I have had Paroxysmal AF for past 18 months. My Cardiologist referred me to Electrophysiologist who recommended an ablation on my initial visit, which he performs himself. I declined for the moment (I’m in US, and my high deductible insurance is such that most of the cost would be mine) and also wary of medical professionals possibly lining their pockets with unnecessary procedures. For now, ES put me on Verapamil 120 mg 1X/day - a calcium channel blocker. However, I’ve had 4 more episodes since I started taking the meds in June, lasting anywhere from 12 hours to 2 days so it doesn’t seem to be working for me. My question is does this type of medication work for others here to stop their PAF?
I have a follow-up appointment in 4 weeks so I’m contemplating what my next option should be. There are no other lifestyle changes I can make to help improve my situation, so I may eventually go the ablation route but don't like jumping into this without thinking it through.
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moleman37
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Verapamil is a weak anti-arrhythmic and serves mostly for rate control. Ask if you qualify for a class one antiarrhythmic such as Flecainide. Either as a pill in pocket (pip) or in your case, perhaps on a daily basis to prevent the episodes from happening.
Agree. I'm on Propafenone 750 mg per day total. Not an issue with the bradycardia. The Calcium channel blocker is mostly to control the fast heart rate when in AFib.
Have you had a cardiac echo?
What are your potassium and magnesium levels? my PAF is well controlled with the propafenone and potassium chloride 20 meq three times a day and magnesium citrate (Magnesium Citrate 1,333mg) three times a day which provides 200 mg of elemental magnesium per tablet.
With this regimen magnesium blood level runs mid normal range as as does blood potassium level.
Levels of these measured in the blood do not necessarily reflect what the levels are intercellular. Both of these electrolytes are important for cell electrical stability and tend to calm cardiac irritability.
BTW I'm also on ÇPAP and monitor O2 Sat and heart heart while sleeping as well as wearing apple watch. I check my monitor tracings every morning. I use the O2 ring. Whole process takes only 1-2 minutes. Valuable information
I'm using CPAP nightly too and monitoring O2 on my Samsung Watch 7. I actually had more accurate O2 readings on my Watch 6, so thinking of getting the O2 ring now to fix that situation. Thank you for the tip on that!
Can you tell me if the Magnesium and Potassium were recommended by your doctor please and also what is the 02 ring and CPAP. I have a FitBit watch and thinking of getting an Apple as everything I use is Apple lol, what would be your opinion? Thank you x
I've looked them up for you. The O2 ring monitors oxygen levels. The CPAP machine forces air into a mask worn over your nose and/or mouth, in cases where people have sleep apnea. If you Google it there's an NHS article about it.
Thank you, Jim. Yes, didn't know if my dosage is perhaps too low or another type of medication might be an option as you suggested. Thank you, very useful information that I will pursue!
Don't be scared into doing an ablation. My cardiologist and his nurse tried to frighten me into doing an ablation saying I strongly risk having a stroke without one. I went to another cardiologist affiliated with a major medical school for a second opinion. He said that I have no symptoms, do not need an ablation, and my risk of stroke can be controlled by taking Eliquis 5mg, an anticoagulant, twice a day, which I am currently doing. I recommend you get a second opinion from a cardiologist on faculty with a medical school in your area and who does not make his living by doing between 200 and 300 ablations in a year.
ES meaning Electrophysiologist (EP) ? Did the cardiologist cede your care to the EP ?
Reading your bio, you are 63 and have mild sleep apnea which you likely are aware can affect your afib.
I would encourage you to continue to research all options to treat afib with sleep apnea. Research other Cardiologists/EPs for opinions.
Suggest you call the prescribing doctor or his nurse of the Verapamil to express the concerns with the results even before your appt in 4 weeks.
At the relatively young age of 63 many treatment options should be available including ablation, maze procedure, etc. Also, you are likely aware at age 65 you will be eligible for Medicare which can alleviate cost. And hopefully, the progression of afib and sleep apnea can be controlled in the interim.
Interesting case, best to you and please keep us posted !
You are correct, I did mean to say EP. Yes, my cardiologist referred me an EP which was fine by me.
Thanks for the "relatively young age" comment and taking time to read my bio. In reading the posts, it's so helpful to get feedback from others who may have had similar experiences and can better understand the situation and mental exercises we all go through trying to treat (or to live with) this condition.
I take a total of 405 mg of Magnesium Citrate supplements/day - no Potassium but I'll look into that and potentially increasing magnesium, Thanks for that. Other than my annual physical blood test results have no idea what my potassium and magnesium levels are. You mentioned that levels measured in the blood do not necessarily reflect what the levels are intercellular - how do you measure that?
BTW, I did have a cardiac echo (I'm sorry I overlooked your earlier response).
Good decision. I think it is too early to go down the ablation route without more consideration of drug therapy.
The ablation decision is very individual depending on a number of factors. One the medics use in favour is that the younger you are and earlier into the AF period the better chance of success. I am sure there is some truth in that but I think this opinion is outweighed by the risks of the procedure, the chance you may have to stay on the very same drugs afterwards and the hope that the procedure improves as science expands.
You also mention 'there are no other lifestyle changes' to make. I would do more research here and elsewhere on that area, as some are less obvious than others.
My background: Offered an ablation 11 yrs ago by both my cardiologist and EP, requested an increased daily dose of Flecainide (medium, 200mgs) and with many many lifestyle changes I was virtually AF free for those 11 years.
Thank you for that response and hope I can have the same outcome as you!
I will go back and look hard on lifestyle changes - I believe I'm in a good position on the obvious ones (limit alcohol, heathy diet, exercise regularly and not overweight). I could sleep longer but my body will only do an average of 6 - 6.5 hours if I'm lucky. No major stress since I don't have to work for "the man" anymore, but I could work on that.
hello I’ve had 2 ablations , and had to stay on medication after for a bit that wasn’t treated , I’m on bisoprolol beta blocker / and flecinide anti arrhythmic , which worked for me for 13 yrs had no episodes , tried verapermil sent my heart rate up did not suit me , ask about flecinide, good luck , hope you find something that’s suits you
hello I’ve had 2 ablations , and had to stay on medication after for a bit that wasn’t treated , I’m on bisoprolol beta blocker / and flecinide anti arrhythmic , which worked for me for 13 yrs had no episodes , tried verapermil sent my heart rate up did not suit me , ask about flecinide, good luck , hope you find something that’s suits you
I was on verapamil for 7 years !! . Cardiologist who I saw privately told me that it had done me no good at all. (Apart from frequent constipation ) Now on Bisoprolol 1.25mg. Twice a day 12 hrs apart plus a load of vitamin supps as below.
Magnesium Citrate. 200mg
Coenzyme Q10
Vit K2
Vit D3
L Carnitine
Vit C 1000mg
Iron 28 mg
Iodine Supp
Note !! This just what I do and not from any doctors advice. Although one did say as I was leaving the office " just keep on taking those vitamins "
Anyway my afib is better now than it has ever been. Fingers crossed. And best of luck
My only side effect from verapamil so far has been a very dry & itchy scalp, so I had to switch shampoo's to the T-Fal brand and that helped to resolve. I will keep on it for the moment until I can potentially switch to something else but based on my results so far I'm not surprised that your Cardiologist found little value in it.
Hi there, I was diagnosed in July 2020 and had very symptomatic AF. My episodes lasted around 36 hours with a heart rate of 150 - 170bpm. I struggled with this and dreaded the next one happening, often without warning, but normally every 3 months, it was taking over my life and leaving me anxious and distressed.
I paid to see an EP privately (in the UK), a top Professor and an expert in his field. In an attempt to get the AF under control we tried Flecainide (gave me pro arrythmias) and Sotalol which I still take at the moment.
My EP explained to me that AF is almost always a progressive chronic condition that can never be 'cured' as such and it is like a 'jack in the box' the more it pops out the more it wants to pop out. He also explained that ablation was more successful the earlier it is treated, when paroxysmal, once reaching persistent it becomes incredibly difficult to treat and get under control.
I dithered and suffered and couldn't decide what to do, my EP explained the benefits and risks, but ultimately it could only be my decision.
The final conversation led me to agree to ablation which I had in March this year. The deciding factor? My EP said "Just imagine you have boarded a plane to Barbados and your AF kicks off and there is nothing you can do but sit it out at 30,000 feet for hours". That was enough for me.
My ablation was successful and although the first few weeks of recovery were a big bumpy, it is something I don't regret. I have had no episodes that I am aware of since, long may it continue.
Let us know what you decide, but bear in mind AF won't go away and the beast will get to you when you least expect it. Medication alone didn't work for me and the drugs are very powerful which I didn't want to take for the rest of my life.
I have read that it's a progressive condition and if doing an ablation, earlier is better in terms of positive results. I ultimately may make the same decision as you if med's can't help me. Still hoping for alternatives to any surgical procedure at this point since some on this message board have been able to do that. Happy to learn you had success with your ablation and I sincerely wish you continued good fortune with the beast.
I have had to go back to them as I was doing really well, but a lot of unhappiness came in our family, then I caught covid really badly in the summer and my Afib/tachycardia came back with a vengeance. So because of the tachycardia (up to 240 bpm at times) I was put on a high dose of rate control pills. Then my BP and heart rate dropped really low under 30 bpm and about 90/40. Kept fainting and going lightheaded and felt really bad so my husband called an ambulance when I had a bad fall and they took me into hospital
After a while of tests etc they decided to insert a pacemaker. That was last end august/beginning of September and I felt great. Back to normal and so well. After a couple of weeks they stopped all my tablets except the anticoagulant. I sailed through Christmas with ALL the family here for a week no problems except at my age (80 next week) I did feel a bit tired
Then last end february beginning March I had the covid vaccination and 4-5 days later I went down with Covid again and was ill with that plus post covid pneumonia for about 9 weeks. I would say I didn't really want the covid jab as except for first time I had bouts of Afib/tachycardia for roughly 4 weeks after each jab afterwards.
Anyway I was then back to square one with permanent Afib/flutter so back on bisoprolol and flecainide. I feel better for them, but since the covid I still feel tired and breathless and tight chest and feel as if I’m being strangled. Have to stop at least twice going up the stairs, but without my trusty tablets I would be much worse. My EP says it’s the Afib, but my GP seems to disagree
After all that long screed which I apologise for I do hope you feel better soon.
You could try and switch to Flecainide as a rhythmic control drug. There comes a point in time where drugs stop to work and you have to consider an ablation. From my knowledge ablations work better for people with PAF than those with permanent AF.
Yes. Cigna denied coverage for the Wolf Mini Maze in Houston, so I had the Wolf Ohtsuka Procedure in Tokyo performed by Dr Ohtsuka who is a protege of Dr Wolf. Self pay in Tokyo is a fraction of the self pay charge in the USA.
There are a few things not mentioned so far which might be worth considering. Lying on your left side is a common trigger, if you are a side sleeper try sticking to your right side. Alcohol may be a factor, try abstaining for a period and see if it helps. Likewise coffee. Also try what's called vagal manoeuvres. Take a deep breaths and bear down, this can stop an episode in its tracks, as can slow deep breathing. Good luck, and if it comes to having an ablation, I have had two which improved things enormously. I was in my early 70s and it was no problem at all. Research a good EP with a strong record, and not cash driven!
Hah, I am a side sleeper (not as easy using a nasal pillow). I read that too, so I fall asleep on my right side but occasionally roll over to left side at some point! Tried cutting out alcohol and coffee, but didn't help (to my relief, especially on coffee!!). I don't drink much of either though anyway.
Nice to know the ablations helped you so much. Thanks for the comments, it's all good.
I've been on quite a few meds for my a-fib, but Verapamil was the worst. Everyone is different, of course, but I never knew if that one worked well or not because it left me so zombie-like I almost lost my job at the time. My heart rate was so low I'm surprised I was able to keep my head up. There are other medications out there that might do a better job for you. I too am in the US and after I changed electrophysiologists, I had much better results with recommendations.
Verapamil has been the only medication I've been on so far - hope it turns out to be the worst for me too since it hasn't helped my case!! Hopefully I can at least try flecainide or something else.
I think changing EP's is a good idea - this one had very high ratings online so I went to him first.
I am an 82year old retired nurse anesthetist. I developed paroxysmal atrial fibrillation end of last year. Every episode got worse and worse; had three visits to the emergency room. First they started me Eliquis – very expensive. Then they started me on Diltiazem - which interacted with the prednisone I take for another condition. That made my ankle swell him and did not stop the episodes. Then they added Flecainide 50mg twice a day. That was successful enough, except it and gave me so much wind. I was miserable every day. I even went for a complete small bowel series under fluoroscopy, because of this, to rule out any other condition. It was normal, so I unnecessarily underwent a procedure just because of the flecainide.
I elected for a post field ablation last April. I am very happy with the results. I don’t even have to take the flecainide and don’t have that awful gas. I will be on Eliquis for a while, and it most likely will be stopped after my next two Zio monitors are clear.
I went to Dr Reddy at Mount Sinai New York. He is a researcher and has a lot of experience with the pulse field ablation. The reason why went to New York was that my local hospital did not want to put me to sleep because I’m high risk. I have pulmonary issues due to scoliosis. Procedure can be done under sedation, but my case required general anesthesia because of my pulmonary issues I would do it again in a heartbeat.(great pun)
Medicare paid most of it. By the way, doctors are not making a lot of money with Medicare patients as Medicare reimbursements are rather low.
NB: don't fall hitting your head, while on Eliquis. You can have a fatal brain bleed.
I may have to try out a number of medications to get the best results for me, so thanks for that.
Pleased to know your very happy with ablation results. I'm still 16 months away from qualifying age for Medicare - given how much I've paid into that system over the years I was working it would be nice to wait till then to minimize my out-of-pocket costs for ablation however my health and quality of life have to be considered too.
My cardiologist told me to stop drinking all alcohol almost three years ago and (knock on wood) I have not had an Afib episode. I do take Metoprolol and Eliquis. Best of luck!
Interesting results and great to know the meds are also working for you SEARCHER2024.
I stopped alcohol completely but still had episodes... so I went back to having a beer or glass of wine maybe once a week. When I do imbibe, I haven't had any episodes for weeks sometimes, so my conclusion was that it's not a trigger for me. I wonder if there could be a delayed reaction as opposed to immediate cause/effect though.
I see someone mentioning magnesium here so maybe worth mentioning I took Solgar magnesium citrate for two years and didn't have one Afib in all that time. There are other magnesiums but I chose citrate because I suffered constipation and a lifetime of insomnia, it was magic! Everything cleared up, no more AFib for two whole years, but then sadly I had a bout of AFib, I suppose I no longer needed magnesium. I still get an occasional bout but a dose of liquid hawthorn made up by a local medical herbalist, or an emergency valium and bisoprolol deal with that. I've had AFib for a good few years but no one has ever suggested I have an ablation. Of course, here in the UK I wouldn't have to pay, and it would only be done if really necessary.
I am on flecainide (rhythm control), bisoprolol (rate control) snd apixaban (anticoagulant). All was going well since 2017 until I had two bouts of bad covid and post covid pneumonia setting off my heart rate being under 30 so had to have a pacemaker. I was stopped the flecainide snd bisoprolol keeping on the apixaban and things had sort of gone back to normal until I got covid again despite being sooo careful.
Anyway my point is flecainide with bisoprolol were my miracle drugs
Look, AF does not get better as you get older, it gets worse, no matter what medication works for you. The more episodes you have, the more at risk you are for heart failure. At 50, when diagnosed with AF, I was put on diltiazem, then digoxin, then higher doses (and these meds zapped my energy and had other side effects like constipation). Still having 3 to 4 bad episodes per year that required hospitalization, I ASKED for an ablation. (I am in the US). I had an ablation in November 2018 and have been AF free since. Ablations are NOT a cure, but an improvement in the quality of life and a way to keep my heart as healthy as possible. Ablations also tend to be more successful if y0u have them sooner, rather than later. If AF comes back, I will have another ablation if allowed. I know that the day will come when I am much older that my only option will be medication when/if my AF comes back, but until then, I want to live my life to the fullest. Good luck to you!
Thank you for sharing your experiences, Madscientist16.
I received many responses to my post, many here (like you) have had positive experiences with an ablation. Others seem to be coping with just medications. It's sure given me a lot to think about.
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