In 1999 while on holiday David felt very ill and experienced a strange sensation as if he was floating off into outer space’. Feeling completely disorientated, he thought he was dying. He was taken to hospital with a heart rate of 270 beats per minute and given heparin and digoxin, and later warfarin. A little later he had a successful electrocardioversion, and was able to stop all medication for four years. However, he then got a virus and had severe chest pains, and was diagnosed with pericarditis (where the sack the heart is in becomes inflamed). This triggered David’s AF again, and he had another successful electrocardioversion. A few years later, David felt unwell once again and his AF had returned. He had a chemical cardioversion.

In 2007 David had a catheter ablation. At the same time the doctors discovered that the hole in the heart diagnosed when he was a baby was no longer evident.. After his first ablation, David had some bleeding into his leg. He was put on beta blockers and flecainide for the AF, but found the beta blocker slowed him down. His GP reduced the beta blocker dose, and his consultant took him off them after four months. At that time David also stopped taking warfarin, was put on clopidogrel long term, and told to slowly come off flecainide. No aspirin was given with the clopidogrel because David suffered bleeding a short time after starting a course of aspirin.

David experienced another AF episode and was given bisoprolol and injected with flecainide. He preferred chemical cardioversion to electrocardioversion as it was less intrusive and traumatic, and he did not feel unwell after. He was also put back on warfarin and had another ablation. Some time later, he came off warfarin and went back on clopidogrel. David also experiences ventricular ectopics (extra heartbeats) and bigeminy (double pulsing of the heart with a space). His blood pressure falls and he loses concentration as a result. He decided against having a third ablation, and to wait and see how he felt. He says that his doctors were surprised at his decision at first, but when they discussed that his quality of life is good, and that he could also carry on taking flecainide, they understood his decision.

After turning 75, David was advised that he needed proper anticoagulation therapy and not just clopidigrel’ and was prescribed rivaroxaban. However, after about six months, he noticed there was bleeding subcutaneously (beneath the skin)’ on either side of his left ankle which in a short time became a really big haematoma’ on his left thigh’. He stopped taking rivaroxaban, and following further investigations with a haematologist, was prescribed apixaban at half dose. He regards this as sensible’ given the need to balance his history of bleeding with his risk of stroke.

Alongside apixaban, David takes 50 mg of flecainide twice a day plus amlodipine for slight hypertension. He has experienced constipation as a result of taking this medication. He sees a cardiac specialist every six months, and believes that teams with specialist knowledge of AF are vital. He can also contact an arrhythmia nurse with any concerns, and has found this to be a great source of support. David is very happy with the treatment he has received.

David reminds everyone that people with AF may look fine from the outside, but what is going on inside really affects your psychology.’ David listens to his body, and asks questions during his appointments. He looks up information on AF online and has joined the Atrial Fibrillation Association (AFA). He found that tiredness can trigger his AF, so he does not drive long distances, which is something he finds tiring. He says that it is important to find strategies to live as normal a life as you can. He has found it very useful to hear the experiences of others with AF, as it made him realise that he is not alone.

David had not heard of AF before he was diagnosed. He says that we see lots of advertisements about smoking and diabetes for example, but not AF. He believes there should be much more promotion and awareness-raising of AFand feels strongly that the wellbeing of patients should be at the centre of all treatment, and that it is very important to have adequate numbers of staff. David thinks that the checking of people’s pulse rate should be part of everyday clinical practice. He says that a little time spent doing that and picking up AF could reduce incidences of stroke considerably. He believes that patients need reassurance and support from medical professionals, friends and family, but also need to remember that there is a route back to normal.’

Interview held 16.1.12
Follow-up interviews held 29/1/15 and 5/5/15