AF being driven by prednisone for ulcerative colitis

[healingharpist]

Good morning, everyone. I was perking alone fine on daily metoprolol 25 mg, when I had an ER visit5 days ago for a big flare of ulcerative colitis (after 22 yrs of being in remission). After 2 days of 40 mg prednisone and 3 days of 30 mg pred, I went into afib yesterday. My usual flecainide 150 mg didn't stop it; nor adding the remainder by day's end. I don't want a cardioversion at this point.

I'm awaiting my doctors' responses to MyChart queries. But I wondered if anyone else on here has had to take pred, did your AF react, and what transpired? I am supposed to be on pred for the next 3 weeks (gradually tapering down to 0), but if it keeps triggering AF... yikes, disaster under the elms.

Any hope here from anyone? Emotions figure in also because I've been in remission SO long from the UColitis, and now this pain & awful bowel symptoms are complicated by the PAF. Discouraging. Thanks for any hand-holding as we move toward the beautiful Christmas Day! Blessings to all my fellow sufferers. Diane S.

[Aprilbday]

I was first diagnosed with a-fib after an asthma attack sent me to ER and they pumped me full of steroids. They also gave me prednisone to take at home. Once home, later than evening as instructed. I took the 4 pills. About 30 minutes later, I went into a-fib. Was a dramatic experience that landed an overnight visit in the ER with the paddles.

I will say that I was drinking a cola and eating chocolate as well which I think the extra caffeine cause the overload.

I am presently with rheumatoid arthritis and Va k on 20mgs of prednisone daily. I avoid caffeine and no problems yet after over a month on them .

[healingharpist in reply to Aprilbday]

Thank you, Aprilbday. Interestingly--the first heart-racing episode I ever had was after drinking a big, ice-filled Pepsi on the night I moved to a new house! That caffeine, plus ice, just did the job. So sorry for your awful ER visit. I agree, both of us had a big jolt of steroids... and I discovered that drinking more potassium (as in Pedialyte Advanced) helped me convert last night. I'm currently on 30 mgs/day pred for 7 days (2 more to go), then drop to 20 mg for 7, then 10 for 7. So I'm trying to stay in NSR for the next 3 weeks. Got advice from an ER doc that even flec won't work if your electrolytes aren't somewhat balanced. Hope the pred gives you relief from the RA... and may you have a healthy and happy Christmas, to include some chocolate! Diane S.

[Aprilbday in reply to healingharpist]

Thank you so much for your response. Sometimes in sharing things, we learn valuable information. I plan to get pedialyte! I am on prednisone every day now 20 mgs and I will probably have to get either another increase or more meds to calm my immune system down. Merry Christmas 🎄🎁

[Rals52]

I was surprised to read that the prednisone broughton your AFib. It makes me wonder if my long use of prednisone might’ve caused my AFib to start. I have rheumatoid arthritis and started in higher dose of prednisone but I’ve been in just 3mg a day for about 2 to 2 1/2 years now.

[healingharpist in reply to Rals52]

Hi Rals52, thanks for your reply. I would think 3 mg would likely not have any impact on your heart. I was on 40 mg!!! daily for 2 days, then 30 mg for last 5 days (2 more to go), then 20 mg for 7 days, and so on, tapering to 0. My ER dr. friend said "be sure to get your electrolytes balanced" and, sure enough, after I started quite a bit of Pedialyte Advanced plus my usual magnesium, I converted to NSR. So I think my issue was possibly being deficient in potassium; even flecainide may not work when electrolytes are out of whack. When I was on lower doses of pred last summer for an autoimmune inflammatory attack, it seemed to prevent AF episodes, by knocking the inflammation down. So I think you are in the clear! Good health to you, and Merry Christmas! Diane S.

[Aprilbday in reply to Rals52]

Hi Rals, I believe that it was all of the steroids my body was pumped with all at one time to get the asthma to stop: there was a steroid injection, then a nebulizer treatment that lasted 2 hours, then before bed that night I had to take 4 or 6 prednisone pills, was drinking a 16 ounce coke and eating a piece of chocolate as a reward for my troubles (ha!) when boom! My heart decided that it had too much. This is when I was first diagnosed with a-fib, given diltazem and Pradaxa - now taking that for 6 years. No more serious a-fib as of that time.

There was one other time I had this however before my asthma incident . This was an electrolyte issue that sent me to ER. I had been on an extreme diet ( lemonade diet) . On day 6, of this dumb choice I made to give my body a health cleanse , my heart went out of rhythm and rushed to ER. But! Right before the doctors were to shock me into rhythm, my heart went back into NSR without any intervention whatsoever. And blood test showed electrolyte imbalance which I resolved by going off the diet.

So I think I learned that for me, not to take medications with steroids along with too much caffeine. I do have a regular cup of coffee each morning however. And sometimes I have chocolate- actually whenever I want- but as for me I know to never eat chocolate and cola together and not at same time as my prednisone .,

[mhoam]

Hi Diane,

i suffered from UC for 25+ years, at varying levels of severity. As a result I was on and off prednisolone (UK name for prednisone) and on many different dose levels for many years. When I started with PAF, about 10 years ago, I was told there is a correlation (note NOT causation) between UC and AF. This was likely (not proven) to be because of the stress the body was under with the inflammation in the colon rather than the prednisolone.

I haven't been on steroids since 2018 when I had to have a colectomy and ileostomy. I took a long time to recover so my AF continued to get worse. Glad to say that a cryo-ablation in June has greatly improved my AF.

It is really difficult to manage two conditions such as AF and UC, which interact in many ways, especially if the doctors don't talk to each. On the bright side, do not worry if you end up with a stoma, it's much better than the mess that UC can make of your physical and emotional well being.

Good luck

[healingharpist in reply to mhoam]

Thanks for your support, mhoam. Actually, I've had UC for almost 48 years, but in remission for almost 25 yrs. This is a mild flare, but they hit everything w/ pred these days... I have another inflammatory issue, and am working on various ways of getting the whole inflamm. load down as low as possible, to help both conditions. Wishes that you will stay well! Diane S.

[SeanJax]

Steroids at this dosage make you retain water, loose Magnesium ,Potassium and muscles mass too. So low sodium diet while you are on steroids even 3 weeks after you stop it since water retention stretches the atrium and can trigger the Afib episodes. Magnesium supplements are OK and when it comes to potassium if you have money Pedialyte is perfect. If not if you tolerate bananas and coconut water, it is perfect too and cheap. We have Ensure pure protein to help with muscle mass loss too. Stay balanced on the electrolytes even 3 weeks after you stop Prednisone. Hope it helps

[healingharpist in reply to SeanJax]

Thank you, SeanJax, for this good advice. Yes, Pedialyte is pricey, too much sugar, and there are some homemade cheaper recipes...and I've been doing bananas, spinach, & coco water in between. (Is the Jax part short for Jacksonville FL? I live in St. Aug. some of the time.) I got in the habit of taking Mg & wasn't paying attn to the K, so trying to fix that. (Back in the day when dx'd with UC, they had me on 70-80 mg pred daily for months... & after 2 surgeries from the side-effects, swore I'd never go back on pred, but dosing is different now, thank God.) A wonderful, peaceful Christmas season to you! Diane S.