Question about paroxysmal AF- does your hea... - AF Association

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Question about paroxysmal AF- does your heart feel very settled for a few days after an episode of AF has terminated?

yorkcardiology profile image
30 Replies

i was recently speaking to a very nice patient of mine who struggles with paroxysmal AF, frequent ectopics and SVT. Today he mentioned something which i found very interesting and i thought this would be a good place to find out if anyone has noticed something similar...

He told me that he had noticed a very specific pattern:

He will start off by getting lots of ectopics.. then they would degrade into an episode of full blown SVT or AF and then he would find that after the episode of AF spontaneously stop, everything settles down beautifully for 2-3 days with no ectopics at all. He wanted me to explain it and i do have a theory but i guess it would be useful before i work on this theory to find out if anyone notices this i.e does the heart feel very calm and settled for a few days after a full blown episode of AF?

Id love to hear your views

btw jeanjeannie50 and doodle.. i love you both! Thank you for all the kindness you show me:-)

30 Replies
JaneFinn profile image

Hi - and thank you SO much for everything you do for those of us with arrhythmias 🌟

I do relate to that experience, but not every time. I’d say usually I get a sense of ectopics and an unstable heart rhythm in the run up to an AF event (often more tired and ‘on edge’ too, for no apparent reason) and usually it’s more stable for a day or two after. Certainly there’s the massive relief of the contrast of a heartbeat that’s back to a steady 60 bpm after an irregular 190 bpm - which in itself feels beautifully calm after the literal chaos of the AF hours. Despite feeling pretty wiped out and like I’m good for nothing, it’s a peaceful and far more secure feeling!

But my most recent event I had no warning signs, just bam into AF while I was asleep/waking. This event was the first I didn’t self convert from, and a day or so after my cardioversion I had a few ectopics and short tachy run. I don’t think I’ve had that after my shorter self-converted events.

Hope you get lots of helpful perspectives :)

Buffafly profile image

I recognise the run up signs, not sure about afterwards as I usually feel 'wrung out' for at least a day and I don't think about my heart after that so probably it is calmer. It is almost like a seizure - a discharge of electricity.

RoyM profile image

Thanks for all your invaluable advice and help over the years. When I was in AF it was difficult to do much I was wiped out. When I returned to NSR the feeling was one of complete calmness almost like the feeling you get when due an operation and you're injected with the drug to relax you. However, three years ago I went into permanent AF and to be perfectly honest I have never looked back. I am able to cycle, swim, walk five miles a day and most importantly chase my lively six year old grandaughter around. My resting heart rate is in the mid sixties. I have lost a little top end exercising ability but is that the natural aging thing. I am 72 and ever so slightly overweight. Thanks Again.

Izzle profile image

Yes, I can relate to that series of events, before, during and after. Regarding the latter of those I know my BP is slightly lower than normal (say 100-105 instead of 115-120). The calmness I've always thought that this is the heart relaxing and recovering from what must be a slightly traumatic experience. Obviously we notice the difference.

Good health to all

Shcldavies profile image

Yes, when I just had SVT an attack would be preceded by some ectopics then after the heart would be very calm for days/weeks/months. When prescribed a higher dose of Bisoprolol the SVT sometimes morphed into Aflutter then the apparent calmness did not materialise and there were times when I felt rotten for a few days after. When prescribed Flecanide with the Bisoprolol it got even worst. After an EP study/ablation in February the EP said that the flutter was caused by the Flecainide, he said I did not have flutter any more but he couldn't get all the MAT which remained. Good news is that I am now on just Bisoprolol 1.25, feeling good with the odd ectopic and hopefully will come off all Meds when I see the Cardiologist next month.

Shcldavies profile image
Shcldavies in reply to Shcldavies

Further to above, when I started to take more medication, as the symptoms were getting worst, unbeknown to my Doctor I also started to lead a much healthier lifestyle (after watching your videos). By leading the healthier lifestyle I believe my heart started to fix itself but at the same time the medication I was taking became stronger and this became detrimental to my now healthier heart, this further generated an increase medication (which my heart did not need) - perpetual deterioration set in until the EP study/ablation broke the thread. This is my theory from experience but with very limited medical knowledge.

Frances123 profile image

Not always loads of ectopics in the run up but I feel a bit odd or different. A feeling of tightness and being aware of my heart. Afterwards I feel a bit tired but heart feels really good. It’s almost like it needed AF for a good workout. A bit like a session at the gym where you might be a bit tired afterwards but feel great. Always a sense of relief I’m through it. Still get one or 2 normal ectopics.

Thank you for all you do in helping people with this horrid condition. Thank you for explaining things in plain English and helping us to understand and a lot of the time allay our fears.

Hilly22 profile image

Hello Sanjay, I hope all is well with you, and your father too.

I tend to get shortish runs, lasting on average 15-20 minutes though they can go on for hours if I can't get the vagal manoeuvres to work after a few minutes. They start with some very uncomfortable ectopics, inevitably followed by rapid and sometimes irregular beats that cause an ache in my neck and head, followed by a regular rapid beat of around 130.

Sometimes my husband lays his fingers on my pulse during an episode, and before he can say my heartbeat's back to normal I tell him it's over, as a sudden and immense feeling of calm comes over me.

I hadn't thought about it before but interestingly I do feel that my heart is more stable afterwards, with no discernible ectopics, and although I can sometimes get 2 or 3 episodes a week I've never had them close together.

I hope that makes sense 😊

wilsond profile image

Yes,I do have what I call the calm after the storm! As far as I know I don't get ectopics,just go onto erratic beats when I'm in aF...or rapid erratic if I go into flutter. But yes 9 times out of ten I get peaceful day or so. Thank you for your valuable work x

Jennyquilt0 profile image
Jennyquilt0 in reply to wilsond

Hi, thank you for all the hep and advice you give us all. I start with. Bump and heavy feeling in my chest and off I go in PAF when it stops which can be long hours later, I feel so much better and yes calm I hadn’t thought of that before because it is such a relief to be back n NSR so yes calm is the right word.

BobD profile image

Not had AF for many years (three ablataions) but paroxysmal Atrial Tacycardia for which I am on waiting list for ablation at Royal Bompton. My events always seem to start whilst sleeping or as i wake up and either require DCCV or massive dose of drugs to teminate but are followed by a period of unsettled feeling with multiple ectopics (usually stopped by your wonderful breathing exercise) which can roll on for a few weeks before total peace returns.

Thank you for all you do here.


fifitb profile image

Hi Sanjay

Thank you for all you do to help us and so many others, you are brilliant and give such amazing advice and information on heart issues.

I have the Paroxysmal type of Atrial Fibrillation. I also have a pacemaker for when my heart goes to slowly (discovered on a heart monitor e.g. 26 beats a minute and then it can go up to 200 beats a minute).

Like some of the others above, yes, I do feel an AFib episode coming on. I usually get a tight feeling across my chest and lately, more often, a wobbly feeling in/around my heart, and I'm thinking, oh no - please don't lead to an episode of AFib! I can be out shopping, just sitting down reading, walking, it is out of the blue. I also begin to feel really lacking in energy and have to slow down. Plus, I can feel a bit tetchy!! I have been drinking far more water lately as I know that helps, especially in the hot summer days we have had (on occasion this summer!).

My most recent AFib episodes have been less symptomatic, which is strange as I used to always feel faint and dizzy (and felt as though I was going to pass out and die) as well as my heart racing like mad, and ended up being taken by ambulance to A&E many times. I would rather not go there though as really they cannot do a lot but can at least check nothing major is happening. Ambulance crew are always brilliant as are A&E staff!

Last night, while attempting to sleep, I had AFib for about 3 hours, the longest I've ever had (usually 2 hours maximum) and I eventually took one Bisoprolol 2.5 at 4:30 am (I take that twice a day plus Rivaroxaban once a day in the evening). I suffer from chronic insomnia and am waiting to hear about going to a sleep clinic as it is every night, I am awake to 3, 4 or even 6am!! Then I have to be up and sometimes have a part-time job to go to, using my brain at University. I don't know how I am still alive to be honest as lack of sleep is not good, and I'm sure exacerbates the AFib. I am having to pressurise my GP as he/she seems to be lacking in enthusiasm to find me a sleep clinic that sorts out my sleep problem.

After an AFib episode, yes, I feel calm but I also feel wiped out for most of the day afterwards!!! And wonder when it will happen again. I had 2 episodes last week with a space of 2 hours between them, which was really upsetting.

I too am on the 2-5 month waiting list at the Royal Brompton Hospital for my third ablation (one was for Atrial Flutter).

I hope this helps with your research.


LindaDaisy profile image

Yes I do have a run up to PAF but more with a feeling of being unsettled. Afterwards can depend on my treatment. If it reverts spontaneously at home or in A&E with no medication then I do have not just a feeling of calm but I normally can go straight back into getting on with life. But if I get admitted and given digoxin, my heart rate goes down but I’m not back to normal. Then it will later spontaneously revert either in or out of hospital then my feeling is one of relieve but no calm. But I put this down to my frustration due the way I get treated in our local hospital (King’s Lynn) and to the frequent inaccuracy of the notes and discharge letter. I normally end up in the assessment ward. I have left ventricular non compaction and I am amazed at the mixed knowledge that the cardiology team have about my condition. On my last visit I had 5 different doctors in one day and each one said something different. One told me I didn’t have LVNC, one said I had HOCM (a diagnosis from 1986) both without examining me. One said it wasn’t worth getting the cardiology team to see me because they had seen me recently (it was over a year!). One doctor made a mistake and the next doctor didn’t say “yes he was wrong” but gave me a very convoluted explanation as to how He though I was wrong. One of the nurses said they were very short of doctors and were having to call in doctors from elsewhere in the Trust. For the first time in my life I didn’t feel safe in hospital. This feeling was shared by the rest of the bay. Next time my doctor tries to send me in, I will not go.

So in a nutshell, I think that for me the feeling after I’ve spontaneously reverted is linked to how I’ve been treated either chemically or mentally. If my body reverts with no intervention then yes I get the calm and well being feeling.

cbsrbpm profile image

Yes exactly that for me. I do feel a bit wiped out next day but all calm on the heart front for a few days.

My Afib episode will occur over a two day period, then I get a day in NSR then on to the next episode! Not really a lot of time to feel anything. 😂😂

cat55 profile image

Hi, first of all, thank you for taking the time to make your invaluable videos. They have helped me to cope so much better with any episodes. I am a long time (18) years AF er. I have infrequent episodes, it started with really fast AF lasting 1 to 2 days. Felt rubbish for a day or so afterwards. My AF over the years has changed and is now with a slower heart rate and I now feel every bump etc. I have propafenone as pill in pocket which I think shortens episode.. I don't like taking it. Last time, last week, I decided to sit it out and see what happened. Episode lasted 8 hours, then reverted to NSR just as I was going to medicate. I did notice that the very frequent ectopics I usually have every day, were quiet for a couple of days. It was lovely!! I do not take any rate control medication. I stopped Sotalol within months of first episode. Felt awful. I look forward to hearing any theories you have regarding this. Ectopics are so disturbing. Thanks for all you do. Best wishes, Kath. X

cassie46 profile image

Hi Sanjay - I have permanent AF but I have periods when my heart is very calm and this normally follows when my HR has been high and erratic for a few days. Often when my OH asks how do you feel today I often say all is peaceful and calm today. Although I do not have bad episodes as people with PAF have I can feel my heart bumping around a lot of the time, my HR is always on the higher side in the 80's, had AF for 5 years and it has rarely been below this, various mixes of medication tried to get it lower to no avail. It is a lovely feeling when your heart is so calm - I suppose it is because most of the time I am aware of my heart not quite behaving.


Cookie24 profile image

Yes,noticably calm when I go back in NSR- immediately.

estrennen profile image

I have paroxysmal AF, with episodes that occur about twice per week and last 24-36 hours. Sometimes I wake up in the morning with AF and sometimes I feel ectopics during the day before AF kicks in. The day after an episode is done, most times my heart does feel calm. If the episode was particularly rough I will often feel pretty fatigued the day after. I am looking forward to an ablation procedure at the end of September to treat my condition.

Suanna profile image

Hi, I'm fairly new to this so don't have much of a track record to report, but I have worked out that the AF, which wakes me during the night, only comes on when I have trouble with my digestive system. I can't say whether the ectopics I experience are a factor as I seem to have those every day now, particularly in the morning and late evening.

My very best wishes to you, and thanks for all the help and advice you provide for us. I am so very glad I found this forum, which led me to your website.

Lien-Ju profile image

Hello, interesting post! I had 2 afib attacks and this is what I noticed:

Every attack starts by a burst of ectopics then it turn into afib attacks, the first time the AFIB stooped by itself and my heart jump from 130/140 BPM irregular to 60 BPM regular.

planetiowa profile image

I had a PVI ablation done about 2 years ago so luckily have not had to deal with much AFIB since then. Prior to that, though (especially in the 6 months prior to my ablation), I would have 3 or 4 episodes a week lasting anywhere from 1 to 8 hours. For me, I was able to self-convert back to NSR 100% of the time simply by running/jogging after an AFIB episode started. Self-conversion would not work sometimes until I waited for about an hour or so after an AF episode started - and the trigger point I would wait for was when I started having to pee often, which from what I have read is due to release of atrial natriuretic peptide. Once that occurred, I would go out for a run and could convert back to NSR in as little as 3-5 minutes. After that, my heart would be very well behaved - maybe not for two or 3 days but at least for a day or two. Maybe something with the atrial natriuretic peptide that is released that causes the heart to behave better?

doodle68 profile image

Hello Sanjay :-) lovely to speak to you.

I have an episode of P-AF lasting 10-15 hour about every 4 weeks and I have mentioned on here before about my episodes having a 'practice run' before the main event.

I don't seem to get ectopics at all anymore ( I take magnesium taurate) but prior to an episide I usually experience breathlessness and a rapid but regular heartbeat lasting just a few moments. This can happen a few hours before or the previous day.

When an episode ends I just feel 'normal' and very relived the horrible syptoms have gone. I used to feel exhausted and I have come to the conclusion that doesn't happen now because I don't get anxious and 'fight' the AF so save energy , instead I accept it calmly and use relaxation techniques until the episode terminates.

Yes to your question. I have PAF with RVR, very symptomatic. Luckily no a fib in 15 months, take PIP, no ablations( yet anyway). Like a storm in the distance, I can feel A Fib coming. More frequent ectopic, unexplained fatigue then it strikes like a snake! It lasts 2 to 14 hours and suddenly stops. It is much like when a violent storm hits and suddenly blows over and the sun comes out again. I feel like crap during the event, have to lie down, urinating often. One time I weighed before and after and lost 4 lb from urinating over 12 hours. After a fib leaves I feel great like it never happened, no ectopics. Ive noticed I get more ectopics when I’ve gone over board in eating unhealthy for days.

Madscientist16 profile image

Thanks for your interest in this site and for all of the very helpful videos you have made through the years. I surely would have gone mad if it wasn't for knowing more about my condition. I have only had two AF episodes and I was only diagnosed last July, but both episodes happened right out of the blue. One second I am in NSR and the next in AF. I had to be medically converted both times and it usually takes 4 to 6 hours to go back to NSR. I have not had calm after my episodes. I always revert back to my usual, which is a number of ectopics and short bouts of tachycardia daily, and I feel every single one of them.

Goldfish7 profile image

Hi - thanks for your YouTube channel it helps keep me 'sane' , feeling safer and informed. Hope this is useful.

After my PAFs which were pretty violent (early days but ablation may have stopped them) with:

very high heart rate 160to over 200bpm

very irregular heart beat

wildly fluctuating BP

very high troponin levels (when taken into hospital)

Usually lasting 7hrs if PIP used (399mg flecainide & additional 1.25mg bisoprolol) longer if in hospital

My PAF never stopped naturally needing meds to end it as very high heart rate, violent arrhythmia, apparently very low blood pressure, dehydration and high troponin levels meant it needed to be stopped as quickly as possible.

I would be left totally physically and mentally exhausted, I did notice my heart appeared to feel pretty calm if a little 'achy' as if it had run the grand national! This would last for a day or so when I felt too exhausted and dizzy to go out walking anywhere (often bp very low or changeable). Unfortunately on recommencing going for slow flat walks my heart would usually start getting a bit sensitive and I would get breathless and have a high bpm quite often plus what appeared to be occasional ectopics. I was never sure if the high dose of flecainide (or earlier on when I had to keep going into hospital Digoxin) had given me the really peaceful heart following the attack or whether my heart was just too knackered to bother playing up for a while. I did notice that my blood pressure was often left very high or very low for days following leading to dizziness. Sometimes following some PAF attacks (all seemed to be equally violent) I would feel that my exercise tolerance had been negatively affected for a number of weeks and sometimes my blood pressure would appear to settle out at a not 'normal' level for several weeks. e- unsure what that was about either.

Prior to PAFs I had no warning unless the initial few 'kicks' in the chest were ectopics but it always appeared (if awake at the time) to come on very quickly out of the blue with fast heart rate and very obvious and violent arrhythmia. The high heart rate continuing to climb until meds were taken/given.

Hope this is useful - great that you are interested in this area of heart 'malfunction' and prepared to share advice and research.

KathFrances profile image

For a few hour or a day or two after a PAF episode, my heartbeat is slower - I think my heart is exhausted and needs a rest!

nettecologne profile image

Yes I get that. Most of the times the rhythm is as follows: Day 1 PAF, lasting about 12-18 hrs. Day 2 calm, but then I take high dose of Sotalol as pill in the pocket when in PAF. So might be because of that. Day 3 very often PAF again and THEN, as if heart just needed to geht rid of something there is a break for up to seven days. Sometimes just Day 1 PAF and then 7 days nothing. And usually the day or two after PAF is extremely calm, not even ectopics or bigeminus.

Sotalol never stops the AF with me but takes down speed.

And oh, the bliss of that evening AFTER the PAF (if it lasted into the night), lying down and being able to lie on the right side and NOT feeling your heart at all or just a very regular beat.


My experience when my AFib was paroxysmal was the opposite. Typically I would have runs of atrial couplets for up to 24 hours.

Only on one occasion do I remember getting an ectopic reading shortly before an AF episode!

Wonderful to find someone who is interested in all our different experiences rather than treating us as if we are all the same when we quite clearly are not! I was diagnosed almost two years ago and an echocardigram taken a month later showed my heart was fine. The GP told me to take bisoprolol but 1.25mg daily was too much for me- after three days I asked a pharmacist about the tiredness and he took my pulse and told me to stop taking the stuff immediately as a doctor at the surgery confirmed but nothing else was suggested instead.

I saw someone privately and thus started using flecainide as a PIP adding bisoprolol if the heart rate was over 140 after a further 20 minutes. Episodes never used to last longer than 2 hours and often shorter but as they were happening more frequently it was agreed that I would take the flecainide (50mg) regularly to prevent them but this hasn't happened and the episodes are happening even more frequently, the last two (two days apart) waking me during the night and different from what used to happen so the Kardia asks if it is me! I'm thinking of stopping taking the drug regularly as the tiredness following on from episodes (or from the drugs themselves) prevents activities which I used to engage in.

Would you be interested if I try to keep a diary of my experiences, etc?!

Prior to this (except for the after effects of shingles which were tiring) I have always been fit and healthy with a good diet and never overweight

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