Oh, he also added Potassiun 20 meq even though my recent blood work showed that my Potassium level was in the middle of the normal range. The Lisinopril said that I needed to watch the potassium level because too much Potassium can cause problems. He also asked me if I had tried Amiodarone. I told him I have no intention of going on that drug after my research on it.

Judy, since you are uneasy about his suggestions....I think another opinion is a good thing.
I am on a Medicare Advantage PPO plan, and don't need referral for EP. If you are on Original Medicare, call your provider for Part B and ask.

This is stressful to have a new Dr. with a different way of thinking. In my 3 yrs. of afib, I have had 3 different Cardio Dr.s and one EP. The one I have now, I can talk to, the other 2 and the EP did not seem to hear me.

Hi Judy,

I would definitely find another EP.
I'm on a Medicare Advantage Plan requiring a referral to a specialist.
That hasn't been a problem with my PCP.
It's very important for me to have physicians I have confidence in and am comfortable with.
Annette

Hi Judy,
Its tough changing doctors especially when you thought everything was going well! It looks like your new doc wants to see for himself how bad your AF is (taking you off rhythm control and putting you on rate control). He also took you off diuretics! I doubt that he is allowing you to go into permanent a-fib it looks like he wants to see exactly where you stand at the moment. You have your heart monitor use it EVERY TIME you feel bad EVERY TIME. Even if you have to upload lots of files then I would say good, then they know whats happening without a doubt.

The first time I had a 24 hour monitor I didnt write down much in the log book figuring they would see what was going on. Wrong. Their comment was you didnt write any complaints so we figured there werent any. I just got my 7 day monitor off (which recorded everything so I didnt have to push any buttons) but I wrote in the little log every time I was in a-fib what time I went in, how long I was in, when I got out and I even drew little pictures (of me VERY tired) so there was no doubt how I felt.

When my former doctor retired my new doctor was a pain or so I thought. As it has turned out he is very good. So, it could be that your new cardiologist is really good; checking up on everything, making sure everything is good. Then again, maybe not. Give him the two weeks, press the button when needed and see how it goes. You always have the possibility to change doctors if need be.

Hope this helps
across the pond (atp)

Pindolol is used for bradycardia-tachycardia syndrome.

Thank you for your reply. Petey, I do have tachy brady syndrome. But I was only told it was for rate control. I feel so symptomatic during Afib I really don't like to be in Afib permanently. In 2 weeks I will have questions for him. Can you think of any important questions I should ask?

I would tell him you understand the Pindolol was prescribed for your brady tachy syndrome and that the Pradaxa would be continued for stroke protection.

But I would ask why the Tikosyn was stopped (was it not converting you to sinus rhythm? Do you have long QT syndrome or some other contraindication?) Or is it because of the below:

Tikosyn is indicated for MAINTENANCE of normal sinus rhythm for persistent afib (not paroxysmal) that is highly symptomatic. It is reserved for those individuals that are persistent and highly symptomatic because it can cause more dangerous arrhythmias. You said you "don't feel good" in afib. That falls very short of being "highly symptomatic.

I suspect he only wants to know when you are in symptomatic afib. That might be why he wants to monitor you only when you "push the button" (when you are symptomatic). FYI, the tachy brady syndrome may largely be the reason for you "not feeling good" and may be his main concern at this point. If that is true, it would not be in your best interests to take a proarrhythmic drug like Tikosyn. You don't need a dangerous arrhythmia.

Next, I would ask what other conditions you have that are determining his treatment strategy. For example, Pindolol is effective after a past heart attack (myocardial infarction). Other things that might influence treatment are heart failure and cardiovascular disease. These things affect what combination of drugs are prescribed by a savvy cardiologist.

I would tell him your concerns about progressing from paroxysmal to persistent to longstanding persistent afib. He will probably tell you that you are worrying to far ahead at this point. He may have also decided you have failed rhythm control with drugs (I don't know your history) and that it is either ablation or rate control. Again, brady tachy syndrome can be responsible for symptoms, not the afib. My guess is that he feels you are in persistent afib and that it is asymptomatic unless your rate is all over the map. So it would be ablation now or wait and see for awhile on just rate control. If you are not in longstanding persistent afib, you have time to decide on the ablation.

I see you said you were very symptomatic later on in your post, but I'm not sure you conveyed that strongly or if you said enough other stuff to make him feel otherwise... but again, I think he believes it is the brady tachy syndrome causing your symptoms, not the afib. He will find that out by your EKG strips.

Regarding the weight loss... it will not cure afib... maybe, and I mean maybe, lessen burden, but it sounds like it has done nothing for symptoms you have had lately. So he might have been saying you helped your overall health, but don't expect a miracle afib cure from it.

If you are in your 60s and haven't responded well to rhythm drugs, it is best to be on rate control for awhile till things get sorted out.

I would ask about your atrial size (is it mildly or moderately or severely enlarged?) I would ask about anything else relevant in your cardiology/electrophysiology reports and history.

Finally, I would ask him what HE would do if he were in your shoes. If he says "ablation", don't get sucked into doing it anywhere as persistent cases (I have a feeling that's where you are at) need to be done by the best and still don't have the most enduring results. In those cases, you have to be ready to have multiple ablations.


petey

And btw, controlling brady tachy syndrome with a drug IS rate control. Normally we think of it only for tachycardia, but you have both ends of the spectrum... too fast and too slow. If he gave you the typical beta blocker, you would have a too slow heart rate much of the time.

Print my comments/questions out if you can't memorize them and remember... "I'm not a doctor, just another bozo on the afib bus."

petey

Hi JuJu. I fired my first cardiologist after one meeting when I felt uncomfortable with his answers and then went direct to an EP. From the sounds of things, this doc is a cardiologist and not an EP. Will be interesting to see how he answers all of Petey's excellent question. Hopefully he will refer you to an EP since having a specialist consider your case can only help. The fact that you lost 46 pounds is great and impressive. That takes a lot of effort and discipline. I recorded all my episodes (start and stop dates) in a spreadsheet for a couple years and that was helpful more me and my EP in making the ablation decision. Good luck in your AFIB battle.

Thank you Snowshoedude for your comments about my weight. It has been hard work, but only 40 more lbs. to go. I do know that my weight will not cure the AFib, but I do know that it will cause less stress on my heart and I see that as a good thing. My recent blood work showed much improvement...another plus! I hope to rest my goal by spring 2015!

Judy

I have recorded my episodes of AFib and how I felt in my Ipad that I keep with me. Some people in ER like it, but the doctors don't seem to appreciate this knowledge. I think they think that I obsess with it and have anxiety (which I do not). The reason I don't have anxiety is because I have had Wolff-Parkinson-White Syndrome all my life. I am used to all the arrhythmia and tachycardia. I had an ablation in 2009 for the WPW. My ekg doesn't even show it now, though I had an extensive amount of burn in my heart at the time. I now have AF/AFL with Tachy/Brady Syndrome. It is a wild ride from all the BP and HR fluctuations as they can be very low to very high. I am very symptomatic and feel the irregularity of my heartbeat even when it is a low rate AFib. I can have the light-headedness, get shaky, pass out, chest pain. Thankfully, all these don't happen at the same time.

Petey, I hope you are right and when I see the doctor again I will talk to him more. It was a long visit and I was worn out and not able to pursue any more questions/answers at that time. I tried to make it clear to him that I didn't want to be in AFib. My blood pressure was very controlled with my low dose of Lisinopril/HCTZ, but lately since I have been on my weight loss program my BP has soared. That is probably why he attacked the BP problem. I have failed with Flecinide and with Tikosyn. It did help me with my AFib, but it was becoming more frequent, BP wide swings and HR usually lower recently. There were times it was a higher HR, but not as high as what is happening now with no Tikosyn. So maybe the cardiologist wants to see what is going on. If so, I question the monitor since it doesn't record the whole events to give him an idea of my AFib burden. My left artium is moderately enlarged. The cardiologist said my ekg was indicative that it was enlarged.

BTW, Petey, I don't think I am Persistent because I do convert to NSR on my own. But...I do go in/out of AFib many times throughout most days. It is rare when I only go in once and even rarer if I miss a day. In between I just have lots of PACs.

Concerning persistent afib : I meant from a burden standpoint. It is difficult to place people in one category many times. There is a definition of persistent afib that uses 7 days continuous afib as part of its definition. Or much less if you are being treated. If you had been taking a rhythm drug, or even a rate drug, you are being "treated". Then there is a self conversion component to the definition. But it really doesn't matter. What matters most is how often you are in afib (your concern). Some people have self converted after a year. Doesn't meet the definition exactly. Some people self convert but are in afib 80% of the time. Without the rhythm drug, your burden will probably be higher. That's all I meant.


petey

Peter, thank you for clarifying persistent Afib. Mine seems so different from many on this site, so I wasn't sure. I am sure I need to make some tough decisions. After having a lot of burn during my ablation for the accessory pathway of WPW I don't know how that might affect me to have even more burns for another or multiple ablutions. Scary!