Managing Atrial Fibrillation: 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 now.
However, I still experience arrhythmias and missed beats, although palpitations are manageable.
Additionally, after walking two to three kilometers, my heart rate becomes more pronounced that night, and for the next couple of days, 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, but my doctor later switched me to Metoprolol.
Now, I am even afraid that walking might trigger an episode the next day.
Do I need further treatment? Thank you, Doctor.
I appreciate your help.

Mr. Chen, 40~49 year old female. Ask Date: 2021/09/03

Dr. Wu Xueming reply Cardiology

Due to the recurrence of atrial fibrillation after catheter ablation, it is recommended to first undergo a 24-hour Holter monitor to determine if there is a recurrence, and then adjust the medication accordingly.

Reply Date: 2021/09/03

More Info

Managing atrial fibrillation (AF) can be a complex process, especially for individuals who have been experiencing symptoms for an extended period. Atrial fibrillation is characterized by an irregular and often rapid heart rate that can lead to various complications, including stroke and heart failure. Given your history of AF and the treatments you've undergone, it's essential to take a comprehensive approach to manage your condition effectively.

Understanding Atrial Fibrillation
AF occurs when the electrical signals in the heart become disorganized, causing the atria (the upper chambers of the heart) to quiver instead of contracting effectively. This can lead to a rapid heart rate and symptoms such as palpitations, shortness of breath, fatigue, and even chest pain. Your experience of your heart racing after running and feeling breathless after walking or climbing stairs is consistent with AF symptoms.

Current Treatment and Medication
You mentioned that you have undergone a 3D mapping and ablation procedure, which is a common treatment for AF aimed at restoring normal heart rhythm. However, it appears that you are still experiencing episodes of irregular heartbeats and symptoms despite being on medication. The medications you are taking, including digoxin (心利正) and bisoprolol (律博克), are typically used to control heart rate and rhythm.
1. Digoxin helps to strengthen the force of the heart's contractions and can help control the heart rate.

2. Bisoprolol is a beta-blocker that reduces heart rate and blood pressure, which can be beneficial in managing AF.

Symptoms and Concerns
Your concerns about experiencing palpitations and shortness of breath after mild exertion, such as walking or climbing stairs, are significant. These symptoms can indicate that your heart is not responding adequately to the current treatment regimen. It's crucial to communicate these symptoms to your healthcare provider, as they may suggest adjustments to your treatment plan.

Next Steps in Management
1. Regular Monitoring: Continuous monitoring of your heart rhythm is essential. Consider using a wearable device that can track your heart rate and rhythm, providing valuable data for your healthcare provider.

2. Medication Review: Since you are still experiencing symptoms, it may be beneficial to revisit your medication regimen. Your doctor might consider adjusting the dosages or switching to different medications that may be more effective for your specific situation.

3. Lifestyle Modifications: Incorporating lifestyle changes can significantly impact your AF management. Regular aerobic exercise, maintaining a healthy weight, avoiding excessive alcohol and caffeine, and managing stress can help reduce the frequency and severity of AF episodes.

4. Further Interventions: If your symptoms persist despite medication adjustments, your healthcare provider may discuss additional interventions. This could include a repeat ablation procedure or other advanced therapies, such as the use of anticoagulants to prevent stroke risk associated with AF.

5. Cardiac Rehabilitation: Participating in a cardiac rehabilitation program can provide structured exercise and education, helping you manage your symptoms and improve your overall cardiovascular health.

Conclusion
In summary, managing atrial fibrillation requires a multifaceted approach that includes medication management, lifestyle changes, and regular follow-up with your healthcare provider. Given your ongoing symptoms, it is advisable to schedule an appointment with your cardiologist to discuss your current treatment plan and explore further options. Early intervention and proactive management can significantly improve your quality of life and reduce the risk of complications associated with atrial fibrillation. Remember, you are not alone in this journey, and there are many resources and support systems available to help you manage your condition effectively.

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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.

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