15 year AF story

[Laksacurry]

First episode of AF about 15 years ago. Heart rate ~155. Would sometimes reset itself. Initially fixed with Flecanide, then Amiodorone. Flecanide then inadequate and I suffered a very unpleasant fainting/blackout reaction to amiodorone when an IV drip was started in A&E. So further episodes sorted by dc cardio version. Meanwhile I had 3 ‘hot’ laser ablations. The third one worked and I was episode free on 2.5mg bisoporol for about 6 years till AF returned. Quickly sorted with another ablation by the same electo-cardiologist. No further AF for seven years. It returned about three months ago (sept 2023) and I was dc cardioverted back to NSR. The assignable cause was retrospectively deduced as a chest infection triggering the AF. I was discharged and re-admitted 2 days after the cardio version as I had a major faint/blackout at home. The infection and lung fluid was treated with antibiotics, nebuliser and diuretics. Ok to proceed normally confirmed by chest x-ray two weeks after discharge. Then in Nov 2023 further episode of AF. Presented at a different hospital to usual. The cardiologist there elected to try digoxin rather than cardiovert me. I was laying in my hospital bed the following day with my pulse at ~155 when I suffered another very unpleasant completely debilitating faint/blackout similar to 2 months previous. I alerted the nurse but noticed that my heart had now reverted to NSR with a pulse of ~65. The nurse did an ecg straight away and they informed me my heart had stopped for 7 seconds, reset itself and I have been in NSR without incident for 2 months. My meds are now 50g Flecanide twice a day (which I assume is a maintenance dose), and 7.5mg bisoporol. I have little/no side effects with these meds other than increased breathlessness, but I am COPD anyway. I’m awaiting a referral back to the specialist heart hospital that did the original ablations to see how to proceed. Meanwhile I feel fine, I walk every day, have a good appetite. I’m happy to stay as I am if the specialists agree, rather than get the ‘hot spanner’ out again.

It’s on my notes that I’m allergic to Amiodorone, but with hindsight I wonder was that a heart stop/start when they started the IV drip 15 years ago? The faints/blackouts in 2023 seemed very similar. I’d be happy to try Amiodorone again in a hospital environment. Medication rather than dc conversion is an easier option for all concerned.

Like most people the triggers for an AF episode are not always predictable, consistent or avoidable. However in my case it could be definitely kicked off by soaking for ages in a very hot bath! Sounds daft I know, but it was something I needed to avoid.

[Popepaul]

I think that many people have reported a pause in their heart beat as they convert back to NSR. I believe that this has happened to me a few times, it is unpleasant to say the least.Actual syncope can of course be dangerous. I have have not fainted since I started a BB.

[Clarrie]

I used to pass out when reverting to NSR and had a pacemaker fitted. Since then I have not passed out,

[Laksacurry in reply to Clarrie]

Interesting. Thanks for the reply. Maybe the specialist hospital will recommend a pacemaker for me?

[beardy_chris in reply to Clarrie]

My experience was pretty much the same. I had a pacemaker fitted after several pauses (up to 19 seconds!). No problems since but I am now in permanent AF - which is pretty much asymptomatic.