Pred and AFib

[GRB8]

I was wondering if there is any link between pred and/or PMR and AFib? I had a catheter ablation in April 23 and had no further episodes until a fairly severe one in late December. I started developing PMR symptoms in early Jan and was diagnosed in early March. I am now on 12.5mg and plan to taper to 11.25mg in a week or so. Path so far has been fairly smooth but I’ve had 4 AFib episodes in the last 7 weeks. I’m organising a consultation with my cardiologist but am wondering if anyone has had similar experience. Many thanks for any insights.

[PMRpro Ambassador]

It was the autoimmune part of PMR that caused my atrial fibrillation - it started about the same time as the first signs of PMR but was never really a problem or diagnosed until I had a drug reaction to i,v, diazepam being administered for back muscle spasms - worked brilliantly in that but the second infusion triggered a severe 5 hour a/fib episode. They thought it was the pred also being used and stopped that - but the same happened the next night, ergo it was not the pred but the diazepam.

A study has found that atrial fibrillation is more common in patients with RA and also PMR.

What other medications are you on? Had you been started on a bisphosphonate before the a/f started? I had had an abation in January and the a/fib was gone, 3 weeks later I had a bisphosphonate infusion - and it triggered atrial tachycardia! This lasted for several weeks but now seems to have disappeared entirely again.

[GRB8 in reply to PMRpro]

Many thanks - I had a feeling you’d respond as I had in the back of mind that you’d previously mentioned AFib! The knowledge and insight on this Forum is truly incredible and so valuable.

In answer to your question, the only other current med is 2.5mg Bisoprolol, which I only take when I have an episode. I was originally diagnosed with Atrial Flutter, several years ago and only ever took Bisoprolol on an occasional, as and when, basis. AFib came along in November 2023 and led to the ablation in April 2024. Interestingly, the pre-procedure scans showed evidence of historic inflammation of the heart - Cardiologist wasn’t concerned and said it could’ve been some kind of infection (Covid in Oct 2020? or even the Covid vaccine?).

I also had carpel tunnel surgeries in June 2021 and Jan 2022, which now seems likely to be part of the overall mix?

It seems a bit “chicken and egg” - which came first - PMR or Flutter/AFib? My uneducated/instinctive guess is that maybe PMR has been around at a low, unidentifiable level for some time and only became “chronic” (not sure that’s the correct use of the term) in January this year.

It will be interesting to hear what my Cardiologist makes of it!

[PMRpro Ambassador in reply to GRB8]

I have never found the pill in the pocket approach has ever helped and as far as I know it isn't used here. I started on an ACE inhibitor - and threw a wonderful allergic rash which was ignored by the ward staff but the weekend duty consultant recognised it for what it was! Plan B back then was Losartan and bisoprolol at low doses - no adverse effects at all at such low doses. Plus an antiarrythmic. Worked fine until I was having bradys and 7 second pauses - pacemaker and less medication, the losartan was removed. No idea why. Then the Covid bivalent vaccine woke it all up and I finally got an ablation. The first electrophysiologist poo-pooed that but the woman who actually did it agreed it was very likely the cause. It all kicked off 3 hours later.But all calmed down again now.

[Flivoless]

I developed Afib, leading to heart failure after2 1/2 years of PMR and Pred (but down at 4mg). Never had the slightest heart problems prior. Could have been Pred related but who knows?

[Bluey-1 in reply to Flivoless]

Who knows indeed. It’s looking that way for me after 2 years on pred. Like you, never had heart problems before. It’s frustrating that these illnesses just seem to pile up.

[GRB8]

Who knows indeed. Same in relation to Covid and the vaccine. How are you doing now?