I see such a variety of meds for afib. I wonder if people will disclose what they are taking, maybe in this format. I've given mine.
I see such a variation in meds, mainly in quantity of rate-control drugs, such as Eliquis (apixaban).
I wonder about country, because it seems to me that people in U.K. get far better attention than us in the U.S.
I know that bodies react differently to meds, but in my case, I seem to be getting much less apixaban than others, yet my frequent low-50s pulse makes me think I'm getting enough. Yet maybe my frequency of afib is *very* frequent? I don't really know. My doctors are pretty laid back. "See my PA [physician's assistant) in three months," I am told by my cardio.
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Frequency of episodes: About 1 day in every 10 days
Typical duration of episode: 10 to 14 hours
Rhythm control: None
Rate control: Metoprolol 25 mg twice a day
Anticoagulant: Apixaban 5 mg twice a day
Lowest pulse rates often seen between episodes: Low 50s
Highest pulse rates often seen during episodes: 140s
Age / sex / weight / country: 77 / M / 160 / U.S.
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Corazon17
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I was diagnosed with paroxysmal AF in January 2010, aged 65. After about 4 to 6 months I found food to be a trigger and not withstanding medication chose to consult a Nutritionist/Dietician. At the time of diagnosis my Cardiac Consultant discussed ways forward with me but I outright dismissed any thoughts of Ablation. Clearly, I'm still alive now approaching 80 and have relied solely on a change of diet, eating times, food portion sizes and medication.
My medication started off as Simvastatin 40mg, Ramipril 10mg, and Warfarin as determined by my INR, and Bisoprolol 5mg. Around 2012 Felodopine 2.5mg was added to the mix.
I stayed on all meds except Bisoprolol which was changed to Nebivolol 5mg in August 2023. In November 2023 my GP changed my meds to stopping Warfarin and replacing it with Edoxaban 60mg ( against my better judgement - she had been trying to get me off Warfarin for ages and ages). Edoxaban gave me unsolicited and unwelcome side effects .... the most horrendous and vile nightmares ever resulting in massive loss of sleep and so I demanded I return to Warfarin ( I self test at home with my INR testing device and have no issues at all ). I point blank even refused to consider any of these other NOAC's. End of !.
My GP now leaves me alone in respect of Warfarin and I report to my INR clinic every 6 to 10 weeks and we now all get along well.
I did have some AF issues earlier this year while still on Edoxaban and consulted directly a new Cardiac Consultant ( of my choosing and at my private expense ) and he changed my medication - so currently my party bag of drugs is .............. Simvastatin 40mg, Ramipril 10mg - at the moment suspended for a week in an attempt to resolve coughing issues, - Felodopine 5mg, Sotalol 80mg ( taken at night ), and finally my old favourite Warfarin, as determined by INR. I also take Finasteride for a non Cardiac related issue.
Yes, it is for cholesterol. To the best of my knowledge it isn't used for AF. I was originally prescribed it some 3 years before AF kicked off. I was originally prescribed Ramipril at the same time. The Ramipril was in response to my blood pressure being high around 2007 when I was 63. As we know, high BP is recognised as a contributor to AF. I do not know at this stage how long I'd had my high BP, in those days I never bothered .... I guess I lived my life, back in the day, as if I had immortality.
So I think prescribing both drugs at the same age was a precautionary measure.
My last clearly identified, undisputed episode of AF was early 2020. Lasted maybe 18 to 24 hours ... can't remember accurately now. But that was it. I have had nothing since until early 2024 when my heart kicked off quite noticeably. It did feel very much if it was AF however, looking at my Consultants notes he states ........
"Hypertension, Paroxysmal AF, Peripheral vascular disease, Ectopics on holter monitor and Calcified coronary arteries but only mild coronary stenosis" and concludes it was ectopic activity but with no evidence of sustained atrial fibrillation. He has also had his cardiac CT scan performed which has shown calcified coronary arteries but no significant flow limiting stenosis ".
Of course my original diagnosis ( in 2010 ) was paroxysmal AF. The other feature of my situation is that it was identified very early in my AF career that I could at times be asymptomatic. It is this feature that has caused concern and has persuaded my medical team NOT TO stop / start my medication or to use the PIP approach. I don't mind being on drugs for the rest of my days on this planet. Just doesn't bother me. So because of being asymptomatic I can't accurately answer some of your questions because I just don't feel anything.
Yes I asked Urologist years ago should I keep taking..he said “up to you..bit of insurance policy” However he said finasteride needed to be taken with Tamsulosin…?All a mystery to me ..enjoy life
I think frequency and intensity of episodes is important.
I would like to know whether my situation is considered by most of this group to be acceptable -- that is, an episode every 10 days, with rates as high as 150, and lasting 10 to 12 hours without a pill-in-pocket rhythm control, but with an anticoagulant.
Have other people pushed for "doing better" or made to "do better"?
Maybe I'm not aggressive enough. My GP and cardiologist seem to think my case is not dire. Is it because the case is not dire, or maybe because of my age and "retirement" status? I put "retirement" in quotes because I don't feel retired at all. I work harder and have more stress now than I did when I was commuting 75 miles a day to jobs in Los Angeles. Work was an oasis of sorts. Now I deal hours a week with local political shit, U.S. political shit, stock-market shit, etc., etc.
I am broadly similar. You apixaban is for stroke prevention and has no there effects. Being n the UK, bisoprolol is the preferred beta blocker, but both are said to be broadly similar is effects. My heart rate and AF frequency are in line with yours, too - even the highest pulse rate, but that is more often lower these days, for some reason. I cope well with my episodes, tendon to rest until they stop, but more and more just press on with things.
When I had paroxysmal for 20+ years, once the right medication was found it was Flecainide 300mg a day. The reduced episodes to one or two ten-minute episodes a year. After 20+ years I was found to have persistent though asymptomatic, AF. I consider this to be permanent, though asymptomatic, AF. My only medication is Warfarin, dose dependent on INR, currently 7mg a day.
I take no other medication for AF. I was offered Diltiazem,a Calcium Channel blocker, but as my heart rate is in the normal range, I couldn't see a reason for taking it. I am asthmatic also, and take inhalers. I'm 79, male, and from the UK.
I was diagnosed with paroxsysmal AFib in 2014. I was given Sotalol 80mg twice daily and Edoxaban 30 mg once a day and I’m also on Atorvastatin 20mg once a day. I was having 1 to 3 episodes a year.
I had an ablation in September last year, but am still taking all these drugs, although the Sotalol has been reduced to 40 mg . They tried to take me off Sotalol, altogether, but my blood pressure rose too high, so they put me back on it. Don’t know if they’ll ask me to try to stop it again. I will always have to take Edoxaban though and Statins. I am in the UK.
Thanks for the mention of Dr Sinatra - I've found nutrition seems to be important for managing my AF, so I'm off to have a read of his site for any extra info!
I’m in permanent AF, I’ve been discharged back to my GP. I had a CV at the being of the year but after two months went back into AF. EP didn’t recommend an ablation as I’ve been in AF too long and he didn’t think it would work for me.
I take 5mg Apixaban twice a day, Digoxin 62.5microg, Zemtard (Diltiazem) 180 x 2 capsules a day, Atorvastatin 20mg just started in May.
I can range from 33-180 in a beat, thank goodness with high and low I don’t feel any effects. I stay well away from alcohol, caffeine and try to eat a healthy diet, to date I’ve lost 5 stone and hope to lose a couple more. I feel I’m lucky as my AF doesn’t really bother me, sometimes I get a bit breathless and tired but nothing to warrant going to A&E touch wood and fingers crossed, and I’m coming up to the big 70 eeekkk.. 🤗
Apixaban is an anticoagulant aimed at stroke prevention and doesn’t affect the heart rate. That’s controlled (along with BP) by your Metaprolol. Doesn’t sound as if you need to fret, and I doubt if you’d get better attention in the UK!
Good morning from the UK.First of all,I would certainly regard an episode of AF every 10 days or so as needing intervention. The rate control medication is obviously not effective enough,and I'd asking questions as to why I'm not on anti arrythmia meds such as Flecanide( if heart is in suitable condition)
I’ve found that we need to be proactive, politely persistent ,vocal and to keep good notes ,also keep any emails or other information from your medics.
If the heart is structuring abnormal Flecanide should not be used. Neither because because he is pretty close to AF persistently. They call mine persistently but its permanent.
Flecanide is a risky med and sometimes it makes rythm worse.
Diltiazem as a rate control med is better but one can't have that if the Venticles are not working.
Caution as everyone is different.
Metoprolol is banned for me. Research are ?ing the safeness of it for stroke victims.
Ace meds should be stopped if they make you cough. My first hyper med was inherbace and I coughed and coughed so ACE meds are out for me.
Yes I know. Flecanide is a good drug but needs a good structure ,hence why checks are done,by cardiologist or EP,prior to prescribing. I think this person needs to ask if they are suitable, as clearly they are not doing well .xx
I haven’t had an episode for over a year and a half and that last short one was only around the time I must have been infected with covid with no other symptoms but a positive test- ended with an extra pip of Flecainide, so not exceeding the daily maximum.
I now take 50 mg of Flecainide morning and 100mg evening and as that seems to be keeping my heart in order I no longer take anticoagulants which messed up my digestion greatly.
That’s it apart from taking Omeprazole in hopes that my oesophagus will heal from the damage done as I have a hiatus hernia.
I have made it to 80 (and a half) and had well over 70 years of healthy active life before the shingles episode when the pain came before the rash and I couldn’t get an appointment when an antiviral might have prevented this and the chronic fatigue too! So not everything is better in the UK.
I have permanent low rate AF and because I could not tolerate any beta blockers, calcium channel blockers or any type of rate or rhythm control medication which all made me feel worse than AF and we tried lots of them individually and in combination during first year after diagnosis. Have been in persistent AF from diagnosis. Had 3 successful cardioversions, which kept me in NSR for 3 out of the first 4 years. Missed out on an ablation because of Covid lockdowns and Covid outbreaks in the Cardiac department of the hospital and after that as it had been such a long time since - 2 years since I had had scans etc it was found that my heart had remodelled itself and further cardioversions or an ablation would be unlikely to work - I was actually due an ablation in early April 2020 and lockdown started on March 23rd. I had to cancel the next one in September 2020 due to the death of my brother-in-law from cancer and then the closure of the department in the October.
I was lucky at the start of my journey to be able to get on a British Heart Foundation Heart Rehab course run by our local hospital and gym where we were taught how to get back into exercising slowly and safely at classes supervised by Specialist Cardiac Nurses and Physiotherapists. This was good for me as even though I knew I should continue to exercise like everyone I was frightened - especially with the breathlessness and fatigue caused by the beta blockers etc. I had always exercised - it had been my job for 37 years and I had been a semi-professional footballer in my youth so enjoyed exercise but found at the start the only thing I could do which felt right was walk. So glad this course was available as I still continue to exercise.
My average resting heart rate is in the mid to high 50s and watch that during exercise my heart rate does not go over 130. I have a very normal BP which my wife is very envious of as BP is on the higher side of normal and frequently a little too high and she often gets asked to keep testing herself and reporting to GP.
I am just on anticoagulants: 5mg of Apixaban twice a day.
Apix.... is NOT a RATE CONTROL but is an anti-co.agulant (Thinner).
Metoprolol 23.75 x 3 given for Rapid & Persistent AF did nothing but was reduced because I was breathless, fatigued and couldn't exert and the heart monitor 1 year 1/2 later showed 186 Heart Rate with 2 sec pauses at night. No thanx.
Changed by H Specialist to Bisoprolol but got up to 10mg with still no control of H/Rate 156. No breathlessness, slightly improvement when at exerting myself with no pauses at night.
Through all this my Low normal heart rate was 47avg bpm.
Left.
Went to H Specialist referred privately by new Locum.
Introduction CCB Diltiazem 180mg (1/2 dose). Taken AM H/Rate dropped to 51bpm in 2 hours! Taken Saturday.
Between our NZ Healthline & had a Dr speak to me and NZ Heart Foundation Nurse who knew my Specialist was rung Wednesday.
So took AM Diltiazem 120mg CD for H/Rate. Settled at 60s now 2.1/2 years now
Reduced PM BB Bisoprolol 2.5mg for BP as Systolic too high... " "
On PRADAXA 110mg x twice a day. My anti-co.agulant - a modern one.
I learnt that CCBs and BBs need to be separated.
My Night H/Rate remains at 47avg bpm.
I've had 3 operations since 2019 STROKE Embolic, Rapid (now controlled) & Persistent AF,
and Papillary Thyroid Cancer. So Thyroid problems caused AF which caused the stroke.
My AF has nothing to do with Digestion. Gall Bladder out year 2000 it had disintegrated! I have 2 clips.
I'm hoping that the AF might revert back to normal. 4th check found 2 lymphs 8mm & 7mm still with cancer. Also Thymus is being checked in November. Hoping PET Scan killed off the 2 ? Lymphs.
An abnormal Heart Structure with severe dilation of Left Atriummeans no cardiversion, no ablation and no anti-arrhymic med. Actually safer as a former med Diltiazem is acting like one.
I have had paroxysmal af for probably 15 years. Seems to be getting more frequent but am under more stress than usual. Once a month or so. It always lasts greater than 20 hours. Last one was 40 which is a bit much.. Had a couple of cardioversions but my specialist who I see one a year says that I should just wait before going ti emergency as it always stops itself. He has been right so far.
I don't take anything preventative in particular for af but take sotalol as a pill in the pocket until it ends. Never sure how much to take but usually 80 mg per 12 hours. I take bp pills and xaralto blood thinner.
Af does knock me around when I have it, know immediately so it is a huge relief when it stops. It does seem to affect me less now than it used to but I still hate having it...
Will see him in December and discuss ablation or other pills. It is difficult though since I have had periods of 18 months with no af and then generally 4 or 5 a year. Once a month is too much for me, would like to do something I think.
I guess I'm confused (my bad) when you say you don't think anything preventive in particular. Couldn't the b.p. pills also be performing as an anti-afib measure? (Like you, I think, I don't regard blood thinners as an af-preventive.)
Without those rate or rhythm meds, do you have a reasonable resting pulse during regular life?
Were those cardioversions electrical? Did you go to Emergency for them? If you drove there yourself, were you given the OK to drive off?
Antico.agulants are there to reduce risk of a clot only.
BP BBs, Ace etc block various elements from settling in your muscular heart against prevention.
But me with Rapid AF means with me 1st line should have been Heart Rate. I should have been moved to a different med when BBs proved not to control my heart rate. Metoprolol 186 Day, and pauses at Night (My normal h/rate 47avg bpm). And breathless and no exertion ability.Bisoprolol 156 Day but no pauses or breathless.
I see now Calcium Channel Blocker Diltiazem should have been my 1st line. It also has the effect of less pronounced arrhymic beat. Slow the rapid beat it fllows to reduce arrhymic symptoms.
Research are finally looking at BBs as 1st line. That would have helped me. I'm lucky to be alive with what I went through over first 2 years 2 months of AF diagnosis at Stroke, and at 4 days Papillary Thyroid Cancer.
My Thyroidectomy at 4 months post stroke had risks as heart rate would have been over 100. I was discharged at 135. No one rechecked. Asking the surgeon today, he said it is normal to be high after thyroidectomy! He reminds me as a General Surgeon he is not a Heart Specialist. But I had no follow up on the 135 H/beats at rest and I was resting 5 days post thyroidectomy.
In the operating room I had 2 anaesthetists and 1 Dr and the surgeon.
I have a good rappore with my surgeon. I didn;t gel with the Endocrinologist because
1. I said to NO to Metoprolol.
2. Tried to reinforce the Radio Active Iodine Treatmemt. I was low risk. I said No. March 2020 was the beginning of COVID and MEASLES epidemic in Auckland where I needed to go.
3. Suppression of TSH (overdose of thyroxine which is risky for my heart AF and age 70.)
So I stayed under Surgeon all the way. Sadly he is retiring in December. I have been recalled on 4th Ultra-Sound check last February. Had CI Scan and Pet Scan. MRI of Pituitary showing warm but ruled out.
Re CT Scan of 3 areas together but he thinks back lymph? is my Thymus. November.
Otherwise Pet Scan shows unremarkable meaning A1.
Above shows that we are getting through the cracks when Sugeons, Drs and my clinic did not check discharge papers
There was a mistake also in that my Triage team delivered a 110mg PRADAXA x twice day prescription but after being transferred to my local hospital this was put up to 150mg x twice day.
Without seeing a Dr only Therapists (2) on Monday and discharged Tuesday.
We should all write our stories highlighting the mistakes made.
I have been taking bp tablets 15 years before af occurred. My specialist added 2.5 mg felodipine recently. He obviously thinks the af is associated with bp. I agree but they not specifically for af like sotalol would be (being rhythm control and rate control).
I use Cpap which is specifically for af.
My rate has always been low, about 55, the meds haven't changed that, just need to watch they don't push it too low.
I went to emergency twice for af, they cardioverted electrically, probably to better their performance measures for emergency service. Of course I didn't drive. My specialist didn't think the cardioversion was necessary, he suggests I always will revert. He has been right. If he is ever wrong i will book in to hospital. The cardioversion were about 5-7 years ago, not recent.
I know bp and af are related but I don't consider bp treatment as solely for af. You can have bp treatment without it being because of af. I don't need rate control normally as my rate only goes mad when I am in af for which I take sotalol.
Yes. Its a state where you and your medics accept there is no more intervention. Some people here say its actually not so bad as PAF where you never know when it can strike. Anticoagulants of course though.
Apologies for random underlining...don't know why!
Permenant AF in my case, means my heart cannot be put in sinus mode, the aim is to control the beats to stay between 60 and a 100. I was on digoxin for 2 years before my heart decided to stay within the limits, my cardiologist said to get off it as soon as I was stable. Hope this helps you , I find more helpful info here than what the doctors seem to tell me. I know I am not alone!
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roughly in accordance with Dr Stephen Sinatras Metabolic Cardiology 
Ramdom flips from bradycardia to tachycardia. 
Drugs used to keep heart rate down.! 
Are beta blockers prescribed in paroxysmal AF without proper consideration?
Really low heart rate
Also Inspired by Paul's Post: beta blocker vs. calcium channel blocker
