Bumps in the Road? More like a crevasse!

[momist]

Today I am four weeks past my first ablation for PAF. In the first week, I had the expected bumps in the road to recovery, with short runs of AF and a couple of longer sessions of tachycardia (I use a Kardia device). None of them lasted very long, and the AF ones in particular were susceptible to being stopped with an additional Flecainide 50mg tablet (I'm taking one twice a day since the ablation). After five days, they had petered out entirely, and I was starting to feel somewhat recovered and able to do small jobs around the house, like washing pots etc. I then started to take a little exercise outside, e.g. watering in the garden, and eventually moved on to short walks, until I could walk to the end of the road to post a letter and such.

On Thursday last week, we had a very hot day at 32C and I chose not to take any exercise at all, spending the day reading and watching TV. The following Friday morning I awoke at around 5am feeling OK, but as soon as I stood to go to the bathroom I went straight into strong AF. After a few hours, and an extra Flecainide, this changed into tachycardia at around 140 bpm. I then continued in either AF or tachycardia for most of the next three days. On the morning of the third day, Sunday, I was very worried about it continuing like this, and took several blood pressure readings (Omron M3) which all lay around the 110/100 mark. About every hour until lunch time, the difference between Systolic and Diastolic was less than 20 and as low as 10. I then called 111 for advice. The paramedic who called me back convinced me that I needed the ambulance, and so it went.

In A&E at the local hospital, after the usual forms of admittance, I was moved into 'Resus.' (resuscitation section) with an apology that this was the best place for them to keep me under observation until I could be admitted to a ward when a bed became available.

I was put on a drip with a large feed of saline solution, and then given two applications of intravenous metoprolol, all with no effect on my condition. This was then followed by a 2.5mg bisoprolol tablet, still without any effect at all.

As is often the case these pandemic days, I stayed on that trolley for the next 14 hours, under bright lighting and surrounded by machines beeping and chiming as the other patients were being monitored. Occasionally a trauma patient would be screaming as they were dealt with, one with a fractured neck bone. No bed on a ward became available.

Around ten minutes to midnight, after a continuous 67 hours with my heart running around 140 bpm in either AF or tachycardia, I experienced that presyncope feeling. I quickly turned my head to see the 3 lead heart monitor I was on, and saw the tail end of a flat line just starting into a ragged wiggle that settled down into NSR at about 66 bpm. As I looked away, the nurse appeared asking me how I felt, she had run from the other end of the room.

So, I had self converted back to NSR. I was monitored for the next 5 hours, and around 5am a doctor from a medical ward came and assessed me for discharge. I arrived home again about 7:30 am. At no time had I seen a cardiologist - it was weekend after all.

Now, this is not really intended as a dig at the NHS, they really are under very great pressure and underfunded. It's more a reminder that A&E is not necessarily the best solution when AF strikes, although it's a good place to be if you need to be kept under observation. Also, is such a long session of AF a month after an ablation anything to worry about? I don't know. My previous experience of AF was usually a random attack of 6 - 16 hours, with few lasting more than 24 hours. TBH, I was more concerned about the anomalous blood pressure readings. My GP yesterday suggested that it could just be that the home monitor machines, even a 'good' one, should not be used whilst in AF. Only a manual measurement with stethoscope and cuff should be attempted. I also spoke to the arrhythmia nurse yesterday, and she said I had done the right thing in going to the hospital, but didn't comment on the length of this event.

I have now had my regular bisoprolol dose doubled to 2.5mg twice a day, and so far not had any more AF. I'm being more careful now about activity and also keeping well hydrated. We'll see how it goes. Sorry about the long posting here.

[jeanjeannie50]

I understand your post totally. If only we had some sort of guide to say if your heart does this get help, same with BP, but no we're left bewildered as what to do for the best. The only good thing is paramedics when they come usually have a good idea of whether you need hospital or not, saying that, they have usually taken me there.

Once my heart rate was only 115 and my GP sent me from the surgery straight to A&E. Another time a different GP when seeing that my heart was in flutter stuck at 150 (I felt so ill), told me to go home take another Flecainide and if that doesn't work then go to A&E. It did work! So even GP's don't appear to have any basic guidelines.

I think it's time we all started kicking up about this and asking for a formal guideline we can refer to.

So confusing when AF kicks off and we don't know what to do for the best, isn't it!

Glad you're feeling ok now.

Jean

[momist in reply to jeanjeannie50]

Thank you Jean. The extra bisoprolol is taking the gloss off feeling better somewhat, but I will cope. I hate going to A&E, and have managed to avoid it since the fist time, until now. I'm glad the extra flec worked for you at least that once. I did try it twice during the session I described, but to no avail, sadly. It just seemed to switch me from AF into tachycardia (I assume atrial flutter?).

[Buffafly]

A crevasse indeed - ‘fortunately’ a cardiologist has told me there is no point in my going to A&E with AF unless I am (my interpretation) half-dead as the only thing they can do for me is a CV or an emergency pacemaker. I am really sorry things have gone this way for you. It’s true the BP machine doesn’t work in AF, I scared myself once taking my BP during an episode before I had a Kardia and didn’t know that. I hope that’s the last ‘bump’ 💜

[momist in reply to Buffafly]

Thank you Buffafly. I hope so too, but I don't expect so. Fingers crossed there will not be another long session though . . .

[Hidden]

Hi! You may be a little surprised by my comment, but I would like to thank you for two things. As the first, thanks for the data about the BP. It is kinda "normal" to have such BP values when in AF and for the following reason. When in AF, the output of the heart reduces significantly, so the BP spikes (when the blood is pumped out of the heart) reduce very much. The lower BP value was the real pressure value in your circulatory system, and the upper value was reduced for the mentioned reason. You are not the only one to have quoted such values and the small apparatus seems to have still been working properly. As the second, it is so nice that you have mentioned your switching between different types of arrhythmia since it is also kinda "normal". Both situations are possible - switching from AF to AFlutter and from AF to tachycardia. Such patients, who are cool headed enough to remark and remember what was going on during an AF attack, can help the research tremendously!

Yes, something about the attack duration. Never be bothered with the AF attack duration. Despite there is, in general, a trend of increasing the bout duration with the time, one long AF attack does not mean that the next one will be still longer. The duration is of utterly random magnitude and, after one long attack, you may have great number of very short ones. Hope it helps you to feel better...

[momist in reply to Hidden]

Thanks for that. I did mention to several people, both the paramedics in the ambulance, and staff at the hospital, that I wondered if the high (for me) diastolic value was due to the next beat arriving too soon for the normal lower level to be reached, but no one ever commented either way. I was already aware that while in AF, the heart's output is reduced due to inefficient pumping caused by the lack of fill achieved between beats.

The general consensus seems to be that if the high rate of 140 bpm is prolonged too much, the heart will tire and cause eventual heart failure. My usual AF rate is 170 - 195 but can go above 200 on occasion. Why this one stuck at around 140 (138 - 142) for so long, I can't fathom.

[Singwell]

That's quite an ordeal! And I know exactly how you feel about A and E and the stretch that the NHS is under. I've been in a similar position - 17 hours on a trolley with no cardiologist available.abd the staff not really knowing what to do TBH except emergency procedures if you go into cardiac arrest. I too am grateful that the BP readings issue has come up, as I didn't know. Other than that my own GP had told me BP readings are all over the place during AF. So good to know for future! Although distressing because the AF was prolonged, at least the BPM were lower than normal for you. Might this not be a kind of good sign? My EP told me that prolonged AF did not damage the heart unless combined with severe tachycardia. Maybe once you feel more settled discuss returning to your normal med dose with your arrythmia nurse?

As Steelheart says - just because it happened this once doesn't mean it'll happen every time. It's hard not to think that though.

You sound very brave to me!!

[momist]

Thank you Singwell. Regarding the prolonged AF, those who are in permanent or persistent AF usually have lower heart rates within the 'normal' range up to 120 bpm, and I can believe that this is not as harmful to the heart. The heart is a muscle, and if it's going like the clappers all the time, it will get both bigger and stronger, but that's not necessarily a good thing in itself. An enlarged heart is more prone to failure.

I will be keeping the bisoprolol dose under review, the 5mg per day I'm now at is making me feel awful. Weak, wobbly, disinclined to do anything at all and slightly brain fogged to boot. Only two months to my next EP review. Fingers crossed.

[Dr-Gohan]

Great post. Water water water. Fruit and raw veggies. Fish freshly cooked at home.Lowest possible salt and sugar intake.

Herbal tea, ginger is best. Regular black tea 1-2 cups. Eggs and soybeans acceptable protein. Sleep when ever you feel like it. 1-2 hours fine up cleaning watching TV, get tired again back to bed anytime night or day, your heart is repairing 24/7. No smoking or alcohol. Your body desperately wants to be healthy.

[momist]

Thanks Dr-Gohan . Yes, water water water. At the hospital they obviously thought I might be dehydrated, hence the big IV saline. However, I don't believe I was. I keep a glass by me at all times, and often drink a pint with a bit of blackcurrant or lemon barley in it. I don't find large quantities of water all at once palatable, but the squash flavoured variety is always good. The plain glass gets sipped at intervals.

Thanks for the encouragement to sleep often. I'll show that to my wife!