Are the drug protocols problematic?
With AFIB, should you first try cardio inversion? I have heard through research and from some doctors that the drug protocols are not very effective to manage AFIB. Also, due to other issues I am on a lot of medication now and have concerns with interactions.
The AFIB is creating a lot of shortness of breath and dizziness. The heart rate is elevated but the blood pressure intermittently drops to very low levels.
I have an appt with electro physiologist this week .
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A good physician will treat each patient as a unique case. True, there are protocols, but those are diagnostic tools. From there, the individual circumstances and symptoms suggest one, two, or even three possible ways to mitigate the situation. For atrial fibrillation, a non-lethal disorder, it will be symptoms that drive much of the decision-making. This assumes it is an easy and an early case, and not one where there are other comorbidities, or when the patient says they've had the symptoms for years, in which case there might be more urgency to get the disorder under control.
Cardioversion is a sensible first step in early cases, say 'holiday heart' where the patient was on a bender in college or at a New Year celebration and had too much alcohol. For others, with hypertension and metabolic syndrome or full-blown diabetes, a more structured approach that involves medication and even catheter ablation might be in order.
No matter what treatment it turns out is going to be the best, the conscientious physician will immediately suggest a regimen of direct-acting oral anti-coagulation (DOAC) because the greatest risk arising from even a few minutes of AF is thromboembolic events...strokes. If the event turns out to be a one-off, the patient will often be advised to stop taking them after a month or more, but if the AF is paroxysmal, in that it comes and goes on its own, maybe once a month, and if it lasts for more than 10 minutes or so, the DOAC regimen might have to be permanent to reduce the risks.
So, it's good to question, good to listen, good to read and to ponder, but it's also good to treat each case, especially your own, as a novel thing that needs learning. A cardioversion might be all that is needed, but a case where the situation is more complex and where the AF keeps returning now and then, will need some medication or possibly a mechanical treatment...not a fix...a treatment. There is no 'cure' for AF once the heart commences doing it. You can control it, even with strict dietary and supplemental regimens, either prescribed or self-imposed...I know of people who do that...but in most case, most patients, it means taking the considered advice of a specialist.
Drugs can, and do, work very well for many. Some, like me, it worked for a couple of years, and then my heart began to act up even with rises in prescriptions. Think Tim the Tool Man and 'More power!' That protocol can help, but if the heart's disorder is progressing, which it essentially always does, different rates for different people, the drugs will often eventually lose their power. It is why I opted for catheter ablation as soon as I learned of it. I knew the drugs were not an end-state for me early on, initially because I didn't want to/liked having to take them, but also because I had read that the disorder is progressive. Means more drugs, or novel drugs...or....
Before medication or before maze. How long have you had afib.
Eight weeks now in AFIB
Do you mean 8 weeks continually in AF? No previous history? If this is the case, then I would say a cardioversion might just work. But you should also be on a DOAC, for certain, and you might also benefit from metoprolol or diltiazem to keep the rate in check. Does you your ate vary? Is it much higher than 100 for any length of time, say 24 hrs or longer? If so, then you are an acute case and should probably be under doctor's care, maybe even go to emerg?
Eight weeks continuously. No previous history. Already on Eliquis and Metropolol. Heart rate has a lot of variability. High rate is up towards 100 BPM. Blood pressure in mornings have been extremely low.
Okay, this is just my understanding, and I'm not doctor....please:
Metoprolol in your already-low arrhythmic rate may be doing you as much harm as good, and it seems it is placing you in hypotension. Does your cardiologist know of your condition currently? I took metoprolol because my AF put me in the 140-180 range, meaning I had what is known as RVR, or rapid ventricular response. I don't know that your rate would also indicated RVR without the metoprolol...maybe it would. I know of some people who have confirmed AF whose rate is less than 100...which seems odd, but there it is, and again, I'm only a layperson.
On the other hand, maybe the metoprolol IS doing a good job and this accounts for your steady state 100 BPM. If you know this to be so, wonderful. It's working. But the hypotension is worrisome, to my mind, and it places you at risk of a serious fall. If you go unconscious, and fall, is there anyone nearby that would learn of it within a few minutes? It would mean a trip to an ER, but sooner much better than later. If you were to get approval to halve the dose of metoprolol, you might find it all a lot more tolerable, and maybe you'd still be able to keep a lid on the rate.
I don't know how much you have learned about AF, but it's a progressive disorder and it can lead to several unwanted developments that are best staved off early. So, my amateurish counsel is that you ask to be referred to an electrophysiologist right away and bone up on all things catheter ablation.
Meeting with the electrophysiologist this week.
Everything about this is very strange and I believe the AFIB is being caused by the trauma response following a surgery which has caused a very debilitating anxiety disorder that limits my ability to function.
Or maybe the AFIB came first. I know that my response ing heart rate changed significantly after the surgery.
It has been 10 months and I have tried every protocol out there including medicine and non-medicine to address the issue and still struggling.
Well...that bites. You sound like you're about as on top of it as a person can be, but still deeply anxious. Of course, anxiety can be a nasty trigger of AF due to epinephrine and the sympathetic nervous response. Metoprolol, for one, would/should be able to keep a cap on that, as you are experiencing.
You say 'every protocol'. I gotta ask, 'cuz it's my skeptical nature, so please don't take my questions personally:
Magnesium supplements? They help for some, especially if you're low-ish.
CBT or hypnotherapy, maybe both, for the anxiety?
Being in AF will not help to keep you calm, which enables the feedback loop you're apparently in. Thank goodness you're seeing an EP soon. If he/she succeeds in stemming the incursion of the extra voltages into your left atrium, you'll soon be free of AF and can begin to relax.