Update on Covid/AF

[Fight-the-good-fight]

Hi all,

Last week I reported that despite my daily dose of medication (60mg x 2 Diltiazem) I was consistently going in and out of AF due to COVID.

I increased my Diltiazem by 60mg as (PIP) to try and eliminate/reduce the episodes. However, I found despite helping, this was exacerbating my AF - episodes lasting 10 to 12 hours.

Even taking 2x 60mg was causing AF episodes…

On Friday, I reduced my Diltiazem dose to (1x 60mg ) taken morning only. Since then, I have had no further AF episodes, my HR is averaging 63 my BP is averaging 114/71.

What is going on? I am waiting to speak to my arrhythmia nurse, plus I am taking my anticoagulant as normal.

PS, I am still testing positive for a ‘high viral load’

Thanks for listening-still trying to come to terms with AF…

[Buffafly]

Maybe slowing heart has left space for arrhythmia to jump in?

[Fight-the-good-fight in reply to Buffafly]

Hi Buffafly,

Thanks for your suggestion.

However, my AF episodes always result in high HR.

During (Covid) AF episodes, my heart rate was consistently in the mid to high 90’s that was with regular medication.

Speaking to my arrhythmia nurse this morning-she advised me to stay on 1x60 mg diltiazem if it works and my HR, SR and blood pressure remain normal…

[mjames1]

Diltiazem is primarily a rate control drug and therefore mostly intended to keep your heart at a safe rate during an afib episode -- and not intended to convert you to normal rhythm.

What you describe may simply be coincidence, or if your heart was already below 100, it's possible the extra Diltiazem made it more difficult to convert by lowering the rate too much, or by some other mechanism.

Personally I used to find it easier to convert around 100 resting rate than say 80. And therefore titrated my diltiazem accordingly. But that's just me.

Later I used a true anti-rhythmic medication called Flecainide. That always converted me within one to four hours.

Glad things finally worked out, and you found the right dose.

Jim

[Fight-the-good-fight in reply to mjames1]

Thank you for your response Jim.

Going forward, I will be tested to establish if I am a suitable candidate for Flecainide!

[Ducky2003]

I'm going to echo Jim here as I'm on Diltiazem and it's for rate control. I'm on Amiodarone for the arrhythmia.You have my sympathy as I had a cardioversion a month ago after going into AF again following 2 blissful AF free years. Cardioversion successful but got Covid as an unwanted gift.

I was terrified I was going to go back into AF but, thankfully, I didn't. It took almost 2 weeks to test negative.

[Fight-the-good-fight in reply to Ducky2003]

Hi Ducky2003, Thanks for your response.

I do hope your AF continues to settle.

I have been offered cryo-ablation. In the interim, I will be tested to see if I am a suitable candidate for Flecainide.

I must admit, I do not want either. For the moment, if I can keep my HR below 70 - I could possibly tolerate the irregular rhythm.

I continue to test positive for Covid. However, since dropping Diltiazem doze from 120mg to 60mg per day my AF appears to be under control. Coincidence? Maybe, but I am sticking with this for the foreseeable.

Take care…

[Buzby62]

I’ve read that covid can cause AF in people that don’t suffer with the condition, in my experience covid always triggered multiple AF episodes in the early stages of the infection. Without the infection single episodes always reverted and I was free of AF then for weeks. It may just be coincidence or that your infection is subsiding even though you’re still testing positive. Hope you’re clear soon.

Best wishes

[Fight-the-good-fight in reply to Buzby62]

Thanks Buzby62,

The Covid test line is gradually fading, but I still feel incredibly fatigued.

It may be coincidence that my AF has reverted to NSR despite dropping Diltiazem dosage…

Awful, disease and awful AF…

Wish I could feel like my old self again.

Take care.

[Ppiman]

The rate reducing drugs like bisoprolol and diltiazem won't help the atrium directly, only the ventricles, keeping them from responding to the upstairs' chaos and allowing them to beat at a somewhat more normal and useful rate. I have also found that doubling my dose of bisoprolol a month or so ago, has, like you had found, increased my palpitations and AF frequency. Today I have reduced it just to see what occurs and I am awaiting a call from my doctor to discuss this.

It is true that slowing the ventricles does seem in some people to calm the atria and thus stop the AF, but the reason for this is unclear - hence, I suspect, the frequently prescribed increased dose of rate-controlling drugs, to see what happens with the fingers crossed that it might work. An overly slow heart, however, is, I gather, more prone to ectopic beats (as we both seem to have discovered).

Steve

[Fight-the-good-fight in reply to Ppiman]

Hi Steve,

I discussed remaining on the lower dose of Diltiazem with my Arrythmia nurse.

She told me to “carry on” unless my symptoms change.

The dosage is generic, and “no one size fits all” you adapt the dose to suit.

Pre -Covid I was suffering from ectopic beats, plus the frequency of nocturnal PAF was increasing since I started taking Diltiazem.

I have in the last few days reduced my Diltiazem dosage from 120mg per day to 60mg which I take in the morning.

So far, so good - no ectopic beats, or AF episodes. HR and BP remain normal.

I appreciate, it is early days, and I continue to test positive for Covid.

Fingers crossed this works for me.

Good luck, hope your GP agrees with the reduction of Bisoprolol.

[Ppiman in reply to Fight-the-good-fight]

I wasted to self-adjust but to avoid an overly slow rate, hence my description. I was going to ask my GP but in the end thought I'd see what happens as I feel sure I am doing no more than advised.

Out of interest, I asked my specialist if it wouldn't be better to change to a Ca++ blocker from bisoprolol since it wasn't seeming to do much for my ectopics but he absolutely said not and that, if it could be tolerated, bisoprolol was far better. I'm interested that your specialist sees things differently. What have you been told, can I ask?

I tested positive for over a fortnight, whereas my wife as clear after a week. Two neighbours were still testing positive after a month. I gather if you have been vaccinated, though, there's a chance of testing positive longer even though the virus itself has gone.

Steve

[Fight-the-good-fight in reply to Ppiman]

As an add on-have you ever tried acupuncture? Apparently, it can help AF by modulating autonomic nerves.

Neiguan (nay-gwann) pressure point found inner arm near your wrist…

[Ppiman in reply to Fight-the-good-fight]

I have read recently of that and it is in my thoughts despite my history of failure with alternative therapies. I can't help being sceptical, partly by nature and party my love of science - but I have also tried so many over the years (and at no small cost...).

Coincidentally, a friend of my son's was recently espousing the benefits to me of magnesium and diet - fervently so for both ectopics and, as it happens, insomnia (my bete noir). I asked them if it was so good why they still suffered so badly from AF, palpitations and... poor sleep? I suppose it wasn't a very tactful question, but it seemed a fair one. The reply was how much worse they were sure they would feel if they didn't follow the diet and take the magnesium. That seems odd to me.

Steve

[Fight-the-good-fight in reply to Ppiman]

I am kind of with your thought process on alternative therapy. I tried ‘Bowen Therapy’ similar concept to acupressure. The result was full blown AF lasting some 10 hours.

I asked my Arry nurse about taking a magnesium supplement. She said “it would do more harm than good” besides, my magnesium level is normal.

I also asked about electrolytes (same response)

She said by all means take a multivitamin supplement if I want to.

My diet is healthy but not obsessively so.

[Ppiman in reply to Fight-the-good-fight]

I think you have an unusually good arrhythmia nurse!

Steve

[Fight-the-good-fight]

Hi Steve,

Initially, I was prescribed 1.25 mg Bisoprolol once a day and amlodipine (5mg) to lower my BP.

I could not tolerate Bisoprolol, even the lowest dose was reducing my HR too much (high 40’s low 50’s) i was like a zombie and ectopic beats were uncomfortable.

I then switched to Nebivolol, but I encountered the same reactions.

In October last year, my Cardiologist recommended Diltiazem for both HR and BP. He advised me that Diltiazem would not lower the HR to the same extent as Bisoprolol. I wasn’t bothered, at least I could function normally. (60’s).

That said, in hindsight I do believe the (60mg x 2) of Diltiazem was too much. My abstention from alcohol, caffeine and salt reduction has possibly further reduced my HR.

Still feeling Covid fatigued, we picked the virus up at the airport. A (petri-dish) of germs!!

That’s interesting re the vaccine and testing positive for longer. A month for your neighbour’s 🤦‍♀️.

Take care.

[Ppiman in reply to Fight-the-good-fight]

I’m going to ask about the bisoprolol as my heart rate can drop even more than yours and the ectopics are really hard going - especially when doing anything like trying to put the bean fence up this afternoon! 😳

I have a suspicion that I’ll be told that the beta blocker is needed and an ablation for the AF and atrial ectopics is my next step. An arrhythmia nurse did once tell me that the main use of PMs in AF patients was to allow bisoprolol to be continued… .

Steve

[JOY2THEWORLD49 in reply to Fight-the-good-fight]

Hi

Sorry not 47mg but 47 H/Rate at night.

Dog wanted to go out as she had just awoken 7am NZ time.

cheri JOY

[JOY2THEWORLD49]

Hi

Stick with what is seeing you through COVID.

I'm sure everything will get back to normal!

I take moderate release Diltiazem 120mg. It sees me through the day but my night H/R is 47mg avg and it doesn't interfere with that.

cheri JOY 75 (NZ)

Diltiazem helps the anti arrhymic response.