Managing Atrial Fibrillation: Ongoing Symptoms and Treatment Options

Atrial fibrillation

Hello, Doctor.
About six years ago, I started a habit of jogging.
Later, I noticed that my heart would race and beat irregularly after running.
I went to a cardiologist and was diagnosed with atrial fibrillation.
I underwent 3D mapping and ablation, but I have been on medication for four years and still experience arrhythmias and missed beats.
My palpitations are manageable.
Additionally, after walking two to three kilometers, my heart rate increases significantly that night, and a day or two later, I feel short of breath even when climbing stairs.
I've tried this many times, and it always happens.
I am currently taking one tablet each of Dronedarone and Metoprolol 100 mg, which my doctor prescribed.
Now, I am even afraid that I might have an episode just from walking.
Do I need to undergo further treatment? Thank you, Doctor.
I appreciate your help.

Mr. Chen, 40~49 year old female. Ask Date: 2021/09/02

Dr. Wu Xueming reply Cardiology

If your symptoms have recently worsened, it is recommended to go to the hospital for a 24-hour Holter monitor test to determine if there is a recurrence of atrial fibrillation.

Reply Date: 2021/09/02

More Info

Managing atrial fibrillation (AF) can be a complex and ongoing process, especially when symptoms persist despite treatment. Based on your description, it seems that you have been dealing with AF for several years, and despite undergoing a catheter ablation procedure and being on medication, you continue to experience symptoms such as palpitations, irregular heartbeats, and shortness of breath after physical activity. Here’s a comprehensive overview of your situation and potential next steps.

Understanding Atrial Fibrillation
Atrial fibrillation is a common heart rhythm disorder characterized by rapid and irregular beating of the atria. It can lead to various symptoms, including palpitations, fatigue, and shortness of breath. The condition can also increase the risk of stroke and heart failure, making effective management crucial.

Current Treatment and Symptoms
You mentioned that you have been on medications, including digoxin (心利正) and a beta-blocker (律博克), which are commonly prescribed to manage heart rate and rhythm in AF patients. However, the persistence of symptoms like irregular heartbeats and exertional dyspnea (shortness of breath during physical activity) indicates that your current treatment regimen may need reevaluation.

Potential Next Steps
1. Medication Review: It’s essential to have a thorough review of your medications with your cardiologist. Sometimes, the dosage may need adjustment, or alternative medications may be more effective. For instance, if beta-blockers are not adequately controlling your heart rate, your doctor might consider other antiarrhythmic medications or adjusting the current dosage.

2. Further Diagnostic Testing: Given your ongoing symptoms, additional tests may be warranted. An echocardiogram can assess the structure and function of your heart, while a Holter monitor can provide a more extended view of your heart rhythm over 24-48 hours. This data can help determine if there are specific triggers or patterns to your AF episodes.

3. Lifestyle Modifications: Incorporating lifestyle changes can significantly impact your symptoms. Regular, moderate exercise is beneficial, but it’s crucial to listen to your body. Avoiding excessive caffeine, alcohol, and stress can also help manage AF symptoms. You might consider working with a cardiologist or a specialized exercise physiologist to develop a safe exercise plan.

4. Consideration for Repeat Ablation: If your symptoms remain uncontrolled despite optimal medical therapy, a repeat catheter ablation may be an option. This procedure can be effective in restoring normal rhythm, especially if there are identifiable triggers or if the initial ablation did not fully address the areas of the heart responsible for the AF.

5. Monitoring and Follow-Up: Regular follow-up appointments with your cardiologist are crucial for ongoing management. Keeping a symptom diary can help both you and your doctor identify patterns and triggers, which can inform treatment decisions.

6. Psychological Support: Living with a chronic condition like AF can be stressful and anxiety-provoking. Consider seeking support from a mental health professional or joining a support group for individuals with AF. This can help you cope with the emotional aspects of living with a heart condition.

Conclusion
In summary, managing atrial fibrillation requires a multifaceted approach that includes medication management, lifestyle changes, and possibly further interventions like repeat ablation. It’s essential to maintain open communication with your healthcare provider and advocate for your health needs. If you feel that your current treatment is not effective, do not hesitate to seek a second opinion or discuss alternative treatment options with your cardiologist. Your well-being is paramount, and there are various strategies to help you manage your symptoms effectively.

Similar Q&A

Managing Atrial Fibrillation: Medication, Ablation, and Supplement Options

Hello, Doctor. I have been diagnosed with atrial fibrillation for almost a year and am currently taking Rytmonorm. Recently, there was a day when I did not feel any episodes of atrial fibrillation, but occasionally I might experience a sensation of fibrillation once a day. Lately...

Dr. He Dongjin reply Cardiology
Hello, do you need to supplement with fish oil and Coenzyme Q10 based on your current symptoms? If your condition is relatively stable, you can continue taking your medication. If you are not satisfied with your current state, consider trying new treatments while continuing your ...

Understanding Paroxysmal Atrial Fibrillation: Symptoms and Treatment Options

In May of this year, during a follow-up visit, I was diagnosed with arrhythmia, specifically paroxysmal atrial fibrillation and flutter. The doctor recommended proceeding with catheter ablation. After the follow-up in June, the treatment was adjusted to medication management. In ...

Dr. He Dongjin reply Cardiology
Hello, you have nearly 40% atrial fibrillation. The treatment options include medication management and catheter ablation. If you are still feeling very uncomfortable with medication alone, it is important to seriously consider undergoing catheter ablation. Regardless of the appr...

Managing Atrial Fibrillation: Treatment Options and Lifestyle Tips

Dear Dr. He, My father is 58 years old and has had a total of four episodes of arrhythmia since 2012 (in 2012, 2015, 2016, and 2018). My grandfather passed away from heart disease. During the second episode in 2015, he was taken to the hospital immediately, where an electrocardi...

Dr. He Dongjin reply Cardiology
Hello, ventricular tachycardia can be managed with two types of medications that can be taken continuously, but catheter ablation should be considered. A more aggressive treatment option is to undergo catheter ablation. Where is your father being monitored? It might be a good ide...

Understanding Atrial Fibrillation: Symptoms, Diagnosis, and Treatment Options

On December 21, 1992, at 10:00 AM, I experienced a heart rate of around 190 beats per minute, accompanied by cold sweats and dizziness, which lasted until I sought medical attention at 3:30 PM. My blood pressure was 127/97, and my heart rate was 194. I received an injection that ...

Dr. Zhong Yuxun reply Cardiology
Dear Jo, According to your letter, it appears to be paroxysmal tachycardia, most commonly paroxysmal supraventricular tachycardia (PSVT). The cause is typically an additional conduction pathway within the heart, leading to a reentrant circuit. This condition can be effectively t...