New intro/Some questions (persistent AF)

[afib345]

Hi -

Haven't posted here since December or January so sorry for this long summary/afib history outline. Additional posts will be normal length:

I am posting about a couple of question my husband and I have regarding his persistent afib and treatment regime.

He has been in persistent AF (always irregular - but doing rate controlled) since 2000 or 2001.

First Dr he saw was a general cardiovascular Dr who didn't try electro-cardioversion (b/c at that point he was still going in and out of Afib....three to five days in it then out for a week....then back in it).  Instead just treated his rate.He gave him 25 mg (once a day) of Atenolol and told him to take 325 mcg of aspirin daily. (side note: He was in AFib when he started the Atenolol and never went out of Afib after that. I asked his Dr if it was making it worse and he said no. just a coincidence.)

Eventually switched Drs and new Dr added on 250 mcg of digoxin in addition to Atenolol and aspirin. At this point were were told (confirmed) that rate control was best option due to re-mapping caused by persistent AF for so many years now.

After several years with the second Dr we switched due to to not being happy with him (never avaiblable, some questionable medicine change suggestions etc).

Just met with new EP a couple of days ago. Highly recommended. Great hospital, really nice guy. He again confirmed that my husband not a candidate for ablation or any kind of corrective/anti-arrythmic medication due to how long his heart has been persistently in AF (it has been at least ten years now. FYI: He went into  persistent Afib age 36 - which we learned is pretty young for it especially with no known cause. He does not drink and is otherwise really healthy).

His new Dr told us something that the old one never did. We were told that his past echocardiograms were "unremarkable" or "unchanged". That his heart function since using rate control had returned close to or was normal (it was in the 30% range before rate control treatment back in 2000). However, we were never told that his last echo in 2006 showed some enlargement on the right ventricle now (before it has just been slight enlargement on the left) and upper chambers. This right side enlargement has me concerned.

he also said that my husbands last Holter monitor well over a year ago said that his heart rate had gone up past 200 bpm a few times. Again, the old Dr said all looked normal (so glad we left him). The Dr was calm/cool about it all but suggested that my husband double his dose of Atenolol; take 25 mg in the AM and another 25 mg in the PM (when the first dose would have warn off and less effective by then).

He also said it was time for my husband to consider switching to Coumadin. His reasoning; Although my husband has no points on teh chad score (no additional risk factors) they are finding that even young healthy people with AF can still have strokes  - and since my husband is in persistent AF, it gives more reason to want better protection.

On the whole, this makes sense and think he is right. The Coumadin is a bit concerning b/c we are both active (surf a lot) and if he were to get injured to the point of bleeding while on the water - he could run into trouble. But he is a longboarder and sticks to smaller waves so the risk factor is less there.

It's the upping the Atenolol that has me concerned most. My husband is 6'3" but very sensitive to medicine. he had a really hard time adjusting to a larger dose of atenolol before with an old Dr (had him take all at once instead of two times a day - which new Dr said should relieve the past bad symptoms ...like dizziness, blurry vision....he had). But my biggest concern is - what if he gets too used to Atenolol and it stops working for him? Or if this upped dose doesn't work? Or, what if in general his rate cant' be controlled by these drugs? If he is not a candidate for cardioversion via surgery or medicine.....and rate control is his only option - what if these drugs can't control his rate? They do for a while...but then his heard finds a way to beat to fast again?

I know what will eventually happen if that happens (heart failure) so want to hear what others think....If they know of a similar case and how it was handled etc.

FYI: I, not my husband will be posting questions/concerns for him. he doesn't like to deal with this because it stresses him out (increases his heart rate!:-) and just likes to act like he doesn't have this issue and get on with his day. I think that is the right away to go about it (after he takes his atenolol and blood thinner of course:-).

So sorry so long....Any additional posts will be short now. Just a re-introductory dump to get whomever reads this up to date on my husbands situation and where things stand today.

Thanks!

[TachyAfraidy]

Hi. Like Jerry, I have been on coumadin for almost three years now. My transient paroxysmal atrial fib and sick sinus syndrome sent me pretty much straight to the EP for ablation of the left pulmonary re entry veins in 3/09. I was on the table for 11 hours March 10th 2009 while the EP painstakingly tested and burnt several areas in my left atria. I have to control tachycardia with flecainide and a calcium channel blocker now.

I still have bouts of tachycardia but not the skipped beats and shortness of breath that came with the afib. I was 44 years old when this started and I had no idea what was happening to me. I went through Atenolol, digoxin,sodelol, propafenone, amiodorone, and then had to have the ablation, all in a matter of two months. Seemed as if no drug was working for me and my heart. Post ablation, my rhythm morphed into flutter with Tachy bouts, but those rjhythms did not seem as symptomatic as the afib. In April 2009 I went in to the hospital for the third time for cardioversion, but my cardiologist tried flecainide first instead. My heart dropped into sinus rhythm the third morning in the hospital so we cancelled the cardioversion and I have been on the flecainide ever since. All that being said, there are many anti arrhythmic drugs to try if one no longer does the trick. I used to worry all of the time that the flecainide would stop working. Nothing held back my heart, it always felt like a racehorse needing to run. I have been in fairly normal rhythm. If I have a tachy bout, I take extra non time release channel blocker and (knock wood) it has worked for me thus far. I check my bp and hr twice a day when I feel symptomatic and often check my own pulse daily just to see where things are. Just wanting to let you know that at 46 years, I am still here and thriving. If my rhythm  gets worse or I fall back into afib, I would not hesitate to have a "touch up" ablation. Try not to worry. There are lots of drugs that your husband's cardiologist can try if Atenolol doesn't hold the heart rate down. My heart rate fluctuates between 77 and 88bpm when I am feeling well and once every three months or so climbs up over 100 for a little while, that is when I take the extra verapamil. Post ablation for me, I find that things are not perfect in the way of rhythm, but the symptoms are so much lighter and I lead a pretty good quality of life now. Good luck and you are doing the right thing to handle the questions so your hubby doesn't have to. Stress has everything to do with my heart rate. Remaining as calm as my OCD type personality allows me to is the best medicine of them all. It is hard when you feel so out of control with this type of heart disease. At least it has been for me. Keep taking good care of him! :)

[Jerry_NJ]

I think there is a correlation between tall and AFib. I was about 6'6" before age started to move my physic shorter and wider  :(

I am in permanent AFib and take Warfarin for clot control, and also a half 325 mg aspirin, my choice, I could take the low dose instead.  I recently switched from a beta blocker (Metoprolol) to a lower dose BB and a high dose calcium channel blocker.  So far, just over three months, this combination does a better rate-control job than the BB alone.  I run in the 70s at rest and the 90s when walking around.  All safe numbers.  But the AFib and my advanced years have stopped running and hard bike riding...guess I'm thankful I didn't get hit with AFib until I was in my mid 50s.  I am conscious of the risk of uncontrolled bleeding due to the blood thinners, but I don't hold back a lot, I was on Warfarin while my AFib was in remission for a few years, and I ran and rode bikes and never fell, good thing I guess.