Heart Rhythm Control Medication

First, you are in good hands. They know their stuff.
Secondly, you are right to be inquisitive, cautious, and to want to be on top of your own care...for your own good!
So far, so good...welcome to Mayo Connect and to atrial fibrillation (AF in the medical abbreviation community).
Firstly, I am not a physician, and have no other medical training. I have had AF for eight years now, two ablations (the first failed, a 25% probability across the medical establishment). I have read a lot, viewed hundreds of videos, asked a lot of questions. Here is what I have learned:
First general rule: AF is a progressive disorder. It will get worse over time, especially if poorly managed. For some, the progression is quick through the stages to 'permanent', while for a great many it takes years.
Second general rule: because it is progressive, it becomes more resistant to any kind of intervention the more advanced and complex it is. So, the logic goes that one should be somewhat aggressive with its management as soon as possible after diagnosis. You can google AF and its subsequent stages and possible outcomes, the final one being 'heart failure', a most unfortunate choice of term because the heart doesn't fail.
Third general rule: the risk of stroke is now about six times what it was before you developed AF....generally. So, you should take your DOAC religiously as prescribed (direct-acting oral anti-coagulant).
Heart medicines work very well for the most part, but some cannot tolerate them, at least for long, and some have to be started and titrated during a three day stay in hospital (Dofetilide, or Tikosyn, as an example). Anti-arrhythmic drugs tend to lose their effect, especially as the disorder progresses. This is why some physicians encourage their patients who are occasional AF sufferers (meaning paroxysmal) to use a PIP (pill in pocket) approach to using the drug. If/when you fibrillate, pop the pill in your wallet, wait 40 minutes, and you'll probably respond well. Happens quite reliably for many who use this approach.
I only have experience with the Big Hammer....amiodarone. I didn't want to take it, but by EP and the internist at the ER agreed between them that I was going to have to take it for a few weeks at least. I did, and it worked really well to stop my chaotic heart six days after my failed index ablation. I in the unlucky 25% failure group. I have no experience with flecainide, propafenone, Sotalol, Multaq, or other anti-arrhythmics, nor with Diltiazem, bisoprolol, and other rate control medications (mine was metoprolol).
This is getting long, maybe more than you want to digest. But one last caution for you: do keep a close eye on your blood pressure. The rate control medications, as dosages climb over time (maybe, maybe not) can cause very low blood pressure when the heart is behaving in NSR. If you find your heart rate dropping to the mid-thirties fairly often, or if your diastolic pressures sink down to 60 or less, you need to be careful, especially about falling, especially after standing from a long time seated.

Hi Gloaming, thank you for your information. I have done a fair amount of reading and listened to a couple of good sources but there is a wide range of even the best of the best doctors position on things, and you only get so much face to face time with the doctors you meet. I have a lot to learn.

Find doctors that listen to you. I’m still trying to find a Dr that listens. So far everyone tells me how I should feel, what I feel isn’t possible and they tell me here’s more meds. I then say no you’re not listening to me, I don’t feel that way at all. It’s my stomach triggering this let’s find out what’s the problem. I modified my diet drastically and just started to introduce more foods.
I’ve had Afib 1x every few years for a decade and only now it’s an issue once a month since my severe allergic reaction to starting Eliquis (for2weeks) I’m on warfarin now
My Afib always starts with a chest bubble/gas. As it gets more painful it causes afib.
Even in the Er after they try all their meds I start demanding Pepcid. Sure enough the Afib stops!
2 nights ago after 1 hour of Afib and trying everything, I took Pepcid. In 10-minutes the Afib stopped.
I need to get to the Mayo or Cleveland Clinic.
Find yourself good set of Doctors!

No experience with medication but my EP gave me a choice - adulation or medication and I took adulation. But am on Tikosyn and Xarelto , no side effects and I do
Pilates 3-5 times a week. Mayo reportedly has great EPs. Be healthy

Medical opinions such as Afib is progressive and gets worse over time are not for lay people no matter how much you have read. This not what my EP or Cardiologist says.

Nonsense. I treat people ethically who have the temerity and motivation to come here asking questions. My duty, ethically, is to respond with what I know, and with what I have experienced.
https://www.webmd.com/heart-disease/atrial-fibrillation/afib-gets-worse
https://academic.oup.com/europace/article/24/Supplement_2/ii22/6602339
https://afibinstitute.com.au/understanding-the-phases-of-atrial-fibrillation-factors-that-drive-progression-from-paroxysmal-to-permanent-atrial-fibrillation/
Kindly answer questions you intend to address and let others do the same.

Reminder about the Community Guidelines https://connect.mayoclinic.org/blog/about-connect/tab/community-guidelines/ and maintaining respect.

@the and @gloaming, I'm confident that you both want to help and support members who have questions. Thank you for sharing your experiences. Sometimes our experiences differ and the guidance we receive from our cardiologist may differ. That's why Connect is so valuable to share situations, solutions, and support.

@gloaming, thank you for providing some references.

@the, your're right that not all specialists use the term "prgressive". Some may use different terms like these described on Mayo Clinic https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624

Excerpt:
- Occasional, also called paroxysmal atrial fibrillation.
AFib symptoms come and go. The symptoms usually last for a few minutes to hours. Some people have symptoms for as long as a week. The episodes can happen repeatedly. Symptoms might go away on their own. Some people with occasional AFib need treatment.

- Persistent. The irregular heartbeat is constant. The heart rhythm does not reset on its own. If symptoms occur, medical treatment is needed to correct the heart rhythm.

- Long-standing persistent. This type of AFib is constant and lasts longer than 12 months. Medicines or a procedure are needed to correct the irregular heartbeat.

- Permanent. In this type of atrial fibrillation, the irregular heart rhythm can't be reset. Medicines are needed to control the heart rate and to prevent blood clots.

@the, sounds like you're managing your a-fib well with a mix of treatment and lifestyle. Does the Pilates also help with fatigue? What did you learn from your EP and cardiologist about your a-fib?

@wayne727, it sounds like you're reading a lot and tackling the steep learning curve of living with a-fib. Good for you. The information you read can be confusing or contradictory because one-size does not fit all.

In this patient information from Mayo Clinic regarding treatment, it also says: "If AFib doesn't get better with medicine or other treatments, a procedure called cardiac ablation may be necessary. Sometimes ablation is the first treatment."
Read more here: https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630

As you mentioned, you are feeling fatigued. I would mention this to your cardiologist to determine when the right time for YOU might be for a change in treatment. At the risk of giving you more to read 😐 I found this article by Mayo Clinic experts that might be helpful. It's pretty new and is written for health professionals. It might help you and your care team decide on what and when.
- When atrial fibrillation (AFib) ablation timing impacts AFib recurrence https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/when-atrial-fibrillation-afib-ablation-timing-impacts-afib-recurrence/mac-20584500

Wayne, when were you diagnosed with AFib? How long have you been taking medication?

Thank you for your response. I knew from my EP all that you described. I don’t think it is valuable to have a member paraphrase from an article from a for profit clinic in Queensland cited in WebMD and quote from it as if it is the medical standard. I believe as I am sure you do that medical professionals are the only ones that should provide medical opinions. I wholeheartedly agree sharing one’s experiences is totally appropriate. Issuing medical opinions is not.

What is Apogard. When I Google it the only thing that comes up is a brand name of some Japanese toothpaste.