I have occasional episodes of AFib up to 5 days a couple of times a year but have been having more shorter episodes for a few seconds or minutes at times, very occasionally at night when sleeping on my stomach. So a change.
I take apixaban.
My life is normal other than tiredness probably from not sleeping well.
I spoke to the cardiologist over the phone and they suggested an ablation and bisprolol. I asked for an echocardiogram (is that the one where they can see your heart in action?) and to wear a 3 day ecg. They said they would refer me for that.
I don’t feel an ablation is necessary at this stage as my heart rate is otherwise normal overall. And what would Bisoprolol do?
any help thinking this all through is welcome. Thanks
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FiveMilesSouth
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When I was diagnosed with paroxysmal AF ( also asymptomatic) in Jan 2010. I rejected all notion of an ablation. bloody glad I did - no reason for doing so except a gut feeling it wasn't necessary. Listen to the gut feeling.
As the years went on I found my AF was triggered by food/ food ingredients impacting on the heart and gut via the vagal nerve.
I was also prescribed 5 mg of Bisoprolol to be taken in the morning, back in the day. This caused random, full flow nosebleeds. My GP then changed this to be taken at night. Had no nosebleeds since ( 12 years).
I have seen anecdotal evidence on this forum that Bisoprolol can be prescribed in low doses as a PIP or as a regular, higher daily dose throughout the year, ad infinitum ! I fall into the latter category and it holds my heart rate at around 62 to 67 bpm. Prior to AF it was regularly in high 90 bpm. AF hit and it was clocked at 156 bpm.
Something I can only make an observation on is I can't get my brain around why prescribe a low dose as a PIP, to be taken as and when and if required to tame the heart rate. When if you take a higher dose all the time it'll have the potential to retrain/ tame the heart to beating at a nice slow rate and stop AF from recurring. Most of what I've read in this forum taking it as a PIP only addresses the beat and not the retraining. Granted of course there are many who can't handle Bisoprolol.
So we still come back to my point ......... pop a PIP when needed to settle the irregular beat knowing it'll return later or take it daily for ever and retrain/tame the heart so that it doesn't return.
thanks for this. Am processing it all. What is a pip? And I wonder if I need one given my resting heart rate is 60-65. Active is nothing much out the ordinary.
My apologies. PIP, is abbreviation for pill in the pocket. Its a decision made by Consultant or an EP ( Electrophysiologist, maybe a GP) as a treatment option. So if it is decided that having Bisoprolol treatment as a PIP and the dose is 1.25mg, it means you take it whenever your heart kicks off, keep taking it until it gets a normal beat again, then stop taking it. My treatment option decided by my cardiologist/ consultant was 5mg for life. I was 65 when put on it and am78 now. Resonably fit old git, work part time 30 hours a week driving double decker collge bus services. All approved by DVLA and employer is aware of medical history.
If your heart rate is that good and it doesn't trouble you very often I would think not. I can't see how they would suggest ablation and bisoprolol without doing an echo or a 3day holter monitor check.
Yeah an Echo can see your heart in action and will produce a report outlining the overall condition of your heart.
How often does your heart misbehave and trip you into AF.
You do need to research 'Ablation' particularly how many you can hve if the first few don't work - also check out what type of ablations are available. All seems a bit off the cuff to me.
thanks, John. That’s encouraging. I feel like I need more data from the tests to see if what I think is going on warrants any particular additional treatment.
I trip in AfIb for about 5-7 days a couple of times a year and for a few minutes every few weeks. Sometimes I feel I’m on the edge of having afib episode for a while.
With me I know to stay off hard cheese and do better posture. These are some of my triggers. And tiredness. I don’t drink alcohol, smoke or do caffeine.
hi I wonder if the episodes your having that last only minutes might actually be Ectopic heart beats. It’s quite a common thing and happens in most people.
Hi John. Interesting thoughts. When I recently saw my EP he said the thinking is now towards PIP as there is increasing evidence that block treatment makes no difference in any progression of Afib but it causes far more sided effects. He saidPIP will become the standard treatment. From that they mustive found block treatment doesnt sadly retrain the heart. I found that interesting. This was a discussion re P-Afib.
My GP thought the same, about five years ago! He was fully approving of me changing from a daily dose of flecainide to using it as a PiP and I have done that ever since, coupled with 1.25mg bisoprolol. If anything my episodes are less, I only had one last year.
I've been on this Bisoprolol "block" now for 13 years ...... back in the day (2010) PIP was hardly heard of and ablation hardly ever first line of attack as it is today. I have withstood the onslaught of medication very well .... mind you given that I was written up as asymptomatic in the beginning I'm perfectly happy with the block approach.
I had an Echo late 2022 and at its conclusion I asked the guy what state my heart was in. He just commented that I'll send a full report to your GP but its pretty well worn ! My reply was ............... " well it bloody well would be wouldn't it given that I am 78". That ended that discussion !
Thank goodness I drive buses for a company that employs a company doctor - if I have any issues I can always ask for an independant inhouse discussion,.
Might put a post on here about being asymptomatic.
Certainly, my AF (to the best of my knowledge) has been very highly controlled for some years now) and definately hasn't progressed and the isolated incidents I had years ago have kept on reducing, so far this year I've had none. Thanks mainly to Bisoprolol and diet.
I wonder if the PIP approach has also been grasped as a lower cost option to the NHS than the block approach ?
So glad you are asymptomatic. Thats brilliant. And your AFIb is well managed. I didn't get the impression from the EP that PIP idea was coming from the NHS but from research. I shouldve asked him for the research....lol.
I guess this approach definitely wouldn't work for all. He sadly wasn't suggesting it for me. I already know it probably wouldn't as if I do miss taking my calcium channel blocker then my heart starts racing. But maybe for others PIP is perfect.
He may have mentioned it to me because he knows how anti drugs I am! Obviously I have to take them but am aware that long term it causes damage to the kidneys! So it seems to me your are robbing Peter to pay Paul.
I am also 78 and am awaiting results of an Echo test a couple of weeks ago. I was prescribed bisoprolol 2.5mg daily and edixapan at 60mg daily! Getting a few side affects from something and am trying to find out which?
Had two further episodes of Afib since my diagnosis in January this year, so I’m a newcomer to all this stuff!
Inside the packets of medication should be slips of paper. A whole heap of info there BUT what is normally provided is comments on side effects. Routine side effects and not so routine. May pay to read all this and see if anything is there that you can identify with.
Good luck with your journey, the Echo results will give alot of clues as top your heart health overall and give clues for the medical team to decide what to do.
If your afib burden is low, you might wait for the newer pulse field ablation (pfa) to garner some more real world data and become more readily available.
Reading the tests you are going to get, when I make my annual visit to the Cardio among the tests I get is, (when I get the account,) called 'Cardiac examination plus doppler'; What is that for, ? the other I get is 'Cardiac exam 2 dimension', and 'Electrocardiogram without effort'
Being in afib for 5 days at a time is not doing your heart any good even if it's only twice a year. If the afib is accompanied by a high heart rate a beta blocker as PIP would bring the rate down. An anti arrythmic such as Flecanaide as PIP might knock the episode on the head after a few hours. I would say you can't just do nothing as you are risking your afib burden getting worse.
It seems to me everyone’s experience of AF is very different so I can only talk from my experience.
I was diagnosed with PAF exactly a year ago and then realised it is what I have been struggling with for 10 years! I had got to the point where I was having an episode with rapid ventricle response every couple of weeks; lasting up to 2 days at a time. (Fortunately no damage has been done to my heart)
I started on Bisoprolol but it seems I can’t tolerate beta blockers. Gives me really cold hands and feet and I feel so tired on it. I ended up on Diltiazem and Flecainide which did offer some control but again I don’t feel great on it.
I opted for an ablation. I have now had two neither of which have worked because they discovered I have non-pulmonary triggers. In the second ablation I suffered a cardiac tamponade which I am still trying to recover from!
With the cardiologist we are now trying different medication - but all medication seems to suppress my heart rate too much and leaves me feeling unwell. I am about to try using Flecainide as a PIP as I know that does control my AF fairly quickly. It is a bit trial and error but I am hoping I don’t have too many episodes.
I hope you manage to find a way forward that controls your AF as it can destroy your quality of life!
Sorry to hear this Kingfisher44. I think ure right re trial and error. Hope the PIP works for you. You have been through a lot....you deserve a breakthrough.
I am not 100% certain but I believe Bisoprolol slows the heart rate and makes it easier for it to pump. Whilst Flecainide also slows heart rate it also inhibits the electrical activity.
As someone who was reluctant to have an ablation when my episodes of P-AF were few except as a last resort I now think this was a mistake and I should have had one as soon as the episodes became more frequent.
Having done all the lifestyle changes possible, I think I may have delayed the progression of my P-AF for a number of years but as it seems is the way with most AFers, progress it has at speed.
I suppose it can be said I have had a few more good years but the pay off now is a low quality of life while I wait for an ablation that may or may not improve quality of life.
I would have had an ablation sooner but Covid got in the way.
My advice to AFers now would be as soon as episodes become more frequent say monthly at the latest , get on the list for an ablation, you can always cancel it nearer the time if you change your mind. The waiting lists are long and it is best not too wait until your quality of life is greatly reduced.
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2 Ablations, 1 Cardioversion - what next?
Anxiety and fear suggestions
I’m terrified to take Bisoprolol 
WHAT ARE YOUR AFIB TRIGGERS?
Suggestions welcome! 
