Zoledronate infusion and Afib

[Bluey-1]

This is one for PMRpro as I think you’ve suffered as well.

I had my third and final infusion for osteoporosis this morning. I have just gone into an episode of Afib. It’s all been relatively calm this last couple of months since my ablation in September. I’ve been off Sotalol since 6 weeks after the procedure. I’ve had occasional bouts and taken Sotalol for the day or night I’ve suffered. I’ve just taken 40mg (prescription is for 40mg x 2 daily). My Q is, can I take the other 40mg before bed tonight? We have a funeral tomorrow to go to so I want the best chance of feeling well. When I’m in sinus rhythm life feels wonderful, but in Afib it’s a different ball game. Feel so poorly with it. When this has happened previously since the ablation the heart calms down by the morning although it’s draining the next day. It’s hard work managing different conditions, not least GCA, which (fingers crossed) seems to be behaving itself for now. I’m currently on 7.5mg pred after needing to go up to 10mg for some time in September.

[PMRpro Ambassador]

Oh dear - are you sure it is a/fib? The bisphosphonate triggered atrial tachycardia for me.

However, after the ablation my cardiologist had left me on the same medication as before it and when we identified the a/tachy she said to play with my bisoprolol dose to see if that sorted it out and go up to 10mg per day if necessary. I never needed that much and I soon went back to the usual dose but used it as "pill in the pocket" instead which seemed to work better. By the autumn it had all settled down - and I am due my next infusion at the end of the month, I do hope it doesn;t do the same!!

I know exactly what you mean about the day after an episode - wrung out isn't the word!! What time did you take the first dose? Not sure I'd want to take a second too soon after the first but I'm not familiar with that medication at all. That said, 80mg is right at the bottom of the dose and they do say take it before bed to start in case it makes you feel dizzy so I'd think it would be OK.

I wonder if 111 might be able to help?

[Bluey-1 in reply to PMRpro]

Interesting, it could be tachycardia, fast heart rate and high spikes up to 173, but it doesn’t last. Six weeks after the ablation I was told to come off Sotalol and I’ve used it as a ‘pill in the pocket’ since. I go 7-10 days without an episode and feel great. I’m waiting for feedback from the week’s heart monitor in Dec. I knew all was ok that week, I felt well and my Apple Watch verified that - sinus rhythm. Sod’s Law! Getting ready for bed with a warm bath with a magnesium bath soak so will see how I feel then. I took the first dose at 7.20pm. The watch says you may have signs of Afib but I don’t think it’s that specific, re a particular arrhythmia. Thanks PMRpro. You’re right, 80mg is at the low end. Will see how desperate I feel. I’ll take paracetamol as advised after the infusion. It helped last time and I know this thing will pass.

[PMRpro Ambassador in reply to Bluey-1]

Pain in the bum though isn't it!!! And it NEVER happens when you can get hold of the right doctor. Using it as a pill in the pocket - is there a maximum dose for that?

[PMRpro Ambassador in reply to PMRpro]

Bit of reading!

academic.oup.com/europace/a...

says

"The single dose is one which at maximum is no greater than would be the maximal total daily dose of the same agent given for chronic maintenance therapy"

so 80mg fits with that doesn't it?

[Bluey-1 in reply to PMRpro]

It does and I think I’ll take the second 40mg. I read somewhere it’s best taken 1-2 hours before / after food for best effect. I took the first one shortly after eating so another 40mg now may knock it on the head. I suffered in the night after the last infusion. Fingers crossed! Thanks so much. X

[Bluey-1 in reply to PMRpro]

Thanks for your help PMRpro. Back in Sinus rhythm this morning but feeling drained as expected. Interestingly I had bradycardia later in the night plus poor sleep. I felt unwell after the 2nd infusion for a day or so. After the 1st one I felt flu like for a couple of days. It’s so grim when your body feels out of control. At least this was the final infusion. Hope the old bones are holding up!

[PMRpro Ambassador in reply to Bluey-1]

The Sotalol is likely to slow your heart rate - and heart rate also tends to slow overnight. How low did it go?

[Bluey-1 in reply to PMRpro]

HR went as low as 46. Funnily enough the consultant who did the ablation rang me today on his last day in the job before he moves abroad, just as I was at the funeral wake. I apologised as it was a bit raucous with an excited child nearby!

My week’s heart monitor in Dec when not on Sotalol was good, just a couple of spikes. I’ll have a clinic appointment with his replacement to follow up. I filled him in on the episodes I’d had during the last 8 weeks when not on Sotalol. He said not to use Sotalol as a ‘pill in your pocket’. If I were having arrhythmias on a 7-10 day basis, to take 40mg x 2 daily, particularly with a big holiday coming up in Feb. He gave me a private cardiologist recommendation if I wanted to go down that route and be followed up at a clinic quickly.

Really lovely guy, very caring and has been in touch with me several times since the ablation. I’ll wait for my NHS appointment, probably in March when his replacement takes over. All credit to him for calling me with a cold and croaky voice on his last day.

Thanks to you also PMRpro for being there when needed.

[PMRpro Ambassador in reply to Bluey-1]

That's really good - and it was what I wondered last night when we were chatting. I'm on Flecainide which can also be used as pill in the pocket but obviously the EP here prefers prevention. I have to say, I haven't found the PinP approach particularly useful, seems to take ages to work so you still have the horrible leftover feeling next day. Which is the worst thing about it all.

46 isn't bad - before my pacemaker I was hitting about 20 and under!!! 7 second pauses ...

More NHS brain drain - where's he off to?

[Bluey-1 in reply to PMRpro]

OMG, that’s low. I had a 3 second pause on the echocardiogram in July.

He says he’ll return to the U.K. at some point as he’s close to his family here. His wife is Canadian and her mother is ill. He’d worked in Vancouver for a year and they asked him to apply for a job there so he’s taken the opportunity with his wife’s family situation. He has been an amazing guy, did NHS work as will and ensured I was on his NHS list for the heart monitor and follow up. Even though I went privately to see him, I felt he had NHS values, was personable and genuinely cared. He laid out all the pros /cons re the ablation and the possibility that some people may need another. Said he would feel bad taking my money if it didn’t work as well as expected. I told him I accepted the risks but quality of life had become so poor I needed to have something done. I don’t regret it. I was in symptomatic Afib for well over 50% each week and those days were washouts. Onwards and upwards!

[PMRpro Ambassador in reply to Bluey-1]

Understandable. He can only improve things in Canada!!!

Yes I was like that after the Covid bivalent jab had woken it all up, had been livable with before that but it was hard living alone - sometimes I couldn't stand long enough to cook. I ate a lot of salad - with meat that I could take out of the freezer and chuck in the airfryer and do nothing else! Developed a great technique though, good food, no effort!

I wasn't allowed out of hospital until I got the pacemaker - ironically, some years before when the a/f was found, I sat for ages with a woman in my room who was also at severe risk because of long pauses explaining WHY she couldn't go home. She'd already fallen down the stairs once.

[Bluey-1 in reply to PMRpro]

Must have been so hard living alone and feeling so weak. My husband isn’t the best cook, leaves most of it to me. I ration any remotely energetic tasks, don’t like cooking and have recently bought an air fryer. What a boon that is. As, you say chuck it in - salmon is particularly good. I’ve even resorted to mini potatoes in garlic butter in a plastic bag, pricked and microwaved…now that’s really lazy!

[PMRpro Ambassador in reply to Bluey-1]

If I want spuds, I wash them, cut them into wedges, mixed herbs and olive oil ... Almost impossible to find such luxuries as yours here!! But I find the trixk really is to have all the protein in portioned pieces, freeze them and cook at 200C for a bit longer, The outside is crispier/browned and the inside still gloriously juicy. Veggies in a layer on the bottom, give them maybe 15 mins at 170 before adding the meat/fish at 200C, 15/16 mins for rare steak. I don't eat much meat - I buy a good 1" thick rump steak, cut it into 1" fingers which gives an excellent result and use however much I need.

[Missus835]

I've just had my second zoledronic infusion on Dec. 13th. Over the last week, I've been getting heart flutters or irregular or skipping beats, but had not associated it with the infusion. Also, bad acid reflux, stomach burning and a couple of esophageal spasms. This could also cause irregular beats. Just wondering if this is also a possible side affect (effect, I never know the difference). I am on metoprolol for what was a fast heart rate (150 plus) and a BP med. Now my BP is at the low end of normal (100/68 as of Tuesday last), so also wondering if this is causing the AF. Side note, I also have to go for xray on hips and left because I can barely stand on my left leg and this since the infusion. Osteo Specialist is ruling out the bone issues that are a rare side affect of the infusion. Eye roll. That xray is tomorrow. Always something. Thanks for your thoughts.

[Bluey-1 in reply to Missus835]

Always something indeed Misses835. I’m never really sure what causes what but I recalled PMRpro suffering as I did after an infusion. The research paper she linked in her post suggests a possibility. I am never sure what causes these bouts of very fast HR when doing nothing. I just feel it ‘go’, then have to sit/lie/rest and wait for quite a few hours before it passes. I think auto immune conditions like company! I currently have 4 different health conditions, or co-morbidities as is noted in hospital reports. I have two friends who had ablations who’ve remained on beta blockers for stability. I’ve tried being off them for 8 weeks and although I’m overall so much better post ablation, if I have to take Sotalol to avoid such episodes then that’s fine. The thing is we all respond differently to meds. Bisoprolol did nothing for me. What I’ve learnt is that I need to be proactive about following up and reviewing with the GP/ cardiologist. I found myself in the situation of breathlessness and heart failure (who knows, I may still be in that category) by taking the Bisoprolol for 10 months without any review. Recently heard of a friend who was potentially having a pacemaker (HR in 30s) when the cardiologist he saw gasped at the meds he was on (since 2015! - no review), altered them. All is now well, no pacemaker needed! Good luck with it all.

[Missus835 in reply to Bluey-1]

I can empathize with the "no review" as my GP is not a follow-up kind gal. Even when I ask. So I'm in to see her Monday to discuss this and the pred she is so stingy with. Never a dull moment Bluey. Hugs.

[Bluey-1 in reply to Missus835]

Keep at it Misses835. Don’t give up. We have to be proactive with our health. I had to pay privately for the ablation (still paying some of it off on interest free credit!) due to an 18 month wait list, and felt very fobbed off about it with the NHS consultant I saw. ‘You’ll be over 70’, she intoned. Seems to depend who you see.

Thankfully rheumatology and endocrinology seem to work together and I’ve had fantastic support for my GCA and no battle over pred prescriptions.

My dentist apparently has referred me for a biopsy for my oral lichen planus as I’ve not had one since diagnosis in 2016. I’d put her off referral until I had the heart stuff sorted but the nurse who organised the infusion had read all my notes and told me. She said the wait times for the Maxifacial department are very long which is probably why she sent the referral. Seeing the dentist next week so something else to follow up. Never ending isn’t it?

[PMRpro Ambassador in reply to Bluey-1]

My a/f was caused by the autoimmune part of PMR damaging the sinus node, the bunch of electrical cells that govern heart rate by firing signals at the heart to make it contract.

[PMRpro Ambassador in reply to Missus835]

Bisphosphonates have a reputation for causing arrythmias. Mine wasn't too bad but just annoying to develop atrial tachycardia when I'd just been cured of atrial fibrillation!!

The reflux and GI problems are listed adverse effects - should resolve over a while.

It's Effect - what is caused by something affecting something else.

"Affect is generally used as a verb meaning to have an impact on something. Effect is usually used as a noun and refers to a change resulting from something, but it's sometimes used as a verb that means to cause a specific change or something to happen. Rain affects plants. One effect of rain is that plants grow faster."

[Missus835 in reply to PMRpro]

Thank you Pro. You always have a great way of putting things in perspective. The AT was scary and I ended up taking an ambulance into the ER, where it was still ongoing after 2 hours. The triage nurse said "honey, I think you're getting worked up over this". Ya think!

Yes, I thought affect was a verb as something affecting something else, but alway think about it a couple of times. LOL.

[PMRpro Ambassador in reply to Missus835]

What an empathetic triage nurse!!! Did she bother to expalin WHY she thought it was unnecessary? I don't go to the ED because there is very little they can do, even with treatment the episodes can last several hours or more, Unless your heart rate remains at significantly above 125-130 for long periods, you are not at any risk with a/fib. I have a pulse oximeter to check - mind you, I wasn't backwards in coming forward when I woke one morning at 190+ a few days before OH died. That was a 112 call (our 911) and was responded to by the Notarzt (emergency doctor) and 2 ambulances all with blue lights and I was taken in - treated, it settled in a few hours and they let me home in the afternoon.

[Bluey-1 in reply to PMRpro]

I’ve not faced A & E with any of this yet as I thought a six hour + wait to be seen would finish me off!

[PMRpro Ambassador in reply to Bluey-1]

They are usually a bit quicker with a heart patient!! And possibly worth trying an ambo who would vouch for the urgency on arrival or even pre-alert if you were worthy!!! Haven't got such problems here.