cardio appointment

[babs1234]

I’m off to the first appointment with cardio consultant today I think to discuss ablation. I was very concerned last year as very symptomatic but since being diagnosed with sleep apnea and starting with the CPAP I’m feeling so much better even though still getting episodes. Last week. 9% the week before 2% or less the week before that 14%. I’m taking Bisoprolol as a pip if HR gets too high but have very rarely have needed to take it. I’m feeling dont fix what isn’t broken. Am I being silly or should I still go for it ?

[Buzby62]

You will need to discuss with an Electrophysiologist (EP), you don’t say if your cardio consultant is an EP, if not you may need to ask to be referred to an EP. The EP will assess if you are a good candidate for ablation and advise you.

Best wishes

PS page 4 of the AF fact file explains what an EP is - Link api.heartrhythmalliance.org...

[BenHall1]

For my money - I can't see the point in using Bisoprolol as a pip ! It is a medication for controlling heart rate with some additional properties that assist in controlling blood pressure. I opted for it for life back when first diagnosed 2010 ( age 65). I'm now 80, and have moved through a range of beta blockers ..... bisoprolol, nebivolol and now sotalol.

If you take Bisoprolol when your HR gets to high, then it'll eventually bring it down ........ BUT ... it won't stay down. It'll go ballistic again, later when it chooses.

So how high does your heart rate get at its worst ............. and whats it's normal range ?

[Bluetonic in reply to BenHall1]

some people are highly sensitive to Bisoprolol, like myself. When I am on it I feel dreadful , exercise is like walking through treacle, and my sleeping HR can go down to the low 30's bpm.

Most of the time without bisoprolol my resting HR is in the 55-65 bpm range but on occasion if I am ill with a virus or stressed my resting HR can go into the 100's.

So I have bisoprolol as a PIP for these rare events, maybe a handful in the last 7 years. Why should I take something every day that makes me feel worse? The drugs for AF are about QOL

In reply to babs1234 it'll be good to discuss with a professional , although I echo Buzby62, you really need to see an EP, or as my EP said, you need to see an electrician not a plumber.

But we do know that AF begets AF so it may be best to do something sooner than later.

All the best

[BenHall1 in reply to Bluetonic]

Yeah - I get all that. In the beginning of my AF journey in 2010 there wasn't much around and in those days the dark arts of ablation weren't worth considering - in my personal view at the time. Even in terms of medication it was just about Bisoprolol and Warfarin.

I opted for medication for life ... absolutely, no regrets. By Sept 2011 I'd got my heart rate under control ......... yeah, yeah, yeah I went through all the crap, heart rate suddenly dropping, mine often got as low as 44 ( at the time I was a 6 ft., 15 stone guy ) so a heart rate of 44 was not too good. But everything was under control.

Stayed with medication, still all totally under control although, as I've said, once every 4 or 5 years I have an AF breakthrough moment. Apart from that ectopics but since I've been on Sotalol these have significantly faded away. From my perspective my Bisoprolol, Nebivolol and Sotalol have simply and efficently acted as a regulator, holding my heart rate around 73 bpm ........ wish I could say the same for COPD and my breathing difficulties. Even so, when I go out walking/exercising and wind my HR up to around 120 ish when I take a break it soon drops down to the magic 73 ...... and hovers there.

Wot's not to like ?

[Peony4575 in reply to Bluetonic]

Completely agree re Bisoprolol

[Vonnegut in reply to Bluetonic]

Bisoprolol brings the heart rate down but does nothing about the irregularity which is part of the problem! Flecainide does that and 100mg works well as a PIP if you can take that.

[Bluetonic in reply to Vonnegut]

I know

[Cavalierrubie in reply to BenHall1]

John, it depends what your normal heart rate is. My average resting HR is 72. I take Bisoprolol as a PIP because l have fast AF with a heart rate of 120 to 150. It brings my heart rate down during an episode of AF and helps me back into NSR when my heart rate goes back to normal and stays there. My heart rate only goes up with AF so for me Bisoprolol is a must. I can’t take it regularly because l have low blood pressure and it lowers that too much. I think we all need to take the medication that we are advised to take from a medic.

[BenHall1 in reply to Cavalierrubie]

Hi Cavalierrubie,

Mine is about 73. I guess, up to a point it depends on a persons individual Cardiac write up when very first diagnosed. Mine included damage to the left atria which changed its size, therefore impacting on my hearts ability to function as per design (nothing to do with heart electronics ). To me it made sense to stabilise the beats. The other bad bit was to be told - in writing - I was asymptomatic. Also a feature that made sense to go with daily medication. Took the pressure of me - mentally. Just sit back enjoy the ride and let the drugs do their job. Simples.

[Cavalierrubie in reply to BenHall1]

Hi John, Yes, it’s all so individual and complex. I have never known a medical condition like AF that has the potential to “do your head in.” There isn’t two of us alike is there? 😂😂😂 Don’t answer that!

You have a nice day.

Chris.

[OzJames in reply to BenHall1]

John, my Cardiologist wanted me on low dose metoprolol full time not so much to lower HR as mine normally is 60-65, rather as he put it is to try and prevent the adrenaline spike that sometimes precedes an AF episode.

[babs1234 in reply to BenHall1]

The highest had been 178. That was last year. Usually around 140 ish. Normal about 70

[Auriculaire in reply to BenHall1]

Sorry John - this is just not true. If you have a perfectly normal or even low heart rate when in NSR but it goes ballistic during an afib episode - as does mine - then PIP is sensible especially if one is sensitive to the side effects of beta blockers. Why feel s**t 24/7/ 365 days of the year if you are only in afib for say a total of 10days? Bisoprolol will not stop the heart from going into afib especially if afib episodes begin as a result of bradycardia . In those case taking it everyday is actually counter productive.

[BenHall1 in reply to Auriculaire]

Fair enough ….. but that doesn’t apply to me, and never has done. I think I was fortunate in having my diagnosis and treatment determined 15 years ago and not in the current era. With AF outta my hair now at least all I have to focus on now is COPD, which is showing all the signs of being heaps worse than my AF ever was.

[Auriculaire in reply to BenHall1]

A good supplement to take for COPD is NAC - n acetyl cisteine. BUT this can have a mildly blood thinning effect . However as you are on Warfarin you should be able to adjust with your INR. I still take it despite being on Apixaban because it is very good for lung health and also for improving immunity against respiratory infections. It was recommended by our pharmacist years ago when I had a terrible cough and it worked really well. I looked it up online and found it had other beneficial properties and have taken it ever since. Since starting it in March 2016 I have had 2 respiratory infections one in Dec 23 and one in April last year. Not bad going. It has one unpleasant side effect. It makes your pee smell of sulphur!

[BenHall1 in reply to Auriculaire]

Hiya Auriculaire,

Thank you very much for that suggestion, I will get some - hopefully from my usual BioQ10 supplier. You are quite correct, I'm on Warfarin and have my own tech device that enables me to self test my INR and adjust my own doses. So no sweat there. Actually I do that anyway because sometimes Mrs BenHall1 gets carried away with her cooking and from time to time ..... historically - when my INR gets outta hand the reading always tends to increase. My normal theraputic range is between 2.0 and 3.0 - has been known to get to 3.5 or 4.0 ...... no sweat, just get on and deal with it. 😊

I've just checked it online looks ideal. Your personal track record with this is indeed brilliant. When you've had these two respiratory infections ..... have they lasted a normal or longer time than might normally be the case ... not important, just curious. I liked the bit about good for brain health - mentioned this to Mrs BenHall1 - she just gave me a look and rolled her eyes. 😱

Thank you again for your insight.

John

[Auriculaire in reply to BenHall1]

The one in Dec23 lasted about a fortnight in all. It was pretty bad and I had a fever which resulted in 3 episodes of afib in 4 days - unprecedented for me. BUT my daughter in England had what was probably the same bug, was ill for weeks and had to have 2 lots of antibiotics - I suspect a waste of time as it was a virus but she could not throw it off. She would not take the NAC as she was breastfeeding. I remember at the time people on the forum complaining about the cough from hell that lasted 100 days. I suspect she and /or the sprog brought the April 24 one with them or picked it up on the plane . It might even have been covid but I did not test. It lasted about a week and I had a headache as well which is most unusual for me.

A study was done where half the people took NAC before flu season set in. All were then innoculated with flu. The placebo group got flu the NAC group had no symptoms. I cannot say that the NAC is solely responsible for my track record. I maintain a very high level of vit D and I'm also not very sociable! I used to take 600mg a day of NAC but now take 800mg ×4 a week. I would start with 600mg and see if it improves your breathing. I have read you can take up to 1200/1800mg a day safely.

[BenHall1 in reply to Auriculaire]

our messages crossed .... thank you. nice late afternoon weather at last, just done a 1 & half mile walk in 30 mins ... quite done in. will try the 600 and see. y'know this damn COPD thingy is worse than my AF ever was ... mind you, my AF was diagnosed and treatment started in 9 hours from first onset.

[BenHall1 in reply to Auriculaire]

My supplier does a range of stuff ........... 300mg in a small tub of 90 capsules = £17.95, or 600mg at about £24.95 ............ need to research a bit more. Just wondering what dose you were accustomed to. Thanks.

John

[Auriculaire in reply to BenHall1]

That's steep. I get mine on German Amazon -a brand called Raibu, 200 capsules 800mg 19-95 euros.

[BenHall1 in reply to Auriculaire]

I did more research, went to Amazon Uk and ordered your brand, will arrive tomorrow, Sunday, priced at £14.90 for 200 of 600mg. Meanwhile I'm organising myself now, go to Pulmonary Rehab classes on a Thursday, based on their exercise plan I have organised their programme of exercises for when the weather is bad and I'm stuck indoors, and an outdoor walking plan for nice weather and am gradually building up my distances and times ........ times aren't the issue, its the need to walk for both heart and lungs is the thing.

Thanks again for your tips.

[Auriculaire in reply to BenHall1]

That's a good deal. Since Brexit ordering stuff from the UK is a nightmare as you might be landed with import charges and the postage is astronomical. German Amazon tends to be cheaper than French though they do charge a modest postage.

[Desanthony]

definitely still go to your appointment. Discuss everything with your cardio and if they are not an Electrophysiologist (EP) then ask to be referred to an EP and they will guide you best and it would be an EP who would do a cardioversion for you if you are a good candidate. Remember AF is a progressive condition and the earlier in the journey you get a cardioversion and then ablation - if you need it and it is suitable for you the easier it will be. You are usually given a cardioversion first and if that is successful in returning you to notmal sinus rhythm. (NSR) even for a short while then you could be offered an ablation. Good Luck.

[babs1234]

which was the new ablation people have talked about. I’m in the hospital now

[Buzby62 in reply to babs1234]

Radio Frequency RF (Heat)

Cryoablation (Freezing)

Pulsed Field is the newer method, uses energy pulses, neither heat nor freezing.

Best wishes

[babs1234 in reply to Buzby62]

Is this the one you gave to have GA ?

[Buzby62 in reply to babs1234]

Not sure if it has to be under GA but I think it usually is as they need you to be still.

If you put “pulsed field” in the Search HealthUnlocked bar here you will find lots of posts from other members.

Best wishes

[Buzby62 in reply to babs1234]

Best wishes

Check on screenshot to expand

[Hugheart]

Hi babs1234

I believe the question u are asking is whether u need cardiac ablation. My first question is what are you referring to when you list rates like 2%,14%. Are they % of AF recorded over a time interval referred to as AF burden? My second question is are you monitoring your EKGs for AF to determine the % and if yes over what duration do you experience AF?

My point is it’s important to know actual %AF over time intervals to know if your AF burden is decreasing, or increasing and if it occurs more than one week at a time and is it recurring up to or over a year. All of this is important to classify if you are experiencing short term AF meaning paroxysmal AF (PAF) up to 7 days and if it is more frequent for up to a year which is classified as persistent AF,

If you know you are having PAF rarely then the need for cardiac ablation is open to debate, some suggesting yes it should be done to prevent ongoing inflammation that ultimately leads to persistent AF with anatomical changes in the heart making it less responsive to cardiac ablation. Alternatively, the natural history of PAF is not well known but my reading suggests only 30 to 40 % go on to persistent AF. If that is true then not all PAF may need to have cardiac ablation.

I personally believe based on my own experience converting AF to SR, that some PAF individuals might benefit controlling recurrence of AF with scientifically administered magnesium including other features outlined in my protocol . The caveat is the importance of networking with a hearth care professional to determine candidacy for the protocol. Assuming you are interested go to my BIO describing my experience as a physician who had AF.

[babs1234 in reply to Hugheart]

Hi. It’s a weekly report

[Hugheart]

is that an Apple phone weekly report? If yes than for sure if you are interested send me a PM for more discussion.

Higheart

[MissyOscar]

I too went yesterday to see cardio team re. Ablation. Been paroxysmal for 10+ years having 5 A&E visits for AF .. so very infrequent episodes but she said it’s 5 x more than I should have! Wait list is a year plus so gives me time to think. Alcohol I think is the trigger but I’ve given up now since my last episode last August. I’m still unsure

[TracyAdmin Partner]

Hello

Thank you for sharing your post on the Forum. An ablation is a highly successful treatment option for AF, if you have been recommended for the procedure it will be in your best interest. It is understandable to question why or whether you should consider it at this time, but if you have any doubts you should raise these with your doctor direct.

Our Patient Services Team are always here to help should you have any questions, or would like advice about the procedure. Please feel free to call us via our dedicated Patient Helpline or via email: heartrhythmalliance.org/afa...

Alternatively, you may wish to download the booklet 'Treatment Options for AF' api.heartrhythmalliance.org...

Kind regards

TracyAdmin

[FrankFrank]

You have got a lot of opinions above.Mine is about sleep apnea and CPAP machine.As soon as I started on cpap machine I felt much better than I had felt for years,literally overnight!More energy,better rested,no daytime naps etc etc.However about a month later after my usual annual echocardiogram ( had open heart surgery some years back for mitral valve repair)got a call to say I was in heart failure and needed to see cardiac consultant asap.I was very surprised as felt better than I had for years due to CPAP machine.Heart failure now effectively treated pleased to say and all ok.However the CPAP machine has transformed my life without an exaggeration. A day or 2 without it and I really notice the difference .

My message in short is....just because you feel better doesn't mean you dont need help for other cardiac issues that might not necessarily have any obvious symptoms or symptoms at all.

Hope this is of some help.

[Amiodaroneluck]

If your cardiologist and EP suggest an ablation would help your arrythmias, I would do it as soon as you can. Getting the IV in place and the time you have to behave yourself after the ablation were by far the worst part of the process. And you will feel SOOO much better not long afterwards.