New Afib sufferer - BPM now seem to be in range - what next?

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Hi everyone - I have recently been diagnosed with afib (constantly irregular but not in a massive irratic flutter).  My BPM was around 150 but it now seems to be down at around 80 (although that's with my machine which doesn't seem to like afib and it is maybe not a true reading).  I have been taking 3 x meds to bring the rate down and try and get sinus rhythm back and have had one failed Cardioversion  about four weeks ago which lasted about 4 days.  Now that my BPM are lower I do feel better generally but can tell that I am still in afib and tend to run out of energy towards the end of the day or get a bit puffed after a long walk or strenuous constant lifting.  Is the goal of the med team to get the rate down and then leave it there or do they ultimately work towards getting the beat back in sinus rhythm (I know each case is different just wondering what the general plan of attack is across the world).  I generally lack motivation and my (what was once huge) get up and go has cleared off!  Not as bad as it was so does this come back as time goes on and you get used to dealing with the feelings and tiredness? 

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  • Posted

    I'm afraid "each case is different" about covers it.

    And yes, it can be difficult to count BPM (or BP) when the rhythm isn't there, but 80 at least sounds good.

    Just take it one day at a time, and don't beat yourself up further for giving yourself a needed break.  When something eventually improves, that's the time to make sure you get back on top of things, as conditions allow.

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    • Posted

      Thank you jx41870 - i'm definitely more "enthusiastic" for the future and yes you're right - I have started enjoying a sit down every now and again!

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    Hi Yorkshir,

    There is no one goal that's best for everyone. Sometimes they try to get normal sinus rhythm back with either electro cardioversion, medical cardioversion or ablation surgery. Sometimes they decide to leave you in afib but control the rate with rate drugs. Longevity figures are around the same with all the approaches which are about the same as with the general population. In other words, if you control either the rate or the rhythm, you should live just as long as your neighbor who doesn't have afib.

    Personally, I don't like to be in afib so I've also electro cardioverted right away. Last time I didn't electro cardiovert but fortunately naturally cardioverted a few days afterwards. If that hadn't worked I would probably have tried to electo cardioverted again with the help of a rhythm drug. If that didn't work I would have considered ablation. But that's just my strategy, others may look at it differently.

    At this point you should be seeing a good cardiologist as well as a good EP doctor to help guide you with these kind of decisions. I don't know you age or activity level, but that may play a role. It also depends how well you tolerate being in afib even when your rate is controlled.

    I also suggest you consider getting a home afib detection device called Kardia Mobile. It will tell you in a few seconds if you're in afib or not. When I came home from the hospital with afib after the failed electro cardioversion, I ordered a Kardia Mobile on Amazon. It arrived two days later and to my surprise it turned out I was out of afib the first time I used it. Had I not used the kardia, I would have still thought I was in afib given how I felt and how erratic my heart beat was.

    I would stay positive. Discuss my options with a good cardiologist (or more than one) and a good EP. Get a Kardia Mobile so if you come out of afib you will know it. And at the same time learn as much as you can. No rush to make any decisions, because again, as long as your rate is controlled and your're on thinners, you're safe.

    Jim

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    • Posted

      Thank you Jim - very helpful info.  I am 47 now and got the symptoms only around xmas just gone.  The symptoms of afib seem easier to deal with now that my heart rate is lower but still think that I would like to be totally out of afib eventually.  I am seeing a cardiologist again here in Christchurch, NZ next week and he is going to talk with an EP about the options of ablation but he didn't seem too hopeful as my left ventricle function was at 30% first off and climbed upto 40% last Echocardiogram and he said it should be up over 50% before they will consider it so fingers crossed.  Looking into Kardia Mobile as we speak!  Thank you so much for taking the time to answer.  At least these days I sleep like a log and haven't drunk a drop of alcohol for 3 months so that's got to be good on every level!

       

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    • Posted

      No rush for ablation. It has it's pros and cons. Personally, first I'd maybe try another electro cardioversion, possibly assisted by antiarrhythmic drugs. Or perhaps antiarrhythmics alone, if you're not only them. There are also several lifestyle changes that might help, including weight loss, diet, exercise, etc. You can google "Dr. John Mandrola" and check out his website and some of his YouTube videos. For me the Kardia made a big difference. Otherwise, I'd be stressed all the time thinking I was in afib when I really wasn't. Definitely saves a lot of visits to have an ekg taken.

      Jim

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  • Posted

    Hi. Im a Paroxymal AF sufferer too. In and out over the past nearly 4 years. Had 3 ablations, worn out 2 wrist monitors! Ive reached the stage of trying not to fixate on whether Im in or out! Just crack on and do what I can. I felt that by wearing a monitor, I was becoming obsessed and living through my afib. Whilst my cardiologist would clearly have hoped the ablations "stop" it, hes equally satisfied that Im able to live life and do what I need to whilst in or out of episode. My bpm was up in the 150+ at its worst, but by now, I generally stay below 120 even in full episode. Mostly, 95-105would be my episode range, which makes me a bit breathless, but Im able to work and go about my day, albeit a bit slower! I take no meds now either - they made me feel rough all of the time, whereas the PAF makes me feel rough now and then. Took a while to change my mindset, but once I fully understood what my body was doing, I got there.

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    • Posted

      Hi C Congo,

      I concur that too much monitoring can sometimes drive you crazy. Not to say monitoring doesn't have its place, but there may also be a time to ease off, and apparently you found that time for yourself.

      Other than I assume thinners, what other meds, if any, are you currently on and what doses? Just wondering if your meds account for the lack of bpm spikes in the 150 range. Also, have you ever tried the "pill in pocket" approach? Depending on what meds you're on, might be something to speak to your doc about.

      Jim

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    • Posted

      No, I take nothing. Was on Rivaroxaban. Gained 2 st and after recovering from ablation 3, with agreement of Doc, stopped them and stopped Verapamil. Never had pill in pocket. Touch wood, never required cardioversion either.

      Totally agree that monitoring has its place, especially during early days or post procedure. For me after this time, Im just doing my thing! If I go into episode, then relax, chill and wait for it to stop. Biggest difference is the rate - when it was very high, it was all so much more difficult and worrying. Now, its annoying. I still see Doc every 6 or so months, and up to now, no mention of meds again. Dont particularly want any in truth. Just dont seem to agree with me. We shall see!

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    • Posted

      It's interesting that you bpm no longer spikes. How do you know that your're going in and out of afib and it's not just a benign tachycardia and perhaps some atopic beats? Have you confirmed these later episodes with an ekg or just when you spiked at 150? I ask because I also have bpm with afib but recently after cardioverting I started getting something like you describe with lower bpm's and was convinced I was back in afib but it turned out I wasn't.

      Jim

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      Oh! Its AF sure enough! My episodes typically last up to 6/7 hours. They used to be 15-20! Ive had several holter monitors over 7, 14 and 28 days, both before and after ablations. The first 2 ablations were left side, then 3 was in the SVC area. Took me quite a while to recover from that one, but equally, thats the one which appears to have had greatest influence on bpm. Episodes are far less frequent generally and, in the shorter time frame. I have to watch my triggers - certain foods, fatigue, dehydration and pain. I injured my knee a few months back, and the pain from that has been causing havoc! Its settling latterly, but has upped my episodes.
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    • Posted

      Didn't realize you've been ablated. That seems to account for the change in bpm's during your episodes. My episodes are only every five to ten years but they always have a highly elevated heart rate close to 200bpm, but I've never been ablated.

      Jim

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    • Posted

      When I took my pulse at my neck I got around 160 but the ecg showed 190 bph last time. The doc explained it's sometimes very hard to get an accurate bph reading with afib. Fortunately Dilitiazem (cardizem), which I have at home, brings it down close to 100 strarting in under a half hour. That buys me time to decide what to do. Currently the plan is to do nothing other than keep taking the Dilitiazem and a blood thinner until I hopefully naturally cardiovert. Fortunately these episodes are years apart or I'd probably treat more aggressively.

      Jim

      Jim

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      Hi, my last one was four and a half years ago till it started a month ago and would not go back into sinus rhythm with Bisoprolol and my BPM were 260 which was very scary. I am now on Angitil as Bisoprolol affected my Asthma in the middle of Pneumonia so the Angitil has brought it down to 110-120. Awaiting Cardiologist to see what is next but GP is saying probably an Ablation. I have only ever had it twice and it did go back by just a blood test the first time 12 years ago and the last time one Bisoprolol did it after an hour and both times I woke up with it but this time it just came on and will not go back into sinus rhythm but I hope it does before any further intervention is needed.
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    • Posted

      Hi Maziboo,

      Did they try electro cardioversion? That worked for me 3 out of 4 times. If they haven't done electro cardioversion, I would definitely try that before ablation, given the fact that you've only had a couple of episodes years apart. If that doesn't work, there are other drug combinations as well. For me, ablation would be down the list, only if other treatments did not work. You should also consult with an EP as well as a cardiologist keeping in mind that EPs tend to suggest ablation more frequently than cardiologists based on my experience.

      Jim

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