AF Association
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Hi, I am a 38 year old male who has had PAF for 2 years on and off, I have had 2 episodes in last 12 months which required A and E and 2 further where pill in the pocket was successful. I practice Yoga and have cut out caffeine, alcohol and strenous exercise. My condition is clearly linked to an over-production of adrenaline, stress and anxiety- I worry about it happening, it happens etc. I take 2.5mg of Bisprolol (sometimes 5mg) which in the main works well but I am keen to get to the root of the problem which is the anxiety. I am pretty sure that if I can get on top of the anxiety I can also get on top of the PAF and that I can manage it. I have been struggling in the last week and am keen to not go down the route of SSRI's or similar and thus have been referred to a CBT/Mental health professional to explore this further but wanted to find out if anyone else had tried similar methods/routes? Any advice around this would be greatly appreciated.

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I use acupuncture to deal with my anxiety and depression. It does help, makes things slip back into perspective.


I've had contact with the mental health services on three occasions, and my experiences were not happy ones.

The first was after my parents were divorced when I was 10. I'd been getting "tummy aches" when it was time to go to school, that got me labelled as a neurotic from a broken home, and has blighted my healthcare for life. It was this label that led to my AF going undiagnosed for years whilst I was told that I was a steaming great hypochondriac.

The second was after a relationship broke up in the same year as my father and grandmother died. For a year or so I sat there with a twit who just said "mmm" every time I said anything. I'd been transferred to him after another guy left the job, before he went he told me why he was going: "I'm fed up of the way the patients are patronised, and fed up of pretending we're helping when we know that we aren't".

The last time was when I was being victimised at work, and on the brink of suicide. I hadn't heard of Asperger's Syndrome then, but I have now, and it seems to explain who I am in a way nothing else does. I was told that it was my own fault that I was being victimised, but they refused point blank to say why, so I don't know whether they think I have Asperger's or not. All I get is "Some questions don't have an answer", and "You never will get an answer". That was 17 years ago, and they're still refusing now. I wrote to my MP complaining that the NHS are being deliberately obtuse a couple of years ago, but I just got a letter suggesting that I talk to the doctor. It was soon after that complaint that the NHS flatly denied that I'd been taken to A&E and diagnosed with AF.


Dear Ectopic1

I know that some areas of the country have a service within the Mental Health Trusts who can assess, diagnose and offer support for adults with Asperger's Syndrome. That might be worth asking about.


Aspergers is NOT a mental health issue. The title explains a collection of symptoms and it came from the educationalists. It can help to have a formal assessment usually done by a psychologist, not mental health services, especially for educational purposes. There is nothing 'wrong' with any one on the Aspergers continuum, it is just they function very differently.

I am so sorry that you had such poor service in your dealings with Counsellors. If I tell you that up until quite recently most Counsellors who worked in GP surgeries were not qualified and worked on a voluntary basis that may go some way to explain it, but NOT excuse it. As a retiring counsellor and psychotherapist and supervisor of 20 years I too have had experiences like yours, in fact I went into training BECAUSE I encountered someone very similar to you and thought - there has to be something better and there is, but a bit like AF, you need to become an expert before you know what questions to ask in the 1st places. Sounds like you had a person centered practitioner, completely wrong for someone with Aspergers as they tend to process emotions very differently.

Anxiety often manifests itself in physical symptoms which will be very individual. Learning how you react to anxiety and what helps reduce it is the key and that is what a good practitioner will help you to do.


Should have made clear that the above was addressed to ectopic.


Hi, I agree wholeheartedly about stress and anxiety, it is always a trigger for my PAF episodes, never had one where they have not been at play in the mix. I am convinced (but that is just my opinion) that stress and anxiety are a catalyst for AF for many people, maybe not the only cause by any means but certainly a big contributory factor for those of us who have a personality susceptible to stress.

My cardiologist is convinced my stress/anxiety levels cause my adrenaline peak during episodes hence I am prescribed beta blockers. He also suggests a lifetime of living at this high level of stress has affected me sufficiently to kick start my AF in the first place. (I do not have any underlying heart conditions otherwise). He talks about inflammation through high activity, anxiety and high stress over the years. My EP and GP also concur.

I have recently undergone CBT and have found it helpful. It was recommended to me by my GP who organised it through the surgery. However I found the one to one sessions and workbooks rather basic but once I got past feeling somewhat patronised by the young girl taking me through the process I selected the strategies most suitable to me and focussed on those which I thought to be helpful.

If you have a lifetime of stress reaction as I do then don't expect miracles from it but it has a place and alongside other strategies will help. You are absolutely right anxiety brings AF and AF brings anxiety. Hold tight you will get there with the right help.

Good luck



Hi, I have had A.F more off than on for 14 years, I am a very anxious person but I think I have only acknowledged this in the last couple of years. A.F started at a very stressful time in my life and I believe every episode has been brought on by stress/anxiety. I was referred to a well being practitioner but after 4 sessions he has referred me on for CBT. The waiting time is about 4 months so am hoping to start around October. I have just been on holiday for 2 weeks, very peaceful and relaxing and I did notice that my heart did very few missed beats etc and my pulse was very stable. This is my third day back and I am struggling today with lots of ?ectopic beats or I am in A.F. ( have had recent 24 hour monitor which recorded lots of ectopics which I thought was A.F hence the query as to what is going on today). worry about what's going on are not helping so yes I too am hoping that CBT will help, in fact I am really putting my hope into this and want to get on with it. I appreciate that A.F wise the damage has been done but I want to minimise it happening as much as possible. I have propafenone as pill in pocket but not really sure when to take it and I to want to try to keep the A.F at bay. There have been posts on here about mindfulness and help with anxiety which you can find on the internet. I will try to find the posts I do hope you get the help and that you don't have to wait too long for it. let us know how you get on. Good luck with it all. Best wishes Kath


Hi, I have very similar triggers for my paf, mainly mine being exercise, too much alcohol, too much sugar, change of posture and stress/anxiety.

It's a nightmare really, I want to exercise more to feel good about myself, but can't do too much as it will trigger af,

I have been prescribed beta blockers but don't take them on a daily basis as my heart rate is normal most of the yes as a pill in pocket approach.

Considering ablation, but not sure this is the vest route and could end up with more problems.

Good luck with it all, ink I may look at doing something to reduce anxiety ect,.....


Rich - my PAF was exercise induced and in the end, it was inability to be able to run without AF, which made me decide on ablation. I had mine last May and although I still get ectopic beats from time to time, I haven't had AF at all and I'm back to running. I didn't take any medication before my ablation and I'm only on warfarin now hopefully just for another 6 weeks or so. Personally, I can't recommend ablation enough and I would definitely have another one if I need to in the future.

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Thanks for your comments, I see a cardiologist in a few weeks, so looking forward to discussing it with them, although I know the waiting list for a good ep in our area is around a year , so going to be a long old wait......

The more I think of ablation the more I think, should I? As I only get two episodes a year(on average) , but I've clearly become good at avoiding triggers for now. at the same time, I can't remember the last time I ran!!!!!

I'm glad things have improved for you, must be a great feeling to be able to push yourself a little without the worry of af.

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CBT helps with worry thoughts, doesn't eliminate anxiety. If you experience an adrenaline rush as I used to no amount of therapy will help as that is physical caused by an imbalance between the sympathetic and parasympathetic system and may be associated with vagal AF. If you are a person who doesn't react well to environmental stress then look at mindfulness, available on the NHS in some areas, and relaxation techniques. There is lots out there hypnotherapy works for many as does acupunture, try whatever you are drawn to and if it helps great, if not try something else. I use EFT at times of intensity and other energy medicines techniques.

As a general - you need not wait to see a practitioner to do CBT , there are plenty of good books out there and lots of sites which are very helpful and free!

Personally I favor HeartMath (Google it) and use a gadget which gives me biofeedback on my heart reaction to my thoughts. 10 mins practice x 2 day. Helped enormously but still had the meds and 2 ablations for the AF. And now free of it for 5 months since March ablation.


Hi Alex, I agree with your action so far. My cardiologist suggested I have some CBT, I suspect because I was asking too many questions and suggested somebody. I had 6 sessions and halfway through I asked her to confirm it was CBT and she said No! it's Psycho dynamic therapy. Anyway, don't expect anything dramatic but I think it did help as part of a cocktail of measures to de-stress.

How you de-stress, will depend mainly on your individual circumstances and I'm no professional in this area as you will have guessed from the above.

In case it helps, what I did has worked well………first I had to accept some pills were necessary to stabilise me, then I reduced working hours (easy as I'm self-employed & have some savings), then I researched my particular condition fully to understand the options, then do something you have always wanted to do but never got around to (I bought a drum kit at 61!!) - I found this gives you a mental boost. I also consulted alternative practitioners who have prescribed good advice/supplements - my cortisol was high, L-Theanine was suggested but I read on this Forum it may not be good so didn't take that but was told to put my feet in cold water before going to bed - sounds odd but instinctively I felt my feet needed to be cooler and I think it helps.

Just one more thing….mental anxiety can come from feeling physically unwell. Improve your diet, minimal sugar and grains/gluton and your mental state gets a boost…just done this in the last month (after a lifetime of sweet tooth and loving bread) and wow……just try it for 3 weeks only!

Good Luck.


And the most important thing you did was take response ability for your own well being, unfortunately very few are prepared to do that. Well done.


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