Atrial fibrillation after steroids

[Belle11]

Has anyone experienced atrial fibrillation after starting steroids? 4 years ago I had steroid injections in both knees, and less than 48 hours later suddenly went into persistent rapid AF, having no previous history of it. I found some Dutch research that found new atrial fibrillation was more common after steroids. I'm due for a knee replacement in 3 weeks' time, and usually the steroid dexamethasone is part of the treatment, as it lessens initial pain and inflammation and helps recovery, but I'm afraid it will trigger me back into AF.

A couple of studies I found:-

"Our findings strongly suggest that patients receiving high-dose corticosteroid therapy are at increased risk of developing atrial fibrillation." jamanetwork.com/journals/ja...

AF triggered in cattle after dexamethasone. The cattle recovered after being given a mineral solution. link.springer.com/article/1...

[Kaz747]

Are you on any meds for AF? My AF has generally been under control for 4 years since my last ablation but I do get tachycardia and lots of ectopics at times. I take 25 mg of Atenolol each night and my EP recommended that leading up to surgery, or a cortisone injection (I've had a few of those) I should increase my dose to 50mg for a few days and anything that puts extra pressure on the body can lead to AF.

It's worth asking your doctor about.

[Belle11 in reply to Kaz747]

Thank you Kaz, that's a good idea. I was on 10mg bisoprolol until a year ago, when it was gradually reduced to 5mg (then back up to 6.5mg as I was getting a lot of SVEs) because of shortness of breath and a general slowed down feeling on the high dose. I shall ask my doctor.

[CDreamer]

I developed an autoimmune condition in 2014 - for which the general medication is steroids however I was told that because I already had AF I needed to stay on other medications and need to be ultra careful of steroids. So YES - steroids can cause/worsen arrythmias however I do think that we have to have a pre-disposition to arrythmias to develop them. Sometimes frying pan and fire comes to mind. I cannot take any heart meds at all and need to be very careful with many other meds - I went to the dentist today because of toothache which is thought to be caused by a gum infection/inflammation but most of the antibiotics used by dentists are contraindicated.

I have come to the conclusion that there are always consequences to taking drugs sooner or later.

[Belle11 in reply to CDreamer]

Thank you for sharing your experience. I do agree about taking drugs having consequences in the long term - and have done ever since 4 courses of antibiotics in a year, over 40 years ago, led on to gut issues and food sensitivities which have been with me ever since. I shall have to think carefully about whether I accept the steroids - having been back in NSR for 3 1/2 years since a cardioversion, I'm reluctant to increase the risk of another bout of persistent AF!

I find it interesting that cattle who went into AF after being treated with the steroid I would be given, recovered after a mineral solution. Why are similar treatments not used for humans, rather than powerful drugs with side effects?

[CDreamer in reply to Belle11]

Good question! Many AF’ers find a mineral supplement, especially Magnesium, helps. Magnesium deficiency causes dysthymias. Cattle are particularly prone to Magnesium Deficiency by the way because of the way are agriculture has developed in the last 100 years the ground is lacking Magnesium - you might want to read up on Dr Sarah Myhill’s experiences with farming and her research into CFS and her recommendations. She is very unfortunately derided by many but I learned a huge amount from reading her articles & books. She no longer is a member of the BMC because she has had SO many complaints against her - none of which were upheld but like any doctors who speak out for Lifestyle Medicine, they find their careers in conventional medicine is over, once they publish challenging the status quo.

drmyhill.co.uk/wiki/How_thi...

Another useful book to read is The AFib Cure - I learned which tests are important mostly from this book & to understand them.

drjohnday.com/get-rid-atria...

Lots of reading but information helps you to weigh up risk/benefit of every aspect of our health. My health issues started with gut problems but I was lucky enough to have GP support who believed in Lifestyle as much as drugs & helped point me in the right direction for me.

Hope that helps.

[Belle11 in reply to CDreamer]

I have read some of Dr Sarah Myhill's website and found some useful info there for some of my health issues - it does seem that any practitioner who doesn't tread the pharmaceutical route is likely to be demonised. And I've bought John Day's book too - I think I'd seen you recommending it, and now I need to take on board more of the ideas in it. I'm currently taking magnesium taurate.

Thanks for all the useful info you share.

[Peony4575]

My AF started 3 years ago after taking 100mg Celebrex a cox 2 inhibiting non steroidal so 48 hours after taking the first tab . Apparently in some people it affects the potassium channels in the heart . Lasted 24 hours. Two and a half years later I had another episode after another trigger, my heart obviously had an AF focus awakened . No doubt whatsoever it was the Celebrex . From my reading if you are going to be affected it happens in the first 48 hours.

You confused me a bit . You said you went into persistent AF initially , then you say you are afraid of it being triggered again . So was it a one off episode you had initially ? Rather than you stayed in AF ?

I have the same same concerns about steroids as you have. My suggestion is you raise your concern with your surgeon and ask would it be possible to have the op without steroids or anti inflammatories even if it made recovery slower and more painful and see what he says . Please report back because I have a dodgy right knee ! It adds to the body of knowledge . All the best

[Belle11 in reply to Peony4575]

Thank you for sharing what happened for you, Peony. Sorry, I forgot to mention that I had a cardioversion after 9 months in AF, and have to my knowledge remained in NSR for the 3 1/2 years since.

The people who did the 1st study I shared above found that NSAIDs were also associated with increased risk of AF, and they too suggest it's what the describe as an "efflux of potassium from the heart".

The hospital seems to be willing for me to not have the steroid, but warn that it will impede my recovery - so it's between a rock and a hard place!

I'll report back either way.

[Peony4575 in reply to Belle11]

Good luck . I would be inclined to suck it and see . People heal differently but doctors dole out the same drugs to everyone as per protocol

[Nairda]

In 2020 I was diagnosed with Vasculitis. At one point, as a matter of urgency I was given a high dose of IV steroids over three days, Monday, Tuesday and Wednesday. On Thursday I ended up in hospital with a serious case of AF. I suspected it was the steroids but my cardiologist and other doctors discounted it. I still believe it was the steroids.

[Belle11 in reply to Nairda]

Thanks for sharing this Nairda. Doctors seem to be very unaware of any connection, or the research that exists, unfortunately.

How are you now?

[Nairda in reply to Belle11]

I was on Methotrexate for 2.5 years and Prednisolone for much of that time for the Vasculitis. I’m ok now apart from residual numbness in my feet and some fingers. As for the AF, the first attack has so far been the last. For the AF I’m on 60mg Edoxaban and 1.25mg Bisoprolol.

[Belle11 in reply to Nairda]

Glad you've been free of AF since your one attack, and hope the vasculitis also doesn't recur.

[Snowgirl65]

I went into a-fib after my GP gave me a steroid allergy shot (I didn't know it was a steroid), and afterward, a nasal spray also made of steroids. He knew full well I have a history of a-fib and I trusted his judgment. Never again.

[Belle11 in reply to Snowgirl65]

Thanks for sharing what happened to you, Snowgirl.

It does seem that doctors don't know about any connection - and it seems to take so many years for new information to filter through!

Your story, on top of what people have shared earlier, is making me think it may be better to grit my teeth and manage after surgery without steroids.

How are you now?

[Snowgirl65 in reply to Belle11]

You may be right in taking matters into your own hands. Regarding my experience (thanks for asking), the steroids caused such a massive a-fib episode that I called an ambulance for myself and was in the ER overnight and into the next day; it took a half day to bring my heart rate down. That, in turn, necessitated my third ablation. It seemed an errant vein wrapped around previous scar tissue in the heart which caused this horrible scenario. I'm fine now (knock on wood!) after my early December ablation. Wishing you well, Belle11!

[Belle11]

Thank you for your good wishes Snowgirl.

A third ablation - not fun! Your attack sounds rather similar to what I had after my knee injections (except this was my introduction to AF) -very rapid and irregular heartbeat, and I spent all day in A&E being given ever increasing doses of bisoprolol until they got my heart rate down to about 90bpm.

I hope your ablation holds up for you this time.