Qs re: Chronic/persistent AF starting in 30s

[afib345]

First post to this forum - and I promise future ones wont be this long:-) Just wanted to state medical situation and past current treatment before questions:

My husband has A-fib and has been in chronic (a.k.a. "persistent" A-fib) since he was 36 (diagnosed and became persistent in 2000, oddly right after starting Atenolol for it - but told no connection to Atenolol -That he was probably already about to go into persistent AF at the time).

The first cardiologist he saw back then put him on a regime of Atenolol (25 mg) and 325 mcg of aspirin instead of cardioverting him...mostly because my husband didn't notice his irregular rhythm unless the rate went haywire occasionally (which it did from time to time back then before diagnosed and put on Atenolol).

Eventually this same Dr decided to try cardioversion and anti-arrhythmic drugs (a "why not give them a try" approach). At that point I had been reading up a lot on A-fib and - from what I learned, cardioversion after one year of being in Afib had very little if any chance of working (or keeping my husband in sinus rhythm for very long; that his heart rythym had mostly likely "remodeled" and now thought the irregular rhythm was the normal one).

While weighing the treatment options we came across the Rate vs Rhythm study that had just been published; this confirmed our decision to treat the rate instead and forgo cardioversion which probably would not work. My husband also made the move from his cardiologist to an electophsiologist who also agreed rte control the way to go at that point.

Eventually this new (current) Dr added Digoxin to his daily regime (250 mcg) due his heart rate being a bit up at one appointment. He has been on this regime of Atenolol, Digoxin and Aspirin now 7 (?) years.

Over the past few years he has had a few "flagged" blood test; two of which are extremely low blood sugar levels (one was 44 and another was 47. both times his blood sugar went up by the second test - before being down again the following test). Since he is only on the medications I already mentioned, I did some online searching on them and found that low blood sugar levels have been noted in some people taking Atenolol - and that Atenolol "masks" the symptoms (which can be dangerous).

His EP has said this "could" be what is causing his low blood sugar occasionally and has told him to stop taking Atenolol and switch to a calcium channel blocker called Cardizem (recommendation as of today).

I am really concerned about him being told to just suddenly stop Atenolol and switch to this new medication like that. He has surgery scheduled next week and my gut tells me his body will still be adjusting to the new medication never mind withdrawing from Atenolol. I think he should 1) wait until after his surgery/recovery from it before trying this new drug/stopping the Atenolol and 2). Learn some more about this new medication before starting it.

If anyone has any input, please share. Also, if any of you out there have a similar story (went persistent with your AF at a younger then normal age for this arrhythmia) please let me know what you have learned (if anything) about long term use of these medications. There is no date due to this age group not having been studied and it is very frustrating. My biggest concern right now is how my husband keeps having these small or weird medical issue the past few years and I am wondering if these medications are building up in his system and causing some adverse effects now.

Thanks so much for any info you may provide.

[afib345]

Thanks so much for the reply/ info Gary. Adding it to the list of things to read up about /ask his Dr about. Really appreciate it!

[Gary3201]

I don't think you will really encounter any problems here.You have to see the half life of the BB and see that it takes awhile to clear your system. Cardizem is a very effective medication to lower the HR It also works pretty much right away it is not a drug that has to build up in your system. Depending on the severity of your husbands HR the Ep would have started him on either 180 or 360 MG. It is not uncommon to be told to take a 360 and if the hr after 3-4 hrs stays up then supplement it with a 180mg. I think though I would also reconsider the cardioversion it is a simple procedure and at least temporarily gets you back into sinus rhythm. Arrhythmias do change over time and a medication that at one time may have controlled it becomes no longer effective or perhaps the dosage strength needs to be revised.

best of luck with the surgery and keep the faith
gary

[afib345]

Thank you so much for this really helpful information. Shortly after posting  my questions tonight our PCP Dr called to say what you just did; definitely wait until after surgery before making any medication regime changes. He also convinced about it being necessary at this time. In addition, I had sent an email to my husband's EP early today expressing our concerns and he just emailed back saying that he has retracted his early suggestion to switch to a ccb - certainly this close to surgery. We were thinking of moving to another EP for a while now and maybe this is a sign that it might be the right time.

So - plan is to keep doing as he is doing medication wise for now (certainly until well recovered from surgery), and then set up an appointment with a new EP. Already working on getting names/referrals for when we are ready.

Again- thanks so much. I knew nothing about ccb/bb ....using them together...tapering off one while starting another...and now have some good info to start getting familiar with ccbs before speaking with his current EP (or new one down the road). Really appreciated.

[itdood]

I agree, that he should not stop the BB cold turkey.  If he has any rebound effects, yikes.  He's been on it a long time from a youthful age.  Speaking of remodeling, I think BBs can cause some remodel too.  It's shown that peeps build up a resistance to BBs, probably a part of the remodeling process.

If he wants to swap out a BB with a CCB, I would say start really slow on the CCB keeping the BB the same.  As he ramps up the CCB, ramp down the BB.  Take as long as you can to do this.  It's common for peeps to be on a BB and CCB at the same time.

I wouldn't try this until he has a long stretch of no other changes going on, i.e. don't try this until after his recovery from the surgery.