what are possible further interventions for a wearisome Permanent AF condition ?After discussions about an ablation which was over Covid period, I have been in permanent AF for two and a half years and had one cardioversion which worked for two days. I have an echocardiogram once a year to check my aortic and mitral valves functions ,there is some regurgitation . I walk for about 45 mins a day but am now becoming more breathless and exhausted. I had thought a pacemaker might work but this has been dismissed as not suitable. I‘m on 1.25 Bisoprolol daily and Apixaban (a blood thinner ) twice daily. I’m a 76 yr old grandmother and have a fairly active life but am concerned now that I’m not able to exercise properly . Any suggestions please
permanent atrial fibrillation for two... - Atrial Fibrillati...
permanent atrial fibrillation for two years so what now ?
Please see my answer to previous poster.
If we look at the positives, your AF burden appears to be low, as is your current dose of Bisoprolol, so provided your heart rate is within normal range, ie 60 to less than 100 bpm, I think little is likely to be gained by seeking further interventions. Whilst interventions such as an ablation, in its various forms, are available, they are not without risks. As I understand it, once someone has progressed to persistent/permanent AF and it is well controlled by medication, their condition tends to remain stable and they tend to lead relatively normal lives and having AF doesn’t normally shorten their life.
From what you have said, you seem to be in a relatively good place. As we age, I think exercise tends to become more difficult even without having AF but it will be interesting to hear what others say……..
Thanks Flapjack, yes you’re right and in many ways permanent AF is less stressful . I rarely take my blood pressure or check my heart rate or indeed wake up and worry about my pounding heart anymore. The effects of anticoagulant ( Apixaban) and permanent AF however do mean I‘m out of puff a lot and becoming more so as I get older.
Hi Axex - really depends upon you and your medical team and what you want to do about it and ho symptomatic you are? Your access to various medical services and advice is also a big factor as I have found that some is much more expert than others.
As far as I can tell the options are:-
Do nothing about the AF and continue monitoring the Aortic stenosis and Mitral Valve - do you know what your EF (ejection fraction is?).
I suspect you may need to ask more questions about how those affect your symptoms and at what point would they treat?
For the AF - without any complications - the treatment options would be:-
Mini-maze procedure - new and would involve surgery.
Pace and ablate which would involved pacemaker - you might dig further to ask why it would not be considered suitable? I had pacemaker RST therapy in preparation for P&A and it stopped nearly all my AF.
Medication - Amiodarone - very toxic but worked for my husband at 89 who also has Aortic stenosis and Mitral Valve regurgitation.
None of the above are always straightforward and come with their own risks and complication so if you QOL, even if declining is tolerable, I would consider sticking but I might get a second opinion and ensure it is from a top EP - for which you may have to consider going privately, considering where we are with the NHS, but you might be lucky.
Whatever you do - keep exercising but maybe consider doing x2 smaller walks in a day rather than one longer and/or consider seeking out a specialist Cardiac rehab physical trainer - they used to be available on the NHS but I think that went a while ago but there are plenty around and my husband goes to a local class and has benefitted hugely from doing so. Keeping muscle strength is very important so best done with strength exercises - that may then in turn help your walking.
Hope that helps - best wishes.
Thank you CDreamer for your reply and really useful suggestions . I‘ve noted them down and will be following up and asking more questions. I‘ve no idea what my EF is, but at least I know what it stands for now. I‘ve had echocardiograms for the last three years and a letter from heart department afterwards to explain findings ..but that’s it .Cardiac Rehab sounds a really good idea if it’s available locally. Pace and ablate is what I thought I‘d be offered at this stage but no one is really keen to discuss further. Thanks again for your suggestions , Axex
Although some here find that 1.25g bisoprolol is a low dose, that isn't by any means always so. For me, 1.25 mg is a potent dose and one that provides a very similar level of effect to when I was on far larger doses, even 10mg. I have read that it is an unusual drug in that its effects are not linearly dose responsive and I have found that. It might be, then, that, like me, you can take your dose as and when needed instead of daily? This will depend upon your doctor's assessment and agreement, of course. Unlike you, I have only very occasional AF and take the bisoprolol for mild tachycardia.
I have read that the valvular regurgitation you have is a common difficulty as age progresses. Certainly my friend has had it for many years and he has never had any treatment for his permanent AF except warfarin anticoagulant. Regurgitation will have a noticeable effect on your stamina, of course, as it has on his but he seems to have adjusted to that.
In terms of exercise, perhaps a little less walking and more of a different, upper body type exercise might work? I've read recently how important that seems to be and it's not something I do but now feel I ought.
Steve
Thanks Steve. The Bisoprolol 1.25 I take at night , it seems to work better for me then and I‘m less breathless by the afternoon so I walk then . I think the idea of upper body exercises sounds good and will investigate , I do sing twice a week . I‘m expecting valve replacement or surgery sometime in the future but as yet heart dept thinks it’s not necessary. Thank you for your input AD
Personally, I’d be looking at getting an ablation asap. I’d reckon on being around another 20 years at least and that’s a very long time to be sitting at home lifting tins of soup for exercise.
Hi CliveP when I went into ˋlong ´ AF it was at the beginning of Covid and I had a hour long telephone conversation with a heart surgeon who specialises in ablations at a private London Clinic. He had looked at my ECG readings and read an accompanying letter about my AF history ,he suggested that my age and weight made it unlikely that an ablation would work for very long. Covid meant that an app. for a NHS cardioversion took a time to come round so after three months I had a private one which lasted 3 days. An ablation was not offered and neither was another cardioversion and after a week on a dreadful drug combination of Apixaban ,Adizem and Bisoprolol it was decided that just Apixaban and 1.25 Bisoprolol would do. So here where I am today. I like the ˋtins ´ idea !
I’m wondering what you mean by ‘exercise properly’? I was amazed to find what is considered a suitable exercise HR for someone my age (77). According to my watch I achieved 36 minutes of aerobic exercise and two minutes anaerobic yesterday just pottering around the house! Obviously that wasn’t all in one stretch but it must count for something?
Buffafly thanks for your reply. I‘ve rather given up on cardiac monitoring but I do check the pedometer app on my iPhone daily and normally do about 5000 paces a day c.3miles I think. It doesn‘t tell me ˋaerobic or anaerobic ´ . That’s in two sessions of walking . I also sing twice a week . I think a gentle keep fit class would be good. A new year‘s resolution maybe but an arthritic knee and permanent AF do make life uncomfortable ! AD
At the moment 'warfarin anticoagulants' is (so far) sufficient to allay worries. In my book, there are far to many patients that are encouraged to take 'bisoproplol' plus to tackle mood temperaments. The advice of 'exercise' and by building up the strength of muscle improvement.
Thank you Mary for your reply. What do you mean by mood temperaments ? I imagine the Bisoprolol 1.25 is there to control heart rate and blood pressure but it might be worth trying without if that’s agreed. I don‘t take more than 1.25 pill but it’s my choice to increase it if my heart rate is way up. I tend to use breathing now to bring my heart rate down. I do try to exercise every day ….. we have two dogs .
Bisooprolol can make you feel very tired. It may be that it can be decreased even more. I would ask if it is necessary, or if another Betablocker could be tried, which might not cause so much tiredness.
Varying your exercise as suggested above (ie some small 'weights'), may also help.
Also I tried taking L-carnitine, which is meant to be good for hearts, and it really helped my energy levels, but it is not suitable if you have thyroid issues.
I will try L-carnitine thank you.
I am 77yrs and I have had a pacemaker in for 3 years, which has worked very well, on a low heart rate. Unfortunately my heart started to go too fast and I now have constant FB. I was first prescribed Bisoprolol on 1.25mg ., because I was feeling so poorly… heavy legs, breathlessness and so tired, over time they put my Bisoprolol up to 10mg. Then they wanted to put it up another 1.25mg, at which point I refused as it wasn’t making me feel any better. I asked if I could go on another tablet Nebivolol. Although I still have some complications it really was the difference between night and day. Find a one that is best for you. Good luck.
thanks Rachel. I’ll mention it to my GP . it could be worth trying another beta blocker . As a matter of interest what is FB and does your pacemaker keep your heart rate regular now ?
I take Diltiazem plus a BP med for my HR and BP, can’t take Bisoprolol because of asthma. I have to say, looking at your list of complaints - arthritis, leaky valve, lymphoedema plus permanent AF - I think you’re doing great! But as you suggest you are overweight then losing weight would be the most helpful thing you could do.
Hi Boberch (I thought I‘d replied but it’s vanished into the ether). Briefly….. Bisoprolol does seem to control my heartrate, I take 1.25 at night. I understand it’s to control my heart rate and blood pressure. If I‘m walking more than 200 yds I find my pulse can be fast and erratic so I pause and wait until it comes down.AD
I had AF without even knowing until I had a stroke. I was diagnosed with paroxymal AF which progressed to permanent AF. I do pilates twice a week which I only started after my stroke, it helps me not only physically but mentally too. I found the stress and anxiety of AF caused me so many issues and made me feel unwell. I now try to keep myself busy and not dwell on AF, obviously I still get the symptoms but try to occupy my mind and control my breathing etc. Good luck, but I highly recommend pilates, its worked wonders for me
Thanks Vrouse , I‘ll look at Pilates and Cardiac rehab this year. Do you go out to Pilates class or do it at home ? Happy new year.
I did it at home at first to see if it was for me but found it quite expensive. I then joined a local class and love it, made some good friends and its become a social activity whilst doing some good at the same time. They do lots of levels from beginners to advanced and cater for all ages. I go to a back and joint care class and the trainer adapts different moves depending on whatever problems we have. Highly recommend it. Wishing you a happy and healthy 2023.
Two Years On
Permanent atrial fibrillation
Permanent Atrial Fibrillation, LVSD and Coronavirus
Atrial fibrillation ablation 
paroxysmal atrial fibrillation 
