AFIB Again.

I know we have some experts on this so here goes.

I’ve had PAF since 2018. No drama, no treatment. Just every month or two it started at night and went away during the day.

After a four month break something completely different is happening right now.

For the last 72 hours I’ve been in and out of AFIB. At the times it’s been regular the rate has been high. (RHR of 74 instead of my typical 44)

I went to the doc after 30 hours (it was so unusual) and got beta blockers. I’ve no idea if they have an effect or not. (I’m taking 250mg of Bisoprolol, once a day)

Currently my HR is steady (often with missed beats) but the rate is high. That has happened for prolonged spells.

It feels like I’m in one long spell of AFIB and I’m not ‘normal’ even when my heart is normal.

Will a finger pulse ‘thing’ show irregular or individual missing heartbeats – I hate feeling my pulse) which one is the one of choice?

Should I call the out of hours doc? The longer AFIB goes on the worse it is. I fear all this time when it’s uncorrected is just training my heart to be rubbish.

Anyone know why the rhr is high even with there’s no AFIB, it’s always a big high for the rest of the day after AFIB has stopped but this is off the scale.

If I’m resting with a regular heart rate and I jump up I go into full on Afib and get a proper head rush. It typically settles back to ‘normal’ or as normal as it’s been over the last few days.

I don’t *think* the beta blockers have ‘changed’ my AFIB becuase the period before I popped the pills were similar to what’s happening now.

Anyone have any insight?

Some studies have shown that AFIB patients are chronically low in the electrolyte potassium.

Thanks Edward. I eat Bananas like they’re going out of fashion but back in 2018 I was low in potassium (to my one suprise!) and (unusually) didn’t bang down my normal Banana quota this week.

I’ve scoffed three bananas just now and I’ll keep on top of banana consumption.

I had afib and atrial flutter, one can cause the other apparently. The atrial flutter greatly increased my heart rate.

I had them persistently for at  least 18 months (and by persistent I mean my heart beat was never normal) and didn’t die, but if you are stressed about it phone the NHS helpline and ask there advice, maybe ask if you should have an EKG.

How quickly does it take for the beta blockers to kick in? I wonder if it’s something that has to build up in the system.

A bad night sleep and too much caffeine send me into afib.

NHS 111 booked me a slot at A and E so here I am….

How quickly does it take for the beta blockers to kick in? I wonder if it’s something that has to build up in the system.

A bad night sleep and too much caffeine send me into afib.

Good question re BBs, what worries me is Google says BBs *can* make it worse.

Sleep is a trigger for me, I think, but I suspect caffeine helps it! I’ve never conclusively established triggers except alcohol but I’m not 100pc sure about that.

Good luck with A&E. Hopefully it all sorts itself out.

There’s many different types of AF…you’re in the right place for them to hook you up to see what yours is. (Tho I would have though your doc would have done this before prescribing beta blockers)

Hope it gets sorted.

I am a doctor. Not your doctor. Not medical advice.

You’re doing the right thing going to ED as it sounds like the rhythm may have changed. As a bare minimum they can capture the rhythm on ECG which will be invaluable in the future. Hopefully they can also fix the rhythm, or at least slow it down a bit.

It sounds like you’ve probably got A Flutter now which commonly co-exists with AF.

Bisoprolol takes a few hours to get into your system. There are shorter acting versions that we can give IV if necessary.

Assuming we’re still talking about AF or A Flutter, you’ll probably be sent away with some rate control and blood thinners.

It sounds like you probably need to visit a heart rhythm specialist in a clinic.

I’m taking 250mg of Bisoprolol, once a day

I hope not. Perhaps sir means 2.5mg?

Bananas contain about 300mg potassium whilst the RDA is 4700mg. Better sources of potassium include avocados and salads. Potassium is a vital electrolyte, (I can’t remember his name) won a Nobel prize for discovering the sodium potassium pump. Sugar knocks potassium out the body also so I would look at that too.

long term AF sufferer here.
i was in perm AF for 5 years. got mended and was ok for 7 years.
now been back in perm AF for the last 10 months.

one thing to remember is, you can still live a ok life and exercise once in AF.
once they find out what is the problem, and they sort your meds you should be fine.
bisoprolol never worked for me, made me black out when exercising.
i now take tildium. i can ride 100 miles on it, slowly mind. i ride every day, on and off road.
once you go in AF it can be a bastard to get out of it. some peoples heart prefer to stay in AF.
i am at that stage now. had too much work done on my heart over the years.
so they may control your heart rate rather than the rhythm.

but like i said, you should be ok once you get a specialist to take a look.

good luck, and keep trying to get it sorted.

Sorry to hear this. I’m free of AF (for now at least) after two ablations (cryo and RF).

I keep an eye on my rhythm by finding the pulse in my neck. It works for me.

Get the best advice you can. Some of the info I have received from my local hospital cardiology department was off the mark compared with the arrhythmia specialist (cardiac electrophysiologist) who I got a private consultation with. It was 150 quid well-spent to hear possible treatments and outcomes.

Hopefully you’ll find a good solution for your specific set of circumstances. However, as ton says, you can still live a grand life with it. My dad has had permanent AF (genetics eh!) for around 25 years. He ebikes twice a week for 40 miles; he’ll be 83 in 3 weeks.

Best of luck.

Hopefully A&E sort you out for your immediate situation. I got one of these..

Kardia mobile ECG thing

My Cardiologist / EP recognised its output. But for me it gave me some confidence to “see” if things were ok or not even when I am rate and rhythm controlled. ** (Not that I understand the traces fully!). It exports a pdf you can email to your Doctor.

**I am 2 odd years in with exercise induced atrial tachycardia which drifted into poss a fib. One RF mapping/ablation procedure that didnt work and a recent cryo ablation that I dont know the outcome of yet, fingers crossed.

Good luck.

I am a doctor. Not your doctor. Not medical advice.

You’re doing the right thing going to ED as it sounds like the rhythm may have changed. As a bare minimum they can capture the rhythm on ECG which will be invaluable in the future. Hopefully they can also fix the rhythm, or at least slow it down a bit.

It sounds like you’ve probably got A Flutter now which commonly co-exists with AF.

Bisoprolol takes a few hours to get into your system. There are shorter acting versions that we can give IV if necessary.

Assuming we’re still talking about AF or A Flutter, you’ll probably be sent away with some rate control and blood thinners.

It sounds like you probably need to visit a heart rhythm specialist in a clinic.

Thanks! You’re spot on – a flutter with AF on and off. You also correctly spotted that I’m not taking a quarter of a kg of beta blocker!

To all, thanks everyone really useful information amd reassurance:
AandE sent me to the out of hours doc who has referred me back to the cardiologist.

He thinks I’ll be going down the ablation route and seemed to have a good handle on everything. He didn’t think there was any point in restoring a natural rhythm with cardiothingy because I’m going back into natural rhythm myself periodically and popping back out. 🙁

So, worst case scenario but at least I have clear understanding from a guy who seemed to know what he’s talking about.

I had afib and atrial flutter, one can cause the other apparently. The atrial flutter greatly increased my heart rate.

I had them persistently for at least 18 months (and by persistent I mean my heart beat was never normal) .

Thanks, can I ask what the fix was?

OOB, hopefully you come back with a positive update from A&E.
I too have PAF but only diagnosed Feb this year.

How did you know you were in AF? If you were using the elevated HR numbers then that could be caused by many things eg hard exercise the day before or Flu, Covid etc.
For info I have a Fitbit Sense watch and can run an AF check in 30 seconds. I can have elevated HR and not be in AF. Supposedly 98% accurate in clinical trials. Other such tools are available eg Kardia mobile above.

Also, with your head rush concern. People without AF can experience this too, especially after exercise. Do you know this puts you into AF?

For me, I’m new to all this. I’m PAF and asymptomatic so don’t even feel the AF. I discovered it from raising strange HR number with GP. I have had lots of tests, have a consultant cardiologist but it’s not easy to see him or get guidance on wtf do I do now???
As things stand the only guidance I’ve had is carry on exercising, always wear an HRM, and back off if you exceed 180 bpm. Which may be the right advice but it was given to me prior to an echocardiagram stress test and an MRI scan of he heart.
So I’m very keen to hear of others journeys with AF and medical experts and what proved most valuable to you inc. tech that you feel is valuable and reliable.
One last thing, I’m 56 and can see HR readings from a chest strap to a Garmin device of 230+ bpm when I’m in AF and pedalling up a big hill and that’s spinning not beasting. Without the hrm I’d have no idea my heart was working that heart, I’d have guessed at about 150bpm effort. I have no idea if this is normal for People with AF, or if I’m a freak, or if my heart is going to explode at some point.
It’s all very scary at times when your heart is not normal!
Karl.

Hopefully A&E sort you out for your immediate situation. I got one of these..

Kardia mobile ECG thing

My Cardiologist / EP recognised its output. But for me it gave me some confidence to “see” if things were ok or not even when I am rate and rhythm controlled. ** (Not that I understand the traces fully!). It exports a pdf you can email to your Doctor.

**I am 2 odd years in with exercise induced atrial tachycardia which drifted into poss a fib. One RF mapping/ablation procedure that didnt work and a recent cryo ablation that I dont know the outcome of yet, fingers crossed.

Good luck.

Many thanks.

I have the alivecor thing (although seems dead at the moment). It was invaluable in identifying the AFIB.

How did you know you were in AF?

It’s a familiar sensation to me now but I double check with my own fingers on my pulse.

Other such tools are available eg Kardia mobile above.

Yeah, I’ve got that, that identified the AFIB to the Doctor. (Ironically, the hospital had an ECG but the docs didn’t have access to it.)

Also, with your head rush concern. People without AF can experience this too, especially after exercise. Do you know this puts you into AF?

Not until this week but checking my pulse confirmed the headrush coincides with the irregular pulse.

get guidance on wtf do I do now???

I don’t know, but you *should* find guidance. As others say AFIB begets AFIB. If you can find a way to avoid it happening while it’s paroxysmal(sp?) you’ll be delaying progression. (Ignore the nonsense about ‘vagal Afib’ not progressing.)

I wish I’d taken mine more seriously in the early stages.

As things stand the only guidance I’ve had is carry on exercising, always wear an HRM, and back off if you exceed 180 bpm. Which may be the right advice but it was given to me prior to an echocardiagram stress test and an MRI scan of he heart.
So I’m very keen to hear of others journeys with AF and medical experts and what proved most valuable to you inc. tech that you feel is valuable and reliable.
One last thing, I’m 56 and can see HR readings from a chest strap to a Garmin device of 230+ bpm when I’m in AF and pedalling up a big hill and that’s spinning not beasting. Without the hrm I’d have no idea my heart was working that heart, I’d have guessed at about 150bpm effort. I have no idea if this is normal for People with AF, or if I’m a freak, or if my heart is going to explode at some point.
It’s all very scary at times when your heart is not normal!
Karl.

In AF your heart (a pump) is not pumping very well. I’d be quite surprised if you were climbing substantial hills feeling ok in AF. You should feel dreadful and/or like you’re about to pass out.

Thanks, can I ask what the fix was?

Ablation, took a few go’s though. The first time they only did ablation for the afib, then the second time they realised they needed to do the flutter as well (different nerve cluster sending out the wrong signal) that lasted about 6 months and started to come back again so they redid the procedure again and I have been good for a few years now. In hospital the third time a nurse noticed I have sleep apnea which is a common cause of heart rhythm problems.

Thanks MSP

Anyone know why I haven’t been offered flecainide by either of the GPs I’ve seen since this started? It seems an obvious thing to try?

I’m currently in permanent AFlutter and On and off AFib (More on than off perhaps). Surely they should be urgently trying to get Sinus rhythm back? As things stand my heart is remodelling and making a good outcome less and less likely?

Not sure why not for you. I have always been asymptomatic, it was wacky Garmin readings (instant jumps in HR of 20-30 bpm) that made me seek medical help…

My Cardiologist gave me a beta blocker first but then an anti arrhythmic too (Flecainide). It was to keep me safe, broadly paraphrasing what I was told. I gave the drugs a go but exercise tolerance was poor, I don’t tolerate them well. Hence looking to getting it fixed via ablation.

I am not sure a GP would prescribe them it was the Consultant that started the medication for me.

Wiki has clues.

Its about balance of risks with drugs like this

https://en.m.wikipedia.org/wiki/Flecainide

Anyone know why I haven’t been offered flecainide by either of the GPs I’ve seen since this started? It seems an obvious thing to try?

It is a safe and effective drug, but it’s not straightforward to use. You have to be confident that there are no contraindications. I wouldn’t expect a GP to start it, in fact potentially many general cardiologists might be wary – at least without a suite of tests first.

You probably want to see a cardiac electrophysiologist – if your GP gives you a choice of where to go you can push for that.

You should feel dreadful and/or like you’re about to pass out.

Not everyone experiences it in the same way – especially if the speed of the heart whilst in AF can be controlled adequately. Many people live out their lives in permanent AF and they can be oblivious to the fact. It tends to be the more active, younger people that perhaps notice it more, but that’s not always the case.

Thanks Superficial.

The out of ours doctor has referred me to a cardiologist (I think he said ‘urgent’ bit I’m not sure.)

Do I need to be banging on the door of my GP today to try “other things” while I’m waiting for the Cardiologist?

Wiki has clues.

Its about balance of risks with drugs like this

https://en.m.wikipedia.org/wiki/Flecainide

Seems pretty safe for my circumstances. My heart has been checked and is ‘normal’ apart for the electrical problems.

Follow up question, I don’t have health insurance but I’d cheerfully shell out a couple of hundred quid for a first appointment to see a specialist privately. Is it worth having that first appointment to see if he can do something to keep me in rhythm before the NHS guy has a look.

I’m hoping “they” know time is of the essence and will act fast but I’m not optimistic.

Thanks to everyone who’s commented. This is a difficult and stressful time.

Should I try to go for a run?

I feel for you @outofbreath. I recently went through my own heart scare. Different problem to you though – something called heart block – which resulted in my heart “pausing”. End result was a pacemaker in a hurry.

I certainly can’t offer medical advice. What I can say is that using a private cardiologist was a relief. I went from knowing I had a problem to having a pacemaker within 24 hours. The cardiologist himself was probably no better different than an NHS one (he was actually an NHS cardiologist). I was just grateful not to have the issue hanging over me for weeks, although in my case I think it’s a fair guess the NHS would have put in my pacemaker in a rush also (having your heart stop is pretty urgent).

I deal with uncertainty by trying to educate myself as much as possible. That leads me down to trying to become a cardiologist almost instantaneously with the aid of Google. I then stress and can’t sleep. Before you know it you think you’re about to die from cat aids. I’m not you, but in your shoes I’d pay good money to get an answer in a week, if the NHS said I’d have to wait 2 weeks. That’s me though.

P.S> I was back on my bike within 8 weeks. Lost a lot of fitness in that time, so nit back to previous levels yet. But feel optimistic that this was a mere blip and I’ll carry on riding my bike into my 70’s just like my dad. Just keep telling yourself “this time will pass” and do some breathing exercises. I’ve had some counselling – not specifically related to my heart – but the skills have helped me calm down.

Go for a run? Personally I would say no but I am no cardiologist.

in your shoes I’d pay good money to get an answer in a week, if the NHS said I’d have to wait 2 weeks.

That’s were I am.

Heart remodelling is happening to me as we speak, seems to me whatever they do needs to be fast.

I don’t have health insurance but £250 for a first consultation might result in a quick prescription of Flecainide or similar which might tide me over until I see the NHS guy.

Clearly if a £110,000 op is required I’ll take my chances.

In my case ‘my’ cardiologist works at the local Nuffield so I’d be seeing the same guy.

This sucks, I’ve never been so scared in my life. …and booking a GP is insanely difficult. 🙁

Mind you, I’m sure the NHS would have sorted you fast – urgent lifesaving stuff is the kind of thing they do well.

In AF your heart (a pump) is not pumping very well. I’d be quite surprised if you were climbing substantial hills feeling ok in AF. You should feel dreadful and/or like you’re about to pass out.

sometimes if you are in AF your heart prefers to stay in AF, and once the rate is controlled you can climb hills slowly all day long. trust me, i do and i am in perm AF.

As things stand my heart is remodelling and making a good outcome less and less likely?

no necessarily so. i went for 5 years being in AF. 2 failed cardio versions, 2 failed ablations. i was fixed with a surgical ablation after 5 years.

from reading all this, it sounds like you are in and out of AF or atrial flutter.
i would relax a bit, and wait to see what the cardiologists decide to do.
i reckon they may have you back in for a cardioversion to put you back in sinus rhythm.

Thanks ton, your posts are useful. I’m really appreciate all the replies.

Based on what my Garmin watch is telling me the AFlutter has been non stop because my resting pulse has been reliably high for me (75). The ‘irregular heartbeat stuff has been a bit more random. (From time to time I also have a skipped beat after a few pulses during a regular pulse which combined with the fact I had a first degree block a few years back is scaring me a bit. Let’s hope that’s the Beta Blocker. GP didn’t seem concerned.)

Spoke to the GP this afternoon which reassured me a bit. (Well, not much truthfully.)

I went to record all this on my AliveCor and it’s dead so I’ve bought another…