Conversion to NSR

[vaga_v]

Hello to all! I am 59, female, faced with first PAF November 2017, at midnight landed at hospital. Nice young lady tried to stop it with several vagal maneuvers but w/o results. After several hours of medication my puls went to from 160 to 90 but not in NSR. Electro cardioversion was planned, but I refused since I was not quite sure if this was for the first time at all. I didn't want to take a risk of stroke and I wanted to start AC and discuss it with my cardiologist prior. So I left hospital with medication: 2,5 bisoprolol, rivaroxaban and 1,25 ramipril for moderate BP. In 3 days I went to see my cardiologist and he found out I am back to NSR. Second episode was in January 2018 during night, again. Similar procedure as for the first one, after my puls stabilised I went home w/o electro cardioversion. After few days ECG was done, I converted to NSR spontaneusly. First AF episode was sure caused by physical activity, we were remodeling the house and I was so tired. Second one was caused by my mental state when I found out I am at hight risk skiing along rivaroxaban, just week before planned vacation. I was so naive about AF and had no clue about limitations of daily activities, sport, travel etc. and I started to panic. What I found out it is that I have to change my head first. I am so glad I found you. My question is about NSR. I saw some of you have similar experience.I was not aware of the moment of conversion to NSR. How you now it? Other thing is about my intention to discuss with my cardiologist to swap rivaroxaban with dabigatran which has reversal agent in order to minimise bleeding risk, any suggestion? Sorry to be so long for the first time. Thank you!

[rosyG]

Hi,

The question about which AC to have is best discussed with your doctors as they have slightly different effects . I have Apixaban which doesn't have an antidote yet but have had teeth out whilst on it and many knocks and bruises. Try not to be too anxious about AC . All AC will have some bleeding risk but look back at Chris' recent post about his bleed and you will have some re-assurance

Your AF seems to have started at night and so may be so-called vagal AF. If this is the case, you need to discuss meds with your doctor as some studies showed beta blockers and digoxin shouldn't be used and can worsen vagal AF. If you want to see what our support group's medical director says about vagal AF and meds google " Dr Richard Bogle's blog "about it.

[vaga_v in reply to rosyG]

Tnx rosyG, that comment about beta blocker is something I wanted to discuss with my cardiologist ,too. I had panic attac 2 yrs.ago. My BP went up,and te ordered tritace 1,25. I had never flutter before.I did quite a lot of research and assume that my AF is somehow triggered by ramipril and I want to discontinue it, too.

[bmand]

get use to it, it will happen again. Sorry but that the way it is.

[vaga_v]

Hi bmand, that is exactly I plan to do :). And in parallel to exploit all possibilities to change my life for better. I assume this AF is a sign from my body I have to slowdown with my hectic life a bit. This site is really precious. I like a video about healing vagus nerve posted few days ago - kind of secret of life :).

[JaneFinn]

Hi vaga - and welcome to the forum

Totally empathise with your feeling being so naive about it all at the beginning. Most of us are totally ignorant of the condition (and the meds prescribed) when we’re first diagnosed, and unless you’re lucky enough to have amazingly good explanations and aftercare, it’s rather like having an unexploded bomb land in your lap with no instructions on how to defuse it!

That’s why this forum, and all the kind and knowledgable contributors, is an absolute godsend to so many of us. And of course the info on the AFA site too. (As it sounds like you’ve already discovered!)

Regarding your question about how do we know if we convert back into NSR... (Btw, those of us who feel every single hideous irregularity are rather envious of those who don’t!)

The easy way to tell is by feeling your pulse, at your wrist or your neck.

If it feels ‘irregularly irregular’ (or ‘all over the place’!) you’re probably in AF.

If it feels regular, you’re in Sinus Rhythm. If when you’re resting, it’s between around 60-100 regular beats a minute, it’s called Normal Sinus Rhythm. (Higher or lower isn’t necessarily a problem, it’s just a general guideline.)

(There are other types of arrhythmia too, but I think this answers your question?)

If you don’t want to do it by feeling your pulse, there are also blood pressure monitors (for instance Omron do one) that indicate if your heartbeat is in NSR or not.

Regarding the anticoagulation question, i agree with Rosy above. And if you’re thinking about skiing specifically, I wonder if the danger is more about bangs to the head? In which case my guess is that all anticoagulation carries the same kind of brain bleed risk, regardless of antidote. But I may be wrong ... we’ll see what others say. Definitely good to chat this through with your cardiologist, along with everything else.

One more thing - have you been referred to an EP? You’ll know from your reading on here that that’s the arrhythmia specialist cardiologist who we need to see to get the best advice and treatment for our AF. Always a good idea to get referred

Sorry for such a long reply!! Good luck... You’re doing great Keep asking whatever you need, and those with way more experience than me will no doubt help! xxx

[vaga_v in reply to JaneFinn]

Tnx for long reply :). Regarding self conversion to NSR, both times I was released from hospital, I was not in NSR, very tired and after a good sleep, on the next morning I felt totally normal. I might be that I self coverted during the sleep. What I've discussed with my GP is to check apnea, too. I am from Europe, we have kind of "anti-arrhytmic ambulance" and my cardiologist work closely with them.

[secondtry]

Hi Vaga, yes there is a lot to learn and change but there are many positives, so start out by regarding it as an opportunity not a deadweight on your life.

It does sound like you have vagally mediated PAF. I am surprised you don't notice when you go back into NSR, that makes life a bit trickier in terms of monitoring episodes but maybe you can learn by checking your pulse.

Lastly, don't panic too much with Rivaroxaban and no reversal agent; in my mind it is more important if you get on with it not to swap to something that might cause problems. Good luck and take care with the skiing (I've given it up for the time being).

[Ianc2 in reply to secondtry]

My understanding is that warfarin can be stopped with rapid effect by an injection of vitamin k and that Doctors are well versed in applying it, which is why you are advised to avoid cranberry juice when you are taking it.

The more modern drugs do not as yet have reversal agents but there is a lot of research going on. They do wash out of the body very quickly however.

With regard to skiing it is not really natural to walk around with planks strapped to your feet. Wouldn't it be safer with a good solid board?

[vaga_v in reply to Ianc2]

Hi lanc2. My father is on warafin, after he had minor stroke last year. I did quite a lot of research, it was hard to convince him not to take to much green vegetables....

Majority of my life sport was a significant part of it. It is not easy to accept all sudden changes. I am back to yoga so far, maybe some light trekking .. will see.

[vaga_v in reply to secondtry]

Hi secondtry, this site rocks! I learn from all of you so quickly, my cardiologist wil have a lot of questions to answer on Tuesday. Regarding back to NSR, as I said, it happened twice and might be in a sleep. Of course I've cancelled a skiing trip, I was under such stress.

[Ianc2]

I think the warfarin dose can be adjusted to allow for eating lots of greens with consistency being the key. with regard to activity I try do a continuous walk of about 2 miles a day, with a longer walk on Monday, Wednesday and Friday, usually of about 5 miles with a café in the middle.

Unfortunately I can't run up hills any more but If I go off to the alps I can usually let the cable cars do the heavy lifting and have a wander along to next ski lift (and hut/café), grab a rosti or a meringue and admire the view. My aim is to maintain a certain level of fitness without pushing it too hard. take care

Ian

[vaga_v]

Hi Ian, I am besotted with Julian Alps and what I will do in the future instead of skiing is exactly what you wrote. up by cable car, good food, great view :)) ..my vagus nerve might like it :))

[MIC1]

Hi, Regarding sports, I played ice hockey for 50 years. After my first afib episode, I was prescribed Eliquis, and my cardiologist told me to sell my hockey equipment and quit playing hockey. He was also very cautious about cardiovascular endurance exercise (indoor cycling). I stopped playing hockey for three months, and when I cycled, I incessantly monitored my rate so that I did not exceed 80% of my max heart rate. After about three months, I had a week of afib incidents, going in and out of afib, and I decided to see an EP. This was the advice that he gave me - but please remember that this advice was tailored to my specific health conditions - if you are in NSR, exercise as hard as you want. If you go into afib, stop exercising. I asked him about playing hockey while taking Eliquis. He asked me the following questions: Do you wear a helmet. Answer - yes. Do you check (physical contact). Answer - no. Do you play with a bunch of old men. Answer - yes. He said "play hockey. If you get hit with a puck, you might bruise a little more. It might take a little longer to heal, but you won't die." So far he has been right. I realize that if a skate blade severs my carotid artery, I am probably going to bleed out regardless of whether or not I am on Eliquis. I have been playing hockey for so long that I can modify the way that I play so that I am not putting myself in dangerous situations. I assume that you can do the same thing with skiing. Of course, I would wear a helmet. Incidentally, I have been playing hockey every week for a year now, cycling four days a week, and in NSR. I think that my doctor's advice removed a lot of stress resulting from afib and allowed me to resume a near normal life. Again, this is my particular experience with anticoagulation, exercise, and afib. I would follow what your doctor suggest, especially if the doctor is an EP. Sorry for the lengthy response.

[vaga_v in reply to MIC1]

Thanks! Your mail is exactly what I am looking for, exploring possibilities with rational approach. I was skiing for 50 years, few bruises, no broken bone, helmet-must. Due to the fact that my first AF episode was 4 monts ago I am still in kind of "really, me?" phase. I will put it on my agenda to discuss with my doctor.