Atrial fibrillation now as well!

[Hopingsail]

So all is going rather well on the PMR front with Pred down to 5mg and slow reduction to 4.5 planned, I have a little boat once more, and then hey ho it‘s off off A&E feeling frightful with severe chest pains…..

At 3.30am after 12.5 hours in a A&E , lots of cardiograms, bloods, x-ray and a good physical going over by young and enthusiastic doctor I am diagnosed with AF and ‘discharged home into the care of my GP’. Well that’s a joke!! Not having heard a bleep from the surgery I phoned and got a GP phonecall booked for a week later.

My GP must have missed out on the ‘ caring bedside manner‘ training: “Yes, I have the information on my computer / no there’s nothing to be done just live with it / the medication they put you on is correct.” Not a single word of encouragement…. So I forgot one of my questions which concerned a Calcium Blocker (Bisprolol) that A&E prescribed and how does that work with Risedronate and daily Adcal?

I since discover talking to friends of my age (77) that a number of them and their acquaintances have had AF and there are a number of procedures that can indeed help and even correct the problem, an ‘ablation’ being most common. I’m thinking of changing my GP, but interested to know if anyone here has experience of AF and ablations and how such procedures or indeed the AF might interact with PMR?

Best wishes to all!

[SheffieldJane]

No not yet,( ie A/F, plenty have on here though, our own lovely PMRPro for one) but can I just express my shock at the appalling way your GP surgery has behaved. I urge you to make a formal complaint, I would also seek to change the GP as a matter of priority.

I hope that you will be bobbing along in your little boat, again very soon. kind regards Jane

Help should be along soon.

[Hopingsail in reply to SheffieldJane]

Thanks Jane - I shall be on to the surgery and try to change GP on Monday!

Whether an ablation might be possible on the NHS within the next decade is another question of course - I’ve been given the name of a excellent private cardiologist though that route assaults my principles (esp as I spent the last 7 years of my working life in an acute NHS hospital!).

[SheffieldJane in reply to Hopingsail]

You are clearly on top of things! Best wishes.

[PMRpro Ambassador]

No problems in my experience. GPs are a bit laid back in the UK and they don't explain properly to scared patients that you don't die of a/fib but you might die of a stroke or heart attack if you don't take your anticoagulant medication faithfully. My cardiologist doesn't care about anything else - but I must take my Pradaxa!

Calcium channel blockers have absolutely nothing to do with dietary calcium and calcium getting to bones. They selectively stop calcium getting into the heart and arteries so the arteries relax - lowering BP amongst other things.

What anticoagulant have they put you on?

I had an ablation in early January - it worked like a dream for 3 weeks but then I had a few episodes. I had a zolendronic acid infusion 2 weeks ago - that can cause arrythmias and seems to have done so! I have a check up in early April and I am hoping they offer another ablation - it isn;t uncommon to need a couple for a good end result.

Until I had the bivalent Covid vaccine in Nov 22 my a/fib was rarely longer than a couple of hours and happened now and again. After the vaccination it went mad about 3 hours later and steadily worsened until I was having 12 hour episodes almost daily. Unfortunately, there was a longish waiting list for non-urgent cath lab procedures and then I had an appointment which coincided with the only doctors' strike ever here which caused another month's delay.

I have a pulse oximeter and use it to check my heart rate. I feel rubbish during an episode and it can be very inconvenient but I have rarely called an ambulance to go to the ED since my HR rarely goes above 130-ish for long, just a few beats and drops back. There isn't a lot they can do in the ED, there a few things you can try to stop an episode, don't think I have found one that works for me yet, Magnesium is fairly standard and is one of the things that they use here in the ED,

If you get too scared with a high heart rate, call 999 though how much good that will do you in the UK these days I don't know! I find just relaxing in a comfortable chair just as good but it doesn't worry me too much. Maybe if I had turned up at the ED every time my ablation might have been brought forward! A friend had an ablation done at New Year 22/23 and has had no problems at all since. After my ablation, my swollen ankles have disappeared entirely and I can now walk up the slope to the village without getting out of breath,

mayoclinic.org/diseases-con....

[Hopingsail in reply to PMRpro]

Thanks so much as ever fir your prompt and informative response … When heart starts banging away and no personal interaction and information is forthcoming from the GP it’s scary and also extraordinarily depressing - not something to which I’m usually prone. I hope you get that further ablation you feel you need - we all need your invaluable contributions on this forum! X

Thinner- Apixaban

[PMRpro Ambassador in reply to Hopingsail]

Just make sure you take the apixaban 2 hours before you take any other heart medication. Taking bisoprolol at the same time is fine but there are a few that make the apixaban level in the blood rise over time because they change the way it is metabolised, That can increase the risk of bleeding. Can't remember which they are, doctors seem unaware and don't always warn you. So Apixaban first, anything else later. Bit of a pain but safer!

[Purple-Owl in reply to PMRpro]

What is an ablation?

[PMRpro Ambassador in reply to Purple-Owl]

A catheter is passed through a blood vessel in the groin to the heart and the rogue electrical cells causing the arrythmia are identified and destroyed, often these days by cryotherapy, i.e. frozen. Radiofrequency ablation used to be used - that destroys the cells with heat generated from a current in the tip of the catheter, bit like a soldering iron used to do,

[mtrafter]

I developed AF 6mths ago, was found during cataract surgery! I am 4 yrs + into my PMR journey on 7.5mg Pred. Subsequently my cardiologist performed a cardioversion procedure which did not work for me, so added another cupful of meds that stopped the AF but made me so lethargic and more fatigued than I was already. Advised to consider Cardiac ablation in order to reduce the medications . I had the procedure 6wks ago and have had my cardiac meds halved I feel sooo much better more energy and more importantly no episodes of AF. I hope to have meds further reduced at next review in 3ths.

[Hopingsail in reply to mtrafter]

Thanks for sharing your experience - good to hear ablation has made a positive difference.

[Pestface]

I don’t know but you deserve to know what can help. God bless and us all through life’s journey

[Pixix]

I’m not saying your Dr treated you right…that was dreadful! But my Mum, my Dad both had AF & my husband has had it for many years. None of those three required any procedures at all…just took the tablets & got in with a normal & active life. I’m not saying, of course, that that will happen to you…but I hope it does. My husband takes bisoprolol, ramipril, warfarin & another tablet, can’t remember the name! Mum & Dad we’re the same! I hope you’re amongst the fortunate, for whom it makes little difference in life (my husband ziplined from 12000 ft in the Rocky Mountains to the Valle floor, age 82!!

[Hulotsholiday]

I was diagnosed with AF six months ago and prescribed Apixabin by consultant. I’m on a watching brief; due review now and he’s going to consider what, if any, further action needed depending on what’s happened since I saw him. He said it could be single dose medication or ablation.

I’ve had a few episodes, the longest about six hours. I also get tachycardia spikes for no reason, but not always accompanied by AF. I have an Apple Watch which monitors everything. Spikes are usually 130 to 160 and until the last one, I’ve managed to bring heart rate down by running wrists under cold water and wet towel across neck. GP said valsalva manoeuvre may help bu I haven’t mastered it.

Btw, GP and consultant warned of bruising etc with Apixabin…it’s a bit of a nightmare. But they said any serious bang on the head warranted a trip to A and E to check for brain bleed. I said I’d feel stupid turning up at A and E saying I’d banged my head but GP said they have protocols for people on anticoagulants and it was important to be checked to ensure the bang hadn’t caused a leak in the brain…with the possible consequence. Hasn’t happened yet! Good luck with a better GP. Yours sounds appalling.

[PMRpro Ambassador in reply to Hulotsholiday]

" GP said valsalva manoeuvre may help bu I haven’t mastered it."

EDs in the UK use blowing into a large syringe like they use for taking blood but it seems to work best when you are sitting on a bed while doing it and then someone takes hold of your ankles and tips you back by raising your legs in the air. Not an option if you are on your own!!! Pill in the pocket is another option in the UK but it has never helped me.

[Hulotsholiday in reply to PMRpro]

Thanks. All the elements of a comedy sketch! I’m speaking to GP on Monday about the pill option; practice nurse said GP can prescribe. Is it designed to stop the AF or the tachy? Or both? I’m guessing it would be first line option rather than go straight to ablation especially as it’s not, in my view, serious at present.

[PMRpro Ambassador in reply to Hulotsholiday]

Lots of people have a/f that doesn't bother them. Trouble is, it tends to worsen over time and the medications become less effective I think - and best results with ablation as obtained when used early. When mine was identified 10 years ago, ablation was still in its early days and unreliable compared to the risks. That has all changed now so ablation comes a lot further up the list. I was managed fine for 10 years with medication and later a pacemaker - I was having rather long pauses with bradycardias!

I imagine they do wait to see how frequent it is once youa re on medication - some people never have another episode or one episode every few months, Ablation gets considered when it is affecting your QOL and you are otherwise living independently and are fairly active. Age is also a consideration - here I was told that now someone developing a/f at 60 is immediately on the list for ablation, at 80 mostly not, at 70, depends on the person.

[Hulotsholiday in reply to PMRpro]

Thank you. At 74…who knows?

May I ask another question? Are oxygen data relevant in any of this? I’m getting some low readings, oximeter and watch, drop to 70. Usually in the low 90s to mid 80s. Why are O2 levels relatively low consistently and should I raise this with GP? I’m not sure if any relevance or correlation. Thanks.

[PMRpro Ambassador in reply to Hulotsholiday]

Yes, if they are that low, you need to get advice and actually, preferably sooner than later. Your O2 sats should be 94+ unless you know you have COPD. Mine are often 93-94 but I can get them higher by deliberately deep breathing and they have been much better since the ablation. But into the 80s and it needs investigation. 70s - really concerning and possibly even worth a 999 call at the time.

[Hulotsholiday in reply to PMRpro]

Thanks. I don’t have COPD or any other lung issue and only noticed low O2 number when I remember to check watch data…it doesn’t raise a low level alert. I have a GP call back on Monday to follow up on apixabin bloods, so I’ll mention it. Thanks again.

[PMRpro Ambassador in reply to Hulotsholiday]

Are the 70s figures just fleeting? It could be the contacts aren;t good enough.

[Hulotsholiday in reply to PMRpro]

Don’t know. The data shows readings taken throughout the day and time recorded. I’d have to monitor closely and cross check with an oximeter to check. I know the HR is correct and ecgs seem accurate. The watch sits well on wrist so I’d guess the contact is ok. But thanks for the thought. I have a suspicion that a few things aren’t quite right. Bodily, not the hardware. It’s a challenge to put all the info together to complete the picture. Happily? I’m not prone to panic or over checking. Thanks again

[Hulotsholiday]

@Hopingsail, forgot to mention that 6 monthly bloods for kidney and liver function are usual for monitoring Apixabin. You may want to check that’s in hand.

[PMRpro Ambassador in reply to Hulotsholiday]

If you want to tag someone, having put @ and started typing the name, a list appears. You must select the name on the list to create the link

[Hopingsail in reply to Hulotsholiday]

I usually get these checked annually around July tied in with prostate monitory - also cholesterol. In my conversation he poo-pooed the necessity. By then, if all going ok, I may have reduced my Pred to about 3mg. It would be nice to know what was happening at that stage I thought…

[Rubha]

hello there. Sorry to hear you have been hit by another whammy. Re your AF medication, I take Bisoprolol , Pred (currently 14mg) and Risedronate (same family as Alendronate) plus Vit D prescription strength. I have no problems with any drug interaction and as long as these medications are working for me , I’m avoiding any other intervention. Hope you find a similar satisfactory route. Ablation can have its own problems and doesn’t always work. Everyone is different . Sending you best wishes.