Answer:

Cyclical nature of AF episodes has previously been reported, however the exact mechanism to explain cyclical nature of these episodes is not known. I understand that you previously underwent ablation procedure for atrial fibrillation but unfortunately had early recurrence. A proportion of patients undergoing AF ablation procedure need a second procedure to achieve symptom control. Since your episodes are paroxysmal, success rates following second AF ablation procedure should be around 80 percent in your case

Answer:

The success rates of ablation therapy are lower in patients with long standing persistent atrial fibrillation as compared to patients with paroxysmal atrial fibrillation. The success rates would also depend on other factors such as heart chamber (left atrium) size and concomitant heart valve disease etc. Ablation therapy could be considered if the patient has symptoms and has no other contraindications. However you could try external cardioversion to convert him in to sinus rhythm (if patient has been on anticoagulant therapy for few weeks) in the first instance and try antiarrythmic medication.

Answer:

Effexor is a drug used for treating depression/anxiety disorders. If your doctor feels you could be weaned off this medication you should certainly go with his advice. However you would need to continue medication for high blood pressure although Tenormin may not be an ideal drug in a young person (due to its side effects). I would encourage you to discuss with your doctor for a better alternative. I do not think you need to consider ablation at this point of time as you have been asymptomatic for last two years. However you could certainly consider it if you have further recurrences.

Answer:

From the limited data available, magnesium appears to have some inherent antiarrhythmic properties. Magnesium has been shown to be beneficial in treating certain cardiac rhythm abnormalities in an acute setting. However its role in prevention of atrial fibrillation is not well established.

Answer:

Pradaxa (Dabigatran) is an oral anticoagulant medicine used for the prevention of clots and emboli in patients with non-valvular atrial fibrillation (AF). There is no specific antidote for this medication. The effect of the drug wears off in about 15-19 hours. It was compared with Warfarin (traditional anticoagulant) in a large clinical trial called RE-LY and there was no increased risk of death due to major bleeding. However certain conditions predispose to increased bleeding risk whist on Pradaxa some of these include- impaired kidney function, coagulation disorders, active ulcerative gastrointestinal disease or use of certain medications. Whist there is no specific antidote pradaxa has been shown to be a safe medication, however if your brother is not comfortable with using pradaxa he can always switch over to Warfarin.

Answer:

You had one episode of atrial fibrillation and you are presently in normal rhythm (sinus rhythm). When patient goes in to atrial fibrillation there are two main aspects that need to be addressed – rate control and prevention of clot formation in the heart. In your case you are in Bisoprolol (which should help with rate control to an extent and rivoraxaban which should prevent clot formation. You were advised to go to A&E so that you could be cardioverted back to sinus rhythm. However you may or may not have one more episode of atrial fibrillation (as bisoprolol helps prevent recurrence) and you should certainly be able to travel. You could also discuss with your cardiologist about tablets which you could take in the event of recurrence of atrial fibrillation (pill in the pocket strategy).

Answer:

You had one episode of atrial fibrillation and you are presently in normal rhythm (sinus rhythm). When patient goes in to atrial fibrillation there are two main aspects that need to be addressed – rate control and prevention of clot formation in the heart. In your case you are in Bisoprolol (which should help with rate control to an extent and rivoraxaban which should prevent clot formation. You were advised to go to A&E so that you could be cardioverted back to sinus rhythm. However you may or may not have one more episode of atrial fibrillation (as bisoprolol helps prevent recurrence) and you should certainly be able to travel. You could also discuss with your cardiologist about tablets which you could take in the event of recurrence of atrial fibrillation (pill in the pocket strategy).

Answer:

If you have already been assessed by a physician and diagnosed with postural orthostatic tachycardia, then yes your symptoms of tiredness can be attributed to this conditions. There are a few life style changes which could be beneficial, these include adequate fluid intake, avoid long periods of standing, regular exercise, wearing strong support stockings, and improve salt intake. A few medications such as beta blockers, fludrocortisones, Iivabradine can also be tried. I would encourage you to revisit your doctor and discuss some of the above mentioned treatment options.

Answer:

You are experiencing symptoms of palpitations. The fact that you are symptomatic at rest and not otherwise is a good sign. However you need further cardiac evaluation which includes performing an electrocardiogram in the first instance, a few blood tests to exclude anaemia and thyroid disorders. Further investigations (such as echocardiogram or holter monitoring) would be contemplated based on initial evaluation.