Paroxysmal AF

[A-U-B-Y]

If you have had just the one episode how can you be diagnosed as such.

[Goldfish_]

You can't unless you happen to have had an ecg monitor on at the time or it went on long enough for you to get an ecg done.

[A-U-B-Y in reply to Goldfish_]

Sorry I think I should have been more clear in the way that I posted

What I meant to say was if it was just the once ( I was admitted to hospital with a heart rate of 180, confirmed on the ECG in the ambulance) then is this classed and diagnosed as Paroxysmal AF.

Sorry to be so ignorant but none of this has been explained to me , apart from the fact that I remain in sinus rhythm.

Thanks in advance for your advice

AUBY

[rosyG in reply to A-U-B-Y]

Strictly speaking it can't be said to come and go when it's only been there once but it has been there and is not there now (!!!)so can be classified as Paroxsymal AF I think!! Mine was classified like this after the first episode so I think this must be standard practice.

Hope you are getting on well now and having tests to check if there are any underlying causes?

Lots of informed people on here so do ask questions and they will answer`!!

[A-U-B-Y in reply to rosyG]

Thanks RosyG,

Had an Echocardiogram and cardiologist was happy with the result. I'm on Bisoplorol 2.5 and Apixaban

I was told that I have to remain on the medication due to my age and the fact that I'm female.

[Polski in reply to A-U-B-Y]

This is true of the Apixaban which protects you from stroke and is therefore considered essential. It is not necessarily true of the Bisoprolol. That is there to keep your heart rate below 100 if/when AF occurs, which is important for the long term health of your heart.

Beyond this, the drugs are about improving your Quality of Life (which is important to people with a lot of AF events), but which Bisoprolol tends to decrease for many of us, as you have discovered. You could discuss with your doctor whether it is necessary to take it if you have really only had one occurrence. My doctor has agreed that I need not take it daily, but that I should keep it as a PIP ie to take if/when AF occurs - to prevent the need for that rush to hospital, and to keep the heart rate down at such times.

Be aware that when one decreases Bisoprolol one's heart can be unsettled for a while, so take it slowly and don't panic if you get the odd unusual beats/sensations in the first few days. It is best to decrease slowly for the same reason.

[A-U-B-Y in reply to Polski]

Hi Polski

I have been wondering about this myself, and you have answered my question

I'll be seeing my GP next week to discuss lowering my Bisoplorol dose fron 2.5 to 1.25 as at the moment I'm having dizzy spells.

Thanks for the info

Regards

Auby

[Finvola]

What I now suspect was my first episode of AF was over 10 years ago - I thought it was something wrong with my lungs.

I had nothing else for over a year, then the odd 'funny breathing thing' for some months, followed by about 3 years of nothing.

Eventually an episode was caught and PAF was diagnosed.

What I'm trying to say in a roundabout way is that if my first episode had been caught in 2006, the diagnosis would correctly have been PAF - ie AF which self-terminated in a specific time.

I think it's good that you have been diagnosed with the first episode - it means that steps can be taken to minimise effects and symptoms, even though the diagnosis is never something we wanted to hear.

[A-U-B-Y in reply to Finvola]

Do you mind me asking but are you on medication, and if so how are you coping?

I've been on Bisoplorol and Apixaban for nearly 3 months and I haven't felt myself since.

How long does it take to get used to these drugs , or am I being too impatient.

[Finvola in reply to A-U-B-Y]

I take Apixaban, Bisoprolol 1.25mg and Flecainide 2 x 100mg and have had no AF since 2014 when I was having between 6 and 10 episodes a month, causing misery and distress.

I now feel well, have a normal life but the drugs do slow me down - which is their function, I suppose. I started off on 2.5mg Bisoprolol, but it made me really wobbly and breathless and I was so glad to have it reduced when I started Flecainide.

Your feeling of being different is probably from the Bisoprolol which slows your heart and it does take getting used to. Do talk to your doctor about symptoms as there are other doses, drugs and combinations which may be appropriate for you.

[A-U-B-Y in reply to Finvola]

Thanks Finvola,

I'm hoping to have my Bisoprolol reduced to 1.25 in the next two weeks as I'm struggling on it. I have bad legs and dry eyes, before this I was a fit and healthy 65 year old , going swimming 3 times a week. Now I'm finding a short walk exhausting , and feeling breathless if I climb a short flight of stairs.

Sorry to moan!!

[A-U-B-Y in reply to A-U-B-Y]

Hi again Finvola , Forgot to ask what is Flecainide for ?

[rosyG in reply to A-U-B-Y]

Flecanide is to keep your heart in normal sinus rhythm Lots of people on here have had problems with Bisopherol and have changed to other drugs to get rid of the feelings you describe- wait to see what they say about what has suited them- you don't have to suffer when you can switch!!

[A-U-B-Y in reply to rosyG]

Thanks Rosy!

[1browneyes1 in reply to A-U-B-Y]

I have been on Apixaban for 6 months with no side effects as yet. Bisopralol slowed my heart rate too much and made me feel like lead boots were on my feet. I had to stop taking it. X

[fallingtopieces in reply to A-U-B-Y]

I have just had the one diagnosed AF episode and that was in June 2012 when I was 52. Mine had a definite trigger which was a slushy ice drink and was caught on a paramedic's ecg machine. I was back in nsr after an hour and a half, before I got to hospital in fact but was still diagnosed with PAF.

I'd been given bisoprolol previously as a pill in the pocket for ectopic beats. It did not agree with me either, it took all my energy away and gave me bad dreams even as pill in the pocket, so I came off it.

I'm still under an EP and take no medicines but do take plenty of supplements which I credit for no more AF (as yet)and keeping ectopics to a minimum.

If you have only had one AF episode and you're otherwise in nsr I'm not sure why you've been put on bisoprolol. The apixaban is a sensible precaution once over a certain age.

If your regular heart rate is low ish like mine, ~58-65 Bpm, the bisoprolol will take it lower and prevent it from rising on exertion when you need it too, which could explain why you're not feeling yourself and feeling dizzy.

Pat

[Hidden]

Hi AUBY,

Don't forget, a person can be in AF ... and not know it .... that is, be asymptomatic.

[A-U-B-Y in reply to Hidden]

Hi Carneuny,

Just a silly question, but if you are in sinus rhythm does that mean you're not in AF most of the time.

This is such a complex condition!

[Hidden in reply to A-U-B-Y]

When in sinus rhythm not in AF at that time x

[Hidden in reply to A-U-B-Y]

Hi AUBY,

OK, let me clarify. When a person has been diagnosed with paroxysmal AF that means basically, in its simplest, it is just "intermittent" AF. It means that there can be a sudden recurrence or intensification of the symptoms and equally, there can be a spontaneous termination of the symptoms or the termination can be with intervention. In other words they just come and go when they feel like it and if spontaneous they can stop within 48 hours.

So, when I am in NSR (normal sinus rhythm or just plain 'ol sinus rhythm) I am NOT in AF. It is natures default (correct) heart rhythm.

HOWEVER, in my case my cardiologist wrote in my report that I am asymptomatic which means - confusingly - that I can be in a state of paroxysmal AF and not even know it. I can slip in and out and not know it. Just because I don't experience symptoms doesn't mean I'm not in AF..... in a way its great in another way its alarming.

I found that in the beginning I was in and out of pAF like a rabbit in and out of a burrow. Then I realised this was only when I had the symptoms. I could have been in and out a lot more frequently and just not be aware of it. After some 4 months of this pAF rubbish it dawned on me that when I could feel it, experience the onset of pAf it came after I had eaten food, notably my evening meal.

Long story short - I have kept with my medication as originally prescribed but I have changed my diet significantly. I have also acquired knowledge and technology and experience to monitor my heart. So, if I feel "unwell", the first thing I do is check my pulse (you know fingers on wrist), if I'm home I'll get on my BP monitor. This is a device recommended by NICE here in UK for identifying when a person is in AF as well as the traditional blood pressure readings. This tells me I have not been in AF since April 2015.

I do not consider myself cured of AF - I do consider that through medication and diet I am very well controlled AND OF COURSE - since before April 2015 I have not had to seek any form of intervention from my GP, A & E, a Cardiologist or an EP for my pAF and that for me is the ultimate test.

I've simply done what I can to control my own destiny and its worked.

Hope this helps,

John

[Goldfish_]

Paroxysmal , so probably best to state that you have had a single isolated episode of afaf last less than 7 days and usually less than 24 hours occurring more than once. If it lasts more than 7 days then it is persistent and if it continues long term it is permanent. So if your episode only occurred once I don't think it can be classified as paroxysmal although you are at increased risk of this.

Exactly what you call this is debatable. Lone af could be appropriate but this term is not well defined.

Probably best to call it as an isolated single episode lasting however long with no evidence of recurrence

[BobD Volunteer]

I believe that definitions are somewhat fluid these days. Persistent tends to be used for any AF which does not self revert yet which can be reverted with cardioversion. Permanent can not be cardioverted to NSR at all. Different definitions tend to float about I have noticed at various meetings but that was in use last October.

[icklebud99]

You may only have noticed or felt the one episode but you could have had PAF for some time and not known. Maybe when asleep you have been in AF, therefore once you have an episode that has been recorded the diagnosis is PAF and you need to be medicated as it probably will happen again. Hope this makes sense.

[expences]

I am in the same boat. I've had one episode, two years ago on the 1st March. I was told the same thing, that one doesnt know if one has AF while sleeping. Seems odd to me that I have never caught an AF pulse once during the day in all that time. I have been prescibed two different anticoagulants which gave me a side effects, one of which was like you, cant walk up hills and had a woolly head. Please let me know if you find out anything , wont you.

By the way, beta blockers do slow you down.xx