In AF again.

For the last 7 weeks or so I have had no AF and hardly any ectopics. Ectopics had been a particular problem in the evenings and I was convinced that there had been a real improvement. In fact I had somehow, very stupidly, persuaded myself that the AF could be controlled and avoided althogether. Woke up about an 30 mins ago feeling a bit more tired than usual and realised that I had gone into AF. Last night there had been nothing at all. Nocturnal AF is a particular problem as one may not be aware of the AF. Have taken an extra sotalol and am hoping this episode will terminate.

[jeanjeannie50]

How are you feeling now Sam?

Can you put your AF attack down to anything you ate or drank? It always makes me feel better if I can do that, I feel I have control over it.

[Hidden in reply to jeanjeannie50]

I have just had an ECG and it shows I am now back in normal rhythm. The PAF stopped immediately after I entered the doctors- the most likely explanation is that walking up a steep hill to the surgery somehow knocked it back into rhythm. The PAF lasted for 12 hours. I’m still getting a few ectopics, so it might go back into PAF later. I had just had the best 2 months since I was first diagnosed with PAF: almost no ectopics and no irregular beats, so it’s a bit of a mystery why it returned with-for me- such a long episode. I can’t think of anything I ate which would have caused it. I did have one pint of beer at 5, the day before, but the nurse said that was unlikely to have been the cause as the alcohol would have been out of the system by the time the PAF started. Most of the time the PAF was fairly slow but just very persistent. I have gained a kilo in weight and have been less careful with diet than before, so I’m going to address that and do more walking. Thanks so much for your reply.

[jeanjeannie50 in reply to Hidden]

That's sods law for your AF to stop as you got to the doctors.

Hope you stay well now.

[Hidden in reply to jeanjeannie50]

Thanks.

[Flossie72 in reply to Hidden]

I'm glad your episode has subsided. Most of my attacks occurred at night, usually I would wake up about 3.00am desperate for the loo and feeling like death. I suspect getting too hot was a trigger, although I have read that blood pressure drops when we sleep, and if it goes too low it can trigger A Fib. I usually ended up in A and E as it would/could go on for days.

Hope you keep well now,

Sue

[Hidden in reply to Flossie72]

An interesting suggestion. I might try measuring blood pressure before going to bed and on waking as I have an Omron monitor.

[Marcus30 in reply to Hidden]

is it only this last 2 months you have started having PAF?

I disagree with the 1 beer not potentially causing it.

My AF journey (long now) was definitely triggered by alcohol, most are.

My EP recently explained with alcohol it can be up to 2 or even 3 days that it could be the cause of triggering ectopics and PAF.

I hate to say it, as I was an avid drinker, but if starting on a PAF journey, alcohol is the biggest contributor.

my strong advice, if lifestyle changes and reduced or non drinking does not control things well, ablation is a wonderful option. More evidence that the earlier you have one the better the long term results, However, my ablation lad to atrial flutter (worse than paf) and an increased HR.

EP's are terrible at giving you the pro's AND cons.

but overall I would say early intervention is well worthwhile if PAF is coming along more than once every few months. Also great to get off all meds!

Good luck.

[Hidden in reply to Marcus30]

I have had PAF for about a year. I did not know that alcohol could cause problems even 2-3 days later. I will have to be cognisant of that in future. I get PAF on average about once a month, but once in a while get, say, 2-3 episodes over a fortnight; other times I might. It have anything for a couple of months. Is atrial flutter a known product of ablation?

[Marcus30 in reply to Hidden]

I think so, potentially.

Ask your EP that very specific question?

Say: I have heard that flutter may result from ablation, is that true and what best guess % chance that may happen?

I had a 2nd procedure for this which worked, and at the same time they "topped up" fib ablation reducing the chance again that comes back.

So not all bad and flutter is supposedly much easier to correct.

But despite that I think I would seriously look at your alcohol consumption.

I got to the stag that plus 4 drinks almost definitely I would go into fib, but was going into fib even unrelated to alcohol. Are you a regular drinker?

over this past year do you feel your concerns are slowly increasing in frequency and severity? or "holding steady?"

[Hidden in reply to Marcus30]

I typically drink a maximum of 4-5 drinks in a week now -not much. I tend to stop drinking for a week if I have PAF. Prior to PAF I did normal social drinking- maybe 2-3 drinks, 3-4 tines a week.

I wouldn’t say the episodes of PAF are increasing in frequency. I started to think that earlier during the year but then had a longish period without PAF. One consultant told me that things will inevitably get worse

over time, another says they may not.

I was told there was some atrial flutter on an ECG a few months back, but I don’t know what that mean-does it mark a worsening of the condition?

[Marcus30 in reply to Hidden]

Definitely a question for your EP:

Ask:

- Does earlier ablation improve long term result?

- if I have had some flutter, can this be identified and ablated at the same time as fibrillation? Can the fib ablation make the flutter worse if we don't ablate for that at the same time?

Fib usually comes form the lhs atrium, ablated via PVI (pulmonary vein isolation) and flutter mostly comes from the rhs atrium, ablated via a CTI (caval tricuspid isthmus line) which is very quick and easy compared to the difficult fib rhs pvi ablation, so is usually done "on the way out" after the fib ablation.

If your EP is not concise and precise with answers, ask your GP for a second EP opinion (or google local EP's, read up on them and ask your GP for a referral to one of your choice).

Do a good deal of asking of 1-3 EP's and know what your options down the line are.

Try no alcohol for 3-6 months (really bloody hard I know, as I was a 25 a week drinker with wine being my life. But try, then go back to your 4-5 a week.).

[Hidden in reply to Hidden]

Definitely yes. I know little about atrial flutter. I’m guessing it’s nit particularly good.

[mbhakta]

Good news Sam that you're back in normal rhythm again.

Manoj

[Hidden in reply to mbhakta]

Thanks. I hope I stay that way for a while. The worst thing about PAF is its unpredictability.

[Lilypocket]

Hi

I was changed from Sotalol to Flecaine nearly 4 weeks ago. On Sotalol I had about 1000 ecoptics a day ( that I knew of) and Afib lasting 12hrs every month. After the switch the ecoptics completely disappeared. After 3 weeks I had 3 days of shortish episodes of Afib the longest lasting 3 hours. Nothing at night. Going to see cardio today to see if I need a dose adjustment. Maybe Flec could help you ( if you don't have heart disease/ failure as it is contraindicated.

Take care.

[Hidden in reply to Lilypocket]

Flecainide is said to be good for ectopics. I was told I could change so now might be the time.

[Lilypocket in reply to Hidden]

Where do you live? Flec is usually the preferred drug in UK and France ( except in my case..don't know why Dr started me on Sotalol first). Flec definitely worth a try in your case. You will have to do an exercise test to make sure no hidden problems before changing. Good luck!

[Hidden in reply to Lilypocket]

I’m in the UK. I was more or less given a choice between Flecainide and digoxin and chose the former. I could switch, but it’s always a bit worrying switching meds. Some people here have had problems with digoxin. One nurse said that they sometimes switch people back and forth between the two- when one becomes they switch to a new one, then back again when that becomes less effective (and the original one is no longer as familiar to the system).

[Lilypocket in reply to Hidden]

Don't know what Digoxin is 🤔

[Leeson]

Have you had an ablation or just taken tablets for af, and if so how long since your ablation.😊😊

[Hidden in reply to Leeson]

I am going to be assessed for an ablation on the 31st July.

[Hidden]

Well, I will probabaly be referred for one.

[Rodders7777]

Your symptoms are so similar to mine except I’m managing Ona very low dose of Bisoprolo. It’s funny how it comes around once a month, 4:00am until around lunchtime, HR c. 90-100, then out of nowhere, disappears! I’m hugely grateful not to be worse but I too am wondering whether an ablation is the way forward rather than Flec? (I’m using the Apple Watch ecg which seems to work really well )

Anyone any thoughts?

[Hidden in reply to Rodders7777]

Yes, it does seem to come around monthly. It’s always tempting to look for a reason (“I was more stressed than usual” or “I ate too much spicy food”) but often it’s unclear what the cause is (or even if there is one). I have been told that they like to do ablations early, before the the heart gets remodelled. Does the Apple Watch detect AF at night and would it wake you up with an alarm?

[Rodders7777 in reply to Hidden]

I actually charge the watch overnight unless in AF. The alarm would wake you by vibrating your wrist. I feel it works well.

[Hidden in reply to Rodders7777]

I will definitely get one. I don’t like like the idea of having AF whilst asleep and not knowing about it.

[Madscientist16]

Have you been tested for sleep apnea? Having A-fib during the night or while sleeping may indicate that you may have it. There is a link between sleep apnea and those who suffer from A-fib. Many who were treated for sleep apnea got rid of their A-fib.

[Hidden in reply to Madscientist16]

I haven’t been tested, but have never woken up breathless. Intererestingly, I woke up a few minutes ago with a faster pulse than usual- although it was regular. I took my pulse before going to sleep and it was 50. When I woke up, it was 60 and seemed a bit heavy. After 5 mins it reverted to to 50. This might have been caused by a vivid dream (although I cannot remember it).

[Hidden]

Since that term means “the occurrence and development of events by chance in a happy or beneficial way” it is not applicable in this case; that is the decision will obviously not be based on chance.