AF Association
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To call ambulance -- or not?

I notice that almost everyone indicates that they are aware when an AF episode occurs, and that there has been a lot of advice to call an ambulance when the episode is particularly rough. While only occasionally I've felt what I assume to be AF -- a sort of mild fluttering -- I'm very aware of frequent palpitations and Premature Ventricular Contractions (are there what are called Ectopics in England?) but never certain that they are all a part of AF. Would welcome any comments about that, please!

But back to the ambulance question: Not long after the AF diagnosis, I had a severe and prolonged (two or threel hours) episode of palpitations and PVCs, with heart thumping and racing up to about 170. I eventually took an extra Flecainide and things gradually settled down. When I told the cardiologist about this, adding that I had come close to calling an ambulance, he made this remark: "Why would you call an ambulance? All they would do is an EKG and tell you that you have Atrial Fibrillation. Well, you already know you have AFib. All you need to do is take an extra Flecainide, not call for an ambulance."

Comments, please?

Thanks to all who contribute to this helpful site!

Fran.

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It's going to be different for everyone, I think. Everyone has differing severity of symptoms, lasting different lengths of time. We all have differing levels of experience with AF that will affect the decision. Some have other medical complications to consider, and many will simply differ in how scared they are by an attack.

It was one of the main questions I had for my EP; at what point should I go to hospital? It's written down in the letter she wrote to my GP. For me, if my Flecainide doesn't sort it within 3 hours, then go to A&E. There is nothing about taking a second dose.

Whether I call an ambulance to take me to A&E will probably depend on where I am when it happens. I actually live 15 minutes walk from my A&E so two of three times I just walked there. The other time I called an ambulance and there wasn't enough time in the ambulance for them to fill in the simple form for my name, DOB, address etc, on the journey!

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I take a 50mg flec and repeat it after 3 hours or so if things haven't settled. Some episodes have lasted up to 24 hours, but I have never been to hospital for treatment.

If you are very short of breath or have chest pain then certainly hospital is indicated, but otherwise probably not

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Like I said, different for everyone, but I intend to follow my ep's advice

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Thank you, Goldie. That makes sense now that I'm a bit more familiar with AF. I am on 50 mg twice a day. Initially, the dose was 100mg twice a day, but that knocked me for a loop and I could hardly function. Still don't feel like myself on half that dose, but cardio recently suggested taking 50mg three times a day, in order to avoid breakthrough episodes. Well, I'm not willing to do this as a regular routine, and would take that extra one on an as-needed PIP basis. Speaking of which . . . does anyone here go the PIP route with Flecainide while regularly taking an anticoagulant such as Xarelto for the "just-in-case" ?

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That's exactly what I do. If your risk score is appropriate you need to be on an anticoag

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Thanks, Goldie. That's very helpful to know.

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I take Pradaxa and will do so for the rest of my life. I am also prescribed 2.5 bisoprolol which I take at night.

At a recent consultation with my EP we discussed the use of flecainide as a PIP. He said to take a 100 tablet if the AF was established for 20 minutes with a further 100 after 3 hours if necessary.

I explained that I didn't like taking drugs and have tried to sleep the AF off. He didn't like that idea.

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Jennydog, thanks for your insight too. It's so helpful to have input from people who've been here longer than I have!

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Wasn't there recently a reassessment of ambulance response urgency? In order to prioritise truly life-threatening calls, some other calls might not be responded to as quickly. I wonder where this leaves AF in the urgency stakes.

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Good question! By the way, I live in a small community 25 miles from the nearest hospital with an emergency room, and 8 miles to the nearest town. In town there is an Urgent Care for non-life-threatening walk-ins.

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The correct advice is that any chest pain, fainting or passing out and you call an ambulance. We are all different in the way we experience AF and how we are able to cope with it. Here in UK if you call 999 for an ambulance you are taken to A and E which stand for accident and emergency of which AF is neither. It is chronic condition and as one of our long standing members once stated if he had called an ambulance every time he had an AF event he would have had one stationed out side his house 24/7/365.

My own personal view is if you are still tryng to get a diagnosis then A and E is useful as they will do an ECG (US version EKG) but otherwise don't clutter up the system for real emergencies. In that respect I agree completely with your cardiologist but see my first sentence.

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Thanks, Bob. I appreciate your input. Thing is, I was still fairly new to this AF scene and my heart was going so wild at that time, which made me wonder if I ought to be checked out to be sure it was "only" AF. I live alone and it was late night, when things can seem worse. Here in my part of US, an ambulance call doesn't necessarily mean a trip to the Emergency Room. In fact, the only time I have ever called for paramedics was during the years when I was full-time caregiver for my terminally ill husband, and exhausted emotionally and physically. Woke in the night with my heart racing and seemingly jumping all over the place. After waiting almost an hour, I called the NurseLine and described the symptoms and she advised calling paramedics. The guys came in with their portable ECG machine, and were able to tell from the readout that I was in AF (that was definitely news to me at that time). They advised seeing doctor as soon as possible, gave me the paper printout of the ECG, and left.

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The advice from cardios is so different. I now have two PIPs of 1.25mg Bisoprolol and 50mg Flecainide. And the cardio's instruction is that as soon as an episode of AF starts, take them both together. If they haven't sorted out the problem within an hour, then dial 999. But I have only very occasional, but severe episodes, so I imagine I'd only be doing that once or twice a year, and hopefully now the PIPs will work and I won't need to do it at all.

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I've seen someone on another thread say that they didn't want to waste A&E's time, so instead of going straight there they got a same day GP appointment. The GP took their pulse and then sent for an ambulance, thus using up the time of the GP, an ambulance AND the A&E!

I'm sure once one gets 'used' to their condition they will not need to rush to hospital so quickly.

I guess a halfway house might be to call '111' (if you are UK based) and give them the responsibility of how to proceed.

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As well as different advice for different people, I had three different lots of advice from three different HCPs. GP said "wait 40 mins if not back in sinus, then get yourself to A&E". Coronary care nurses said "come straight in we don't mind,better safe than sorry" . Cardiologist said "if it's at night try and get back to sleep and come in in the morning unless chest pain or short of breath!!". I agree in principle to the wait and see advice unless you feel dire or have chest pain. Sometimes you just need reassurance though I'm sure.

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I was told to call Ambulance, luckily My episodes are not often, 2 in 2years, Last check up was told by Arrythmia nurse to take 100mg of Flecainide as a PIP (already take 2x 100mg per day.) I have been taking Flecainide regularly for 11years.I am also on Warfarin and Ibersartan and rattle when I walk.!!!!!!!! As most of us will tell you everyone is slightly different.Best of luck. J so.

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I totally understand your original question and I totally understand the replies - the advise given by doctors and hospitals is baffling.

I originally had AF in 2011 at that time put on heart meds I was told not to drive for 6 months and told to go to A&E if I had AF. I had ablation in 2013 and after that operation had several episodes of AF and was sent to A&E by ambulance from the GP surgery several times. Each time I was cardioverted chemically with amiodarone drip. On one occasion by the attention given it must have been serious. (low BP and AF) In fact before that event I felt I was almost fitting and also had a strange feeling which the nurse got quite excited about (!) cannot remember her words but 'feeling of doom or something' - a feeling that came over me and passed rather than a permanent state.

I then has a short period off the drugs before AF returned in early 2015 and I was again cardioverted chemically in hospital. The duty doctor thought they would treat it as a one off and I didn't need to go back on the drugs (blood thinner, BB, Flecanide) but the cardio consultant thought different. I had AF events several times after that - Heart rate up in 190's and my instructions given by consultant was to go to A&E if it didn't settle after 2 hours. Each time out came the amiodarone drip. On one occasion by heart rate was 240 and there was suddenly a lot of men in green coats looking at the monitor - i.e. I didn't get the impression it was simply chronic (even if it was)

No one at any time told me this is a chronic condition - I was instructed to go to A&E. Then later in 2016 the same consultant I had been seeing explained to me about pill in pocket i.e. the 100mg extra dose and only go to A&E if it dosn't settle in 4 hours. From that point I followed the advise and didn't go to A&E - the pill in pocked worked a treat. I couldn't believe not one hadn't told me about it before! Luckily I stay calm and do not panic when I get AF - my dearest wish being NOT to visit A&E helps!

Early this year I had Ablation Number 2. 2 weeks later I had my first AF since ablation and when I rang to speak to the Arythmia Nurse at the hospital - she said to take the extra dose but basically said to me that I 'they' would only be worried about it if I had been in AF for 8 weeks or more!!! My surprise here being this contradicted every instruction I had been given for 5+ years. I was gobsmacked at time and baffled myself however despite the fact I have daily warnings - I have only had AF 3 and each one has settled at home within in 4 hours.

My latest instructions are now to go to A&E when I get the next one because the consultant wants the reading. The last attack happened whilst I was in a GP surgery but they were unwilling to give me an ecg and by the time I got home - prepared to go to A&E if it didn't settle - it did settle. A missed opportunity I felt at time ....so the NHS would rather I did clutter up the A&E than the GP surgery!

Only from reading the messages on this forum have I ever understood this is a chronic condition - NO consultant has ever explained it to me in that way and none of my experiences until have indicated it was not serious ie admission to hospital after A&E and chemically converted so many times with amiodarone. A long story but - hence why I understand your question and perhaps my reply will reassure you that there are others who find it baffling and cannot give a definitive answer. I certainly know when I am in AF - I can even feel when my heart rises into late 90's which is perhaps a bit unusual. Luckily for me I stay calm when AF does fire off and by using a BP/pulse monitor I can monitor myself easily and believe I have a good idea of when instinctively I would need to go to A&E. With the last 3 events I have also fallen asleep whilst in AF (day time) and woken up with it gone. Wiped out but gone.

I am currently only on the BB which will allow the extra Flecanide when and if necessary. I personally get from the forums that a lot of people here feel we should all be on a blood thinner but I'm going with the consultant on that one and feel better for being off it. Wish I could do something about the BB as I have NO energy and wonder how much better I would be off it - but I am playing the recovery of my latest ablation slowly and patiently and praying I stay off as many drugs as possible.

Your flecanide comment I also understand I didn't tolerate it well. In end the min dose that just about contains things was 150mg and it was suggested i have it 50 x 3 but in practise I found it easier to get the doses spaced at 75 x 2. Tablets not easy to cut in half though.

Thank goodness for forums

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This is such a useful thread. Thanks Nanfranz, for starting it. I have had two AF attacks so far, over two months apart. For the second occurrence, I was in a caravan (US: camping trailer) in a farmer's field, and chose not to send for an ambulance. I had read up on here about AF and simply didn't see the point of going to a strange hospital and generating lots of work for the NHS with transfer of records etc., just to get a new ECG trace. I have a Kardia device and did my own trace with that to pass to the GP when I get to see him.

First attack lasted over eight hours, the second one more than five hours. They leave me feeling totally wrecked.

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The Ambulance association generally suggest that you only have one heart and if in any sort of doubt, call them.

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I would say with a heart rate like that get use to the ambulance. I have had my AF trigger VF and cardiac arrest. I have an ICD because of it. (Implanted cardio converter device) it's basically a pacemaker and a defibrillator all in one. I happen to be a person that has been run through the mill and I'm out of options

Try to figgure out what is causing your AF. For some it's food others it stress, and in odd cases it's bending forward or movements. Then you can go from there with your doctor but keep a good eye on yourself..

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I suspect that things are handled very differently in the UK and America. I live in Maine and the only time I have called an ambulance was when I was going in and out of consciousness due to afib. We had called my EP and she said to go to the emergency room. At the time this happened I was not on an anticoagulant, and they had not ever really seen me in afib, so I went in and they were able to document the afib and get me out of that episode. I was put on Eliquis and metprolol since I also had SVT, and went along for a couple more years, but as episodes continued and got closer together I finally had an ablation this April. I was told that they don't like to leave people in long bouts of irregular heartbeats. They like to get you back into a NSR as soon as possible. I am 3 months out from the ablation now and although I still am experiencing irregular heartbeats from time to time, no afib. Where I live, the emergency medical people on the ambulance begin treating you right away and are in contact with the hospital during the ride to the hospital - even through video if necessary. I found passing out to be very scary.

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My doctor said call an ambulance only if I have dizziness or chest pains. If my heart rate goes over 140 or if the episode has lasted over 4 hours, I can have my husband take me to the hospital. Other than that I can stay at home.

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