Woken by AF two nights in a Row

[AndyDuk]

Hi all, does anyone else get this? I've been woken by AF in the early hours of the morning two nights in a row. I'm on flecainide, bisoprolol and get bad attacks about once every 3 months. Not had this before, so I wanted to check before I head to my GP, and no doubt get issued the normal sick note, which I don't really want as I enjoy my job and work from home! I'm back to normal rhythm now.

[BobD Volunteer]

Paroxysmal AF starting at night is probably vagally induced. (Look it up in the search facility.)

Why do you need a sick note? If you can manage to function then do so. Don't let AF win.

Are you under a proper cardiologist./ electrophysiologist or just your GP by the way?

[AndyDuk in reply to BobD]

Absolutely 2 x Cardio Version and a Cardio Ablation. Unfortunately, the sick note has been my GP's tactic as shes know I have a busy and stressful job and are a single dad to a teenage girl with autism. So its rest see if it comes back which 9/10 is does not.

[Finvola]

That's a real pain - have you/are you eating something different or perhaps dodgy which could set off your vagus nerve?

[sarniacherie]

I was diagnosed with PAF in 1989. A few episodes have seen me carted off to A & E but with encouragement from my consultant(s) I try to ride out the storm at home. In all these years I have never been able to identify a trigger. The attacks start out of nowhere it seems and go when they are ready. Frustrating to say the least. If you knew what to avoid it would be a big help. Unfortunately for sufferers unpredictability seems to be the nature of the beast. Good luck.

[Hidden]

Hi Andy. You have a lot on your plate, so I imagine stress is part of your AF. Might be worth looking at some sort of meditation / yoga based approach? Others have found that helps.

Also, sounds simple but try avoiding sleeping on your left side. It's a well known trigger and is sure to kick me off within a few minutes.

[Hidden in reply to Hidden]

...also sleep apnia has a recognised link to AF. This is potentially dangerous and is worth thinking about. If you have a partner ask them if you ever seem to stop breathing or catch your breath in the night or even snore heavily. Sorting out sleep apnia can mean sorting out a big part of the af.

[AndyDuk in reply to Hidden]

Thank you for the advice. I already don't sleep on my left and have had AF for about 6 years now. Cycling in my meditation :-), I also use my fitbit to run through breathing exercises when I need to.. Yoga is not a bad idea

[AndyDuk]

Well last night I had a full 6hrs uninterrupted sleep. I'm going to look into the Vagus Nerve more, I know Sunday my daughter treated me to a Chinese maybe it was the shock of a teenager buying Dad dinner that did it ! Thank you all for your help and replies

[dmac4646 in reply to AndyDuk]

it could be MSG in the Chinese - I avoid it like the plague...

[ILowe]

Two suggestions, but you need to feel comfortable with self experimentation. I will show you my reasoning, and what I do. My doctor accepts that I adjust these things myself, and I ask first about any new medicine. I also tend to act conservatively and reduce a suggested dose, rather than increasing it. You do not state the doses of flecainide and bisoprolol, so that my reply might be a bit different when I know!

1. I think that for some people, like myself sometimes, bisoprolol is the reason for the AF. This is my reasoning.

a) A healthy heart has its own natural rate, which varies during over 24h. It even varies during the night, due to the different stages of sleep.

b) A healthy heart has a variety of rhythms. Variety is normal. We can work against nature by limiting it. healthunlocked.com/afassoci...

c) Rate and Rhythm work in what my old biology teacher would say, synergistic harmony.

d) When the rate is too low, Rhythm strikes back, and the irregularities increase.

e) At night, the rate naturally gets low at times. Under the influence of bisoprolol, this could get too low. healthunlocked.com/afassoci...

f) Therefore, a key suspect is the bisoprolol.

Now, I hear well those like Dr Sanyay Gupta that a little bit of bisoprolol enhances the effect of flecainide, and limits its habit of leading to tachycardia when given in higher doses. Hence the reason they are usually prescribed together. Bisoprolol, for a season, also has many good effects. But, forcing the rate down below the natural rate to me is a recipe for AF. Therefore, if your bisoprolol is small, say 1.25mg or 2.5mg, you could simply stop it for a season. The experience of myself and my wife is that neither of us have had problems stopping it at such low levels. If you are on more, you might want to reduce it.

2. Are you taking flecainide in two doses, morning and evening? If so, it could peak while asleep and inactive. Peaking during the daytime is fine. Now, flecainide can sometimes be obtained in slow release capsules,. The idea is that instead of taking 50/50 pills you take 100mg capsule in the morning. That would avoid any peaking. A variant of that would be morning 50mg pill (fast release, needed to interact with my adrenaline, especially on the great pleasure days, the days when I lecture). Then take 50mg slow release in the evening.

I found a few weeks ago that the beneficial effects of 50/50 flec + 1.25mg biso, were wearing off. I therefore stopped the biso, and that helped. A couple of times I had an incident, which was easily controlled (at the suggestion of my doctor) with a boost of 50flec + 1.25biso.

[Lovethatlast]

You cannot imagine how excited I am that someone besides me knows that food, or other triggers that have to with the digestive process, can cause an afib attack. I have tried to tell my cardiologist this is what I think 🤔 is causing my afib. I don’t have a “heart” problem, but I have a problem that affects my heart and causes it to afib. His reply was, “nope, it is because you are getting old.” Tks !!