In 2019 I had Open Heart Surgery twice in the space of 11 days to fix an Ascending Thoracic Aortic Aneurysm. Spent a month in the cardiac unit and that's when I first developed Afib. Before that I actually had Bradycardia, strangely enough. I was put on a high dose of Amiodarone for the Afib. Got discharged and readmitted with Pneumonia 4 weeks later. This time I had severe Afib due to the infection. Cardiologist decided to ween me off the Amiodarone and put me permanently on Bisoprolol. At the end of 2019 I had another infection and got readmitted this time I had Tachycardia.
Ive had the full set of rythm issues.
Beginning of last year I started getting Afib again .but my heart was going rapid just irregular. My GP noticed it as well and referred me to my Cardiologist. They done an ECG and gave me a 24-hour heart monitor but as luck would have it nothing showed up. Cardiologist reckons that because they've put me on so many tablets since my heart surgery to slow my heart rate, Bisoprolol, losartan, Aspirin, Artovastatin, plus my other medication that's why I'm getting Afib/irregular heartrates.
Im getting the Afib again and more frequently. I'm not really sure what to do. Because I'm feeling I bit guilty like a time waster when nothing shows up the exact moment they check me over. I can't produce an Afib to order.
Im only 56 and a healthy weight.
Written by
cjbroon
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Sry for your issues, encourage you to not worry as much as possible (easier said than done). Your relatively young age (56) is a positive to win the battle.
From what I have read, not uncommon to develop afib after heart surgery. Would be good to ask for a medical device heart monitor that monitors for a longer period than 24 hrs. Zio patches are great if available in the UK.
And consider investing in a Kardia, Wellue, or Apple Watch.
Because I'm feeling I bit guilty like a time waster when nothing shows up the exact moment they check me over.
This is a very common, yet unfortunate situation. What you need is a home event monitor like the Kardia or Apple Watch..
With either of these two devices, you don't have to worry about not capturing an Afib episode during a set period of time. But when the episode eventually does happen, you can easily take a medical grade EKG to document the event. That EKG then can be emailed or shown to your doctor.
I had AF after my aortic dissection open chest repair, or rather, my old AF returned. Yes, about 30% of open heart surgeries, whether aortic, cardiac, CABG etc., wind up having post-operative AF. Usually, a limited period on Amiodarone works, but not always, and yours appears to be one such case.
Beta blockers are the standard first-line approach, but are most used in those of advanced years with structural heart disease and whose AF produces rapid heart rate. They are used in the "rate control" strategy. The other strategy is "rhythm control" where more truly anti-arrhythmic meds (including Amiodarone) are used to try and return you to normal sinus rhythm. There is good evidence that rhythm control has benefits (assuming it works) in that your heart is under much less stress when it is beating normally.
So you've got two things to consider, in my view. 1. Rate or rhythm control, then finding someone to take you down the chosen path, and 2. getting enough data to show that doctor so they can help you.
Re. 1, I am a firm believer in rhythm control (my own AF has always been "symptomatic" as they understatedly say, i.e. ruddy awful), though it's not always easy as you have found. An alternative proper anti-arrhythmic med to Amiodarone is Flecainide. It can't always be used, but an ECG and an echo will tell the doctor whether it's suitable for you. The other option, especially if anti-arrhythmics don't work is an ablation. Either way, if you want to go the rhythm control route, you probably ought to find an Electro-Physiologist (EP), a cardiology specialist in rhythm disorders. Because of this they sometimes have a slightly different view on matters.
Re. 2, others have suggested the Kardia and Apple watch. They are both well-accepted, but as episodes can catch you at odd times, anything that requires you to actively trap the episode will inevitably miss things. I'm not familiar with these but one I am familiar with is the Wellue 24 hour monitor which you wear like a Holter and you download afterwards. This will simply catch whatever happens including whilst you're asleep.
You're definitely not a time-waster, and you should know that it is important to get to a solution that suits you and your lifestyle. If that involves rhythm control, the sooner it is dealt with the better, since AF can tend to just get worse over the years. If anti-arrhythmics don't work, then ablation is becoming a preferred first-line treatment, and we know that ablations are more successful when the AF is still paroxysmal, i.e. treated early. An EP will give you good info on all this.
One final point, there are cases where beta blockers will tend to trigger rather than suppress AF. This is the class of "Vagal AF" which tends to occur in younger, fitter people, who may have a naturally low heart rate (e.g. athletes), and whose paroxysmal episodes tend to start at periods of low heart rate, such as at night, after large meals, in recovery after exercise. Beta blockers are great for slowing a fast heart rate down once you're in AF, but if you have paroxysmal vagal AF they produce the slow heart rate which can trigger an episode. This info goes in and comes out again of the international guidelines on AF and seems not to be well-known amongst many non-specialist doctors. I can personally vouch for it from a 30-year history of vagal AF.
p.s. have just read your biog. So sorry to hear about your brother, but glad to see your own aneurysm got spotted. I dissected with my ascending aorta at 4.6 cm, and I can assure you that an elective operation is much preferred to an emergency operation. Check my bio for links to our charity Aortic Dissection Awareness. We have quite a few bereaved relatives there, and a support section for them, if that ever became relevant.
Funnily enough before any of my surgeries my Cardiologist actually said i had Bradycardia which meant I hsd an slower than normal heart rate. I've got it all the paperwork regarding it because I had keep it,as my job decided to go down the medical retirement route after thd surgery as I was a front line Police Officer.
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Amiodarone as pill in pocket
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