Atrial Fibrillation (AFib) Support Group
Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spread through the heart and cause contraction of the heart muscle and pumping of blood.
Hello everyone. I have been away a long time trying to put AF in the backseat of my mind. Unfortunately, AF has a way of making its presence known every day :) I missed keeping up with you all and hope you are all doing well. I am still trying to get control of my symtoms. My Cardio increased my Flecainide to 100mg/twice a day, however, I still have episodes a few times a week. I seem to have the most trouble with heart rate when I moderately exercise. I walk almost daily and about 12 minutes into my walk, I start having symtoms and my heart rate bounces back and forth between the 90s and 170 BPMs and feel light headed. In order for my heart rate to improve, I have to stop walking and stay still for a few minutes to calm my heart down. I am still resisting rate medication because when I am inactive, it makes my heart rate and BP too low. My Cardio gave me Verapamil to take if my heart rate does not come down on its own but I have not tried it yet since I can get my rate down within an hour of stopping activity (sitting). I have been on daily Metroprolol, however, did not tolerate it well. My last visit to the Cardio, I was not in Afib at the time I was in the office but in junctional rhythm (this was always my predominent rhythm for the past 10 years until AF developed). He said that my EKG shows a delay in conduction and said a pacemaker may be in my future as it appears I have AV nodal disease. He also said if I can no longer tolerate the high heart rates that there is always the option of AV ablation/pacemaker implantation as a last resort. I have had two catheter ablations for AF (pulmonary vein antrum isolation with posterior wall isolation) that did not cure. My EP stated that if I came for another ablation, I may need more than a few more because he will need to target other areas of the heart that sometimes drive AF. At this time, I do not want anymore procedures but wondered if anyone on here ever had the AV nodal ablation or also have AV nodal disease (I believe it is also known as heart block). Not sure what degree of heart block-didnt think to ask. Thanks for any input you all may have. Carrie
Some random factoids I remind myself to keep things in perspective:
1) Ablation(s), whether 1 or 2, are performed to try to ideally get you in NSR without drugs.
2) If that doesn't happen, ablation should minimally reduce symptoms of afib and/or keep you out of afib using the crutch of drugs (for a finite period of time).
3) If 2 ablations doesn't do it, you are really at square 1 looking at rhythm or rate control drugs.
4)NSR has better outcomes (when a person never had afib or where ablation "put afib in remission") than being in afib.
5) Rate control has better outcomes than rhythm control (mostly because of a variety of side effects that can be major from rhythm meds).
6) Afib doesn't kill you if you are rate controlled and anticoagulated... well, at least your stroke risk it cut from 67% to 90% based on what anticoagulant you are on.
7) For the symptomatic, rate control usually controls symptoms.
8) rate control has minimal problems.
9) The only long term possibility with rate control is, in some cases, fibrosis and remodeling progress, though usually slowly. Another thing is that it needs to be adjusted to work but not tire you too much. Exercise can alleviate much of that. Afibbers "could" be more vulnerable to dementia later in life and some afibbers with other heart issues could get "reversible" heart failure (just means your ejection fraction goes down).
10) Most strokes and heart failure afib cases happen later in life.
11) Untreated afib: 33% of afibbers will have a stroke. They may have other heart issues by tthe way like plaque. But that means 67% would't have had a stroke without treatment.
12) In a lifetime (according to my EP), less than 20% of afibbers that aren't rate controlled could get "reversible" heart failure. That means 80% don't. Again, when you are 90, you are going to die of something, or at least have some medical issues.
So why do I go through this exercise? To weigh risks and put my risk of treatment in perspective. When I look at the instant risk of treatment (rhythm control meds have the scariest stuff: multiple organ toxicity and possible other arrythmias that can be fatal), and even ablation's "instant risk" of adverse outcomes, the annual risks with rate/coagulation control don't look so bad.
That logic applies to me, maybe not you. For me, "asymptomatic", CHA2DS2VaSC Score of "0", and "no heart disease" are key to my strategy at the moment.
I hope this helps someone. BTW, I read that amiodarone works 50% of the time and is most toxic, and Multaq (Dronedarone) works half of that time (25%, and is less toxic) according to my EP and research I have done... AND it tends to not work after awhile (sometimes a long while).
Petey
Anticoagulants: If Coumadin lessens stroke risk 67%, that means lifetime risk treated is 11%.
If Pradaxa is 35% more effective than Coumadin (67% times 1.35 = 90.45%), that means your lifetime risk is about 2.8%. I know these numbers are yardsticks, depending on your health and life habits, but it puts it in perspective when you are looking at a 2% risk of stroke during a procedure performed in 1 day (versus yearly risk). My opinion only.
From what I've read about flecainide it could be causing the delay in conduction. I definately think it is worth a try to see how you do with rate-control only without using flecainide before you go to the extreme of an AV nodal ablation and pacemaker.
Here is an excerpt from the FDA information on flecainide:
Flecainide slows cardiac conduction in most patients to produce dose-related increases in PR, QRS, and QT intervals.
PR interval increases on average about 25% (0.04 seconds) and as much as 118% in some patients. Approximately one-third of patients may develop new first-degree AV heart block (PR interval 0.20 seconds).
Here is a link to the information sheet:
http://www.drugs.com/pro/flecainide.html