Just Found out I have AFib and going on Eliquis

My EP called me into the office today to report that my latest bedside monitor upload from my Medtronic ICD showed 3 to 4 episodes of AFib in the last three months, two that lasted over 3 hours! I didn't feel anything during these events and the doctor informed that about 50 % of people don't feel these episodes. She recommended that I go off generic Plavix and start taking Eliquis and stay on the baby aspirin to reduce the stroke possibility.

I've had a few vertigo issues driving to golf in the mornings on two separate occasions but my Internist didn't appear to be very concerned. I did have occasional shortness of breath at the start of some walks but that appears to have gone away after they tweaked some ICD settings.

I'm concerned about having to live with AFib going forward, as I'm approaching the big 70 in October, and was wondering how others are dealing with this out in Pacemaker land Yo!



by AgentX86 - 2020-07-30 21:05:33

If you are truly asymptomatic, Afib is nothing to worry about.  Afib, itself, isn't dangerous at all.  There are two side-effects that may be, however.  Blood clots can form in the left atrium because the blood flow becomes turbulent.  These blood clots can travel to the brain causing a stroke.  That's why you're on Eliquis - to keep clots from forming. 

I don't understand the aspirin, though.  It's less than useless in this sitution.  Anticoagulants are a tradeoff between ischemic stroke (blood clots) and hemorraghic stroke (brain bleeds).  Aspirin increases the latter without helping the former.  Eliquis has some risk of hemorraghic stoke but much lower and a good trade for its reduction in ischemic stroke. Eliquis is the best of the bunch for this.

The other problem that's seen with Afib is tachycardia induced cardiomyopathy.  Keeping your resting heart rate below 100bpm will keep this from happening. 

Other than these two problems, Afib isn't a problem if you're asymptomatic.  Some of us aren't so luck and are highly symptomatic.  ...and it really sucks.

The bottom line is that you shouldn't worry too much about Afib.  Keep taking the meds and you'll be fine but it is crucial that you do.


by kmcgrath - 2020-07-30 23:29:11

Thanks for the feedback. The reason I'm staying on the aspirin is that the doctor feels it will help my two stents "plumbing" to stay clean. I'm pretty good about staying on my meds so hopefully things will be fine going forward.

Atrial Fibrillation (AF)

by Gemita - 2020-07-30 23:56:55

I am sorry to hear of your AF diagnosis.  Not nice at all.  You are fortunate though to be asymptomatic at the moment and I hope it remains that way. 

I instead feel every little quiver in my chest when AF starts and I only really get relief when it stops.  Fortunately, my pacemaker is really helping me by keeping my heart rate up and steady.  The higher heart rate is, in many instances, helping to outpace my arrhythmias, thereby reducing their duration and frequency, so it has been a very useful additional therapy for me personally, but of course it doesn’t work for everyone.  I am also on Bisoprolol, a beta blocker, because I have AF with both a slow ventricular response rate and an incredibly fast ventricular response rate.  My pacemaker prevents/controls sudden heart rate falls and the Bisoprolol controls sudden heart rate increases.  It is a real balancing act to keep control sometimes.

Yes the two most important considerations with AF is to

1) consider AF stroke protection if we have risk factors and Eliquis is one of the safest of the newer anticoagulants out there in terms of bleed risk I was told (particularly a gastric bleed)

2). consider rate control/anti arrhythmic medication to treat the condition if we become symptomatic, for example, start feeling breathless, with chest pain, dizziness, weakness or start having extremely high heart rates, since high heart rates if prolonged can be dangerous and lead to heart failure symptoms.

Providing AF is firmly controlled it is usually not regarded as a dangerous arrhythmia to have, although for those of us with underlying heart disease, lung disease and other serious health conditions, it can worsen these conditions so it is wise to get AF under control quickly to prevent it from progressing.  

Unfortunately the natural course of AF is for it to progress over time when it may become permanent and more difficult, if not impossible, to treat which is why early intervention is so important.  Additionally because of the irregularity of rhythm, blood flow to the rest of the body during episodes can be sub optimal and may make it more difficult to exercise or carry out our daily activities.  I can get many adverse symptoms like breathlessness, chest pain, near faints, weakness and awful brain fog, not to mention the problems of increased urination caused by high atrial heart rates when in AF.  Apparently, when in AF, the “atrial natriuretic peptide hormone” in the atria kicks in and acts as a diuretic to lower the blood pressure and regulate the calcium and salt in the body.  Clever yes, but certainly adds to my distress during episodes!

I am in my early 70s too.  I may need further treatment in the future if my arrhythmias worsen but for the moment I am happy with my present therapy.  Other treatments could include an ablation.  

Triggers for AF include dehydration, high blood pressure, ischaemic heart disease, sleep apnea, trauma/stress both emotional and physical and many chronic health conditions which cause inflammation.  Some of us find alcohol and certain foods to be major triggers.  For some there is often no cause found.

I do wish you well and hope that your AF can be tamed.  

OTC supplement

by Theknotguy - 2020-07-31 10:37:10

I've had afib problems for years.  What you don't want is a blood clot in your heart.  Not fun.  Nor do you want to go into afib with RVR.  I can tell you from past personal experience you don't want either.  As Gemita said, afib tends to get worse as it goes on.  My Ep also said it's an increasing experience for the heart.  As the heart has more afib it tends to increase.  

Something you may want to discuss with your cardiologist.  I was surprised when my EP suggested I get OTC magnesium supplements and take those.  I was really surprised he suggested that but have been taking the magnesium for years now.  I don't know if it was changes in medication plus the magnesium or just the magnesium or what but my afib sessions have decreased in intensity since starting the magnesium.  I don't think of it as a cure-all or fix-all but it does seem to help.  Plus my EP recommended it.  So it may be a question for you to ask your cardiologist/EP.  

I've been on Elequis (Apixiban) for years and get along fine with it.  A lot better than being on coumadin (rat poison). You may want to check with your EP/cardiologist's office to see if they can help if your medical insurance doesn't cover 100% of the year.  

Hope everything else goes well for you.

Stop the aspirin

by crustyg - 2020-07-31 13:36:27

One of my cardiology docs pointed out that baby-aspirin is no longer recommended by UK NICE in this scenario.  In fact the anti-platelet effect of *any* NSAID isn't great when you are fully anticoagulated with a NOAC like apixaban.  I avoided all NSAIDs like the plague while I was on apixaban, precisely because platelets are your first line of defence when a tiny blood vessel breaks and NSAIDs reduce their effectiveness.

I would recheck the advice to continue on baby-aspirin.


by AgentX86 - 2020-08-01 18:17:36

Yes, magnesium (and potassium and sodium) are critical trace metals for the heart.  Really, all muscles need these electrolytes.  The first sign of a shortage of these electrolytes is often leg cramps.   Magnesium very often solves this problem immediately.  Western diets have an excessive amout of sodium (some have issues with retaining it) but potassium and magnesium can be problems.  Magnesium suppliments are a good idea. 

Potassium is a two-edged sword.  Too much is just as bad as tool little.  Both can cause deadly arrhythmias.  It's not a good idea to play around with potassium.  Bananas are fine (can't eat enough) but suppliments should be prescribed only by doctors.

Magnesium is self "regulating" (or should I say "irregulating") long before it gets to a toxic level.  It's probably the metal that's the most often short in our diet.  It's harder to come by but just as crucial.  Don't take Magnesium Oxide, however.  That's good for sunburns but doesn't get absorbed by the body.  It will cause diarrhea (think "milk of magnesia").  One of the organic magnesiums is far better.  It gets absorbed far more readily and doesn't cause the intestinal distress that the oxide form causes (or can be used in smaller doses).

Magnesium citrate, glycate, and malate are the most common.  I find they act differently on me so I had to play around to find the one that works best (minimum dose).

BTW, another source of magnesium is dark chocolate.  It takes about 12oz a day, though.  It has a few unpleasant side-effects, too.

Aspirin and magnesium

by islandgirl - 2020-08-02 16:33:23

I would write down when you have symptoms such as vertigo and SOB to see if they correspond to any afib occurrences.    

I do not have afib, but have had bouts of aflutter.  I take Xarelto and a 325 mg aspirin each day (Xarelto at night, aspirin in the morning).  I have a variety of arrhythmias....  My EP says the aspirin keeps the blood from being too sticky....so he says they each work in different ways.  I've been taking 'Slo Mag' for many years, since my arrhythias began.  I take lasix, so I also take prescription potassium. 

Check with you EP for specific questions, as we are all have different medical needs.  

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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.