Pradaxa and Multaq are both new drugs and clinical experience with their use alone or in combination does not allow to draw any conclusion. I would be reluctant to consider that each drug can potentiate the effect of the other, when used in combination. However, the use of each drug alone already provides some considerable benefit according to the most recent evidence in terms of preventing future thromboembolic events, a condition which is unfortunately not infrequent in your case, and reduction of hospitalization and mortality associated with atrial fibrillation. Most importantly, control of symptoms associated with atrial fibrillation should be considered in your case as a major determinant to guide other adaptations of therapy. If symptoms associated with AF relapses are consistently reduced by this combination, then no other therapy is required. If, on the other hand, symptoms associated with AF relapses are frequent, then an alternative to Multaq (flecainide, propaphenon, sotalol) might be considered to relieve you from symptoms.
Despite the presence of identifiable triggers, atrial fibrillation does not precipitate unless cardiac substrate, either functional or organic is present (many people are exposed to your same triggers but do not precipitate atrial fibrillation events). Your cardiovascular condition needs to be fully investigated in search of potential co-morbidities including underlying heart disease. If, as expected in a situation like yours, no underlying substrate is identified, frequency and discomfort generated by AF relapses should be waited against to the potential disadvantages of a chronic antiarrhythmic therapy or a catheter ablation therapy.
Conversion to sinus rhythm 8 hours after onset of your atrial fibrillation episode does not appear to be achieved by catapress or heparin. Therefore, spontaneous restoration is the most likely cause of the conversion to normal sinus rhythm in your case. None of the drugs here have been put on , either a beta blocker or aspirin, are preventive of future atrial fibrillation episodes. Pounding feeling that you have from time to time does not necessary relate to atrial fibrillation relapses. I would recommend that you have an elektrocardiogram been taken at the time when the pounding feeling is raised, except if its duration is too short to allow you to access and EKG carding site. An event monitor would also help in this direction, provided that you may correctly submit a self activated recording at the time of pounding feeling. Most importantly, you should have your cardiovascular system fully investigated in search of potential co-morbidities which, if present, should be treated and possibly fixed to limit their potential role in generating of your atrial fibrillation episodes.
Atrial fibrillation may first occur as a persistent form in a substantial proportion of cases. The very reason why this occurs is not fully understood. At this time, you should anyhow undergo full cardiovascular investigation to possibly identify heart disease that may be subliminusly evolved in your body. If this is not the case, as it is highly probable given your sport attitude, you may continue to compete in your sport. Check for blood pressure and make sure that it is constantly within normal range. If hypertension is found, make sure that proper treatment is initiated. This will not preclude your sport activity and will ensure a safer balance to your heart limiting the risk of atrial fibrillation recurrence in the future.
It is very unlikely that blood pressure meds facilitate atrial fibrillation recurrence. However, giving your empiric experience, we should not underestimate the potential for this specific drug to determine, in your case, a higher risk of atrial fibrillation recurrence. Alternative antihypertensive drugs can be administered resulting in the same or even better control of blood pressure which, for the prevention of atrial fibrillation recurrence, is a mandatory requirement. Also, make sure that your cardiovascular system has been fully and troughoutfully checked and that appropriate treatments have been initiated in response to any underlying clinical condition that was found during check-up. Finally, antiarrhythmic drugs or catheter ablation can be considered in order to limit or even abolish atrial fibrillation relapses.
Atrial fibrillation may first occur as a persistent form in a substantial proportion of cases. The very reason why this occurs is not fully understood. At this time, you should anyhow undergo full cardiovascular investigation to possibly identify heart disease that may be subliminusly evolved in your body. If this is not the case, as it is highly probable given your sport attitude, you may continue to compete in your sport. Check for blood pressure and make sure that it is constantly within normal range. If hypertension is found, make sure that proper treatment is initiated. This will not preclude your sport activity and will ensure a safer balance to your heart limiting the risk of atrial fibrillation recurrence in the future.
Cpap can certainly benefit the respiratory exchanges at the pulmonary level which may, in turn, improve oxygen delivery in the body periphery. This situation may certainly improve heart perfusion and consequently rhythm balance. This virtuous pathophysiological mechanisms triggered by Cpap therapy may in your case limit or even abolish further atrial fibrillation episodes. With regard to the role of sleep apnea syndrome in precipitating atrial fibrillation episodes, it is very difficult to draw any conclusion giving the very rare occurrence of symptoms. Atrial fibrillation may in fact occur twice throughout your lifetime or may recur more often after a second episode. I would suggest that you have your cardiovascular system fully investigated by a specialist so that any co-morbidity (underlying heart disease, blood hypertension, thyroid dysfunction) may be consistently ruled out or, if identified, properly treated.
If I understand correctly, the two former catheter ablation procedures have provided you some benefit, although with no complete resolution of symptoms. The third catheter ablation procedure may add on top of previous treatment to aim for complete cure. I would suggest that you consider a third catheter ablation procedure and you select a high volume, highly experienced centre to optimize the probability of complete success. A mini maze does not appear to be recommended in your case.
While many patients have fast heart rates during episodes of atrial fibrillation, there are many who have controlled heart rates as well. This slower rate may be due to underlying disease in the electrical system of the heart, medications that slow down the heart rate, or in some cases, well trained athletes who tend to run slower heart rates, even during atrial fibrillation. Treatment needs to be individualized as some medications used to treat atrial fibrillation may slow the heart rate down even further.
The natural history of paroxysmal atrial fibrillation is to become more frequent and last longer as time passes. Medications called antiarrhythmic drugs or an ablation procedure are often used to keep the heart rhythm normal. Most of the drugs act within several days though some may take months till they have their full effect. Regardless, if your episodes are getting worse and not better, you should consult with your physician – preferably a cardiac electrophysiologist who specializes in rhythm disturbances - to discuss the available options.
Dr. Andrea Natale
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients. For further details Please visit :Link
Dr. Dhanunjaya Lakkireddy
Dr. Dhanunjaya Lakkireddy, MD, F.A.C.C, FHRS. is a board certified electrophysiology expert and practices at Mid-America Cardiology and The University of Kansas Hospital Clinics in Kansas City, KS, USA. He has several distinctions in clinical and research career to his credit and serves as an associate editor for Journal of Atrial Fibrillation.For further details Please visit :Link
Dr. Dhanunjay Lakkireddy, MD, F.A.C.C, FHRS, The Kansas City Heart Rhythm Institute (KCHRI), KS, USA.
Disclaimer
1. JAFIB and the invited expert reserve the right to decline any question. The question declined will not appear in the list of questions asked.
2. The questions or advice from the expert can not be considered as alternatives to your clinician's advice. This discussion is only for educational/informational use. Your EP doctor is THE person to advice you on treatment and management of your condition.
Feedback : Your suggestion on this new initiative are much appreciated. Please write to the managing editor(editor@jafib.com) about your feedback on "Meet the Expert".
