Help needed with AF medication homework please!

[Rainfern]

I have an appointment at short notice with my EP on Thursday. This is following the cardioversion that gave me NSR for a week before returning to persistent Afib with resting heart rate in the 90s. I am currently on Adoxaban, and propranolol at night.

I'm hoping to have a conversation about potential medication as well as getting on a waiting list for ablation. If nothing else I possibly need to be on a more specific beta blocker. I have read the AF Association factsheets, but do feel a bit confused about the difference between rate and rhythm control, between beta blockers and antiarrythmics, because there seems to be some overlap. Can anyone recommend further reading (simple stuff for a tired brain please!)

I know the effectiveness of meds for Afib and their side effects is hugely individual, but if anyone wants to put my mind at ease re what worked for them, or conversely why something didn't work so well that would be great. I trust my EP entirely to make the right choice so I'm not asking for advice so much as personal knowledge and experience.

With thanks.

[BobD Volunteer]

The important thing to know is that it makes no difference if you are on rate or rhythm control as both are merely for symptom control (Quality of Life) .

Yes some of the drugs do supposedly have dual functions for example propafanone which is a rhythm control drug does have some beta blocking ability as well but this is not the primary function. Sotalol is another dual action drug but is in and out of fashion for various reasons.

Bottom line is there is no best solution, only what works well for you as AF is not a disease but a condition which needs symptom control. Ablation may well give many years good QOL but then so can good rate control.

[Rainfern in reply to BobD]

That's really helpful, thank you Bob. Especially useful to understand good rate control can be on a par with ablation. Seems to take time allowing the "symptom control" aspect of Afib to sink in, rather than believing in a "cure"!

[BobD Volunteer in reply to Rainfern]

You can cure a disease but seldom a condition. lol 😁

[secondtry]

I would start off with your EP by asking 'what are the implications of taking no more drugs'.

[Rainfern in reply to secondtry]

Great idea, thankyou

[seafin]

Maybe you have already been here nhs.uk/conditions/atrial-fi..., but here is a quote from it:

"Restoring a normal heart rhythm

A variety of medicines are available to restore normal heart rhythm, including:

flecainide

beta blockers, particularly sotalol

An alternative medicine may be recommended if a particular medicine does not work or the side effects are troublesome."

Controlling the rate of the heartbeat

The aim is to reduce your heart rate to less than 90 beats per minute when you are resting.

A beta blocker, such as bisoprolol or atenolol, or a calcium channel blocker, such as verapamil or diltiazem, will be prescribed.

The medicine you'll be offered will depend on what symptoms you're having and your general health.

A medicine called digoxin may be offered if other drugs are not suitable."

So some beta blockers (apparently) can do some rhythm control.

The video (12 mins long) Dr Klaus Witte "What are the treatment options for AF" on the page on this link heartrhythmalliance.org/afa..., is good at clarifying treatments that address the cause and those that address the symptoms.

My understanding of what he says is that he divides treatments into those controlling rhythm (AADs and catheter ablation) and those controlling rate, where the former address the cause (i.e. they prevent the irregular rhythm in the first place), whereas the rate control drugs manage the irregularity, but do not remove it, by controlling the heart rate.

Sorry if you are already aware of all of this.

Good luck with your EP appointment.

[Rainfern in reply to seafin]

That's brilliant Seafin, just what I'm looking for. Although I've read a fair few posts here on the forum I've not taken in some basic stuff that didn't apply to me at the time. So this will help me understand what the EP is talking about if/when medicine is discussed as an option. Thank you!