Hi I have had 4 visits to A&E with rapid AF with pulse rate over 150 . Twice it’s reverted on its own after about 3/4 hours twice required I.V.metoprolol
Each time I have felt palpitations and breathlessness and have left it for just over an hour before calling an ambulance. Not been kept in once reverted to sinus rhythm. Feel like a fraud for calling the ambulance and would love to know what others would do.
When would you call the ambulance or would you just wait until it gets back to normal itself
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BobJ52
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That's happened to me and after the third time in the ER I felt that way too. I didn't call an ambulance because I believed I could make it to the ER without help and I didn't have chest pain. I also didn't feel like I was going to pass out. But I was naive, being too active when my HR was that fast. Actually, in those first 3 visits, I wasn't really short of breath, just fast AF (160+). The shortness of breath came in later episodes and that's when the cardiologist threatened to call an ambulance and get me to the ER because I wasn't able to walk without help. Now with propofenone I know what to do: take two right away and go to bed until I get back to NSR. Or sit quietly until then.
If you have any chest pain or feel faint or dizzy then go to A and E. Otherwise most of us ride it out. As one member once posted "If I called an amulance every time I went into AF I would have one parked outside my house 24/7. "
Do make sure that you are refered to a cardiologist or better still an electrophysiologist for a proper ongoing treatment plan.
Welcome Bob - As an AF veteran of some 12 years I would only call ambulance in an emergency and although AF can feel as if it is an emergency to us, it very rarely is. It is a chronic conditions so treated as outpatients and I now would need to be at death’s door to want to be taken into A&E.
Firstly AF is not immediately life-threatening - although it sometimes feels as though it is.
However, to answer your question these are guidelines given to me by my GP when first diagnosed - if not taking Anticoagulation then if your AF continues for more than 24 hours: if your HR exceeds 200: if you have chest pain:: if you suffer syncope (fainting) or pre-syncope: if you have any underlying condition which complicates matters eg: asthma: diabetes etc. If you feel extremely unwell and cannot walk and talk.
I don’t know how A&E function in your area but I have been kept waiting for over 9 hours without being seen or monitored because they were so busy. When in AF and I had extreme breathing problems because of an underlying condition though I was straight into resuc so my view is that sitting in an A&E waiting room is the last place I want to be in winter.
Have you been referred for outpatient clinic? Were you advised about anticoagulants? What does your GP advise?
and reading up on AF will help. In the begining it can be rather scary so knowledge is potential power. They can also be very helpful if you phone them.
This forum is also an outstanding source of support and information so read all the posts - you will learn very quickly - and if there is anything you don’t understand - ask - no such thing as a stupid question.
Hi Bob I have had P-AF for a number of years and have episodes roughly once a month lasting up to 15 hours.
Although I feel ill and breathless during an episode I have never called an ambulance, the last thing I need during an episode is the anxiety caused by being whisked off in an ambulance to spend hours laying on a trolly in a corridor in my local hospital.
The only treatment they could offer anyway would be to try to control or terminate an episode with medication and I am sure I would not be seen as a priororty at my hospital and would most probably revert to normal sinus rhythm during a lenghly wait to be seen .
I have been told I must go to hospital if I have an existing heart condition other than AF, any chest pain, I feel faint or if an episode lasts more than 24 hours.
It is for each person to decide what is the best for them, for me the quiet calm of my own home offers a better chance of controlling my episodes of P-AF than the alternative.
I did ask by EP at the arrythmia clinic (by way of the nurse) if sitting out my episodes was causing any damage to my heart, he said not considering the frequency and duration .
My P-AF although inconvenient and unpleasant has become part of my life, I don't let it scare me anymore but accept it and get on with things.
Thanks that’s good to hear, being only 6weeks in and not seen cardiologist yet, am seeing them next week, I have been calling. Up until now have only had one long wait when I had already reverted to sinus rhythm before ambulance came due to the long wait for it to come.
I have also had difficulty breathing and felt really unwell and have not had the courage to wait it out. Maybe going forward I will be more courageous and wait the next episode out and see what happens. My fear is the heart gets so stressed that it says sod it and gives up completely
Hi Bob I too have difficulty breathing and can't talk due to lack of breath. I found this was exacerbated by fear and panic and easier to cope with if I remain calm and used a measured breathing technique . I breath slowly and deeply counting the breaths until I establish a pattern. This not only reduces panic, diverts attention from the episode but it also helps to get a good supply of oxygen into the body and that has to be good for a struggling heart.
During episodes I carry out essential tasks then lay down to listen to the radio or TV which also acts as a distraction. If I am lucky I fall asleep which helps to make the episode pass.
I think if you’re yet to be seen by a cardiologist you have no way 🙅♂️ f knowing if you have other heart conditions. Personally if you feel unwell and faint, with a high HR I would go straight to A&E no messing.
I like you am relatively new to AFib only had it 8 months but my three attacks have all been quite dramatic and all involved a visit (& admission ) to hospital. Twice I reverted on my own but the last time I was given cardio version (IV meds) .
I have moderate CHD and Asthma so with a HR of around 150/160 when first In AFIb if I start to feel feint ( I give I always do) I go straight away.
It really is such a personal journey I’ve read so much on here over the last few months, the advice everyone shares is such a help especially to us newcomers
I would push for an appointment with a cardiologist asap or even go private for a consultation if it’s likely to be a long wait
When to seek emergency help probably depends on the patient and the doc. I have PAF with rapid ventricular response. I went to the ER the first time, (4 yr ago)but have been lucky enough to manage it at home since. Ive had maybe 8 episodes over 4 yr, last one 18 mo ago. My doc has me take extra meds when it happens and it has always stopped in less than 12 hours. He says if I have chest pain or get really short of breath to come to ER. It is a scary thing.
Hi thank you all for your help and kind comments I’ve had about 10 episodes in the last eight weeks and only on five of those if I felt ill and called an ambulance.
I have a monitor fitting on Monday plus a myocardial perfusion scan next week and then see the cardiologist immediately afterwards
Hopefully we will make some progress and get my medication right so that I can carry on a reasonably normal life thank you for all the reassuring comments they have really helped to reassure me
If your cardiologist is not an EP (electrophiologist) ask to be referred to one. They specialise in heart arrhythmias. You can then discuss ablation Vs medication options and make informed decisions on what's best for you.
When I was getting similar attacks early in my afib days I was told by my local hospital, that if it is over 130 for a significant amount of time go to A&E. I did not use an ambulance. Significant to me was 8 to 12 hours. (After an additional pills I took should have had an affect). I also wanted the option of a cardoversion which they wont do after 48 hours unless you are on A/C. However if my previous attacks had lasted less than this I would not have bothered. I was also worried that afib begets afib so did not want to spend so much time there.
I was the same with rapid AF (other than I have never converted back to sinus rhythm without meds) - and would wait for around 1hr before going to A&E where I would usually remain for 24 to 48 hrs until my heart sorted itself out and my troponin levels which were always very high began dropping to under 10,000 (don't know the unit). This took meds and, after not being listened to for around a day being given anti arrhythmia drugs (digoxin) rather than just huge doses of beta blockers that would always crash my blood pressure.
My local cardiologists were happy for this to continue and put nothing in place to stop this waste of hospital time and my misery (matching my non existent treatment plan). However, after managing to get referred to an electro cardiologist (on advice from an ICU Dr to my GP) I was given a 'Pill in Pocket' dose of flecainide and additional bisoprolol which saved me from having to go to hospital as I was then able to revert myself to sinus rhythm within around 7hrs at home.
I'm not medically trained but my advice would be to see if you can be given pill in pocket meds to revert yourself at home if you have no additional complications. If not I think it is possibly better to keep going to hospital to be reverted back to sinus rhythm as a very rapid heart beat can be damaging for extended periods to your heart and other organs if blood is not being delivered adequately.
Hi I am already on 6.25mg Bisoprolol plus Isosorbide and Candesarten and still having rapid PAF every couple of days. Normally lasts about an hour or two and then reverts to SR onits self. However I have had events where even on the meds I have had rapid heart rate of >160 feeling breathless and called paramedics. Have been advised to call ambulance as if in AF for long time they are concerned incase heart decides enough is enough and gives up, if driving yourself to A&E, mine is 30 miles away, this could be difficult...
I'd guess that A&E is your best option if this has been your advice. However prior to my ;
'successful ablation' I was also on candesartan, indapamide, bisoprolol and Dabigatran daily but could still take pill in pocket meds - up to 300mg flecainide and additional 1.25mg bisoprolol when in rapid PAF. Id never try to drive while in PAF as within 15mins or so of an attack starting I wouldn't have felt safe driving.
Some people can tolerate AF and some can't depending on the severity.
I cannot function when I have an episode. Nausea, breathlessness, chest pain and dizziness puts me in a panic so I end up in A&E.
If a patient is in A&E for over 4 hours then they have to be admitted into an appropriate ward as an inpatient.
The health ministry has recently stated that GP's and hospitals must treat arrhythmia patients more seriously to get them cured asap. On the long term, this specific illness is costing the country far too much regarding older untreated patients.
Don't know if this will help you or not, but it won't hurt you to try:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas or Thyroid - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
And Oh - if you find that your sugar threshold is lower than 50 grams a day - it's nearly impossible to eat less than that each day, which will keep you in permanent Afib. If this is the case, try going to a Nutrition Response Tester. I am doing this and she has improved my gland processing such that we have increased my sugar threshold from 48 grams a day to about 75, which is high enough to stay under - and keep afib from happening (unless I indulge in a sweet something – which I do too often). Hope this helps.
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I have had P-AF for a number of years and have episodes roughly once a month lasting up to 15 hours. 
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