped it to 2.5. That one did knock me for six so was changed - it does the trick though.
Don't be frightened there's no need. Your get on top of this I promise.
I was on 2.5mg of Bisoprolol which made me so tired that I couldn’t do much.
I’m no longer on Bisoprolol as I had a cardioversion recently and are currently in NSR, however the procedure doesn’t always last long so I’m just thinking ahead.
Would you mind advising what you are now on instead of Bisoprolol as it would be useful to know of an alternative medication I could talk to my doctor about.
I'm on Sotalol 80mg three times a day. They will most likely start you off on a lower dose to start - still worth talking to your doctor about though. I would certainly mention Flecainide as well - can work wonders. IMO I should still be on that. For me personally that's the one to go for - please note I am not a medic.
Good luck.
Paul
Edit - you normally start on these med's before your CV - it allows your body time to build up. If you go back in to afib ask about flec before the CV. You normally start on 50mg twice a day and it can be built up to maybe 100mg twice a day before your next CV. I got two years out of the last one doing this.
Your ‘edit’ note was interesting, something I was not previously aware of.
As I’m new to all this i’ve started reading the book ‘The AFIB Cure by John Day’ which often gets a mention on this site. I have just come across a section which mentions that such meds will improve your chances of staying in NSR to 50-50 after a CV.
I have an appointment with my cardiologist this week and will mention the above and see what he says about starting them retrospectively.
From my experience your GP will not know if this medication is right for your condition (the GP will not know what your exact condition is). It will probably reduce your risk of AF but will also likely cause side effects which you may be able to live with, get used to or will be unsuitable for you. I don't know anything about edoxaban except it is an anticoagulant , which you need for AF to reduce the risk of stroke, with little side effects other than bleeding more than usual if you have a cut etc. I would be a little apprehensive starting on 5mg Bisoprolol given the frequency of your condition as it may make you lethargic and tired but you may get used to it - some GPs would have started you on 2.5 or even 1.25 to see how it effected you. In truth no one will know if this is the best medication for you. Your GP did not send you for tests as your medication will likely control your AF for now at least and will adjust your dose or medication as/if you explain your side effects. Not ideal but as this is not a life threatening condition they go with what has worked for their patients. You will likely have to present with more severe symptoms before they take it more seriously and send you for tests. WARNING don't exaggerate your condition as they can prescribe medication too severe for your condition and with higher risk of side effects or making your condition worst. All that said I would take the medication and if you do get side effects do not hesitate to see your GP to adjust you medication accordingly.
Hi Rhodes, I’m sorry you’ve had to join our club but, as you will see from the replies you’ve already had, there are lots of kind and knowledgeable folk on this forum so your friend did well in telling you about it.
I was diagnosed in A&E last year, like you, after a couple of episodes spread months apart. I realise that I’d had a couple of episodes 10 years before as well. AF is a strange condition and I certainly found it scary when my heart would rocket off for hours, hence ending up in A&E! I think the fact that our hearts have a tendency to go into AF is enough for the medics to give the medication first, if the condition is caught in A&E, before doing further tests, as it’s pretty much a given it will happen again at some point. Further tests should be done in my view though, to look for any underlying conditions that might be causing it.
I was also given Bisoprolol but was very resistant and feared taking it to be honest, due to the list of side effects, so originally, after discussion with my GP, only took it when I had an episode. (called a PiP - pill in the pocket approach) It didn’t terminate the episode any sooner but did keep my heart rate down so I could ride out episodes at home. As your episodes are infrequent maybe that is an approach you could discuss with your GP?
I do think you need to press for a referral, though, or perhaps pay for a private referral to an electrophysiologist if such is possible? Any further tests you might need could be done on the NHS but al least it would get the ball rolling.
Also look at lifestyle changes. Other than certain foods and caffeine, stress and anxiety are triggers for me. There are lots of incredibly useful posts on the forum here about lifestyle and things that help during attacks. Have a search under CDreamer and JeanJeannie to name just two members who have written extensive and very helpful posts on these topics.
Sorry for the lengthy post but hope it helps! Good luck to you and don’t forget, as has been said many times before, there’s no such thing as a daft question😊
Just saying hi. I suspect we may be acquainted!! Can only echo what has been said already. You are a child compared with me and certainly I would push for cardiology referral. Once you get your head round all the info you will feel much better.
Hello Rhoded, Your story sounds very similar to mine and we are the same age. My trouble started last October.
I have had a telephone conversation with a cardiologist, a three day heart rate monitor and an echo cardiogram . Still waiting for the results and an appointment for an angiogram.
I stopped taking Bisoprolol in consultation with my GP, because it floored me. I have been given flecanide as a pill in the pocket but would have to consult a medic before taking one.
All of the above advice is brilliant, aren’t these people lovely on here , but I would just add one thing.
I read the NICE guide in Edoxaban and it says we need monitoring when we first take it. After a month at least.
I had to contact my GP and remind him. He said that was a good idea. We had a chat about my condition and he has arranged a blood test. I pointed out that I weigh just above the 60kgs mark. NICE suggests anyone under 60kgs should be on half the dose. I have no other risk factors for a stroke, other than being female, so I am considering cutting the dose but want to make sure all my hospital checks don’t throw up any surprises first. I think my episodes started and stopped during a very stressful few months last year.
Hope this helps. You are not alone. I wish you well.
Hi and welcome. It is very usual to be quite scared after AF episodes but please know that although they feel very scary there is a lot you can do for yourself which will help, not least learning as much as you can. We have all been where you are now so we do understand.
First - know everyone’s experience of AF is unique and it’s a rogue condition, sometimes with known underlying causes - but mostly none that we can trace.
Treating underlying causes can sometimes mean no more AF.
These are the knowns:-
Being overweight
Sleep disturbance, poor quality or Obstructive Apnea
Thyroid Dysfunction
High BP
Too much exercise - ie Elite Athelete status type exercise
No exercise
Sugar
Alcohol - especially binge drinking
Certain medications or ‘recreational’ drugs
Lack of good hydration
Electrolyte imbalance
The list is almost endless but you might get the picture.
Look at Lifestyle over medication every time so although you need medical supervision to help you navigate the ever changing landscape of arrythmias, you need a doctor who specialises and is updated with the latest information. There are some GPs who are very knowledgeable and there are quite a few who know very little and go ‘by the book’ - ie: assess for stroke risk, prescribe anticoagulants and Bisoprolol - which some people can tolerate and find helpful but many can’t for those who cannot, therein lies a downward path.
The anticoagulation - if your assessment for such was advised - is most important
And that is why you need expert advice and assessment from a specialised cardiologist called an Electrophysiologist. But because they are thin on the ground - you rarely get to see one at the start of your AF journey so are treated by GP’s who only refer when the first line meds don’t work for you as they are normally not competent (in the professional sense to treat and to prescribe alternative treatments and drugs).
If you can afford it, I would suggest you seek a private consultation with an Electrophysiologist. You may need to travel to see one, but it will be worth the £200-300 just to have the consultation as I believe I could have avoided many of the pitfalls I fell into had I not waited 7 years to consult.
In the meantime know that although AF can feel horrible, it is rarely immediately life threatening and A&E rarely have a cardiologist available so you will not be treated, just advised.
Apart from reading the literature on the AFA website consider signing up for the on-line Patient Learning programme.
There are many, many sources of other information and lots of weird and wonderful suggestions which you will read on this forum, some work for some and others experiment with variable results but stick to the tried and tested of what works for now and tackling anything anything on the list above will help.
Ask any questions, no such thing as a SSQ (seriously silly question) an acronym my son devised when I got too nosy about what he was up to!
All the above are wise words. I would add that hydration and stress are two things to keep in mind.Hydration is important for your health but especially for your heart.
Stress will add the AFib events or symptom similar panic attacks. So when you can read up on all the things which may help you avoid unnecessary future events.
Look up Dr Sanjay Gupta (AFib) online and learn all about yourself and your ailment and how to live with it. He’s well known and easy to understand.
As said previously, all pills will have side effects but the reason for taking them is clear. It’s to help you help yourself.
There isn’t such a thing as a stupid question so ask away.
Hi, the meds you have been prescribed are what is advised by NICE. Ie, anticoagulant and heart rate control. After 2 episodes of AF four years apart, I was prescribed 5 mg bisoprolol and was completely knocked out, useless after about lunchtime with lethargy, am now on 2.5 and a lot better. Re. Anticoagulant, I weigh well under 60 KG so asked to go on Apixaban because you take one twice daily which I feel better about rather than taking a whole 5mg in one go, so that is an option. Also do have a look at Sanjay Gupta, the one from York Cardiology not the American of the same name. His you tube vids are very helpful. In the past 5 years I have had 2 private appointments with him, which were well worth it for peace of mind. He is also my NHS consultant. Dr Gupta is great, a mine of information and expertise, and he has a positive approach, plus he is a very nice man and after speaking to him I felt a lot better about the AF. I hope you get it all sorted out soon, good luck.
I agree with all the comments above,but my reason to add to them is the life changing effect occasional AF, permanent ectopic beats, lots of them, and a leaky MV have had on my active lifestyle.Walking far without getting breathless is the main one, I used to hike and hill walk up to 5 years ago, yes I am 77 and can still swim a do yoga. I don’t have anxiety but am pretty peed off with ageing and lack of mobility !! Keep active everyone !
Hi Rhoded, just saying hello - and sorry you need to join us.
I can’t improve on the informative advice others have given so won’t try - except to echo that you should get a consultation with an EP specialist.
I was diagnosed last May and had only had three episodes before that. I was put on Edoxaban and Bisoprolol. As has been said, Edoxaban is fine, but the Bisoprolol 2.5mg was too high for me - heart rate around 50 and little energy, so reduced to 1.25mg.
I was quite anxious in the first weeks, as are very many people, but gradually both head and body settled down. It just takes time - you will get there I’m sure!
Thank you Lyn I agree the anxiety of it all is awful and especially when they gps don't listen and just give you a bog standard starting dose which is basically what he said !!
Challenge - you have the right to be referred to a specialist of your choice - you may need to travel & you may need to wait on a l o n g waiting list but sooner on it, sooner seen.
Not sure why you are taking tablets for extremely infrequent PAF. You could carry pill in pocket for the next episode but unless you are getting more than one episode a day, by the time the tablet kicks in, the episode could be over. Sounds like you are in the early days, I had over 3 years of that before Ablation was necessary. I am going to stick my neck out here with anticipated criticism but, the tablets do not fix the AF and the side effects of the tablets can make you sufficiently anxious to induce further episodes of AF when you at your stage.
Hi. The Bisoprolol starting dosage seems too high, especially when you're at the beginning of the AF journey. 1.25mgs or possibly 2.5mgs would have been a better starting point in my view, given that it's a drug with pronounced effects/side effects in some - unless you suffer from heart failure and/or at high risk of a heart attack, in which case the added protection/dosage may be justified. You're right to persist in asking for an echo as it may reveal information that helps improve your treatment. Ablations don't work for everyone, but for those they cure it can mean many years free of the curse of AF. The beginning is the best time by far to push for the best possible treatment. Waiting too long gives AF the opportunity to modify heart muscle and electrical pathways to the point where the odds of an ablation working are considerably reduced. Being afraid/anxious/concerned is pretty normal. Use it as motivation to push for the best solution for you.
Thank you so much for the info. I too think 5mg start is too much. But think my gp just reading off a script. I did insist on a cardiologist but he said the lists are massive and he said first line is the gp to prescribe on the information. But insisted on an echo as that's what the docs in A and E told me. !!
Hi Rhoded- welcome to the forum. There are lots of knowledgeable people here many who have been dealing with afib for years. I would agree with some of the other posters who suggested that 5mg of Bisoprolol is too high a starting dose given that your afib episodes are not frequent. Some people are fine on this dose - I felt like a zombie and told my GP that if I had to live the rest of my life feeling so awful I did not wish to live! He reduced the dose and later I changed to Nebivolol. Many of us do not go to A&E any more when afib strikes but sit it out at home having learned coping mechanisms. It would be better to see an EP whatever your GP says. The frequency of afib attacks often increases and getting it seen to early may prevent progression. However with the woeful state of the NHS at the moment you might have to see a specialist privately. At the beginning of the afib journey it is all too easy to worry but stress and anxiety can encourage episodes so try not to be scared. As for taking the tablets the anticoagulant is the most important and you should not put off taking it till after your test results come back. It will protect you against stroke.
Have just found this link re referrals to a Consultant nhs.uk/nhs-services/hospita... First 4 lines do not feel particularly helpful "You're entitled to ask for a referral for specialist treatment on the NHS.
However, whether you'll get the referral depends on what your GP feels is clinically necessary in your case." Poop.
I am new to Afib myself and am confused about the condition. I had 4 episodes of heart palpitations which lasted a few hrs each over a 2 yr period. My gp started me on propranolol and sent me to a cardiologist who specializes in electrical problems with the heart. I wore a 30 day monitor which showed I am in Afib 9% of the time. I only felt one episode of racing heart during this time. I hear people on this forum talking about knowing when they are in Afib but other than that one episode I did not know. Cardiologist now has me on xaralto and diltiazem and he wants to implant a loop recorder. Since I am having knee replacement in 2 weeks I am putting off having the loop recorder inserted. As I said,I am confused and wonder if I really need this.
It's just all so confusing and to me seeing a cardiologist would be the thing to do to see what's going on before giving all these meds. So frustrating.
I have a loop recorder and it took less than 5 mins to insert under local anaesthetic! It will provide great data over the next three years (battery life) as I too experience few afib episodes though with “unexplained symptoms” that they’re trying to link to afib. Because of this procedure I was able to wean off low dose 1.25mg nightly (agree best for sleep) of Bisoprosolol (use it as PIP instead), My annual follow-up is next month so the meds issue may be revisited after the Medtronic alarm sounded a few times recently. Meantime this past year I’ve addressed diet looking at triggers. Any stimulant like too much coffee (now have one a day), sweets (sugars) for me it’s ginger stem biscuits/Tim Tams/Sticky Date pudding , etc , some herbs (chili/curry/turmeric) have to be limited. Alcohol is OUT! Lifting heavy things OUT! Getting overheated OUT! Drinking up to 12 glasses of water with a slice of lemon daily is IN and I find the BEST preventative medicine to alleviate HR/dizziness or jitters
Good luck with the knee surgery! So hard managing multiple issues at the same time. The loop recorder placement is truly a simple thing though. Just takes a few minutes and you’re on your way. My mother was like you, she never really felt her afib, though she was in permanent afib. I always felt every bit of it!
Yes it is hard to manage.My surgery had been scheduled before the Afib was diagnosed and then had to be changed from a surgery center to a hospital because of the Afib.It delayed the surgery by one month to make that change. I am ready for it to be over!
Hi, again with the disclaimer that none of us are doctors here, I'm going to more or less agree with RichMert.
With only 4 episodes, 2 years apart, I see absolutely no indication for long term Bisoprolol, a beta blocker. All it will do for you is conceivably give you unwanted side effects. I had afib for 30 years and only took a beta blocker to control my rate when in atrial fibrillation, not when I was out of afib like your doctor is suggesting.
As to the the edoxaban, an anti-coagulant, there is something called a CHADS score that you can discuss with a cardiologist or electrophysiologist and make a shared decision on whether to take it or not. The score will be rated based on your age and other medical factors to compute your stroke risk. That said, makes sense to take it until you have that discussion and perhaps do your own research.
Also, as mentioned, depending on how long your episodes are, you might discuss with the cardiologist, a Pill in Pocket (PIP) approach so you might not have to go to the hospital the next time you have afib. The PIP approach I used for over 20 years was simply to control the rate until I naturally converted. I did this with a fast acting calcium channel blocker, diltiazem, and a small dose of a beta blocker. Now I do it with an antiarrythmic drug called flecainide.
Lastly, a good workup by the cardiologist is important to examine the structurally integrity of your heart, etc, but lifestyle can play an important part in keeping you out of afib. One of the most important things you can do is to maintain a proper weight.
As others have said, this is all too common. And indeed GPs can help us manage AF. What he’s done is made you safe for the moment because us AFibbers are 5 times more likely to get a stroke. So by lowering your HR with the Bisoprolol and protecting you from stroke with the anticoagulant he is doing the right thing. It’s also highly likely that if you went to hospital with your AF they would do the same. In the UK bisoprolol is the first port of call.BUT your GP has no right to block you from a cardiology appointment- you are entitled to one. And if he continues to block you I would write to his governing health trust with a complaint. Dig your heels in.
Newbie as well after second episode, I joined this group. Absolutely brilliant people sharing experiences which helped me. Luckily my heart consultant worked at the hospital they took me to. I ended up on edoxoban too, was on bisoprosol 1.25mg anyway. I suggest getting a fitbit or tech to check heart rate and reassure you about afib. The one thing they said to me was on next episode to take 5mg of bisoprosol straight away. I think you should talk to an expert about your way to deal with an episode. Good luck for the future.
A couple decades ago when I first encountered a-fib, my GP told me I didn't need a cardiologist or EP -- that he could treat my condition. I think now he probably advised that because of the income flow -- I alone probably sent his kids through college! If you feel your GP isn't doing his job properly and isn't recommending a specialist, look into one yourself -- and definitely ask questions; a lot of questions, especially when medications are prescribed.
Wow, you got lots of help so far! I'm glad you are down for an echo - the outcome of that should reassure you. All I will add, is ask again if you have any more questions. Read as much as you can on here. Read the answers to other people's questions. Remember that almost none of us is medically qualified (Dr Dave is an exception) but we have all been there and know some things.
Hi, lots of good advice here for you. One thing you could do is invest in a Kardia EKG monitor (google it). Then next time you have an episode you can record it on your phone. But definitely insist you see a Cardiologist - it's your right! Good luck going forward.
You have a low burden like most people have stated. Which is similar to me. I use my Apple Watch to randomly check for afib and it has recognized my afib the one time I have had it since initial diagnosis. I do pill in the pocket for all the meds including anti coagulant. Find a good EP and talk about your concerns. All the other advice is awesome so good luck and try not to stress. My first 2 months post diagnosis were miserable as I researched myself into anxiety spiral. Also, good to know if family members have had afib as that might help understand how you will progress. Mine seems to be mimicking my mothers side of family which all the males seem to have it and slow progression(knock on wood).
As others have said, sorry you’ve had to join us, but what a good group this is, so much kindness and experience to share. Hope you can find a way to see and electrophysiology doctor soon, just to put your mind at ease. If the lists are long, the expense of going private might be worth it for peace of mind.
I think you should really be referred to a cardiology as ( I am sorry to say) even though your GP seems to be trying to help you, he is not a cardiologist and may be overprescribing medication for you here. He should be referring you to cardiology, where you can have a proper investigation done on your heart and proper medication prescribed to you. Cardiology would probably suggest the pill in the pocket approach. I can’t understand why you haven’t been referred.
I cannot advise about medication, although if you are only having attacks seldomly at the moment, I think 5 mg is much too high a dose and like others have said it should be 2.5mg or 1.25mg, to start with. I really would query this with your GP. I am actually tapering to 1.25mg right now and on about 1.6 mg and my heart rate is approximately the same as it was on 2.5 mg. I was going to try the PIP approach, taking meds when I have an attack, but I don’t like having attacks - so at the moment, as Bisoprolol is preventing them by maintaining a lower heart rate, I’ll carry on for now, though I am well aware it can change.
What is your average resting heart rate? Do you know? Bisoprolol can take the heart rate and blood pressure down a fair amount and 5 mg could do that. What is your blood pressure normally? I’d personally query that amount with my GP. They seem to be acting too cautiously, given how your attacks are at the moment. In my experience my GP isn’t experienced with AF and the cardiologists are best to prescribe your medication for this.
I would like to say though, that if you start taking any dose of Bisoprolol for any length of time, it can be difficult to stop taking it and have no medication to take instead.
You asked what it’s been like taking it…I will be honest, it makes me feel tired and there can be side effects….it also takes my HR down to 55 at rest which adds to the tiredness. This very low dose still does that, which is why 5 mg may be too much for you. We are all different though and some tolerate this drug better than others. There are many drugs out there - Bisoprolol is the cheapest beta blocker which is why they give it out first.
I am not on anticoagulants either, I’m 56 and low risk with a CHADS vasc score of 0, so I would wait until you see a cardiologist and ask them what your risk is before you start taking the anticoagulant like some others have said. If you are low, you may not have to start an AOC until you’re 65. Your GP seems a bit over cautious here, without a full investigation on your risks of a stroke and echocardiogram on your heart, your risk and CHADs vasc score can’t be made yet so I’m not sure what he’s basing his facts on.
One thing you can try and think about was what you were doing before the attack….what time of day it was, had you eaten? Try and pin point what triggered it, though it’s easier said than done. There are many triggers and some of us can’t work out our triggers. Common ones are alcohol, coffee and anxiety/stress….and times of day.
Please ask your GP to refer you to a cardiologist 😊
Hello Rhodes I totally agree with Flapjack , knowledge is power. I would also add one of the first things my Cardiologist told me was to cut out all caffeine which did help.
Welcome to the forum which you will find gives some excellent common sense replies and advice to the nasty, sneaky condition which is AF/PAF. I am more concerned that you have not been prescribed an anti-coagulant. Irregular heartbeat can leave you at the risk of a stroke and that's the last thing you need. In your shoes I would get back to the hospital and speak to someone in the cardiology department and tell them what you have said on your post here. In the current climate it seems like your GP is trying not to add to the pressures the NHS is under due to Covid by referring you to a specialist. However, your health is important and I wouldn't leave it if I were you. Insist on an appointment, write down all the questions you want answers to and chain yourself to the chair until you get them. Good luck and don't take no for an answer. It's your life.
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Update - Bisoprolol to Diltiazem
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13 weeks post ablation
