going to casualty dept

Hi All,

I've been told by my doctor to go to casualty if the afib lasts longer than an hour - is he being extra cautious? What have other afibbers been told ? From posts I've read during the last year or so, it seems some afibbers have episodes varying in length ranging from minutes to days! To be told to go to casualty after an hour of AF seems a bit hasty. As I posted previously, I've been AF free for a year, but I'm well aware that can change overnight. Any thoughts on this?



38 Replies

  • Hi Musetta, are you on any medication for AF? If you are, it depends how long it takes to kick in if you are using it on a pill in the pocket basis.

    I was advised that they have a 48 hour window to be able to treat you - take out the A&E wait and time for treatment, and allow some safety. Before I was given medication for AF, we worked on 24 hours before heading to A&E. Then was given Flecainide as a pill in the pocket approach, which usually stopped it within about 90 minutes. It depends what's "normal" for your AF episode - you'll know when it's not doing what it normally does. The 48 hours is crucial, though.

    I'm on daily Flecainide and Tildiem Retard now, so any episodes are usually over in 30 mins. I'd view 2 hours as unusual now, so probably wouldn't leave it 24 hours before getting help.


  • I forgot to say that before I was put on Flecainide (as PIP), my AF episodes used to last about 10 - 15 hours.


  • Hi Caroline,

    Yes I'm on Apixaban and Diltiazem 240mg plus another two anti hypertension pills Valsartan and physiotens(moxonidine) I agree with you -

    next AF episode, I'll ride out unless my pulse rate goes up to 200 - which it has done in the past and my BP shoots up to unacceptable levels. Is the pill in pocket (Flecainide) taken as well as the other Af meds? I'm also a 45 minute ride from nearest hospital - I need to be in pretty dire straits for me to go to emergency!



  • Hi Musetta, at the time that I was taking Flecainide as P-I-P, I was on Bisoprolol daily, so yes, beta blocker daily and Flecainide when an episode occurred.


  • Go on how you feel. I would listen to my cardiologist/Ep if you have one rather than gp they know very little about arrhythmias I have found.

    If you are unsure give your Ep a ring and seek advice or pop along to hospital if in doubt and worried. Hope things ease for you very soon.


  • Thanks for your reply - good to read different and sensible view points.



  • I find the advice to go to a&e if AF lasts over an hour both worrying and alarmist. I was given similar advice by a locum GP years ago. Quite frankly had I done so then I would have been in and out of hospital twice a week, every week.

    You learn how to deal with episodes in ways which suit you best. I now take 100 flecainide as a p-I-p but if possible will go to lie down to sleep it off.

    Were we all to attend a&e as advised then we would be queuing round the block!

    Trust your instinct and act accordingly.

  • Thanks for your reply. Do you take your pill in pocket as well as other AF meds?



  • Yes, I take 2.5 bisoprolol but this is to help my heart which has fibrosis due to radiotherapy. It cuts my rate from about 80 to 65.

    I have never had consistent advice about pip and I suspect that others on this site are the same.

    Some seem to think that you need both bisoprolol and flecainide. I have seen others saying that they use just bisoprolol.

    Flecainide has always worked well for me when I took it daily at 100 rate pre-ablation. Now my AF is infrequent and much milder. I wait to ensure the arrhythmia is established then take a 100 flecainide. The wait also helps to achieve an empty stomach which is ideally needed.

    Having said all that there has been the odd occasion when I have quickly taken a tablet to ward off an inconvenient episode.

    So far all this strategy is working but if things deteriorate then I will have to reconsider.

    Best wishes.

  • thanks jennydog - I'll talk to gp re -pip next time i'm due for a visit.

  • Just to warn you that GPs cannot normally prescribe flecainide. It is usually started by a Cardiologist then the GP does the repeat prescription.

  • I think quite a few GPs are nervous about anything to do with the heart and therefore are cautious because they don't want get wrong (nor do we!!!). My GP was worried about my HB rate on one particular occasion at the surgery but my EP was wasn't when I saw him a few days later because he is used to seeing patients with higher HB rates or BP. However now he wants to have a lower rate for me now after I had an ablation but went back into persistent af less than 72 hours later. Whilst in NSR it was just over 60 bpm. In your case because you are paroxysmal it will depend on how fast your heart is beating and what your BP is and the combination of both. However don't forget that most devices on the market give false readings for both when someone is in af.

  • If you take the advice of your GP you will soon become persona non grata with your local A and E department as they really don't want you there as you will find. Unless you are passing out or have chest pain they will just stick you in a corner and leave you till you go back into NSR in most hospitals. The only proviso I would say is if you are still trying to get a proper diagnosis by ECG in which case the odd trip to A and E to get that ECG would be useful. Once AF is proved and you start to understand you condition you will be less frightened by it and more able to cope at home.

    See a decent EP as well as few GPs are even remotely capable of treating AF.


  • Hi BobD,

    I agree, unnecessary visits to casualty and clogging up the system is unwarranted. However, each time I've been to casualty (a 45 min drive) My the AF symptoms have been such that I've needed IV meds to revert back to NSR. Minor AF's I deal with at home and fantastically, I've been free of the damn thing for a year - but having read other post on this forum, I realise the next AF is always around the corner. Thanks BobD for your always quick and informative replies.



  • Musetta, it is such a varying situation, depending on severity of symptoms, personal health and circumstances and individual preferences. My GP told me to get to A&E if my heart rate stayed above 100 for more than an hour. That would have involved a 45 minute drive, a waiting time as long as your arm and upset and worry for me and my husband. I decided to lie down, breathe, be scared witless the first few times and then realise that I could cope and feel safe at home.

    It's fine for me as I have no other health problems and my AF usually reverted to NSR after a few hours - I think my GP was being as careful as yours. My feeling is that each of us will know if/when we should follow that advice.

  • Hi Finvola,

    My casualty is also a 45 minute drive and I only go when absolutely necessary - pulse over 200 and bp high - but other Af's when manageble, I ride out at home.



  • I agree with everyone else comments. Most consultants as far as I am aware state if you have rested and taken any prescribed medication then 4 hours is appropriate time to wait - although I tend to sleep on it and see if it is still present in the morning then go.

    I do have to defend GP's though as they know your other health and there may be other health issues that mean you do have to be more cautious than normal with any episodes of AF.

    48-72 hours is the absolute cut off for cardioversion without needing warfarin due to risk of stroke. If you waited longer ( like myself the first time I went into AF) then you have to be on warfarin and at target for a period of time before they even put you on the waiting list for cardioversion...took 6 months last year for myself!!

    hope our comments help

  • I agree with Howesgilly. I'm new to all this but waited at least 5 days before my first visit to A&E. I don't know exactly when it started but could be sure it had started by a certain time. Everyone said if it had been 48 hours they would've done cardioversion immediately. I guess I'm lucky as I'm only waiting 5 weeks which isn't too bad as I was told I had to have anticoagulants for 4 weeks before cardioversion. Presumably going forward if I'm on anticoagulants the 48 hour window would be longer?


  • Just to be clear on this 24 OK and 48 hours is OK--just--- for cardioversion but few A and E departments will do this anyway. In extreme circumstances a DCCV can be done at any time using a TOE (trans oesophagial echocardiogram ) to check for any clots which may have formed in the left atria.

    In UK the hospital would need to admit you to cardiac ward which few will. There is ample anecdotal evidence on this forum of people who have been treated as a damned nuisance for having the temerity to go to A and E department by the staff there. As I said earlier if there is passing out or chest pain that is different but just AF fast or otherwise will get little sympathy from the doctors there who will tell you that it is not life threatening and many people are in permanent AF living their lives without dashing to A and E all the time. Whilst there are a few patients who need hospital treatment during events the vast majority do not and as has been said, once you get to know your version of AF and understand it more you will usually be quite able to manage it at home. Knowledge is power.


  • I was admitted to CCU from A&E. Might be because I was sent to the hospital by my GP. I had an ECG at the GPs surgery from which GP diagnosed AF and I was sent with a copy in my hand. He phoned AMU but they didn't have beds so I saw an AMU consultant in A&E. It was the AMU man who said would've done cardioversion if I'd been sure it had started less than 48 hours ago. What is AMU then? I know it stands for accute monitoring unit but where does it fit in?

  • I was told if lasted for more than 24 hours ( but that was before anticoagulated), if I had any pain, was breathless and clammy, if my HR exceeded 200, if I felt more unwell than usual or was unduly worried.

    It is individual but there can be general guidelines.

    Did you ask your GP their reasoning for that advice? It could be there was another concern OR it could be that he/she knew virtually nothing about AF and was playing safe, I think I would like to know which. My GP told me that I probably knew more about AF than he, having experienced it and studied it, so said trust my own judgement.

    Bob is right, I went to A&E a few times and apart from put me on a ECG and monitor did nothing and said go see your GP and ask for a referral to my cardiologist. But I gather each A&E is also very different..........

  • Hi CDreamer,

    Forhow long did you have your AF diagnosis before you were anticoagulated?



  • I was diagnosed in 2008, saw a local cardiologist who prescribed aspirin. My GP thought I ought to be anticoagulated but I went with the cardiologist - mistakenly I now believe,

    When I saw an EP (privately) in 2013 the first thing he insisted upon was anticoagulation NOAC, and he advised an ablation. I became quite unhappy with my local cardiology department who had never suggested any other treatments other than aspirin and Bisopropolol.

  • Hi CDreamer,

    It's hard to fathom - after all the publicity, that aspirin is still being prescribed for AF!



  • This was 2008, before a lot of the publicity. I first learned of the ineffectiveness of aspirin for AF on this forum. Aspirin is still used after an event such as MI, TIA or stroke as it is an anti platelet.

  • I had an MRI scan on the heart and the radiographer said you are taking Asprin as a blood thinner aren't you????!!!!!

    Should be using term anticoagulant and certainly not Asprin.

  • Hi Musetta,

    100% in agreement with BobD, I have been to A&E twice during the month of Jul, only went there to get an ECG for my EP. They wanted to keep me there, but I said no, I have it under control, just give me a copy of the ECG, which they did. I then went on my way and within a couple of hours, my heart went back to normal rhythm.

    Knowledge is the key.

    Best Wishes


  • BobD is right. I've been told by my local A&E AND my GP surgery not to go there unless I have chest pain or breathlessness. Thanks a lot! Last "bad" episode I had a telephone call with my GP and found that reassuring. Previously I'd gone to A&E on advice of calling 111, but they just monitored me all day and did blood tests and Xray (OK) and sent me home with HR of 120bpm. Fortunately, I soon dropped to my usual permant AF rate of 88bpm which with meds is manageable. Think next time I'll do as they say and not 'bother' them unless chest pain etc. "Feel the fear, and do it anyway"!!! Oh joy!

  • Musetta

    Understand how you feel. I am sure we all remember our first AF incident.

    Now in AF permanently, 7 years under the belt, medicated, link to the hospital, there are no thoughts of A and E. You manage and having swotted up on the problem you know when to "head for the hills" to get emergency treatment.

  • Hi DavDug -

    I usually ride out an Af episodes at home - it's when symptoms become unacceptable - i.e pulse rate over 200 and there's a spike in my already high blood pressure readings. Also I live a 45 minute ride from nearest hospital so less visits the better!



  • Hi, I am on Flecainide as PIP and my EP says it takes up to an hour to take effect, so I would think that going to A&E that quickly would be odd.

  • Hi Sue,

    I only go to casualty (a 45 minute drive) if symptoms are unacceptable i.e pulse over 200 and a spike in my BP readings, eg 190/95

    A question I've asked a couple of other people - do you take the PIP as well as other AF meds? If so, what are your other AF meds?



  • Wow, sorry about suggesting you were rushing to A&E, with figures like that I would probably be knocking on their door.

    My Meds are verapamil each morning and warfarin each night and statins but they make me ache/cramp so I am not taking them this week. Previously I was on just the dreaded Bisopropol but saw and EP who put me on my current regime, which finger crossed seems to be helping greatly.

    Hope that's of use to you.


  • Sue. Get a blood test done if you are getting cramps. When I did it showed liver function was out and simavastatin was stopped by GP immediately (I got phone call as soon as they received results electronically). After about two months tested again and back to normal.

  • Thanks for that - will discuss with own GP as soon as he returns from hols.

  • Really sorry to ask what seems a stupid question but I don't know so I'm going to ask. In the context of this discussion what do we mean by 'chest pains'?

    I've had quite a bit of tightness across my chest going up to what I would call discomfort since this all started depending on how active I've been or how stressed by the work I'm doing or rather not doing. But I wouldn't call it pain to the degree of bad teenage period pain or lower back pain that's enough to make me change my plans and take loads of pain relief. I tend to ignore pain and get on with it so I'd be interested to know what we mean. I'm assuming chest clutching collapsing on the floor thinking heart attack? Is that what we mean?



  • Hi Heather - U sound like me. My tightness has turned out to be angina caused by a 60% blockage.

    My 'early life' was about overcoming pain barriers ...sport/endometriosis etc.

    I did pursue this tightness but was told last year by local hospital that "there's nothing wrong with your heart". I went and saw an EP privately (thanks to you all) .....There's actually a lot wrong with my heart. I have received an apology but no offer of a new heart 💔. Listen to all advice and don't be afraid to be wrong.

  • Does your doctor have a financial interest in the hospital? I can't think of any other reason he would make such a recommendation! !

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