Damage to heart per AF Attack

Had to phone 111 today. Been in AF nearly 36 hours now. ECG captured heart rate at 101bpm but it's varied between 76 & 130bpm. I can see how 170+ bpd can wear the heart out but what about just over 100?

Reason for asking is the comments made by the nurse from 111. Also, what does 'Nonspecific T wave abnormality probably digitalis effect mean'?

How long would people leave it before asking for a cardio-version if heart doesn't revert to sinus itself?



32 Replies

  • Nige, it's not a question of you asking for a cardioversion. The medics will decide if you need one taking many factors into consideration, not least whether you are properly anti coagulated.

    Many people have a heart rate hovering around the 100 mark. Did you go to A& E ?

  • Nige

    Key. Did they send paramedic and they take you to A&E or did you get taken there by car.

  • Hi PeterWh,

    111 sent ambulance. Had an ECG and we decided hospital wasn't necessary

  • Sorry to hear that. Keep your chin up.

    What medications are you on?

    Unless you are on an anticoagulant (and in the case of warfarin have a recent INR test printed result) they might not do a DCCV because of the risks of a blood clot dislodging. However no harm in asking now but bearing in mind the time now and also the hospital's facilities and medical staff on duty they may not want to do it until the morning.

    A few times I have had a bundle branch block probably digitalis effect. Also some other bits. They rectified themselves.

    Let us know how you are getting on.

  • Meds are Amlodipine 5mg

    Ramipril 5mg

    Rivaroxoban 20mg

    Bisoprolol 5mg

    Now in day 3 feeling exhausted yet as I put on post further down haven't got a particularly high HR. Wondering if I'm feeling so lousy because my HR is yo-yoing so much (between around 75 & 120bpm). From what I'm being told by my GP I'm describing symptoms of someone with a HR of 150+ so I'm just trying to understand where I'm at. This is my second attack in two weeks, the first lasting 49 hours.

    I'm at 56 hrs now. All our tricks to get back into NSR aren't working :-(

  • I think a much higher rate would be needed before you got heart damage- at one patients' day a consultant said you'd have to go for a couple of weeks at 200 rpm but I don't recommend trying it!!

    The other question - it just means they think digoxin may be affecting your recording- I wouldn't worry about that, just check when you have another ECG

    Hope you get back in NSR soon

  • In the fact the first time I got that I wasn't on digoxin. I was told that it's just a general question because over 50% of the time it is due to digoxin but there are other reasons.

  • Normal heart rate is specified as between 60 and 100 so 101 nothing to worry about NIge . It should go much higher when you exercise anyway so why worry too much? People do worry about being in AF when it is paroxysmal but do remember that many are in permanent AF and manage to live long and happy lives. Generally speaking A and E is only for if you have chest pain or are passing out and I really would not take any notice of what 111 may say as they are not medically trained to understand AF. Reading ECGs is a very specialised skill which few have and computer generated answers can just plain confuse. Speak to your specialist doctor (EP?) if you are worried.

  • Bob, can people stay in permanent afib with continuous rapid heart beat of 150 and above, that is if meds fail to bring rate down without risking heart failure? if you know, appreciate the feed back.

  • captainKFF , if I may chime in here, I went into heart failure eight years ago ....was admitted with pulmonary oedema.....after 3 weeks with fast AF. I can't remember the exact rate but suspect it was about the 140 mark.

    I would say that a permanent rate of 150 was not acceptable . At one time when my rate was unresponsive to drug treatment , a pace / ablate procedure was mentioned.


  • Uncontrolled AF with a rapid rate can over time lead to cardiomyopathy (enlarged atrium) which in turn could lead to heart failure. This is why the first line of treatment is always rate control. When I went into atrial tachycardia (a different arrhythmia to AF) at 140-160 whilst on rhythm control drugs a cardioversion was arranged. This was a few months after an ablation so I was still on Warfarin which made it easier to organise quickly. Since I was on my way to the airport for a trip when it started I had to email my EP team from France and by the time I got back from my trip and they had a slot available I guess it was about three weeks. No problems for me other than struggling with tiredness. No sign of any cardiac stress and one zap was all it took. We are all different of course so there is no gold standard. Do remember that cardioversion can ideally only be done within 24-48 hours of AF starting or after the patient has been anticoagulated for at least four weeks (with a stable INR if on Warfarin.) I know of people who have waited months for DCCV when INR has been out of range.

    Many smaller hospitals are reluctant to do DCCV from my experience and can be quite obstructive.

  • Since I am on Warfarin for life, I was told by my British Consultant Cardiologist that when abroad if the AF does not stop then i should go go any emergency unit and ask for a DCCV within 48 hours. I intend to get a letter to that effect. Maybe that idea would help others. Certainly there is a precedent here. Hospitals routinely work out protocols, and send them to the GP and the patient, so why not add this to the protocol, which is a great document to have with you if you ever go to emergency?

    I wonder what the cost of going private in Britain is, and where to go. Any idea in London or another big city?

    As for the Warfarin level, I am fortunate outside Britain: I take my own risks, I self dose with only myself to argue with, and for DCCV I thought stable INR level is largely irrelevant provided it is high on the day of the conversion, and you run it high for the next month or so. That is what a French trained doctor thought who converted me. If need be, fasting for 24 hours would push up the INR. I know it is hard to argue against the doctors, but we start with knowledge -- do I have a good case to argue.

    Your comments were helpful. Thanks

  • Perceived wisdom in UK is INR between 2 and 3 for four consecutive weeks or cardiovert within 48 hours of onset which is hard to define in many cases. I would rather err on the side of caution and wait than risk it. Stroke is NOT something I gamble with.

  • I naturally run between 3 and 4 since I have an artificial heart valve, and that merits a higher range. I had 4.2 on the day of my conversion, and the consultant would have accepted anything between 3 and 5. These balance of risk points are arguable, there is no one answer.

    But, I fail to see why four stable weeks is needed before conversion. I am totally in the dark as to their reasoning. When I follow wisdom, I listen and investigate before I speak!!

    Agreed I think, the INR is a balance between the risk of bleeding and the risk of a clot. When you add in the cardioversion risks, you add in a strong reason for, at least a month or so, increasing the INR. Hence my consultant saying "the higher the better" for cardioversion.

  • Certainly around here talking to the lead Anticoagulation nurse the norm is 2.5 to 3.5. They are dealing with patients who are at 6 or 7 different hospitals doing ablations. My own EP / hospital insisted on that range. Also the range for ablations for those with persistent AF as plots assumed tgey will need a DCCV. Paroxysmal AFers more variable.

  • Bob, thanks for the reply, I recently learned, that iatrogenic atrial tachycardias(flutter) after an ablation is a complication worse than the original Afib and can be refractory to meds and hard to ablate, this is making me think twice about undergoing an ablation, I must add you must really brave to remain for three weeks in these high heart rates.

  • Thanks for your reply, Bob. As ever you are so knowledgeable and a huge asset to this forum. Thank you.

    What are your thoughts to my reply above....... Feeling tired and fatigued and sometime light headed when my HR isn't in warp drive?

    Is it the yo-yo affect?


  • You're supposed to have at least 3 weeks anticoagulant before cardioversion.

    Pill in the pocket flecainide maybe worthwhile for you though to take for episodes of af.

    Non specific t wave changes are very common and indicate no definite evidence of heart attack but maybe other underlying heart problem. Not many people take digoxin these days

  • Just read that with Rivaroxaban they can cardio vert after 7 days. Assuming this is correct?

  • I have a general high HR - normal for me is late 80's to mid 90's and often jumps around to well over 100. I am in permanent AF but I do now when it is really playing up I can feel it. I was told not to go to A & E unless it was over 130 or more for six or more hours but if I had pain with it or dizzyness to go straight away.

  • My heart rate in AF is a little lower than yours Nige. The beta blockers I take mean that my normal bpm is in the region of 48/56, which my GP and EP are happy with because it's not affecting my day to day life.

    When I'm in AF, my bpm rises to somewhere between 70/90 and when I was going through some other health issues a couple of years ago, I went to A and E twice pretty soon after going into AF. On both occasions, I was sent home while still in AF and, on the second of them, was told that, given the rate my heart was beating at, they would not be concerned about me being in fibrillation for months. I've since had this confirmed on three occasions by different medical professionals I've spoken to, so, although my episodes have lasted as long as 53 hours, I'm not going to bother contacting anyone now unless my symptoms (which are very mild compared to many other sufferers I believe) get worse or my bpm increases by something like 60% from what it is now when I'm in AF.

  • Tobw, thanks for your reply. May I ask exactly what are your symptoms when you're in AF? Just trying to grasp a greater understanding of this thing. Thanks


  • I get the usual need for a pee every quarter of an hour or so when an episode starts and, very rarely, I have felt pretty unsteady for a few seconds. Apart from that, I can feel a bit weird when my daily bisoprolol kicks in, but, to be honest, it's just a feeling of palpitations and a vague notion that I'm not feeling "normal". It's easier to say what doesn't happen when I'm having an episode - I don't get breathless (I am able to go on all of the fairly lengthy walks I take with my dog) and never feel any chest pain.

  • I had a conversation about this with my EP a few weeks ago as I cannot take rate control drugs, which I knew and was terrified of being taken to A&E in AF and some over worked doctor giving them to me without checking my history.

    EP said that high rate - I was talking about 150-170 for 24 hours would not be dangerous but it was as well to have a cardioversion as soon as possible as the sooner the heart is in NSR the better as whilst AF begets AF - NSR begets NSR.

    Obviously we were talking about short periods of time not persistent or permenant AF but I do know I can function perfectly well with HR if 130-150 and AF but faster and I struggle.

  • I was told that I should wait no more than about three months before cardioversion, to slow the slippery slope and potential damage. Warfarin would not stabilise INR so changed to Apixaban and magic!

  • Hi, just posted good link which hopefully answers one question.

  • Between Ablations and suffering from PAF, my NSR settled on 105 for some strange reason but they did not seem overly concerned. I would have been totally unaware had it not been for the monitor telling me. They considered a cardioversion but decided to wait a few weeks for the second ablation. I have to say that I had all the same concerns about heart and lung damage when it hit 175 and I think we forget once we are 'cured' that it is a scary place to be regardless to how many times you have been there before.

    Looking back now, I sort of understand why they did not seem phased by my visits to resus. They are satisfying themselves that everything is ok but as the patient, the location racks up the anxiety. I wish I knew of this site at the time, it helps when you are getting the same information from somebody that has been there.

  • Thanks everyone. One more thing. Whilst my HR has fluctuated between75 & 112 (ish..... from memory), the average over the past three days has probably been around 85 leaving me feeling very weak and lethargic. Is this the AF or the fact that I've been adjusting my Bisoprolol to reduce my HR?

    What have others experienced?


  • Certainly increased bisoprolol may make you feel more lethargic. Hopefully this improves though

  • The AF itself will also make you weak and lethargic.

  • Thanks again everyone. I am very pleased to announce that shortly after my last post I reverted back to sinus..... after 56hrs 20mins.

    Best wishes,


  • Just to touch on one of the earlier points, I had a DCCV without the weeks of INR stability, my EP was happy to do it as long as I had a TOE to check for clots at the same time which I was fine with

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