Normal? Am I being paranoid?

[busterbrindle]

I'm a 51-year old guy who has had 3 episodes of Paroxysmal AF over the past four years but is in otherwise good health. I run 5K 3-4 times a week and mountain bike without issue. The first two episodes were stopped by electrical cardioversion in the E.R. when medication did not work. After the second episode they recommended I see a cardiologist.

I'm currently in my third episode (2nd day in). My cardiologist wants me to try to convert medically before doing an electrical cardioversion. Digoxin and Cartia together did not work. Today he had  me take 300 mg of Rhythmol a.m. and I'm supposed to take 300 more tonight, and he will electrically convert me tomorrow if this doesn't work.

My case is complicated by the fact that I have a bleeding disorder and absolutely cannot take any blood thinners. Even an aspirin gives me horrible nosebleeds, and sometimes I get spontaneous bleeding that goes on for an hour or two for no reason at all.

I took the first dose of Rhythmol two hours ago but now am feeling panicky and scared to death. The package insert seems to have an EXTREMELY strong warning about this medication being very dangerous and just reading it makes me feel as if I'm going to suddenly drop dead at my keyboard (don't laugh). On the plus side, my heart rate is now down to 63 BPM (about normal) from 130 just a couple hours ago and even though the beats are still irregular I'm noticing that I'm not getting as many "flutters".

I have some diazepam that I normally take to keep me calm when I get a bleeding episode, and am thinking about taking one now to calm me down, but I'm afraid that if I do that I might go to sleep and never wake up.

Is this panicky feeling normal for afib? For Rhythmol? Am I just being a paranoid fool? Any advice appreciated!

P.S. the cardiologist has recommended I consider ablation to prevent episodes from recurring in the future. He feels the episodes will become more frequent as I age because my brothers and sisters all have the same episodes, and my father now has AF episodes 3-4 times a year. Opinions? Heart surgery seems drastic--but the way ablation was described it sounds like a fairly low risk outpatient surgery.

[DeltaDawn23]

I believe the success rate depends on the individual and the condition and structures of the heart.  Sounds like it was a no brainer for you and I am so happy it worked.  They've given me 60% odds first time around, perhaps 75% 2nd time because of enlarged atria.  It is always good to hear a success story.

[ksig]

Hi, Busterbrindle
I had more than one ablation because I had developed another errant path for AFib.  I also had AFlutter.  The success rate for ablations is in the 95% range.  They are still the best medical decisions I have ever made.  I had AFib that was unstoppable.  I was taking a boatload of meds, all Class III drugs and they were not stopping it.  At the time I was a pricipal of a middle school and needed energy to stay on top of my school, kids and staff.  With Afib, I was wilting fast on a regular basis.  HRs of 180-200 would simply wear me out and made it difficult to get out on the field to watch a game.  I wanted my life back.  So I went UCSF and they gave it back to me.  I have since retired but still go into the city to UCSF as my cardiologist is there.  Life is great after ablations.

[DeltaDawn23]

I had paroxysmal Afib in 2003 and then went 6 years, then the last 2 years have had 2 episodes that converted on their own and then since December of 2010 have had 2 episodes that had to be electroconverted.  They are now calling it persistent -- I think the last stage is permanent.

They tried Rhthmol 300 mg as a pocket pill the second to the last time when I was in the hospital.  My heart was going in and out of NSR, and they finally had to electroconvert me.  The last time, they put me in the hospital (after having a Cardiac Cat Scan to determine no blockages and gave me 600 mg. of Rhythmol as a pocket pill.  It didn't work, so I again had to be cardioverted and I was then put on Norpace, as well as the Coumadin, Atenolol and Xanax I was already on.  I have been in NSR for 4 months now.  

I have runs of pac's and tachycardia.  I believe the panic comes after because I am pumping out adrenaline and the Xanax calms it down.  I also have some breathing exercises I do that help, as well as increasing the Atenolol and Xanax when having an episode.  

I just read (on this board) about an ablation procedure done in England on the beating heart that has a 90% success rate. I hope it is available here soon.   My odds are 60% the first time, 75% the second time.  I think at this point I will wait for better odds.  My atria are enlarged, which worsens my chances of a successful ablation.  The cardio thinks they may shrink back down and will do an echo in a year.

If you decide to have one done, find someone who does a lot of them.  I will go to the University of Michigan Hospital, they do about 800 a year.

I have recently retired and think the lessened stress may keep me in normal sinus rhythm, at least I am hoping.

Hope some of this helps.  You are not alone in the panic -- it is very common.  Good luck to you.  

[busterbrindle]

Thanks for the feedback. My heart went back to NSR two hours after taking the Rhythmol. I have to take one more dose tonight, and one in the morning then get an EKG. After that I guess will be the test of whether my heart has actually returned to normal or if it's just the meds.

Appreciate the advice on the ablation. Am curious ksig, why did you need a second ablation? Do they only work for a certain window of time?

What I'm trying to weigh is whether, at this point, ablation is worth it or if I should just stick with taking some meds once a year when I go into afib?

[ksig]

I, too suffer from AFib and I have had a couple of ablations, each well worth it.  Each time I got better.  I was on a boatload of arrhythmia meds, many of which were Class III drugs.  The only one I did not take was amiodarone.  The drugs worked well but my AFib kept returning for hours at a time. So I needed relief so my EP said that I needed the ablation so I did it.  Now I only take Pradaxa and atenolol.   I see you are in San Francisco.  I had my work done at UCSF and would highly recommend them.  I wish you well.
ksig

[LindaTX]

Wow, I do feel for you....been there, done that.  I did have an ablation almost a year ago for a-fib and I am doing quite well except for an occasional bout of tachycardia that I take a ToprolXL followed 20 min later by some flecainide and usually the Toprol takes care of it.  For anxiety i take a clonazapam and that settles me down.  Rhythmol is in the same class as flecainide but I don't believe it is as strong. You are not being paranoid but I do believe anxiety does have a bearing on your a-fib episodes.  I'm sure you've heard that a-fib is progressive through the years, and I have to say I am glad I went ahead with the ablation.  I had an excellent EP and that is a must!  PVI Ablation is a catheter procedure, not the drastic heart surgery you are thinking it is. Your bleeding issue would have to be taken into consideration when discussing ablation with your electrophysiologist.
I wish you all the best....it sounds like you are in good physical condition and that is a real plus.  Just try to relax (easier said than done)....and follow your heart.