Odd episode at the train station - AF Association

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Odd episode at the train station

On Friday, after I had finished work -I hadn’t had a particularly stressful day and didn’t feel particularly tired-I was standing waiting for the train. I noticed a few mild ectopics (say, one every minute) and suddenly they began to increase in frequency until I got about 6 or so fast, fairly heavy irregular beats. At this moment, the train arrived so I got on and took a couple of Kardia readings. Both showed normal with a heartbeat of about 65. I wondered whether I had had a momentary episode of PAF- or was this just ectopics? And why at such an unstresful time? Is this a marker for progression to more permanent AF I am asking myself. I notice more ectopics now, often after eating, but (unless it is occurring when I am asleep) have not had a clear cut episode of PAF for over a month. Any opinions?

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It would be extremely hard for anyone to accurately say what caused your blip I'm sorry to say. My heart used to do its own thing some days even when I was completely relaxed and I've spent hours trying to work out what caused this blip and that but to no avail, I came to the conclusion after years of frustration it was just AF doing what it does and I had to manage as best I could.

A few things to note though, when you have a heart condition you become hyper sensitive to every single heart beat so you will be noticing and reacting to occurrences that most people wouldn't even think twice about, this can in turn cause underlying anxiety which will exacerbate the symptoms especially if you are constantly checking heart rate ect.

The turning point for me was having an ablation which I know is not for everyone but the success rate is high and it gives most people a much better QOL. My symptoms went downhill last year within 6 months and I was, and still do live a very healthy lifestyle. Progression of this condition can be maintained by meds but not indefinitely in a lot of cases so if you get the opportunity to have an ablation procedure it's worth having a long think about it while the symptoms are not to intrusive. Best wishes and I hope you keep well.

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I think you are right about becoming hyper-sensitive. I have my ablation assessment at Barts at the end of the month so I will have a better idea of where I stand. I’ve had plenty of ectopics, albeit minor ones, today, mostly after eating -which isn’t usual for me. But two glasses of wine produced no effect whatsoever. AF is a strange beast.

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Indeed it is a strange one, it can be as much a mental battle as a physical one as I have found out. I hope your assessment goes well and try to accept the professional advice and go with what they suggest, that is another area I look back on and regret. My GP said I should have an ablation in 2016 but I ducked it to my cost and ended having to have one two years later..... Lesson learned.

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Well, if the EP says I should have an ablation I will have to accept that advice. I wasn’t given a time scale by the consultant who referred me; I’m assuming there would be something like a 6 month wait. I’ve been told, that-given how expensive the procedure is- it’s unlikely I would have been referred if it wasn’t thought to be necessary. My GP said that current thinking is that they should intervene early before the thing really takes off; the time required for the procedure is shorter for PAF too. I’m not going to like it however- there are undoubtedly substantial risks involved. I’m still half- hoping that the EP will just propose a change in medication or say the procedure can be delayed for a couple of years, but this is probably naive.

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Hi Sam, ablation or not is the age old question. Clearly you need something whether it is an ablation or better drug therapy or more changes to your lifestyle. Regarding an ablation, you don't say how old you are and how healthy but I am thinking around 50 with no other issues. Have you spoken about this with your cardiologist as well and explored supplements with the guidance of an experienced Naturopath. I can see the logic of an early ablation but in my opinion it is far from a no-brainer. I was offered an ablation by two cardiologists and an EP (who quoted 70% success rate) 5 years ago but chose drug therapy and lifestyle changes/supplements, which has resulted in good QOL. I am stalling until the ablation procedure improves. Good luck whatever you choose.

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Yes, the success rate I was given was “about 60-70%” but there seems to be a lot of different figures knocking around (some much lower than that). There is also a lack of clarity about what constitutes “success”- does this mean the symptoms completely disappear, or just that things are a lot better than before, or just that the procedure went without any hitches?

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I believe the medics term a 'success' as 12 months without AF.

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I would imagine the timescales differ by area, I saw the EP on a Thursday and the following Friday I was having the ablation. Looking back that was the best option as I didn't have a long time to worry about everything. Also my symptoms had become so frequent so quickly I just wanted to get the job done. Try not to worry and best of luck to you whatever you choose.

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I suppose it also depends on how urgently they think you need the procedure. In my case I would prefer late summer for work reasons. If they said, February or March I’d probably have to say no.

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Your ectopics are vagally induced by the sound of it.

I found that ectopics would typically creep in when my heart rate was low. If you’d just boarded a train and your rate was still only 65, then it could have been several beats lower when you experienced that short run.

It sounds like you had a short run of ectopics, not AF. Don’t panic.

(Do you do anything to stop ectopics once they’ve started? Coughing could stop them for me. A few big coughs, in quick succession, aimed to jolt your chest)

You would almost certainly do well on ~600mg of magnesium citrate a day, every day.

I have taken 800mg daily for 6 years and Magnesium has significantly reduced my ectopics/arrhythmias. I take other supplements too but believe magnesium to be the life changer.

Pat

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Yes, I think the ectopics (and the PAF) are vagally induced too- PAF always occurs

in the evening/night and when relaxing (eg *after* work) - the contrary of what might be expected. I find that slow breathing sometimes tames the ectopics bot not always. I started with magnesium but stopped after I was told to speak to the GP first (which I haven’t got round to doing). I’m getting quite a lot of exercise at the moment, but not sure what else can be done to improve vagal tone.

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In my experience there’s no point speaking to a GP on this. They usually know nothing about them and are keen to not be blamed for any adverse effects( minimal if any).

Even my EP didn’t want to comment, except to say he knows many people take them with good results.

I haven’t seen my EP for 4 years now (touching wood here).

I just took a look at some of your posts where you mention quivering, ectopic runs and increased activity turning into AF.

I have had all that too. I couldn’t prove AF until 2012 when I had a violent episode which was luckily caught on a paramedics ecg. I have also had days and weeks in bigeminy and trigeminy.

My ectopics are few and far between now and long may that last🙏🏼. I’m on no meds btw.

Pat

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I haven’t had any “quivering” recently oddly enough, it’s been more ectopics. I’m waiting to see the St Barts EP, so my plan is to have a long chat with him about the whole situation. I hope there is plenty of time at the meeting to do this. As I’ve indicated before, I’ve had a number of different opinions on the seriousness of what I have, ranging from “it’s not very serious” to “it’s serious”.

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Very good to hear your experience and that you are not taking any meds. I declined most of them too and just take flecainide if/when I have an episode of AF. They never last long so are pretty simple to deal with. I'm impressed that so many of you have been able to see an EP on the NHS. I had to go privately to see one. I only got to see a cardiologist at my request and he was hopeless (plumber rather than electrician!) Good Luck everyone- all of us different!

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I had my first EP appointment privately, then NHS with the same EP. Saw him privately again when I thought I couldn’t wait. If you need to see an EP find one who’s private and NHS, make the first appointments privately and ask to be NHS thereafter.

Pat

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Useful tip!

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Sadly the guy I saw no longer works in the NHS but he is very nice and has helped me a great deal. I can't see my doctors ever even thinking of sending me to see an EP. I only found out about them from the Atrial Fibrillation Association as the cardiologists I did get to see never thought to pass me on to one! Hope you continue to do well!

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I had two ablations for PAF. I am now in permanent AF.

When I discovered this site, I realised I knew nothing about the causes of atrial fibrillation. The EPs I saw were only interested in drugs and procedures. I would advise you to research a holistic approach to managing PAF.

In your position, I would try to find a cardiologist who favours a more conservative approach, to get another perspective, particularly if your symptoms are not too bad. Also see whether you can find ways to address any stress in your life.

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Yes, this is exactly what is concerning. When you say that you are now in permanent AF, do you mean that this was the direct result of the procedure/s , i.e. the post- ablation instability never settled? Did the consultant give an explanation? On the question of lifestyle changes I agree. I’m not very overweight, but I ought to get to my ideal weight as there is evidence that this sometimes improves the AF burden.

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With hindsight, I think my first ablation was a curate’s egg. Too aggressive, according to the second EP, with the suggestion it had caused a lot of scarring. On the other hand, it was 4 years before I became permanent.

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I have come to the conclusion that when I have space to think ( or maybe indulge in introspection!) My symptoms are more obvious. It has already been said that we afibbers are tuned in to our heartand blips that others wouldn't notice are immediately on the radar. I've had a quiet week and thus have logged short runs of tachy and more ectopics than usual in my head. This of itself increases my health anxiety but I would put money on the fact that if I'm more fully occupied the same events may well go unnoticed.

Tnis too shall pass.

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This is a complex question-a GP said more or less the same thing that you are saying: “you are probably just aware of the ectopics because you are thinking about them”. However, when I have had PAF episodes they have always been preceded by ectopics which increase in frequency. Usually, I get more ectopics after PAF too. The usual pattern is: first, a few isolated ectopics, then ectopics which increase in frequency and are “heavier” than the earlier ones, then the ectopics “trip” over into PAF. So for me, ectopics

and PAF are linked: if I get more than a few, I immediately think “are these ectopics going to trip over into PAF” or will they just stay as ectopics? Usually it’s the latter, but it puts me on edge all the time. It’s true that when I am distracted or enjoying myself they don’t seem to occur as often. So it’s a complex question. The GP always takes my pulse and says “nice regular pulse of 64”. My heart always behaves itself in the surgery- it’s a like a dangerous driver that drives impeccably when traffic police are in the vicinity.

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I totally understand that!! Although a GP trainee who saw me before my GP on an unrelated subject on hearing I had PAF took my pulse and said " irregular as expected" when in fact as I surreptitiously checked it was perfectly regular!! So medics can jump to conclusions too. My ectopics have never heralded AF but it doesn't stop me thinking this time they might.

Back to the breathing exercises. Even they freaked me yesterday as I couldnt slow my breaths as I usually do. !!!

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There are lots of variants of breathing exercises. I use 4-7-8 breathing (for inhale-hold-exhale in seconds) but there May be better ones.

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Please bear in mind there are different types of ablation. Some are very straightforward, have low risks attached with quick recovery times. Other types of ablation involve puncturing the dividing wall in the centre of the heart so they can attempt to get at the more difficult areas they wish to ablate.

The risks with this type of activity are higher, success rates are lower and recovery takes longer. As BOB says frequently ' It is all about quality of life'. I have had a successful ablation but a medication for a throat I took knocked me back into an irregular pattern and so I have slipped back into a permanent irregular pattern which I can live with quite happily. I can exercise and sleep well.

Up until recently I saw my cardiologist once a year and last time we carried out a risk / benefit analysis along the lines of:

'the area of your heart that is misbehaving is very difficult to get at and an attempt to ablate will carry distinct risks. You are of an age where recovery will be slower. Currently you take no medication apart from warfarin and your blood pressure (140/80) is not unreasonable (after we finally got measure it)'.

So I pay a lot of attention to lifestyle, keep my weight down (Xmas - aargh )and enjoy having a 6 mile walk at least 3 times a week. I used to suffer a lot from wind and bloating until I stopped lactose.

So I have an appointment to see my cardiologist in 2 years time. 'If anything changes don't hesitate to contact me' he said.

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That’s interesting- I thought *all* ablation involved puncturing the wall of the heart; that is supposed to be the most dangerous part of the procedure. At any rate your outcome sounds pretty good. What age are you if you do not mind my asking?

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74. I did think for a moment that your irregularity may have been caused by the shock of a train arriving on time.

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Thanks for that, made me laugh!

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It’s a small rural line on which the same train goes back and forth all day- it’s usually on time. But you are right about trains in general!

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Left atria ablation for a Fib puncture the heart wall between right and left atria.

Right atria ablations typically for flutter don't need to do this. I am not medically trained but I do not believe the puncture between the atria is dangerous.

I have had one of each ablations a month apart.

I was advised 65 % success rate for the pvi afib ablation left atria and I think 95% for the right rf ablation

These are averages, for all ablations, some of the ablation will be on fit people. Some on people with many other problems/ comorbidities. Some on young, people, some in old people. I am not medically trained but I would think the success rate will vary with the different categories.

Additionally from the figures i was given, the " unsuccesful" ablations did not for the most part make you worse, they just did not fix the whole problem.

There only was a small percentage where the outcome was worse after the ablation.

Finally the EP will consider your situation before he goes ahead and during the procedure. Anything he/she thinks is a problem would stop the procedure.

Everything has risks, driving being a pedestrian, flying on airplanes, or climbing the stairs.

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Lots of replies there, all boil down to one thing. Us AF types are all too focused on what our hearts are doing!

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I get runs of ectopics that I can stop if I cough... I told the doctor, and she just rolled her eyes and said if it didn't last for more than a few seconds, it wasn't AF. Made me feel slightly stupid! I do think it's part of having a crazy heart though, but something I try not to worry about.

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