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A Fib experience/advice

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Brokenhip

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May 20, 2019
Messages
22
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Melbourne, Australia
Eva suggested I should start a new thread rather than have it imbedded within in a reply.
I had an AF episode 2 weeks ago with an erratic pulse I could feel in the neck. Tried cycling the next morning, lasted 5 km as HR was much higher than normal and erratic. Off to the GP, did an ECG which was sent to my cardiologist & between the two practitioners they have put me on a beta blocker Sotalol (40mg twice a day) & an anti coagulant Pradaxa. The AF settled about 36 hours after it started, so not sure whether it was the meds or it would have corrected on its own.
Have continued cycling but finding it hard work as HR is maxing at around 90 bpm. A very recent annual stress test max. HR was 140. Plan to see my GP on Friday & discuss a strategy to come off the Sotalol which the cardiologist is OK with & in the short term use a pill in a pocket, & see what transpires.
I am 69 year of age with a bovine aortic valve & generally cycle about 250 kms per week. So any input into the types of intervention, cardioversion/ablation/medication/pacemaker as well as the ability to continue exercise would be grateful. I guess I could stay on the Pradaxa to help reduce the risk of throwing a clot & the subsequent consequences.
My AVR was in Feb 2018 & I did go into AF about a day & a half into recovery which was controlled with an amiodorone drip (24 hrs), then tablets for 6 weeks. No problems until now & the cardiologist does not think this current episode is related to the AVR.
Any thoughts, experiences please.

Peter.
 

ottagal

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Hi Brokenhip,

Sorry you haven't had any responses on this and that you are dealing with afib again.
I won't be much help as I only dealt with afib post surgery which resolved within a few weeks on beta blockers and anticoagulants.
My only thought would be to make sure you are being monitored. I am not sure how far 'after' AVR afib is considered unrelated to AVR. Did you get a holter monitor for 2 weeks to see where things were at?
Interestingly, a family member found out her afib was actually a consequence of hyperthyroidism, even though she had a cardiac history. This was quite a surprise to all of us. Perhaps, a full blood work up would be worth it.
I am not sure what the best intervention is for your case. Can you see a cardiologist who specializes in afib?

My understanding was Pradaxa was typically prescribed for afib unrelated to AVR.
Wishing you all the best moving forward.
Hope you get some answers.
 
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Brokenhip

Member
Joined
May 20, 2019
Messages
22
Location
Melbourne, Australia
Hi Brokenhip,

Sorry you haven't had any responses on this and that you are dealing with afib again.
I won't be much help as I only dealt with afib post surgery which resolved within a few weeks on beta blockers and anticoagulants.
My only thought would be to make sure you are being monitored. I am not sure how far 'after' AVR afib is considered unrelated to AVR. Did you get a holter monitor for 2 weeks to see where things were at?
Interestingly, a family member found out her afib was actually a consequence of hyperthyroidism, even though she had a cardiac history. This was quite a surprise to all of us. Perhaps, a full blood work up would be worth it.
I am not sure what the best intervention is for your case. Can you see a cardiologist who specializes in afib?

My understanding was Pradaxa was typically prescribed for afib unrelated to AVR.
Wishing you all the best moving forward.
Hope you get some answers.
Thank you ottagal,

With consultation involving my GP & cardiologist the decision was to cease both Sotalol & Pradaxa & just continue with a mini aspirin. Stopped about 10 days ago, heart rate returned to normal after about 3 days and at this stage has stayed in rhythm & I have continued cycling. So at this early stage hoping it may have been a one off. Should further episodes occur then back on the meds as above followed by greater investigation.
I do have an annual check including, echo, holter & echo stress test & ironically this was all done & fine just a few days before the afib episode.
Anyway, all good currently & hoping it stays that way.

Peter.
 

Enigmalady777

Active member
Joined
Mar 27, 2018
Messages
35
Location
Santa Clarita, CA
Eva suggested I should start a new thread rather than have it imbedded within in a reply.
I had an AF episode 2 weeks ago with an erratic pulse I could feel in the neck. Tried cycling the next morning, lasted 5 km as HR was much higher than normal and erratic. Off to the GP, did an ECG which was sent to my cardiologist & between the two practitioners they have put me on a beta blocker Sotalol (40mg twice a day) & an anti coagulant Pradaxa. The AF settled about 36 hours after it started, so not sure whether it was the meds or it would have corrected on its own.
Have continued cycling but finding it hard work as HR is maxing at around 90 bpm. A very recent annual stress test max. HR was 140. Plan to see my GP on Friday & discuss a strategy to come off the Sotalol which the cardiologist is OK with & in the short term use a pill in a pocket, & see what transpires.
I am 69 year of age with a bovine aortic valve & generally cycle about 250 kms per week. So any input into the types of intervention, cardioversion/ablation/medication/pacemaker as well as the ability to continue exercise would be grateful. I guess I could stay on the Pradaxa to help reduce the risk of throwing a clot & the subsequent consequences.
My AVR was in Feb 2018 & I did go into AF about a day & a half into recovery which was controlled with an amiodorone drip (24 hrs), then tablets for 6 weeks. No problems until now & the cardiologist does not think this current episode is related to the AVR.
Any thoughts, experiences please.

Peter.

I feel your pain. I've had aFib for years, even before my OHS in 2018 for a mitral valve replacement. Last year it went completely bonkers (heart rate in the 140's ALL THE FREAKING TIME). Went in for a defibrillator implant and had a cardioversion done and boom, heart rate back to normal for the first time in YEARS. I was also put on amiodarone and bisoprolol and went about my business happily.

Endocrinologist took me off the amiodarone in May of this year due to thyroid issues, and all was ok until two weeks ago. Boom, heart rate back in the 130's and 140's. Dang it! I contacted my cardiologist and he had me double the bisoprolol, and I have an appointment with him tomorrow.

I was on Pradaxa prior to my OHS, then went on warfarin (mechanical valve) afterwards. I didn't have any problems with Pradaxa, but it didn't help the aFib, it was just a precaution to prevent blood clots.

As for the cardioversion, I've had that done twice - once in 2015 (didn't work at all) and again last year after the defibrillator implant and it worked that time.

Truthfully, I was also on an IV drip of amiodarone when they did the cardioversion last year, so whether it was the cardioversion alone or the combo of the amiodarone AND the cardioversion that put my heart back in sinus rhythm, I don't know. In any case, the aFib is back and I'm miserable.
 

Woodcutter

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Joined
Oct 25, 2020
Messages
2
Interesting topic (for me) hence my first post to a site I've browsed for years. I have a mechanical mitral valve that took 2 attempts before success. Firstly a repair that unfortunately made things worse enough that a few months later the valve was replaced. This was 7 years ago at age 50.

I am a longtime distance runner. Hundreds of races, many marathons. In my mid-40's I had AFIB. Suddenly turned on and several cardioversions, drugs - alone and together - were not successful. I would pretty easily get my heart rate over 200. Ablation resolved this. A few years later my lifelong murmur degraded to the point that the mitral work was necessary. I did have another ablation at that time (Doc said it was standard practice for my history since I was opened up anyway). This was cryo vs. the first which was RF/heat.

I run much slower these days but still monitor my heart rate regularly (Garmin watch and the Kardia device). Last year I could tell something was amiss. Through my decades of running I have been able to quickly tell if something is wrong. Same symptoms as AFIB. EKG and the wearable monitor both confirmed AFIB. I requested another ablation (given prior success) and The Dr. gave it a 50/50 shot. He told me he would not go "too near" the mechanical valve and I both understood and agreed. But . . .. once in the EP lab with 25 leads attached, he found it was not AFIB but flutter. Actually 3 of them. If if I recall correctly they were at 150, 180, and 220 bpm (I'll have to check my records!). One was in the typical location at the isthmus between right atrium and ventricle but the other two were around incision scars from the mitral valve work. The ablation resolved these.

My summary is that I could tell when I had an arrhythmia as it significantly impacted my running. Never particularly bothered me otherwise. Various drugs that either slowed the rate or attempted to changed the rhythm were also immediately felt during exercise.

I found "The Haywire Heart" by Case/Mandrola/Zinn to be a good reference book on exercise and arrhythmias with a focus on the older endurance athletes. It is informational and not highly technical. I.e. a pretty easy read. Their background appears to be primarily cycling (Mandrola is a cardiac EP). One mental caution though: the basic premise is that years of stressful activity can lead to problems. I am able to exercise which has been my goal. My competitive days are many years in the rear view mirror but I admit, my mind does not completely accept this!
 

vitdoc

Well-known member
Joined
Apr 16, 2017
Messages
135
Location
Southern Ca.
I have had three open hearts two for aortic valve and one for aortic aneurysm. I started having A. fib prior to my last surgery 14 years ago. Subsequently I had three ablations. the first two worked for a year or so. The last not so great. But I also had mitral insufficiency and had mitral clips placed four years ago. The A. fib went away spontaneously about two years after the clips. Probably less strain on the left atrium after the clips.
Now I just went back into fib. Got cardioverted and reverted after two weeks. So I am considering a fourth ablation. There have been some newer approaches to ablation that may make it work. I never liked any beta blocker due to the slowing of the heart rate while exercising. I am a cyclist. Amniodarone is probably one of the most effective drugs but its side effects made me not ever use it. Multaq a derivative of amniodarone is less effective but less toxic. There are a few other drugs but some come with significant risks (sudden death). So for athletes a.fib can be a pain. Beta blockers slow the heart, amniodarone has significant side effects. So I went for ablation. Reasonable successful for episodic a.fib less so for chronic longstanding a. fib. better for a. flutter. My most recent episode seems to fluctuate from fib to flutter. So I might be having another ablation soon.
 

Brokenhip

Member
Joined
May 20, 2019
Messages
22
Location
Melbourne, Australia
I feel your pain. I've had aFib for years, even before my OHS in 2018 for a mitral valve replacement. Last year it went completely bonkers (heart rate in the 140's ALL THE FREAKING TIME). Went in for a defibrillator implant and had a cardioversion done and boom, heart rate back to normal for the first time in YEARS. I was also put on amiodarone and bisoprolol and went about my business happily.

Endocrinologist took me off the amiodarone in May of this year due to thyroid issues, and all was ok until two weeks ago. Boom, heart rate back in the 130's and 140's. Dang it! I contacted my cardiologist and he had me double the bisoprolol, and I have an appointment with him tomorrow.

I was on Pradaxa prior to my OHS, then went on warfarin (mechanical valve) afterwards. I didn't have any problems with Pradaxa, but it didn't help the aFib, it was just a precaution to prevent blood clots.

As for the cardioversion, I've had that done twice - once in 2015 (didn't work at all) and again last year after the defibrillator implant and it worked that time.

Truthfully, I was also on an IV drip of amiodarone when they did the cardioversion last year, so whether it was the cardioversion alone or the combo of the amiodarone AND the cardioversion that put my heart back in sinus rhythm, I don't know. In any case, the aFib is back and I'm miserable.
Wow, that is a lot of different interventions & most disappointing the A Fib has returned. Hopefully you can get some answers & a resolution after seeing your cardiologist. Good luck going forward.

Peter.
 

Brokenhip

Member
Joined
May 20, 2019
Messages
22
Location
Melbourne, Australia
Interesting topic (for me) hence my first post to a site I've browsed for years. I have a mechanical mitral valve that took 2 attempts before success. Firstly a repair that unfortunately made things worse enough that a few months later the valve was replaced. This was 7 years ago at age 50.

I am a longtime distance runner. Hundreds of races, many marathons. In my mid-40's I had AFIB. Suddenly turned on and several cardioversions, drugs - alone and together - were not successful. I would pretty easily get my heart rate over 200. Ablation resolved this. A few years later my lifelong murmur degraded to the point that the mitral work was necessary. I did have another ablation at that time (Doc said it was standard practice for my history since I was opened up anyway). This was cryo vs. the first which was RF/heat.

I run much slower these days but still monitor my heart rate regularly (Garmin watch and the Kardia device). Last year I could tell something was amiss. Through my decades of running I have been able to quickly tell if something is wrong. Same symptoms as AFIB. EKG and the wearable monitor both confirmed AFIB. I requested another ablation (given prior success) and The Dr. gave it a 50/50 shot. He told me he would not go "too near" the mechanical valve and I both understood and agreed. But . . .. once in the EP lab with 25 leads attached, he found it was not AFIB but flutter. Actually 3 of them. If if I recall correctly they were at 150, 180, and 220 bpm (I'll have to check my records!). One was in the typical location at the isthmus between right atrium and ventricle but the other two were around incision scars from the mitral valve work. The ablation resolved these.

My summary is that I could tell when I had an arrhythmia as it significantly impacted my running. Never particularly bothered me otherwise. Various drugs that either slowed the rate or attempted to changed the rhythm were also immediately felt during exercise.

I found "The Haywire Heart" by Case/Mandrola/Zinn to be a good reference book on exercise and arrhythmias with a focus on the older endurance athletes. It is informational and not highly technical. I.e. a pretty easy read. Their background appears to be primarily cycling (Mandrola is a cardiac EP). One mental caution though: the basic premise is that years of stressful activity can lead to problems. I am able to exercise which has been my goal. My competitive days are many years in the rear view mirror but I admit, my mind does not completely accept this!
An excellent summary & similar to my experience albeit more severe. I always use a HRM with a Garmin 500 or 130 and have even shown the heart rate graphs (Strava or Garmin Connect) to the GP & cardiologist when appropriate.
Will chase up The Haywire Heart, currently have a Bicycle Road Maintenance book by Lennard Zinn.

Thanks, Peter.
 

Brokenhip

Member
Joined
May 20, 2019
Messages
22
Location
Melbourne, Australia
I have had three open hearts two for aortic valve and one for aortic aneurysm. I started having A. fib prior to my last surgery 14 years ago. Subsequently I had three ablations. the first two worked for a year or so. The last not so great. But I also had mitral insufficiency and had mitral clips placed four years ago. The A. fib went away spontaneously about two years after the clips. Probably less strain on the left atrium after the clips.
Now I just went back into fib. Got cardioverted and reverted after two weeks. So I am considering a fourth ablation. There have been some newer approaches to ablation that may make it work. I never liked any beta blocker due to the slowing of the heart rate while exercising. I am a cyclist. Amniodarone is probably one of the most effective drugs but its side effects made me not ever use it. Multaq a derivative of amniodarone is less effective but less toxic. There are a few other drugs but some come with significant risks (sudden death). So for athletes a.fib can be a pain. Beta blockers slow the heart, amniodarone has significant side effects. So I went for ablation. Reasonable successful for episodic a.fib less so for chronic longstanding a. fib. better for a. flutter. My most recent episode seems to fluctuate from fib to flutter. So I might be having another ablation soon.
The slowing of the heart rate while exercising is certainly most frustrating & was the main reason I was keen to stop the Sotalol & see what transpired. Still OK after 2 weeks & 300 kms.
What are your thoughts on Sotalol as I believe it is a potassium blocker similar to Amiodarone?

Thanks, Peter.
 

Eva

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.....
Interestingly, a family member found out her afib was actually a consequence of hyperthyroidism, even though she had a cardiac history. This was quite a surprise to all of us. Perhaps, a full blood work up would be worth it.
“Interestingly” very true indeed! I have hypothyroidism and my my endocrinologist tries to keep me at the lowest effective dose of thyroid hormones, as too much of it elevates heart rate. my cardiologist advised me to take my metoprolol in the morning for the same reason!
 

Eva

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...
I do have an annual check including, echo, holter & echo stress test & ironically this was all done & fine just a few days before the afib episode.
Anyway, all good currently & hoping it stays that way.
Peter, I hope you stay well and healthy.
It is unpredictable when these fibrillations or flutters happen. In March 2019, I had an echo and my cardio was very happy with it. In less than 24 hrs I went to the emergency for ”unspecified flutter”!
Keep us posted. :)
 
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