New to AFib - this forum is a blessing. Still more questions …

I was Diagnosed 15 weeks ago when I went to GP after Resting HR stayed at 80 (normally about 60) after Covid. Neither GP or Cardiologist is certain of link, however the cardiologist seems convinced I’ve had this pre Covid. He can’t explain the HR changes…
I’ve been told I have an enlarged Left Atrium and this is causing the AFib and nothing can be done to fix the AFib so he wants to protect me from stroke via Eliquis.
As I was symptom free except for the increased resting HR, my GP put me on a beta blocker and the cardiologist also put me on blood pressure tablets. The cardiologist stated that he wouldn’t intervene as I was symptom free and if he returned me to sinus rhythm via cardioversion or ablation, I would not stay in sinus rhythm and revert to AFib.
My Blood pressure was around 110 / 75 but could drop to 72 / 53 at times after the drugs started.
After starting tablets I then got symptoms of dizziness / fatigue.
What I have done is started a cardiac rehab exercise programme to see how hard I could exercise safely. It started off moderately but after last visit to cardiologist (and he looked a Echo and not just read the notes), he said I could exercise “as hard as I wanted and I would know if I had to stop”.
Thanks to this forum I have purchased a Kardia 6L and started taking magnesium.
I’ve returned to sinus rhythm firstly for 3 days, back to afib for 4 days, returned to SR for 11 days, returned to afib for 2 days and now in SR (4 days so far).
Resting HR now 54 and dropped BP tablets.
Can I ask:
1. After being told it was permanent is this typical to go in and out?
2. Can I expect periods of AFib to increase or expect periods of SR to increase?
3. Is there any research on physical changes to afib hearts with exercise?
4. Is anyone else taking an exercise approach and how is it going?
5. I quit a stressful job and I think this helped. Is there any known link with stress and AFib?

Thanks for your help.

Nelson

Hi Nelson,

1. After being told it was permanent is this typical to go in and out?
Without continual monitoring, there was not way for them to know it was permanent. So that diagnosis is erroneous.

2. Can I expect periods of AFib to increase or expect periods of SR to increase?
Likey AFib to increase.

3. Is there any research on physical changes to afib hearts with exercise?
I'm not aware.

4. Is anyone else taking an exercise approach and how is it going?
I've had afib over 18 years. In the first 4 months, had a 2 1/2 month episode. I'm active and continued as normal during the 2.5 month episode.

5. I quit a stressful job and I think this helped. Is there any known link with stress and AFib?
Yes, stress is a known trigger.

My non medical opinion is that with a resting HR of 80 in afib, you should not be on a beta blocker.

You could ask your cardio to put you on a rhythm med, flecainide, on-demand. See: [www.nejm.org] This could likely shorten your episode lengths. In your case, a rhythm med chronically might be indicated. The fact you are paroxysmal & not persistent may change how your cardio would manage your case. You should inform them of this info.

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Nelson
The cardiologist stated that he wouldn’t intervene as I was symptom free and if he returned me to sinus rhythm via cardioversion or ablation, I would not stay in sinus rhythm and revert to AFib.
My Blood pressure was around 110 / 75 but could drop to 72 / 53 at times after the drugs started.
After starting tablets I then got symptoms of dizziness / fatigue.

I agree with George's responses and would add that your cardiologist completely omitted the first and most obvious treatment -- antiarrhythmic drugs. You are not in persistent afib and I can't imagine why you were put on not one but two BP medications if 110/75 was typical for you without drugs. Of course you felt dizzy and fatigued with a BP of 72/53. You're lucky you didn't find yourself face down on the floor. 110/75 is as near to a perfect BP as you can get. What are these other "tablets" anyway?

I'm going to take a guess here that the cardiologist you're seeing is a general cardiologist and not an electrophysiologist (EP). An EP is a cardiologist who specializes in treating arrhythmias. We liken them to electricians and general cardiologists to plumbers. I highly recommend that you seek out an EP.

Something is missing or misunderstood. There's no way an insured and practicing cardiologist or GP would prescribe BP lowering meds for someone with a typical BP around 110/75.

Find a good EP ASAP.

Thanks GeorgeN, Carey, gloaming and JoyWin for your responses.
Since my post Ive been off blood pressure tablets 2 weeks and my BP has remained about the same (110 /75) .
Even though resting HR was 52bpm GP, wanted me to stay on beta blocker - Bispro.
I’ve had a 2nd Echo and saw my cardiologist (still the plumber - not an EP) yesterday.
Resting HR now 50 and he still also wants me on Bispro! He stated Bispro assisting in keeping heart in SR.
Even though he initially diagnosed Permanent AFib - didn’t seem phased it was now paroxysmal.
So outcome of visit, echo result showed ventricle volumes now correct (I was in SR at the time), stay on Eliquis and Bispro, see me in 4 months. Not interested in treatment because I’m symptom free when in AFib. He wasn’t interested in “pill in pocket” anti rhythmic medicine. No advice as to what to do when I go back into AFib.
So, taking everyone’s advice I’m going to try and get a referral to an EP.
I’m also continuing with my maximal exercise routine.

So - does Bispro help keep SR with a low resting HR?

Thanks again

Nelson

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Nelson
So - does Bispro help keep SR with a low resting HR?

It definitely lowers your HR, but whether it actually helps keep you in NSR is debatable. The current medical doctrine is "might help, can't hurt" so most cardiologists will prescribe it, but I'm skeptical that it prevents afib except in a very small percentage of patients. Those patients it does work for are probably the adrenergic afibbers, and they seem to be the minority. If things like exercise, excitement, sudden scares and such tend to trigger your afib, then you might be adrenergic and a beta blocker might help because what it blocks is adrenaline. But if you're like most and those aren't your triggers, then I'm really skeptical it will prevent anything.

I don't know about you, but I absolutely hate beta blockers because they suck the energy right out of me. So if I were you, I would give stopping them a trial. But I'm not you and if beta blockers don't bother you, then they certainly won't do you any harm. Your choice.