Unexpected Fast AF

I posted earlier about some AF which started this morning at 0130. I took various Kardia readings and discovered that the heart was beating at about 75-85 bpm for several hours. When I got up at about 0900, however, the reading shot up to 146 bpm, then, very surprisingly, 10 minutes later after taking my morning Sotalol, the heart went back into sinus rhythm. I emailed the ECG showing the fast AF to the GP, who told me I must immediately call an ambulance if it recurs (in spite of the Covid risk which she didn’t quantify).This is a new development: I had plenty of fast AF in 2018/19, but last year I had AF infrequently and at lower speeds around 80bpm. Has anyone else experienced these rapid speed changes from 80bpm to 146bpm to normal rhythm all on the space of about 20 mins?

I’ve also been told that I must take the anticoagulant Apixaban which I am dreading as I had a subconjunctival haemmorage last time I took Dabigatran over two years ago.

[meadfoot]

I experience these rapid heart rate changes with my af. It’s is always the way for me. My Kardia shows big changes during a one minute recording. It can go from around 65 beats per minute to 250plus during a recording each time. I can feel the rapid change in how it makes me feel without the Kardia reading but the recording just confirms it. It then gives an average rate at the end. It happened last night and again this morning. I hate how it makes me feel both physically and emotionally.

If I called an ambulance every time it happened I would live there. Having said that if your doctor is concerned then take their advice. Only you, the GP and your cardiologist knows your individual case. Don’t risk leaving it if they think you need hospital care. Follow medical advice.

I give my ongoing experience only to let you know you aren’t alone with it. My EP has told me how to deal with it, via flecainide as pill in the pocket plus my daily beta blocker. If it isn’t controlled and I feel faint and chest pain then go to hospital. It’s important to know your own cardiac condition and act accordingly.

Hope things resolve for you quickly, sending you a big hug.

[Hidden in reply to meadfoot]

She said that it was ok if the rate was below 115 not to go to hospital. Other doctors have said 100 bpm requires an ambulance. Problem is, nobody wants to go to hospital at the moment because of Covid.

[meadfoot in reply to Hidden]

Can you call your cardiologist perhaps via his secretary for advice and email your Kardia report to them. Do you have an arrhythmia nurse as an alternative to speak with. My GP sent me to hospital on one occasion when I was in her surgery and I wouldn’t have dreamt of going myself as I have far worse symptoms then at that point, a and e felt she had panicked and overreacted. However go if you feel safer and a medic has instructed you to do so. I would try my EP route first but do whatever feels right for you. Good luck.

[Hidden in reply to meadfoot]

I was discharged last year- no idea what as the AF was ongoing. SonIve got to be referred again to an EP. I can still speak to the cardiac nurses.

[baba in reply to Hidden]

"I can still speak to the cardiac nurses."

I would try speak to the cardiac nurses, they have direct access to the EP and may be able to refer you directly. Worth a try.

[Singwell in reply to Hidden]

Hi - I've had AF in the 90s from Kardiamobile reading (this is averaging of course) and then a few minutes later it's been 130. I've also been up to 146. I've seen others here reporting 160-200. The point is, you took a PIP and it went away. That's what paroxysmal AF does. Both your HR and BP will leap about. Are you on anticoagulants? That's obviously a consideration. I agree with others re what to look out for: can I breathe? Am I in pain? Do I feel dizzy? If I were noticing any of these consistently then I'd call an ambulance. My experience only but it's certainly something I discussed with both my GP and Electrophysiologist.

[Jeaniebeans in reply to Hidden]

A normal healthy heart rate at resting is between 60 and 100. Being active it's not unusual for this to go up to around 115 to 120. So long as it goes down again quite quickly on resting I was told this is all perfectly normal.

[dadfrogboy in reply to Hidden]

I would suggest 100 is pretty low to go to hospital. mine is often well above that.

[Hidden in reply to dadfrogboy]

Yes, there is some controversy over this. Two consultants and various GPs told me that If, after taking an extra half tablet of Sotalol and waiting for 20 minutes , the heart rate was still 100 or above I should call for an ambulance. One said above 90. A cardiac nurse said 115 however. The point has been made that if everyone with AF called for an ambulance for anything 100 or above the service would be overwhelmed. That is true, but since they won’t all call at once, it is arguably reasonable to call an ambulance.

[Hidden in reply to meadfoot]

Thanks for reply. I slept well last night and didn’t have any problems. This sort of thing always comes out of the blue-hopefully I won’t get it again for a while.

[BobD Volunteer]

Not sure I would go to A and E in the present climate. All you will do is sit around for ten hours and then get sent home. Why not e mail your EP or cardiologists secretary. GPs seldom know enough and sometimes panic. Only if you have chest pain or fainting would I consider it.

[Hidden in reply to BobD]

Yes, this was my thinking too- but she insisted the stroke risk outweighed the Covid risk (she didn’t quantify that risk, but suggested it was non-trivial). I haven’t had any fast AF for at least a year, and I wasn’t expecting the heart would suddenly shoot up to 146 from 76 in the space of a few minutes.

[BobD Volunteer in reply to Hidden]

You really do need to think about antcoagulation though.

[Hidden in reply to BobD]

Yes, I told the GP I would take a first dose tonight. Don’t like the idea though. I’ve been prescribed 2x5mg Apixaban, but wondered if a lower dose was viable?

[rosyG in reply to Hidden]

The lower dose of Apixaban is just for if your body weight is very low, age high, kidney function poor: needs assessing if these apply! Otherwise you might be under anti coagulated

[Singwell in reply to Hidden]

Do take the anticoagulants! I now understand why your GP was so concerned. Personally I don't have any problems with mine - I do bleed a bit more easily if I snag my skin - but it's not a big deal. The risk of stroke is real for any of us.

[bassets in reply to Hidden]

As others gave said, please take the Apixaban. It just made me a bit more tired but otherwise was ok and I've had it for well over a year now.

[Buffafly]

Yes, tachybrady syndrome apparently.

[Hidden in reply to Buffafly]

I’ve sent off for a Kardia analysis, so it will be interesting to see what comes back.

[Paulbounce]

I could be totally wrong here Sam so best follow your doc's advice.

Yes that's happened to me and it was the device picking up an etopic. Shoot up to about 250 - 270 once.

Meadfoot wrote

"I can feel the rapid change in how it makes me feel"

Yep - I feel it right away these days. I know the second it kicks in. When it does I take my pill in the pocket and it seems to deal with it.

I find after a few days from afib (until about a week after) I'm right on edge in case it comes back. My HR this morning was 49 - I'm happy with that. It will hit 73 - 77 as the day does on - I undertsand this.

I most likely won't but I posted a few months ago about @paul controversial's post. I'm not a medic so won't do it - I won't answer any PM's about it either. No point in asking.

I creased to be amazed that many GP's (some do) don't pick up on it. It does of course depend on what other med's you are on.

Paul

[Hidden in reply to Paulbounce]

I have sent the ECG to Kardia for an analysis and to the GP. The GP says it’s fast AF, not atrial flutter( which is what I thought it was initially). I know exactly what you mean by being on edge after one of these episodes. You just don’t know if it will come back (in my case at night). Usually it doesn’t for a while but just the same...

[Singwell in reply to Hidden]

Being on alert is our biggest challenge isn't it? Mine most certainly. Hope these responses have helped a little and that things calm down.

[KMRobbo]

Pre ablation my Afib was always fast and variable. 130 to 195 resting, and it would jump around. Although I was totally asymtomatic in afib other than the high rate, my hospital advised anything sustained above 130 go to A&E. So I generally went with 24 hours. The second last time I went I was In it variable but mostly high rate above 160 for 8 days. I was still asymptomatic except I was very tired! 8 days @160 is a lot of marathons even for a young man, which I was not!

I also used to stay nil by mouth as soon as I had the afib , so if there was a chance I could be Dccv cardioverted, which If I recall correctly was 12 hours for food and 6 hours liquids, but if you were not anti coagulated then they would not perform DCCV AFTER 48 hours from onset. So there was a narrow window to arrange this if not on AC.

[Tapanac]

I also keep having fast heart rates (tachycardia) which sometimes go to 168 although once it was 240. Those times I have had to call an ambulance and taken into hospital with either a cardioversion as it lasts until treated or medication.

However last week it went on for 8 days but I couldn’t go to hospital as so much Covid in there so was treated by FaceTime and drugs at home. Eventually I did resume a fairly normal rhythm (if you can ever have a "normal" rhythm with atrial fibrillation/flutter/complex tachycardia). The reason for all this writing is to say that I was told Afib is rarely a killer although any heart rate continuously doing a 24/7 marathon can do damage so best to call someone if it is above 120 for any length of time.

My second thing to say is that I was told that apixaban is the kindest anti-coagulant especially to the brain and stomach so try not to worry about taking it. I had a brain tumour and eleven and a half hours surgery 4 years ago and although I had to stop my apixaban 24 hours before and 24 hours after surgery, it was fine.

Try not to worry and I hope you feel back to normal soon