When to seek treatment for Paroxysmal A Fib?

[LeeOhBee]

I've had two attacks of paroxysmal A Fib in the last two years so it's very irregular. I'm going on vacation down in the States next week - a VERY expensive place to visit an ER. If I go into A Fib how long should I wait before going for treatment? Would it be okay to just get a flight home?

[pottypete1]

You should not have to see an EP while you are away and if you go into AF and you do not have the “pill in the pocket” remedy with you, you can wait until you get home for advice.

AF is not life threatening in itself but you should consult an EP to discuss the options regarding possible treatments and anticoagulation.

AF for us sufferers is more about quality of life rather than danger to life.

Pete

[Janith in reply to pottypete1]

What is pill in pocket?

[pottypete1 in reply to Janith]

Hello

A pill in the pocket is when a patient is given permission to take a dose normally of Flecainide (a rate control drug) in an attempt to revert AF to Normal Sinus Rhythm.

Some do it as an addition to their normal drug prescribed medicine. Others as the only option.

It worked for me 80+% of the time for many years. On those occasions when it didn’t work I had to be electrically cardoverted.

This should only be an option under specific instruction of an EP.

Hope this helps.

Pete

[Hidden]

Hi , I have PAF, started 18 months ago, get very occasional episodes, nearly 7 months since the last one, l have a tiny locket on my watch with my pip in. Won't go out without it, it gives me a sense of security, AF used to scare the life out of me but not any more , thanks to this forum and the advice I have received you realise there's no need to fear it, as Pete said as long as you have the correct medication you will be fine, I'm in Spain at the moment, spend most of the year flying back and forth, have a lovely time in the US.

[Hidden]

Hi Lee

I think it is difficult to give advice about your situation without knowing a little more.

Have you had a full work up for your PAF?

Are you on anticoagulants?

How long were the episodes?

How can you be sure you have not had episodes you were not aware of?

I suppose the main concern I would have in your situation is that I would want to know what risk I was at of having a TIA or a stroke, and the logistical and financial implications if that happened while I was away.

I know that my answer does not address your question, but I think my comments are probably not unreasonable.

[etheral in reply to Hidden]

Not being on anticoagulationand suffering a life altering stroke is your main risk.if your ventricular rate is over 120 you could be in hemodynamic risk. These are reasons to go to US Emergency Department immediately. Travel health insurance may be appropriate.

[Hidden]

Thought I'd just mention travel insurance, have you got it and have you declared your AF? It shouldn't be a problem, just costs more and in the unlikely event that anything did happen, such as a TIA, you need to be sure you're covered.

I've had AF for a long, long time and it has never stopped me going anywhere. If I get a problem I would just sit it out.

We're going to the US next year, thinking New England at the moment.

Be careful not to drink (alcohol) more because you're on holiday, and have a great time.

Koll

[CDreamer]

I have travelled to the US many times, had AF episodes on planes, trains, cars and boats all over the US and have never had to go hospital.

Get specific instructions from your EP as to when you may need ER but mostly I was told

- if you have chest pain

- if your HR is near or exceeds 200 for any length of time

- if you feel clammy and generally very unwell

- if you are in AF for more than 24 hours as the sooner you are cardioverted the better

- regarding TIA or stroke - know the symptoms and do not delay in seeking medical advice.

Are you anti-coagulated? If not might be worth talking to your doctor before you go?

Ensure you have good Travel Insurance (I always use TravelInsurance4medical and they have always served me well and are reasonable) and you have declared AF and as long as you are not awaiting any tests and your doctor has not said anything about not travelling and there are no co-morbitities the excess loading is very little.

Do NOT attempt to travel to US without travel insurance with or without AF!

Once that is in place stop worrying as that can exacerbate AF and really enjoy. Whereabouts are you going?

Best wishes CD,

[CDreamer]

PS - take Koll’s point about drinking - alcohol that is but also dehydration can trigger AF.

Hydration is incredibly important whilst travelling -

drink only water and about twice the amount you think you may need. Same if you are going to Colorado or any dessert areas or at altitude, I get altitude sickness very quickly and take a long time to adjust and in places like Denver and Los Vegas I have to be really, really careful.

[Kresta]

I live in New Zealand and my doctor told me one of his other patients went to the US for a holiday and while she was there she had her first ever bout of afib. Naturally she was concerned and went to the nearest hospital. To cut a long story short she came back to NZ with a pacemaker which my doctor thought was over the top. Afib is mostly treated with medication here.

[CDreamer in reply to Kresta]

US do tend to over treat but without knowing all details it may have been a good solution for that patient- pacemaker works for my husband thus avoiding Meds which longer term is more expensive & risks serious side effects.

[momist]

No one has asked, so I will. How symptomatic are you when in AF? If you are totally incapacitated, then there could be a problem. I know that I'm not, and can continue to function (at a lower level) during a bout. I get no actual pain, and although my energy levels are low and I tire incredibly easily, and struggle with complex tasks, just doing normal things is still possible. I would risk that on such a trip, but we are all different - how does it affect you?