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Heart Disease (Expert Forum)
AF Getting Worse
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AF Getting Worse
by jimnlin, Dec 19, 2005 12:00AM
I've been under treatment for an arrhythmia (AF?) for about 2 years. Initially, it was treated with propranolol when it occurred. As it became more regular, I began taking sectrol 200 mg/day. This worked for a little while. When it (the "skipping" - palpatations) returned I was switched to 400 mg/day. Last spring, it returned and the dosage was increased to 800 mg/day (400 2x). Around Thanksgiving, It returned worse than ever. The episodes last several hours and have been joined by an increase in heart rate (pulse). At times, the rate is over 200 bpm. They have also become associated with eating at times, but not always. Whether due to anxiety, or the condition, I experience shortness of breath and dizziness. I am also taking Welbutrin and Lexapro for depression. They are very effective for the condition. My Dr. wants to reduce them or eliminate them completly. I'm not comfortable with this. Is there a relationship between them and the arrhythmia? I also experience sleep apnea and am currently using a c-pap machine. This has helped with the apnea, but the arrhythmia has only become worse. Also, I'm not taking a blood thinner for possible clotting. Should I be taking them? I'm considering a visit to Cle. Clinic, but am unsure about my insurance.
Doctor's Answer
by CCF-M.D.-MJM, Dec 19, 2005 12:00AM
Hi Jimnlin,
It sounds like you are having a rough time. If you are interested in coming to the Cleveland Clinic for an evaluation in our atrial fibrillation center, call 216-444-4369. If you have insurance questions, try the following numbers:
Daniea Rogers 216-445-2321
all anthem an d non-ohio blude cross/blue shield insurance payors, all cigna payers and all aetna payers
Robin Johnson 216-444-6598
for all medical mutual insurances payor (supemed plus, classic, hmo, etc)
Andrew Kish 216-444-5343
Medicare, Medicaid, CCHS, United Healthcare and all remaining insurance payors.
Welbutrin is a stimulant and have an affect on atrial fibrillation. I haven't heard anything about lexapro worsening atrial fibrillation.
Sleep apnea is associated with an increased adrenergic state and may increase the frequency of atrial fibrillation. C-pap is the best short term solution. If you have OSA from obesity, the long term solution is weight loss.
Regarding warfarin -- anyone with hypertension or diabetes mellitus and atrial fibrillation should be on warfarin. There are other risk factors as well like reduced heart function or structural heart disease, previous thromboembolism and age. You should see a cardiologist or electrophysiologist to help you with -- it can be tricky if there are other risk factors for bleeding.
There are antiarrhythmic options as well depending on your profile, but again, this is a complicated discussion.
I hope this helps. Please come and see us if we can be of any assistance and good luck.
It sounds like you are having a rough time. If you are interested in coming to the Cleveland Clinic for an evaluation in our atrial fibrillation center, call 216-444-4369. If you have insurance questions, try the following numbers:
Daniea Rogers 216-445-2321
all anthem an d non-ohio blude cross/blue shield insurance payors, all cigna payers and all aetna payers
Robin Johnson 216-444-6598
for all medical mutual insurances payor (supemed plus, classic, hmo, etc)
Andrew Kish 216-444-5343
Medicare, Medicaid, CCHS, United Healthcare and all remaining insurance payors.
Welbutrin is a stimulant and have an affect on atrial fibrillation. I haven't heard anything about lexapro worsening atrial fibrillation.
Sleep apnea is associated with an increased adrenergic state and may increase the frequency of atrial fibrillation. C-pap is the best short term solution. If you have OSA from obesity, the long term solution is weight loss.
Regarding warfarin -- anyone with hypertension or diabetes mellitus and atrial fibrillation should be on warfarin. There are other risk factors as well like reduced heart function or structural heart disease, previous thromboembolism and age. You should see a cardiologist or electrophysiologist to help you with -- it can be tricky if there are other risk factors for bleeding.
There are antiarrhythmic options as well depending on your profile, but again, this is a complicated discussion.
I hope this helps. Please come and see us if we can be of any assistance and good luck.
CClinic is probably the best in the country for A-fib and my cousins in Michigan frequent the clinic often and are very pleased.
~~~~~~~~~~~~~~~Happy Holidays~~~~~~~~~~~
I always wondered why some persons with frequent PVCs or episodes of PVCs go on to develop PAF or chronic a-fib, yet a-fib is triggered in the pulmonary veins and atrium and not the ventricle as in PVCs. Does the ventricle pick up the electrical foci from those area of the heart and fire prematurely on a random basis rather than directly from the ventricle itself, just my speculation,I'm lost as what to think. It also amazes me that PVCs and atrial fibrillation can be occuring at the same time, oh well just a thought.
From what read it appears that about 1 in 4 persons will experience a-fib after age 40, whether it be paroxysmal or chronic.