Started to post and it’s got very long and I mentioned this in that post but I thought I’d make a separate post. I am in atrial fibrillation in the other post. I talk about my age of my weight but this is a specific thing I’m back in atrial fibrillation after 12 weeks of being in normal rhythm. After a cardio version. I’ve had a few cardioversions and it usually lasts about 8 to 12 weeks before I go back into atrial fibrillation And my conditions in the fibrillation are not bedridden but I have less energy. I’m out of breath so my quality of life is less. I suspect I’m gonna have to wait 2 to 4 months on the national health service in England to get another one or longer e.g. another cardio revision , ., I saw my doctor. I'm still taking these medications flecanide 100mg, bisopribol 5mg and rivaoxaban. , he agreed to increase my dose to 200mg flecanide. The cardiologist had mentioned that if I stayed out of atrial fibrillation for six months or longer, they would consider ablation. However, I would have to switch to Amiodarone, which I decided against and stuck with Flecainide. Then, I had another cardioversion 12 weeks ago, and unfortunately, I'm now back in full-time atrial fibrillation. I've been referred back to the hospital in England, where they might do another cardioversion or consider switching to Amiodarone, but it will take at least two, maybe four months. I have a private cardiologist whom I've consulted, and they will perform a cardioversion this Friday for £2000. The procedure itself isn't expensive, but there's a cost for hiring the operating theater, around £1400. So, my dilemma is whether to opt for private treatment because it may only last for eight to 12 weeks and isn't sustainable long time since I go back into AF every 12 weeks so 12k a year and they may not do unlimited ones, and all of them is an under anaesthetic general anaesthetic,. Financially, it's not sustainable. Any views ?
weight loss wehovy and AF medication - Atrial Fibrillati...
weight loss wehovy and AF medication
As you already know, cardioversion (DCCV) is not a cure for AF but it does show that you can be back in NSR so an ablation may be an option. In my view you would do better having a private consulation with an electrophysiologist to dsicss ablation than wasting money on DCCV.
Remember any and all treatment for AF is primarily for quality of life as cure is not a word generally used here. Provided rate is well controlled and the patient anticoagulated where appropriate there is no difference in outcome.
Are you in the USA? I am not aware of electrophysiologists and are these cardiologists with specialism in AF? I have seen 3 specialist cadiologists via the NHS and privately in the uk. I am seeing another in May who is an expert in atrial fib and the local expert.
In UK Yes EP is a cardiologist who specialises in arrhythmias. They are the electricians rather than plumbers. AF Association is a UK charity .
Where are you going and who is the specialist?
You are the expert Bob. I asked the same question although I know I have been a nuisance asking all my questions about ablation I think ( so far) it's the best decision I made! Can't cope with the 'beast' in the jack-in-the-box 😜
From your recent posts, what sticks out is that you're not going be offered an ablation until you lose the required weight, or stay out of a fib for six months. However, given your history, that sounds unlikely, unless you lose the weight.
Why your doctor is not letting you take a drug like Wegovy is beyond my pay grade, however, it sounds like you're between a rock and a hard place, and if it was me seek out a second and third opinion about Wegovy or similar.
Because if you can get down to your target weight, then either the antiarrhythmics may work better, or if not, then there's ablation. And if you're lucky, you may stay in normal rhythm just with the weight loss alone.
So to me, it sounds like the weight loss should be your number one priority and if you're going be spending money privately, spend it seeing weight loss specialists who are used to working with drugs like Wegovy.
Jim
I can buy it privately wegovy. If I lived in Cambridgeshire the next county I could get it for free but where I live it is not available because different areas have different spending rules or drugs. I could get it for 200£ a month
I was thinking more going private to a good doctor, rather than just buying it. You want to make sure it's safe for you to take and that you will be monitored properly.
Jim
What is Wegovy ? is it a weight loss drug - never heard of it here in South Africa ?
Wegovy is a relatively new injectable weight loss drug. There are now oral versions.
What's Wegovy?
Wegovy is a relatively new injectable weight loss drug. There are now oral versions.
Jim
Thin people get AF too. Weight loss is no guarantee of an end to AF.
Thin people get AF too. Weight loss is no guarantee of an end to AF.
Per studies, losing weight is probably the single most important lifestyle change someone medically obese can make in order to both reduce their afib burden and/or increase their chance of a successful ablation.
Of course thin people can suffer from atrial fibrillation, and there are no guarantees losIng weight will help, but that doesn't change the recommendation of most cardiologists, which is to lose weight, if your medically obese.
Jim
If any kind of medic sees you walk through the door fat, they instantly right you off, tell you to loose weight (as if that thought had never passed through your mind before) and do sod all to help you.
My AF started when I was slim, fit and very active. It's exactly the same now my hypothyroidism has rendered me fat, desperate and stuck to the sofa. I was never offered an ablation and never will be now.
There is a terrible bullying that goes on within healthcare of any kind towards fat people. And frankly it's mostly completely rubbish, based on myth. It does let them abandon a significant proportion of the population though. Obviously there are things that loosing weight helps. But they have no idea how to advise you to do that properly and no care about whether it works or not.
I don't understand why you'd need to be in NSR for 6 months for an ablation. I managed less than 48 hours after a cardioversion and this was deemed enough to be put forward for an ablation.If this is about weight, that is another matter and one worth discussing further, I'd say. This will be linked to both the predicted outcomes and the risks of the procedure so obviously very important.
I was told it doesn't matter if you are in AF on the day or indeed when and how frequent the episodes are. I was told that success is better when you have paroxysmal AF and dramatically reduced once this becomes permanent
I look upon AF a short circuit in the electronics of the heart. An electrophysiologist deals with that. Have a look at the Atrial Fibrillation Association website where there's a mine of information about AF. It also contains a list of electrophysiologists. Others will tell you the cost these days, but read up first about AF. An electrophysiologist can then refer you back to the NHS.If cardioversion only lasts 2 months I wouldn't keep having them.
You've now told us that you are overweight. The easiest way to lose weight is to eat fewer calories than your body uses, but still have a balanced diet. Cut out added sugar and processed foods. If you are able walk every day for 30 minutes. You could start off doing 10 minutes a day and work up to 30 minutes. Walk around the block a few times. Drink plenty of water daily. Keep hydrated.
The being short of breath could be a side effect of Bisoprolol. Bisoprolol reduction has to be made under the supervision of a medic. Don't do it yourself. There are other beta blockers.
I was never prescribed a beta blocker because I'm asthmatic. I was prescribed 300mg of Flecainide a day and an anticoagulant. That reduced episodes of AF to 5 to 10 minutes a year. But we are all different. There is no standard human body.
I get confused about the use of Bisoprolol. My dose dropped to 1.25mg from the initial prescription of 5mg, because it made me lethargic, and I am basically asymptomatic. I then asked my Cardio if I could just take it when I felt my HR was rising and he has no problem with that, but made no mention about gradually weaning off a daily dose. My BP med of Verapamil (120md and Lisinopril (10mg) seems to keep my HR under control. I only take the Biso when it enters the 90s.
If I was you I would push for an ablation. Why would you want to keep putting yourself through this when there is a better chance of controlling the beast more permanently through ablation?
cardiologists say I have to be out of af after cardioversion for a long time before they would consider ablation. They also would require me to go on amiodaran which is toxi and the side effects could be horrific.
I wouldn't pay for a private cardioversion since it's expensive and will likely be temporary. The alternative (if I understand your comment) is to be given low dose amiodarone while waiting for an NHS CV? This seems to me to be the best way given what you have said. This drug has been shown to be safe in the low doses used these days (search "low dose amiodarone safety to find the study).
Steve
do you know anything about amiodaran - it seems to be very toxic
I was about to be given it in 2019 for my atrial flutter, but my ablation came in time so I wasn't given it. I found a large online study that looked at its safety when used differently from the way it was in the past, i.e. in a much lower dose and with suitable safeguards. If you search "Amiodarone low dose safety" (without the quotation marks) you'll find the study.
Steve
It’s a horrible drug and really messes up the thyroid. It should be banned. The medics say it won’t cause issues at low doses but it does. I have both permanent AF and hypothyroidism. I would rather have AF than hypothyroidism. It totally ruined my life where as AF just gets in the way a bit. I wouldn’t touch a thyroid damaging drug with a barge pole.
thanks for the reply - super useful - re amiodaran - did you go blue or grey and do you have to never go in the sun - i read this and researched it and declined taking it and stuck with flecanide and a second cadioversion. However, I guess the doctors are going to say take amiodaran as it increases the chances of staying out of af and that is a pre requirement for me to get ablation. Incidenty, today the doctor rang me and said my BNP test was nearly 2000 so heart failure is the biggest concern now as the stats on mortality rates are grim reading. Do you know anything about this?
I don't know anything about heart failure. I have not taken Amiodarone and never would because of what it does to the thyroid. waveylines in the thyroid forum (and she might be on this forum too) has had an ablation and was put onto Amiodarone despite her misgivings and she has suffered greatly from it. It takes months and months to leave the system too. If you can find her, go to her profile and read up on her resent posts about what happened following her ablation.
what affects does hypothroidism have on you
Everything! I have no energy, no stamina, get exhausted if I try to push myself. It made me depressed (but I am on enough medication that I can mostly avoid this symptom now) but I remain in a low mood, anxious, miserable and unable to partake in most of the things I loved to do in life. It also filled me with fluid and gave me terrible weight gain that is impossible to shift. My gait is wrong and I walk very slowly. My legs hurt unbearably and my feet are suffering neuropathy. I would not wish it on my worst enemy.
i am so sorry to hear that - was the cause of this a side effect of the amiodaran?
I wasn't clear enough. I have never taken Amiodarone. But I know someone who has taken it recently, following an ablation. This woman is also hypothyroid, long before the Amiodarone, but it completely messed up her thyroid numbers and her treatment and left her quite poorly for months.
For anyone who has suffered by taking a drug, it must be awful and the idea that it should be banned seems a totally fair reaction. But for those who don't get the side effects, and who find the drug helps them, their view would surely be different. I had the most horrendous long term reactions to two lots of tablets back in the early 2000s and I felt much as you do about amiodarone. Looking online, I found many others who agreed with me - very many. Indeed, there was a website set up specifically for this. And yet those same drugs are very widely prescribed still today and are, I can guess, helping an awful lot of people.
I can't speak from personal experience of amiodarone, only that had I been asked to take it then I would have wanted to discuss it in detail with my doctor. The study I found online and referred to above seemed a very good one, and was comforting. There are many here who have written in with good comments about the drug, and certainly others who have had a bad reaction to it. It's big negative for me is the very long time it stays in the system. It seems from my reading that all anti-arrhythmic drugs do, however, carry many more risks than rate-controlling drugs like the beta-blockers, and that amiodarone is unusual in not having any potential pro-arrhythmic side effects, unlike some others.
Steve
good points well made - however, i think some drugs are more toxic than others eg amiodaran I remember had 50% having some side effects and that is a lot. I think if it were a choice between serious health issues and this drug was the only one that could help I would take it. My major issue if heart failure and I am not sure how much AF affects this? It is the left ventricle possibly not working and therefore less of a hormone produced in the ventricle that show the ventricle is not working. That is what the raised BNP value is however, I had an ecocardiogram when my BNP was 900 and the structure of the heart was fine but now 1800. I think this chat board is very useful
I wouldn’t want to take any drug that worried me without my doctor’s explanation of why I needed it. “First do no harm” is the first part of the Hippocratic oath which, even if doctors no longer swear to it, is still their credo.
There’s a good chance, too, that each of us has a clinical history that is different from any other and this could mean that one drug is better for one person than for another.
The internet can also be a poor source of information as it pools individual data from a vast geographic area into a single place and can make something seem meaningful when it might be anything but. It also attracts negative rather than positive comment by the nature of these things.
Steve
agreed but I always have a filter on that I try to detect BS or quackery
Same here. I was thinking about what my consultant said when we discussed amiodarone treatment back in 2019. I recall that he was cautious and even downbeat about it but did say that it was the only choice for patients with a wide QT segment on their ECG which, thanks to my persistent atrial flutter at the time, presumably meant me. This was why, back then, I couldn’t take flecainide or sotalol, leaving only third line drugs. Thankfully my ablation came along really quickly so I ended up taking only bisoprolol, digoxin and rivorixaban.
This might well be the reason, therefore, why the drug is used in some people.
Steve
so did you ever take amiordaran? The docs say i have to take it before having a cardio version and the amiodaran is designed to keep me out of af for time and then they will do an ablation
I did say that I hadn’t taken it as my ablation came along before it was needed.
I think it’s commonly prescribed in the run up to a cardioversion or ablation by some doctors. In those uses it’s likely to be a safe drug but a long chat with your doctor is called for, I’d say.
Steve
what dose of amiordaran did you take if you don't mind me asking? I know the doctors are going to suggest it to me and I am worried about it and your super useful posts reinforce that concern so were you on a low dose?
update - I have seen my doctor and I have said that I have atrial fibrillation My BNP test that indicate risk of heart failure was 800 and is now 1700. The stats I have looked at are grim eg 80+% chance of death within 10 years and 50% for 5 years ( at around 2000 BNP near my numbers). Does anyone know if there is a treatment to lower BNP to under 300 the safe limit or is there a surgical/medicinal treatment that could be used? Maybe I am on the wrong thread so posted this as a separate general one as well. This is not about wegovy but someone might know about this as it is heart related ( a weight loss drug semeglutanide??) thanks M
Hello. I'm responding with regards to Amiodarone. With preexisting hypothyroidism it is contrary Iibdicated, though it can be used on occasions if no other option. For me it messed up my thyroid hormones because Amiodarone lower uptake of thyroid hormones at peripheral (cellular) level. Meaning you cant absorb them as well. This meant I had to lower my dose to 25% of my usual. Now 6 months onI have improved but still only on 65% of my usual dose. Amiodarone takes months even years to fully leave the system.
Re your Afib. You really need to see an Eltrophysiologist (EP). They are cardiologist who specialise in the electrical circuits of the heart. Atrial Fibulation is really an electrical fault. So to find out what is best for you this is who to see. A general cardiologist won't really know.
I would do this before considering any private treatment.
Re diet pills. I'd be very careful. Diet pills really should come with a big warning attached of "danger!" They can cause further stress to your body, including your heart. Given you have Afib I wouldn't take them tbh. You beed medical advice first before considering these tablets....
Healthy eating and regular exercise, step counting is the long haul but the best way. Any surgeon or EP would promote weight loss if significantly over weight as it reduces surgical risks. Whether weight loss would improve your Afib is another debatable matter....lol.
Hope this helps.....
I had an ecocardiogram from a cardiologist and it was fine eg the structure of the heart and my BNP was 1000 and now 1800 and I think structure may be ok. I think if the issue was a structure one I would have had it spotted but worth doing again but waiting list is long although I can spend £400 and get it done privately asap. I believe the issues with heart failure and the BNP elevated value is the left ventricle not functioning properly and would that be electrical? I have seen diagrams the heart failure example of the left ventricle is different physically in shape than the non heart failure one. It is a complicated thing and delays in seeing specialists and scans is a worry.
I think your point about it not leaving the system for a long time and the side effects being almost reversable are super useful to know
If you've been diagnosed with Afib, that is an electrical fault. It often causes a fast heart plus erratic heart beat. It can come and go. But yes it is progressive if not treated. For many people drugs can manage it well. For some like me drugs helped for a while but I needed surgery.....I had a cardiothorasic Ablation....key hole, 6 months ago and been in NSR since. But this is a major intervention and at the moment you need a proper assessment. . You need to see an EP because they can assess you. I would mot spend money on more diagnostic tests. See an EP and get him or her to assess you.
wegovy is Semaglutide a weight loss drug like ozempic
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