PMR and afib

[Hopeful424]

Amy of you with PMR also have afib? Probably caused by either the PMR or the pred!! Anyone had the Watchman implant? Any issues if you have? Concerns me a little, going into my heart which is sound physically, but the electrical part is giving trouble. Don't like Eliquis either! I am having trouble committing to the procedure. Thoughts?

[PMRpro Ambassador]

This is what I just replied over on the other thread where you mentioned this:

The studies I have seen suggest that you don't get off anticoagulation entirely with the Watchman - it requires antiplatelet medication, usually aspirin. I'm not sure I'd consider that significantly better than the DOAC you are on and the procedure itself involves risks as a surgical procedure which includes stroke during the procedure and cardiac tamponade.

I also have a/fib triggered by the PMR - definitely not the pred as it was there from soon after the PMR symptoms started (though I didn't realise at the time) and the cardiologist is quite satisfied it was due to the autoimmune part of PMR damaging the electrical cells that form the sinus node in the heart. I have had an ablation after the a/fib got much worse after a covid jab 2 years ago - but am still on a DOAC (Pradaxa) which I have had no problems with at all. The person who worries most is the anaesthetist at the Pain Clinic who refuses to give me steroid injections "in case you bleed" - luckily my rheumatologist is prepared to do them and currently I am pain-free for the first time for years after some steroid injections!!! ANd I have never even bruised slightly!

[oaktree5 in reply to PMRpro]

would you be aware of any studies connecting PMR with sinus node disturbance. I recently dx. w/Afib and put on eliquis. Also have dx of POTS now. Dx of PMR was in early 2020, came on two weeks after i got first covid jab. My internist and card think the timing of PMR and Afib/POTS just coincidence. I believe there is a causal connection but have not found studies to support. When time perpermits appreciated

[PMRpro Ambassador in reply to oaktree5]

There is a study showing a/fib is more common in patients with a few rheumatological disorders - including PMR which is quite high on the list, only coming after vasculitis which, arguably, PMR is anyway. Thr increased rate was long acknowledged for RA but in fact, PMR seems worse.

pmc.ncbi.nlm.nih.gov/articl....

In my opinion there is far too much tendency to blame any palpitations on pred as that is listed as a side effect and dismissed by GPs.

As I have said, within 3 hours, the bivalent Covid jab 2 years ago had triggered worse episodes of afib than I had had since diagnosis almost 10 years earlier, normally they were never more than a couple of hours max and maybe once a week or less, well managed with medication. The duration increased daily until after a month or two they were up to 12 hours and most days, making daily living very difficult, especially as I live alone. I couldn't even stand long enough to prepare meals! In retrospect I should have pestered the local ED more, might have been sorted out quicker! But I knew there was little to be done, the heart rate was rarely concerningly high and the doctors I spoke to were fairly laid back too. In the end I saw an electrophysiologist who disagreed about the Covid jab but did offer ablation which I eventually had a year after it had got worse and that has cured it. The e-physiologist who actually did the procedure agrees with me about the Covid jab - there has been a German study showing that the myocarditis known about in young men also occurs in older females, not sure about older males. Of course - anything from a non-native English-speaking country tends to be ignored in the USA, as patients on here have been told, though actually, the comment was that it was anything from outside the USA!

The longer I have PMR and am involved in this lot - the less I believe in coincidence. And even it if IS coincidence, you can't prove it and dealing with the problems as an holistic problem, the better it is for the patient! After 4 very unpleasant years medically, sorting the afib and 3 steroid injections for apparently different non-PMR problems have resulted in several amazing improvements in pain and other symptoms. I had had swollen ankles, not dreadful but variable, and there was a push I should wear compression stockings, blaming venous incompetent. Not going to happen, mainly because I can't get the damn things on and off - off worse than on since I live alone! - but from March to November they are simply too hot, even ankle socks can be too much. Since the ablation - no swollen ankles. Who'd have thought, poor cardiac performance causes swollen ankles? After the last 2 steroid injections - I feel at least 5 and probably 10 years younger, apart from slight aging effect. The clinical picture is definitely back 10 years!

[Karenjaninaz in reply to PMRpro]

For anesthetists, steroid shots into the epidural space on anticoagulated patients, is contraindicated. If bleeding occurs you can end up with nerve compression, paralysis and pain. It’s bad enough having skin bleeds.

[PMRpro Ambassador in reply to Karenjaninaz]

Yeah, I know - but these steroid shots weren't into the epidural space! And really - she wasn't offering ANYTHING that worked, it was no to everything that did work at all. My rheumy has been the only one who has really done anything useful.

The face looking back at me from the mirror is a different person to last Sunday.

[Karenjaninaz in reply to PMRpro]

Then that other person is not the right one obviously. So glad it worked for you and you got results.

[papadapadoo]

I was diagnosed with PMR in December 2022. A year later a sleep study revealed afib, which is termed "permanent" but has no symptoms to date. I believe I did not have afib prior to 2022.

[Karenjaninaz in reply to papadapadoo]

Afib can lead to a surprise stroke. It is a progressive disease. The heart is not beating efficiently and you can have fatigue, and shortness of breath as well.

The current thinking is to ablate afib early on to prevent it from becoming permanent reducing stroke risk.

I had the new pulse field ablation last April at age 81 This new procedure is shorter than the old techniques. I am doing well.