"creeping" A-Fib - your opinion/experience wanted

[ks1490]

Hi,

I would appreciate the opinion of anyone with A-Fib experience on the evolution of my condition:

I was diagnosed with aortic regurg/dilated aorta 2 years ago (July 2005), it was a complete surprise at age 40, I had been entirely asymptomatic.

A year ago (July 2006), I had my first episode of A-Fib, I converted within 6-8 hours after taking 2 doses of Toprol.

Six months later (DEC-2006), I had a second episode, since Toprol didn't work within 24-30 hours or so I was electro cardioverted.

In May 2007, I had a 3rd episode, my cardio put me on Amiodarone and Coumadin and I converted after 5 days. I was then told to taper off the Amiodarone over 2 months.

In June, I had a 4th episode, I converted next day just by bumping up my Amiodarone doses, then resumed with the taper.

Last week, I had a 5th episode, I again bumped up the Amiodarone dose but it took me 4-5 days to fully convert. My cardio has said he'll keep me on a low-level dose of Amiodarone for awhile and not taper.

My question to all of you is this: obviously from the above you can see that the episodes have become more frequent and take longer to resolve. My cardio says that there is no link between my aortic valve problem (a mechanical problem, in his view), and the A-Fib (an electrical problem, in his view). My mitral valve, with which A-Fib is more frequently associated, is completely fine. I'm just wondering if any of you find the above familiar, or if you think that this "creeping" A-Fib is a sign of thiings getting worse. My aortic valve/LV dimensions have been stable on the echocardiogram over the past year, I have the echo every 4 months.

I'm going to go to another cardio for a 2nd opinion but I wanted to take advantage of this excellent forum to get other feedback. Thanks!

 

[geebee]

Just curious -did the cardio give any indication of what he thought was causing your a-fib if not related to your valve issues?

I am in constant a-fib due to the trauma of 3 OHS. No meds seem to work so I just let it continue since I am protected by the coumadin I was already taking. Based on my experience with a-fib, I think it is entirely possible your a-fib will continue to get worse and could result in a chronic condition.

I would try to find out just what is causing the a-fib. Perhaps once you have surgery, things might improve. I also think a second opinion would be in order.

 

[ks1490]

He doesn't have a strong view on the cause, although we are looking at sleep apnea as one potential cause since I occasionally snore and all of the episodes have started at about 3 in the morning.

He suggested that if it comes time for me to have OHS due to the aortic valve situation, they might do a "Maze" procedure while they're in there to deal with it.

 

[Ross]

My buddy was cardioverted for the 8th time about a month ago. He's done the Amiodarone thing, been on several other drugs to try to put a stop to it, had a maze done and it still persists. His Doctor told him flat out he needs transplant. He's a TOF patient and has had problems since birth. He's now 44 years old.

 

[Bridgette]

Hi

I certainly don't want to depress you but the Maze is not the cure for A Fib that some surgeons claim it to be.
A surgeon I talked to before my op told me that he had been to a cardiothoracic surgeons conference in the States and among other things they discussed the success rate of the Maze Procedure. Although some doctors and websites claim that there is a 90-95% success rate, it was suggested at the conference that the true figure is more like 75%.
Anyway I had the Maze Procedure last December along with mitral valve replacement and I am still having little bouts of A Fib most weeks although it only lasts for a few minutes before it self reverts back to sinus rhythm. In a way I suppose it has worked because I haven't had an episode that lasts long enough to warrant going to hospital.
But hopefully you might be in the lucky 75% of people that is cured completely by the Maze

Bridgette

 

[Adrienne]

I had a Maze procedure done, and knock on wood, it worked. My surgeon did tell me, however, that the long-term success rate for the Maze is 70%.

 

[Kathleen]

I have a long history of afib and ablations. There is not a reason for you not to do the maze when you have the valve done. They are perfecting the maze faster than the ablations. The one concern I have is using amio as a booster for the afib. There are other meds that have far far less side effects than the amio and can keep your system at a better level than popping extra mgs when needed. That way if you are stable on a med you don't have that nagging concern of it appearing at will. Afib wears heavily on ones mind and it nags at the back of your brain while you wonder when it will appear again.
Kathleen

 

[Susan BAV]

opinion/experience wanted?

opinion/experience wanted?

There have been a lot of discussions here about Amiodarone and the possible/probable side effects. Have you had the opportunity to search it?

While I developed A-fib/A-flutter post-op, Sotalol was what was administered to me in the hospital and it took care of it. I was also given magnesium IVs.

I hope your rhythm problems safely resolve. Please keep us posted? Take care.

 

[ruth]

So sorry to hear of your AFib battle. I had it post op & it wasn't the most fun I've ever had.

The problem that I see in your comparision of the increasing frequency is that the drugs you are on are not remaining constant. What I'm implying I suppose is whether there is a link between the amioderone usage/tapering and the AFib.

I'm now hypothyroid as a result of the amioderone that I took for 4 months, I've since learned that amioderone is something like 60% iodine, geez, no wonder it messes with the thyroid. Ironically my thyroid medicine documentations says that it has a possible side effect of, you got it, heart rhythm abnormalities. I'd like to get off this merry-go-round please.

Perhaps you could see an electrocardiologist? I did and learned that an ablation might work for me. If my AFib returns I might consider it but I'm not inclined to do it proactively. I've had enough excitement for one year

Take care,
Ruth

 

[ALCapshaw2]

The following is a copy of my recent response to John, a.k.a. "67walkon" in the Post Surgery Forum to his quesition about post surgical A-Fib:

A-Fib is a BUMMER isn't it !

I had a few events post op spread over 6 weeks.

First time - in hospital - Digoxin Protocol - resolved after 3 hours.

Second time (at 5 weeks) - Went to local ER, on monitor, resolved after 3 hours.

Third time - called GP on-call, bargained with Doc to 'let me ride it out" and promised to go to ER in morning if not resolved. Resolved in 3 hours.

Fast Forward 2 years, developed Exercise Induced A-Fib.
Cardiologist put me on SOTALOL (generic for BETAPACE which targets A-Fib), 80 mg twice a day. Weaned back to 40 mg (and usually only once a day for a year, then back to 2X day). (Info sheet says to start Sotalol / Betapace, you should be monitored IN HOSPITAL for a few days to see how you will react. Not all Doc's follow that recommendation...)

Many Docs like to use AMIODARONE which is the SLEDGE HAMMER of anti-arrhythmics BUT comes with a Laundry List of NASTY / DANGEROUS Side Effects, not to mention a 6 Month Half Life. It is the DRUG of LAST RESORT. (Do a SEARCH for "Amiodarone" or talk with your Pharmacist about all the side effects of this drug BEFORE agreeing to it's use. Many Doc's swear by it for the SHORT TERM. Beware of Long Term use.

'AL Capshaw'

 

[Adrienne]

Fast Forward 2 years, developed Exercise Induced A-Fib.'AL Capshaw'

There are a couple of people who have mentioned exercise-induced A-Fib. I would like to know if you were really doing very strenuous exercise or not. I go to the gym and do fast walking on the treadmill and am very careful to not get my heart rate up too much. It would scare me if you said that was the type of exercise that induced the A-Fib.

 

[Susan BAV]

exercise-induced a-fib?

exercise-induced a-fib?

This reminds me of something I've observed: If I am not exercising regularly, I tend to notice more extra and/or abnormal rhythm activity. When I am exercising regularly, I believe my heart must be in a healthier state and I'm not as aware of extra rhythms.

 

[EireCara]

Adrienne, I get exercise indused a.fib from just walking. Iv had to have a stress test stopped due to a.fib and v.tachy. I was having it done as an outpatient but they wouldnt let me leave and admitted me straight away. I also get a.fib from just doing nothing. No sense or reason it seems, for me anyway.

 

[ks1490]

Thanks to all of those who responded. Should I take it from these responses, then, that you share my cardio's opinion that the A-Fib is a separate problem in itself and is NOT a sign that my aortic valve issue/dilated aorta is getting worse? Thanks

 

[Stitch]

I am almost 7 years post OP and I am not sure my cardio knew what was going on completely. I had SVT that got worse as I got older (op at 52 with 2 ablations before hand). I had A-Fib twice post OP (the first time in the plane coming home). I still have PVC's now and then. From the info above you are more informed than I was and I did a lot of reading before hand. In the end I think it is a difficult decission for you as A-Fib is really no fun at all. SVT was a cake walk in comparison. I wish you all the best with you struggle.

 

[ALCapshaw2]

There are a couple of people who have mentioned exercise-induced A-Fib. I would like to know if you were really doing very strenuous exercise or not. I go to the gym and do fast walking on the treadmill and am very careful to not get my heart rate up too much. It would scare me if you said that was the type of exercise that induced the A-Fib.

I first noticed the "exercise induced A-Fib" while working in the yard (push mowing grass, hand sawing trees, etc.) It seems that sometimes it would start with only moderate exercise.

I went through a period where I became pretty sensitive to 'triggers' (i.e. ONE bite of Chocolate) but fortunately that has abated and I get by on 1/2 tablet of Sotalol (40 mg) twice a day (for a while I could even go with only ONCE a day and Sotalol is NOT time released).

I NEVER got an explanation for WHY I became more (and then less) sensitive to those 'triggers'.

'AL Capshaw'

 

[Susan BAV]

Thanks to all of those who responded. Should I take it from these responses, then, that you share my cardio's opinion that the A-Fib is a separate problem in itself and is NOT a sign that my aortic valve issue/dilated aorta is getting worse? Thanks

Sorry; I don't know the answer to your question. In this case I can only tell you that in my experience, as my valve deteriorated, I developed a lot more rhythm problems. The cardio I saw at that point didn't think it was related; but he also didn't think my valve needed replaced, which he was very wrong about.

Can you get a second cardio opinion? Or, have you consulted with a surgeon for an experienced/expert opinion? It has been observed by many here that cardios tend to treat symptoms longer and surgeons tend to want to correct the structural issue before there is greater heart damage.

 

[Sandy SHields]

a-fib

a-fib

I have had mitral valve replaced in1983 never had any problem with afib until 1 year ago. I have been put on sotolol, Rythmol now I am on Amiodarone. I have only had short afib lasting only a few minutes since I started it. but here lately I have been so fatigued that I don't want to do anything. I have also have had a lot of joint pain to where I have trouble sleeping and working.
Today my heart feels like it is beating in my throat but my vital signs are fine. don't know what is causing this. Anyway I have study this amiodarone and it is a very nasty drug that you are suppose to be hospilized to start it and a loading dose which I didn't get either my cardio just started me on 200 mg and told me that this may put you in constant afib and left the room. So unlike myself it is a good idea to discuss this with your doctor to see if there isn't a better way. I hope you have a good day.Good luck

 

[RCB]

AF-the building storm

AF-the building storm

Hi,


My question to all of you is this: obviously from the above you can see that the episodes have become more frequent and take longer to resolve. My cardio says that there is no link between my aortic valve problem (a mechanical problem, in his view), and the A-Fib (an electrical problem, in his view). My mitral valve, with which A-Fib is more frequently associated, is completely fine. I'm just wondering if any of you find the above familiar, or if you think that this "creeping" A-Fib is a sign of thiings getting worse. My aortic valve/LV dimensions have been stable on the echocardiogram over the past year, I have the echo every 4 months.

I'm going to go to another cardio for a 2nd opinion but I wanted to take advantage of this excellent forum to get other feedback. Thanks!

It is not often I challenge the opinion of someone's doctors, but since you asked, I will.
Your doctor statement that “that there is no link between my aortic valve problem (a mechanical problem, in his view), and the A-Fib (an electrical problem, in his view).” is simply not true. If the AV is not functioning right, is can cause physiological changes in the heart which may interrupt the normal path of the electrical impulses that keeps the heart in normal rhythm. These physiological stresses are not always measurable in an echo. That has been known for decades. Also, the LA plays a greater role in AF and should not be allowed to exceed 45 mm. While it is difficult to say the AV is the cause of the AF, it is certainly wrong to say it can't be the cause.

AF is serious problem in the long run. Much is unknown about its causes and cures. The AHA states that the odds of having AF are 1 in 6 over a life time and 1 in 4 if over 40. As more and people are surviving HVR multiple times, it looms as a real problem for the future. Dr. Jim Cox invented the Cox Maze procedure over twenty years ago and it is still considered the Gold Standard for AF cures. Also don’t be fooled by the use of the word “Maze”. Only the Cox Maze III procedure has the highest cure rate, other use the name “maze” but it is not the same. Dr. Cox did not trademark the word “Maze”. Also, Maze refers to a pattern that is created with scar tissue that does not allow for an electrical pathway. Ablation refers to stopping by barrier (scar tissue) formed by various means.

Maybe your doctor misunderstood your question or you misunderstood his answer. You really need to see an electrophysiologist at a large heart center to get a good answer to your question, and even then they don’t have all the answers. People with no pathophysiological problems of the heart have incurable chronic AF.

In the mean time do a web search for an AF forum and educate yourself. Good luck!