You should do an event monitor to correlate your symptoms with your heart rhythm. This can be arranged by your doctor or he can refer you to a cardiologist for it.
I agree with doing sleep apnea study for your symptoms. You will need a heart monitor to assess for abnormal rhythm and blackout spells. The duration of monitor depends on the frequency of symptoms ( Holter monitor for daily episodes and event monitor for episodes that are less frequent). This can be arranged by your GP. You need to see your cardiologist for the blackout spells and ECG analysis.
You need to contact the surgeon for the pain.
You have vagal induced lone atrial fibrillation based on triggers as well as response to exercise. The treatment is based on duration and frequency of symptoms. Your stroke risk is very low given young age and one risk factor i.e. hypertension. A beta-blocker like Tenormin is good to use for blood pressure as it helps control the rate during episodes of atrial fibrillation. You can try pill in the pocket (Beta-blocker + flecainide or propafenone or norpace) as it is better than going to the ER...usually take 1-2 hours to convert. I have my patients come to the office or go to ER the first time they do this to ensure they don\'t have fast atrial flutter with the strategy. The decision to do catheter ablation must be based on increase in duration and frequency of episodes as the main goal of the procedure is symptom relief.
CHA2DS2 VAsc score is a better score to use than CHADS score. The usual practice is to anticoagulate with a score of 2. We tend to use ASA with lower scores but the data on stroke prevention with ASA is not very robust. The newer anticoagulant drugs like dabigatran, rivaroxaban and apixaban have a better safety profile than warfarin. I use them in patients with score of 1 who are worried about risk of stroke.
Flecainide works well as an antiarrhythmic drug for paroxysmal a fib patients who do not have CAD. You should have a stress test done before taking it. I ask my patients to take the first pill in pocket drug in the ER or the office depending on when they have the episode. It can take 1-1.30 hour for its effect to work and should not be taken for shorter lasting episodes. You should tasking daily flecainide if you have frequent episodes and consider catheter ablation as it is more effective than drugs. I agree with early ablation as more frequent episodes of afib can lead to atrial remodeling and more sustained a fib.
Treatment of AFib can consist of an antiarrhythmic drug such as flecainide or propafenone if you have no serious structural heart disease, or sotalol or dofetilide if you have underlying coronary artery disease, or amiodarone if you have a significant history of heart failure. If medications fail to control the Afib, then catheter or surgical ablation may be effective. This is something you should discuss with your cardiologist or an electrophysiologist. Finally neither Viagra or Cialis are known to aggravate Afib.
There is no evidence that either drug causes AF to my knowledge, and it has not previously reported as an adverse effect. The use of Viagra or Cialis is of course contraindicated if you are also taking nitrates.
Catheter ablation or surgical ablation can be done for Afib, but it may be best in some situations to try an antiarrhythmic drug first to control the Afib. Ablation procedures can be done on Plavix if required because of a recent stent. In your area you can check with the following EP doctors regarding treatment of Afib.
In a small percentage of cases the frequency of episodes of AF may increase after ablation. These usually settle down after several weeks, but in some cases they do not, and a second ablation is necessary. I am not sure what “interval problems” you had, but usually with dofetilide the QT is prolonged and with propafenone the QRS is prolonged, although the dose can be adjusted to allow continuation of the medication. The sharp chest pain could be due to a condition called pericarditis in which inflammation occurs around the heart after ablation. This is usually treated with ibuprofen 600 mg three times a day, but in some cases requires additional medication to control. If you continue to have frequent AF, especially if the episodes become more prolonged (>24 hours), it may not be safe to travel, unless you are taking an anticoagulant medication such as Coumadin or Xarelto to prevent a stroke, which I assume you are taking after ablation. I would certainly recommend you discuss these issues again with our EP doctor before travelling.