WHAT CAN I DO

[Bobby5454]

I am a 41 year old male with atrial fibrillation since i was 27, i had episodes 4 to 5 times a year that would last from 12 hr to 24 hrs or in some ocasions 2 days but would always convert to sinus rhythm by itself ,but for the last 2 years they have been getting worse,  at first i had episodes every 5 days for 24 to 48 hrs then every other day and since october of  2009 the fibrilation last from 5 to 6 days and the only way to get back to sinus rhythm is by cardioversion  i have had 2 cardioversions done but the sinus rhythm only last from 24 t0 36 hrs. I have seen many Cardiologists and 2 Electrophisyologists but things seem to get worst. I have tried many meds that seem to stop the fibrillations but make me feel very tired and with shortness of breath but besides that no other symptoms. About 2 monts ago i started on Multaq. I have noticed that i feel no symptoms, my heart rate is from 60 to 80 but with the fibrillations. I am waiting for an ablation to be done but the waiting list is long and here in PR there is only one hospital that does this procedure and its having problems with the medical plans. I am very depressed and desperate, what can i do? what other options do i have? I know this is affecting me and my family, i dont know how to work this out.

[LindaTX]

I really feel for you!!!  You are on a blood-thinner, right?  With your history, you need to discuss this with a Cardiologist or electrophysiologist right away if you're not. You could develop a blood clot and then have a stroke. It's very serious, what you're dealing with. Also, things like alcohol, even beer, carbonated soft drinks, even carbonated water, spices, like cillantro, some cold and allergy meds, and a whole lot of other "triggers" bring on episodes.  You need to tell your Dr, I hope he's a Cardio Dr, about stopping the Multaq.  I know its pretty new, but I don't really know anything about it  I'm pretty diligent about what I do, don't do, eat, don't eat, drink, don't drink, I even stopped  taking ambien which was the only thing that helped me sleep.  I'm just not ready to give in to an ablation. So far I haven't had to have a cardioversion,but I would if I had to. I once met my EP at the hospital to be converted after my longest episode of 4 1/2 days only to walk in and resume normal sinus rhythm.  I felt pretty lucky!  My Dr promptly sat me down and said I could go on coumadin or sit back and wait for a stroke.  You bet I started the coumadin.  

[Bobby5454]

Well jerry that's a quiet assertive way of putting it, it is the thruth about the Dr's!!! till this day after 14 years with A-Fib's, every year that passes it does get more problematic, and no real answers.
Besides the A-Fib's i do not have any other heart problems. On day during the summer of 1997 a woke up early in the morning with palpitations very strong and fast out of control, but besides that i did not feel nothing else, so i went to my family Dr, who sent me to a cardiologist, they made a EKG and ECO, they told me that i had an episode of A-Fib, that it would rarely happen again since i was in good shape.(I played Football in Puerto Ricos Supirior Leage, Kind of like a Semi-Pro leag in US) they did ask me if i used any kind of drugs, I told them the truth i have never used any kind of drugs. Then a couple of months later  another episode and so on. Till' this day that they are almost every day, I have been made all kind of test, ECO,Stress test, Heart MRI ,Heart CT and others, and every thing is OK . they even told me i had a strong Heart. After that first episode i keep on playing football because the episodes were very exporadic  about 4 times a year and always happend when i was resting or sleeping, but since 2003 oooh! have they got busy, in this last years it's been very hard because I was a very active person. About a  3 months ago i was at the beach trying to put a beach umbrella in the sand,and i was like in a baseball catcher's position  and when a i stood up i fainted .My wife told me i was out about for 20 seconds, i don't remember anything.
No, i have not told my Dr about leaving the Multaq, but i do feel a little better, I have not stopped the Toprol XL 25mg or the Comadine 7.5mg.
I do read you guys have other heart  problems, how do you feel?, how's daily life?, i hope it's  being OK!

[LindaTX]

Also, I was wondering if your Dr knew you stopped taking the multaq?  Even with stopping the rhythmol I had a fast pulse (between 80-100) for a few days, then it settled down and taking the small amt of beta blocker, 12.5mg,, at night it keeps my heart rate down but doesn't make me tired the next day.

[LindaTX]

Hi, I know how you feel.  I have had a-fib for the last 12-14 yrs. I recently weaned myself off my rhythmol because it started having a pro-arrythmia effect.  I did monitor my BP and pulse rate closely.  I know with a lot of drugs you shouldn't do that, you need to be in a hospital setting.  I'm sure you know your triggers but recently, there was a post  "Welcome to the Palpitations Room" which you might check out.  I have noticed that my BP numbers are close together (20-30pts) when I go into a-fib.  So I tried an experiment. I lay down on the bed and put my feet way up on the headboard,and tried to just relax.  After 5 or 10 min I checked my BP and it was "normal" for me so I stood up and, lo and behold, the a-fib was gone.  I had never been able to get myself out of a-fib before.  I felt great!  I forgot to mention that since I went off the rhythmol I've only had 2 very short bouts of a-fib, one lasting mins and one acouple of hrs.

[Bubba222]

You did not say if you had any underlying cardiac issues - ie, enlarged atrium or valvular problems.  I had a similar afib problem and have both an enlarged atrium and 2 bad valves.  Doctors were considering a catheter ablation but decided to do valve replacement surgery and an ablation at the same time.  I had several episodes of afib right after the surgery and was put on amiodarone temporarily until my heart can settle down from the insult of surgery and the ablation can take effect - it takes up to 6 months.  Amiodarone is the predecessor  to Multaq but it is more effective in preventing afib.  It can be toxic long term but might be a good choice to try until you can get an ablation or get whatever heart damage you may have repaired if possible.  Hang in there, it is a trial and error process unfortunately.

[Jerry_NJ]

Yea, I think the sad truth about doctors (in general) is they are indeed "practicing" - medical science is part: science, part art, part guessing, and part luck.  There may be other parts, and I'm not trying to be negative, but there is a lot going on in the body "medicine" doesn't treat/understand.

Anyway, I'd say yes again to your question.  To my understanding all of the arrhythmic drugs have a risk of just the opposite of what we take them for, cause rather than cure arrhythmia.  That is the main reason, I believe, that the Class III and and some of the Class IC drugs are initiated under hospitalization: full monitor or intensive care monitoring environment.  

I think it is a sad truth we AFib becomes more problematic with age, what's new there?  But, even permanent AFib can be converted for periods of time, it has been in my case and I'm still working on doing it again based on a reduction in the size of my (enlarged) left atrium.  I had heart surgery 2 years ago to repair a mitral valve and that took the enlarging pressure off of my left atrium - part of the problem "feeding" my AFib.

[Bobby5454]

I agree with you 100% being  upset is causing a lot of the symptoms!!! But knowing that i'm not the only one and sharing this experiences is very helpful. Thanks very much for answering.
Yes, I meant electro shock wen I said cardiovertion, and  i stayed on Multaq 400mg two times  daily, Comadin 7.5 daily, and after the 2nd cardioversion the MD. added Tropol XL 25 mg daily. But its been 3 days since I stopped taking the Multaq because since i started two monts ago on multaq, the episodes of A-Fib have  lasted longer and it seems like it got worst. Since the Multaq i have had the 2 cardioversions and it seems like it's harder for my heart to convert by itself  as it did before. Right now it's been 5 days with non stop A-Fib, but now the heart rate stays from 60 to 80, that's good. Before it would be  120 -140, but short episodes probably 24 to 48 hrs every 2 weeks. I am on a diet and have lost 30 pounds,I think that helped lowering the rate . Could it be the Multaq that's causing these longer episodes, or that my heart is changing from Paroximal A-Fib to Permanent A-Fib? I have asked my Dr but he doesn't   give me a concrete answer on this question.

[Jerry_NJ]

Being upset may be causing some of the symptoms, I don't know how to get emotionally back on "track", but that is part of the answer if you can find a way.

I take the cardioversion to be by electric shock, not medication.  If that is the case, did you take any drugs to help keep you in SNR?  I have had several electrocardioversion over the years and two of them did last approximately 18 months each, but I was on Propafenon following the cardioversion.

Afig dictates an anticoagulant, in my understanding, you didn't mention coumadin or warfarin, or even aspirin. I assume you are on at least one of these, if not I suggest you discuss with your medical people.

Ablation is no guarantee, but if it works it will likely last for a long time, maybe for life, I don't know.  I do know that the fact that you do convert to NSR on your own is a good sign for getting results...provided the ablation procedure can trigger fibrillation when needed to find the error paths.