PAF to persistent

[Reena09]

I have been in AF for 2.5 weeks now. Normally always reverted to sinus rhythm before 7 days. Any suggestions on what I could do to help convert back. Do you think it can still be possible that I revert? I’m on 1.25mg Bisoprolol and apixaban. My dosage of Bisoprolol had to be reduced almost 2 years ago as my resting pulse was floating at 48. Any advice appreciated.

[Lizie-Loo2013]

Hello Reena. I’m having the same episodes of persistent Af at the moment.

Sometimes lasting 4-5 weeks! But so far have always managed to go back to n s r!

It can be very tiring, but I do find being in persistent Af feels less jumpy and thumpy if u know what I mean!

Try and stay calm, keep busy if u can, deep breaths help me. Fingers crossed that it settles soon for u. Take care, kind thoughts 😊

[Reena09 in reply to Lizie-Loo2013]

Thanks for your message Lizzie. I don’t even know when I change rhythm as can only tell from my heart rates from the Apple Watch. I have been feeling a little more tired recently but that could be also due to the hot weather.

My concern is that at night by heart rate does go over 100 bpm and I’m only on 1.25mg Bisoprolol and EP prob can’t increase it as resting pulse goes below 48. What meds do you take? And can you deal with the heat? Any other supplements that you would recommend?

[Lizie-Loo2013 in reply to Reena09]

Reena I was diagnosed in 2016. And yes my Af seems to have progressed rapidly in the last 6 to 9 months, but this apparently the nature of Af.

I’m on 3.75 of Bisoprolol, Apixaban 5 mg twice a day, Amlodopine and very recently my cardiologist put me on 100 mg of Flecaneide twice a day. To be honest the Flec knocked me for 6, made me feel quite un well so am trying to adjust the dose that suits me.

We re all different but all have the same worries and concerns. The people on this forum are very informative and so kind.

[Reena09 in reply to Lizie-Loo2013]

Why did you start on the amlodopine and flec? Is it because you are asymptomatic and it was having an impact on your day to day life? I’m not really aware of it other than the fact I can’t walk as fast as I used to and become more breathless on an incline.

[Reena09 in reply to Lizie-Loo2013]

Hi Lizzie - why did your consultant put you onto the amlodopine and flec?

[Lizie-Loo2013 in reply to Reena09]

Hello. Was already on Amlodopine before At was diagnosed for my high blood pressure. Flec is a recent medication that my consultant prescribed to try and calm my heart down. Truly made me feel awful on the 100mg twice a day! So have tried to adjust to what suits me. Not too sure if this is the correct way of doing things, but seem to be managing to control my Af more easily at the moment. Hope I have nt tempted fate! 🤞🏻🤦‍♀️

[Reena09 in reply to Lizie-Loo2013]

Does that mean you could tell when you were in and out of AF? I have no idea other and can only tell by Apple Watch although past week I have reduced energy levels. Not sure whether the heat or the AF.

[Lizie-Loo2013 in reply to Reena09]

Oh I can def tell when in Af! Chest tightens a bit, and then it feels like a couple of frogs jumping around in my chest. Heart rate usually goes up 130 ish for perhaps an hour, and then settles down to about 98 ish. Last time it lasted for about 4 weeks, but I seem to be able to tolerate 88 - 98 beats and usually manage to carry on as usual.

I feel more awful when my heart is trying to revert to normal rate, dizzy , irritable and so tired. Normal rate for me is roughly 55/65 ish.

[PICCASO in reply to Reena09]

I would never trust a watch , easier to use a finger on the wrist and time for 30 seconds then double it , I have stopped checking mine as it got me in a state , I feel better now I dont check it

[Reena09 in reply to PICCASO]

I agree but just want to make sure rate is under control as I have no idea when I’m in AF

[KMRobbo in reply to Reena09]

I was the same 130 to 195 resting HR totally asymptomatic except 5 to 10 seconds of fluttery feeling high I chest/ throat sometimes as AF kicked in . You also had no idea of the heart rate at over 130 and irregular no chance to count by pulse and be accurate. Even the fit bit of my wife counted 70bpm when I was actually at 147 on my Garmin. I was only diagnosed as once the AFIB showed up on my Garmin HR Monitor and stuck around for 20 hours. I could have had it for weeks months or years and it never coincided with the wearing of the Garmin. For the first 20 months and 12 known episodes in AF I was actually able to go running and get rid of the AF in 5 or 7 minutes.

[Reena09 in reply to KMRobbo]

Did you ever consider a cardio version?

[KMRobbo in reply to Reena09]

By this I think you mean DC cardioversion. Yes , but my local hospital does not seem to want to do them. The first-time i was admitted they said they would do one before the 48 hour limit, but they did not tell me I had to be 12 hours nil by mouth, and they fed me lunch! They arranged to do me in the middle of the night, but I then I returned to NSR. The second time they were going to do one at 8 pm on the first day, but the anaesthatist was taken away to deal with an RTA. I was rescheduled for 08:00 next day but again went back into NSR naturally. When I developed Atrial flutter 9 days after an ablation for AFIB they refused to do it even though I understand it is more succesful on flutter than AFIB. No excuse given they were very busy. HOWEVER I was cardioverted on my 12th Afib episode at the same hospital, but by flecainide infusion. (Prior to the ablation) . I had been in high rate afib 130 to 195 for 8 days by that time.

[Reena09 in reply to Lizie-Loo2013]

Also, when were you diagnosed with AF? I was diagnosed in April 2017 and in the past year it seems to have progressed.

[PICCASO in reply to Reena09]

Hi was 2013 and had cardioversion march 2014 , had a couple of stays A an E but now dont drink as much coffee and beer only low alcohol , and still working plumbing at 77 lol oh had quad heart bypass 1999 and small heart attack 2004 , golly thats it

[KMRobbo in reply to Reena09]

I discovered late one evening on September 2015 that I had a resting hr of 165 bpm via my Garmin watch/ hr monitor. I put on the Garmin as I was on the computer and had 5 or 10 seconds of a fluttery feeliing in my chest/ neck . This was similar to a feeling had had a month or previously when running and i had a large hr spike on the Garmin graph when I looked at it. The Garmin charged at the computer so was immediately available yo put on.

I was completely asymptomatic in afib so other than the fluttery feeling for 5 or seconds as I went into afib there was no other indication I was in it.

I went to bed with the Garmin on and was still 165 in the morning and my wife rang 111 for advice as I was going to go to work. They sent an ambulance, and their ECG confirmed the high rate and indicated AFIB. I went to hospital.

I had my second afib attack 3 months later. I was already taking verapamil for rate control, and had some extra pills and it cardioverted to NSR after 6 hours. 4 weeks or so later I had another attack but ended up in hospital despite another pill.

Few weeks later I had another attack . It was on a Saturday

I took extra verapamil, but the AFib did not stop. I really did not want to go to hospital again and waste the weekend.

I had noticed that when i started a run (just to keep fit) that my hr rose very high 160 to 170, but after 5 or 7 minutes (bit less than a mile) it reduced to 145 / 150. So i took another verapamil and Instead of going to hospital I went for a run! And the plan worked - when my hr dropped after 5 to 7 minutes I was back into NSR. So for the next 15 months I did that every time to get rid of afib.

Please note. I was fairly fit, had no other co morbitities, and was asymptomatic in Afib. I was running on one occasion at 243bpm and could not tell until i looked at he Garmin. Iwas notveven noticably slower!

I am not medically trained so am not advising anyone to do this but it worked for me.

Unfortunately the 10th and 11th times I had to to run further and it took two runs to revert to NSR

The 12th occasion happened in July 2017

I was in the car coming back from Scotland (wife driving) after 8 days away and I went to to AFIB. No reason, but I never found any triggers for any attack except possibly stress.

I went for 3 runs over the next 24 hours but it did not stop. I ended up in hospital 3 times that week inc 3 overnights and that was when I had the flecainide infusion. That was also the time I decided to have an ablation which I did Jan 29th 2018.

I concluded that the statement "AFIB BEGETS AFIB" is correct. The more you have afib, the more you will have it. Atrial remodelling.

The Pvi cryo ablation was succesful, but I developed re entrant atrial flutter 9 days later , possibly caused by the flecainide ,Flutter was very symptomatic (unlike the afib)and I had a flutter RF ablation 26th Feb 2018. Not had afib or A flutter since. (So far as I am aware. ) i stopped all drugs May 15th 2018. Not one tablet since. I do have ectopics. Sometimes for days to a week at a time. I just ignore them as much as possible .

Best wishes

[Wightbaby]

I have been in persistent for over 4 years now. I eventually found it easier to cope with than having episodes. I am on the same meds as you (it WAS Warfarin and Metoprolol originally). I did not go for a cardiversion as by the time they got it organised, I had been in persisitent for longer than 6 months and they didn't think it would work. Same as for ablation....i was told i was better to stay as I was, unless i 37 and wanted to cycle the Tour de france or run a marathon. I was about 62 at that time.

Lizie Loo is right about the less jumpy and thumpy...you DO get used to it!

[Reena09 in reply to Wightbaby]

Thank you wightbaby. My concern is that my pulse overnight does go over 100bpm according to my Apple Watch. Is your heart beat always under 100pm when at rest. In the day, it seems to be fine and goes up with exertion.

[Wightbaby in reply to Reena09]

I don't use any gadgets anymore, so can't give you a daily reading...sorry!.......but last check at GP when I had been on Bisoprolol for a few months was around 80. He wanted to up my dose..it's 1.25, but I was feeling OK and so much better than on Metoprolol, so I checked with my cardiologist, and he was happy with that.

[Reena09 in reply to Wightbaby]

Do you take the Bisoprolol twice a day? Any thoughts on a cardioversion?

[Reena09 in reply to Wightbaby]

Did you consider a cardioversion?

[Wightbaby in reply to Reena09]

Sorry, the heat has kept me off here for a while!! Yes I did but i had read a lot about them not being particularly successful and reverting back very quickly......also I had been in PAF for too long, I think and I really doubted it would work. Didn't want to make things worse!

I take 1.25mg once a day (morning)

[Reena09 in reply to Wightbaby]

Thank you. I presume it’s not really having an impact on your QOL and therefore decided not to go down the cardioversion / ablation route? Have you thought about rhythm control drugs?

[Wightbaby in reply to Reena09]

Not been suggested....

Managed a walk today...early! Luckliy, I only live 9 minutes walk from the seafront.

Bit busy here at present though!

[Reena09 in reply to Wightbaby]

Sounds like we are in the same boat. This heat is also getting to me. Can’t go out for my regular walks when it is this hot. Take care

[DevonHubby1]

Hi, my wife also normally self reverted after a few days but last year she had a prolonged episode and when she started getting chest pains she was admitted to hospital. An attempt at cardioversion made things worse. She was put on a mix of Bisoprolol and Digoxin and they kept her in and fiddled with the doses over many days until they got her HR consistently just below 90. As they discharged her as permanently in AF she self reverted and on a subsequent follow up appointment they removed the Digoxin as she was not in AF.

Digoxin is not without its risks and you seem to have no impacts on QOL but it might be worth at least discussing with your GP if any additional intervention is required.

[wilsond]

I take 1.25biso twice a day for rate control and 100 mg flecanide for rythym control..much better than before. Xx

[Reena09 in reply to wilsond]

What time do you take the bisoprolol in the evening?

[wilsond in reply to Reena09]

I take all my meds at 9 am and 9 pm so I remember!

[Reena09 in reply to wilsond]

And that is 1.25 mg bisoprolol twice a day? And flec?

[Thomas45]

A normal heart rate is in the range of 60 to 100. I have had persistent AF for at least four years. I can't feel it like you can feel paroxysmal AF.

My normal resting heart rate is in the range of 70 to 110.

I don't have a Kardia or Apple watch. I don't monitor my heart rate or my BP. Because of bad reactions to beta blockers all I take because I have persistent/permanent AF is an anticoagulant, my preference is Warfarin. I have my own Coaguchek meter to check my blood coagubility (INR), but usually check it every six weeks, rather than more often.

All these gizmos are wonderful as long as you don't get hooked on them. I have no medical training but if you're not feeling well see a doctor. Don't try to analyse all fluctuations in your heart rate.

I should add that I had paroxysmal AF for over 20 years before I was found to be in persistent AF.

[NooNoo14]

I went from PAF to permanent after starting medication for Leukaemia.

I take Apixaban and Atenalol (Beta Blocker). I was told by my heart Consultant that if my heart rate goes over 100 on a regular basis I should increase the strength of the Atenalol but so far this has not been necessary. I was on Digoxin for a while which apparently keeps your heart regulated.

You definitely need to speak to your GP / Consultant to see what they suggest.

[Steve101]

Hi Re-enacts

I was in persistent, made lifestyle changes, lost weight gave up alcohol. Cardioversion put me in NSR, went back into AF after about a month, reverted to NSR after about a week. Consultant told me I was now PAF rather than persistent because of life style changes I had made.

About four weeks ago went into AF , my heart sank. I read on this site about stimulating the vegal nerve can put you back into NSR, one way of doing that is cold to the face. I thought I would give it a go. My wife suggested I had a cold shower. So I stood in the shower, it started off cold and went warm. I screamed like a banshee when it was freezing cold. Got out the shower, I felt I was back in NSR, which was confirmed by omron blood pressure monitor that detects irregular beats. I had also bought a kardia mobile that arrived the day after I was back in NSR, that also confirmed NSR.

Worked for me. Been in NSR ever since.

Good luck!

Steve

[Wightbaby in reply to Steve101]

Don't think that would work for me after 5 years...do you??!!

[PICCASO in reply to Wightbaby]

I would try anything to be rid of it

[Steve101 in reply to Wightbaby]

Probably not. But costs nothing to try.

Best wishes

Steve

[Vince1001]

There's a useful summary here by Van Slooten. You probably know them all. The only ones that works for me are entrainment plus deep breathing.

livingwithatrialfibrillatio...

Best of luck!