Am I heading for full time AF

[DaveBr]

I was diagnosed with PAF 5 years ago and had a pacemaker fitted 3 years ago. My main attacks came during the night and could be quite disruptive . I have noticed over the last couple of weeks that I appear to be in nearly constant AF . My heart rate doesn't appear to go to stupidly fast around 100 but the feeling is horrible along with a shortage of breath which is quite debilitating. Is this going to be the norm from now on

[BobD Volunteer]

Hi Dave. You don't mention what treatment you are on for your AF so quite hard to comment much, As I'm sure you will have been told many times, AF is a progressive condition so generally speaking the more you have the more you will get. That said, permanent AF is not a condition is is a decision. Basically you are your treating medical team agree that no futher attempts to obtain normal sinus rhythm (NSR) will be made and rate control will be your future regime. Many people find it much easier in fact as there are no violent swings to cope with.

[DaveBr in reply to BobD]

Thanks for the reply I currently take 250mg of flecanide and 5mg of bisoprolol daily along with rivaroxaban

[BobD Volunteer in reply to DaveBr]

Quite close to the max flecinide dose (300mg) and high bisoprolol then. Maybe time to consider ablation?

[Hidden in reply to DaveBr]

I've discussed the issue of progression from PAF to persistent/permanent with several EPs and whenever I have, they always insist that there is no way to predict. Certainly, if you have had a change of pattern, you need a review of medication etc. and perhaps an echocardiogram. Studies show that being overweight and even moderate alcohol consumption are correlated with progression. So address these if they are an issue for you.

[Rubymurray25]

Have you ever had any slight or noticeable sleep apnoea symptoms or been tested. I was had AF during the night and eventually it was discovered I had sleep apnoea which is closely linked with AF. My treatment was then changed for the better.

[Ppiman]

I suppose you have thought of this already, but have you tried taking a beta-blocker when the tachycardia begins? I quite often get a fast heart rate of 85-130, often starting during breakfast, and frequently accompanied with palpitations (only very rarely AF). My GP recommended a small dose of bisoprolol (1.25mg) which does help calm things down; it takes about an hour to exert its effect but then it lasts for about eighteen hours to two days. I had to take one yesterday and I was very grateful for it. My current HR as I write this as I lay in bed this morning is 53 bpm.

My elderly friend has had permanent AF for very many years now, which I do think it is properly "permanent" as any and every time I get him to use my Watch or a Kardia he's in AF. He takes no medication for this apart from warfarin and copes very well with it.

Steve

[Cookie24 in reply to Ppiman]

Are you taking the small dose of bisoprolol on top off other meds? I mean are you taking other afib meds daily?

[Ppiman in reply to Cookie24]

Hi - no, only an anticoagulant. I am lucky so far as I seem to get AF very irregularly for length of time, only more frequently for very short bursts of maybe 10 seconds or so.

Steve

[mjames1]

You say that you "appear" to be in near constant afib with a relatively low heart rate. Have you had an ecg taken to confirm? It's possible the Flecainide is working and that what your experiencing is something else. Many here take their own ecg's periodically using a home ecg device like the Kardia or Apple Watch.

Jim