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AF Association
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Confused

I was diagnosed about 5 years go now by having a cardio call fitted. I had one episode that last a second or two and on the back of that was told I had Afib.

However every ECG I have had has never shown Afib present. Last week my HR went to 170 and lasted until I went to hospital and had an ECG again. No trace of Afib only tachycardia which went back normal on its own after a little while.

Is there a possibility I have been misdiagnosed or just that it can't always be seen on an ECG. Thanks

16 Replies
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Sounds like paroxymal AF which is notoriously difficult to catch non ECG - unless episode is sustained.

I nearly always have Tachycardia before AF.

Better question is are you symptomatic?

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I have no symptoms only the fast but regular hear beat. I have been in hospital a few times heart still racing but never caught Afib that's why I was getting confused about the whole thing

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I think it excellent that you are being monitored so well. You can have AF if it only lasts a few seconds & if it is permanent. Sort the Tachycardia & it is unlikely AF will develop. Keep an accurate diary of when Tachycardia starts & what you were doing & what I ate. Sometimes, not always, you can find a trigger. Eg mine nowadays is always when I get up after eating, especially lunchtimes when eaten any carbs, and walked any distance or run upstairs etc. I now stay sitting for 20-30 mins & i no longer have nearly as many episodes.

AF is not life threatening so Meds, apart from anticoagulants, are given for improving QOL. I don’t take any heart Meds other than anticoagulants as the side effects for me were worse than than the ‘cure’.

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Thanks for the reply CDreamer. Food is a massive trigger point for me as every episode i have had i have just eaten. I am on Flecainide but never put on anticoagulants (this was decided by an EP and my own GP). I would love to come off all meds.

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Based on my experience you are right to be confused. I had a similar experience - a 48hr monitor through my GP (and sent off for assessment) diagnosed a 2min episode of af. I went to a private cardiologist to get a more detailed diagnosis and advice and he found 'no clear evidence of af' but a cluster of atrial ectopics. I have since had a 7 day monitor with no af and an overnight stay in A&E with no af and at the moment I am diagnosed with multifocal atrial tachycardia but not af for which I was given bisoporol in A&E but which my cardiologist says I can do without.

As the symptoms can come and go its so difficult to know for sure unless they are captured but misdiagnosis is a possibility.......

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Being miss-diagnosed will remain a possibility until AF has been seen on an ECG. Are you under the care of an EP, or just general cardiology? I think you should be seen by an EP.

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Your GP may be able to loan you a pocket ECG monitor for use when you notice an episode, although if it only occurs for a second or two, that might not be easy!

I wasn't diagnosed, in spite of a 7 day monitor, until I was found to be in AF during my first ablation which was for tachycardia.

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Thanks for the replies. I was diagnosed by a registrar cardiologist after having the cardio call fitted. He wasn't that helpful and said i can live with this.

I wasn't happy so managed to get an appointment to see an EP in Bristol. He was the one who prescribed meds.

I was then discharged and told i could go back if i had anymore concerns. My episodes where and are so far apart i just got on with it.

I recently spoke with my GP as not had a review of me Afib and he sent me to Taunton to see a cardiologist as Bristol have refused to see me as I live in Devon and I would need to live in Somerset to be seen there. (mad but i was living in Devon when i first saw them).

Every single EGC I have had and there has been a few over time has never captured Afib eeven the ones that I have spent the night in hospitals with. It was only that last week i went into my local minor injuries centre due to racing for sometime and they said no Afib just Tachycardia.

This is why I am confused it seems that my diagnosis has been made on one single small blip on a cardio call and nothing else.

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You need to ask your doctor for an Event Recorder (30-Day Event Monitoring)

pinnaclehealth.org/services...

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Who did you see in Taunton? my cardiologist is there and he offered me a 3 day monitor to catch pauses as that was the main concern for me but as I was no longer having problems after my ablation we decided to rely on my Kardia unless I had further regular problems.

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To be honest i can't remember his name.

He has also discharged me and told me to get back to them if i wanted to.

If i am hones i really dont get a lot of problems but u just wanted to see if there is a chance i have beem misdiagnosed

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possibly but are you being treated for the AT?

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Nothing has been said about treatment

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A very fast regular heartbeat which starts suddenly without much exercise is called paroxysmal tachycardia and is generally caused by an electrical abnormality in the heart which can be suppressed by drugs or corrected by an ablation procedure. First the particular type must be identified (SVT, flutter, fibrillation or something else) – and this is difficult if the attacks are quite brief.

If the abnormal tachycardia has been going on for some time the body gets stressed and makes adrenaline. So even when it stops, the normal rhythm still goes fast for a while until the adrenaline settles – this is why people are often told they have a normal fast rhythm by the time they get to hospital.

To record an ECG of the tachycardia you can have a heart recorder attached to you for up to a week but if the attacks don't happen that often (but do continue for at least a minute) you can use an AliveCor device which can record an ECG on your phone (iPhone or Android type). They cost less than £100 and last for years. When you have recorded an attack you can show it, or email it, to your cardiologist.

It's best to see a cardiologist who specialises in this kind of problem, an electrophysiologist, who can advise you what treatment options you can consider.

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Thanks for your reply. I originally saw Dr Glyn Thomas at Bristol who prescribed Flecainide. I had no follow up appointments. Time went by and after a few years i asked my GP for another referal. I was told there was no EP in the area so saw a general cardiologist. I was told to continue with my meds and discharged. I think i need to try and push my GP try and get me to see an EP and get to the bottom of it.

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Have a look at the Omron HCG-801 event recorder and associated software.

It's robust and has not let me down over the past 8 years.

The Kardia is cheap and if used correctly seems accurate in diagnosing AF. I believe a subscription is required if you want to store the records on the cloud.

Maybe you have paroxysmal atrial tachycardia (PAT) or flutter rather than fibrillation. How were your ECGs reported? A cardiologist would not report a tachycardia without defining it. A sustained sinus tachycardia of 170 at rest seems very unlikely.

What diagnosis did Dr Thomas make when he started you on Flecainide? Is he an EP?

I second the earlier suggestion of a further opinion with an EP. You can self refer privately.

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