Atrial fibrillation

Medication for AF

by Selwyn - 2017-03-22 07:53:35

Welcome to the club for advice.

I think your age (? personal profile), and whether you have paroxysmal AF, or persistent A,F are relevent to any decision. There are many older people with AF completely asymptomatic. Many older people benefit from a rate limiting drug.

You do not mention medications tried. Clearly, there is a defined pathway for these. I take Flecainide which is an anti-arrhythmic , rather than a rate limiting drug. 

If you can please  give as much personal medical information as possible that is a help to those offering advice, as per your request.

Although I have a pacemaker for asystole, the pacemaker does tell me ( from the AMS print out) how much atrial fibrillation I have had ( episodes and duration) since the last check up. Flecainide does the job for me, coupled with some Verapramil ( a rate control drug) for any breakthrough. Flecainide can also me used as a 'pill in the pocket' for paroxysmal AF as a minor problem. 

Atrial fibrillation

by Annaelizabeth - 2017-03-22 10:15:53

Thank you for replying Selwyn.  I am 68, and have run the gauntlet of meds from flecainide, diltiazem, amiodarone, dronedarone, sotalol up to present day which is 10mg  bisoprolol.  The professor EP who looks after me in London has also done three ablations.  Sadly it is the prosthetic mitral which has precipitated the atrial fibrillation, and the meds have either had unacceptable side effects or the  now persistent afib has broken through.  Hence the suggestion by my EP that pace and ablate may be a good option, although the afib will continue I will not feel the effects and will only need warfarin.  My concern is that it is a very final option - there is no going back.

Suggestion by Robini

by biggie - 2017-03-23 05:43:13

What types of food and beverages tend to bring on your AFib?

Thanks

Atrial fibrillation

by Selwyn - 2017-03-27 07:27:57

Classically it is alcohol and caffeine associated with onset of AF.  The evidence base for caffeine is not strong. I do try to avoid caffeine as a matter of routine. I remember discussing the subject with the consultant as she was fitting my pacemaker.  Like everything else, I expect it is a matter of how much. The original rat study fed rats huge quantities of caffeine and they developed AF! Alcohol is the same. 

I would be interested to hear what other foods bring on AF. In theory, if starvation is a stress to the body ( and adrenalin is released- blood sugar is raised), this should be associated with onset of AF. I wonder whether dieting is associated with AF?

I have noticed I am more likely to get AF as I am about to doze off.

 Annaelizabeth asks, with regard to whether AV node ablation and a pacemaker will help your AF- I expect if you have symptoms from the uncontrolled AF, then the answer is yes ( as a last resort).  Having tried multiple ablations and drug therapy it certainly is an option. Did you try digoxin? There are also combinations- this ofen means smaller doses ( for instance I take Flecainide WITH Verapramil, none at the maximum dosage).

 The quality of life with a pacemaker for most people is not an issue- life continues very much as before, apart from the yearly check up and when the memory is jogged, an awareness of the box ( this can always be placed in a 'hidden area') Atrial fibrillation can be distressing if the ventricular rate is uncontrolled. 

Clearly, the AV node ablation does not cure the AF- the risks of thrombosis/embolism remain the same as before the AV ablation.

The loss of function of the atria remain a problem at the top end of exercise. The continued right ventricular pacing is also associated with heart failure.  Ask about the long term - short term outcomes are good. You may also wish to ask about ATP pacing? I would be interested to hear what they say ( some studies show real benefit, others not).

You can always ask for a second consultant opinion. In the NHS, this is best arranged by your consultant in charge of your care. 

Do let us know what advice is offered re. the above.

Kind regards,

Selwyn

atrial fibrillation

by Annaelizabeth - 2018-02-01 13:55:35

Well, I have gone ahead with the pacemaker, I had a two lead medtronic put in the day before yesterday.   The AV node will be ablated in three weeks time, when I will then be totally pacemaker reliant.  The AF is totally related to having a prosthetic mitral valve, it is a virtual given.  So now I wait, once the AV node is ablated the heart will be paced at 70.  At the moment I feel a little tired, with  a slightly sore shoulder, nothing out of the ordinary I assume.  Finger crossed!