I’ve P-Afib and usually get an episode once a month or so usually lasting anywhere between an hour and 24 hours? My GP’s approach is a “pill in pocket” when I feel my heart racing and I take a 1.25mg Bisoprolol tablet which brings my heart rate down a little but obviously does nothing for the irregular heart rate. Anyway it usually passes in the timescale stated. However right now I’m in Afib and have been since last Thursday morning at 1.00AM and it’s now Saturday morning. Whilst I don’t feel unwell as such I am aware that my heart rate is erratic although my pulse is pretty much staying between 75 and occasionally 103 BPM? My question is do I ride it out or rock up in A&E? Like I said, I don’t feel at deaths door and as I’m on full time anticoagulants anyway (as I have Factor V Lieden following a DVT/PE six years ago) I think I should be covered for a stroke etc. I read the paroxysmal atrial fibrillation can last up to seven days? I hope it doesn’t last seven days however! I just feel sitting around in a hospital for hours on end might not be the best thing? Interested in people’s thoughts, how long has your longest episode lasted before it righted itself?
Paroxysmal Afib, longest episode befo... - Atrial Fibrillati...
Paroxysmal Afib, longest episode before seeking help?
I think that for now, this boils down to your discomfort versus hours spent at A&E. You sound fairly chilled out about your current bout of AF so it might be worth just riding it out somewhat longer, as you have a good insight into what's going on and are also on medication. But definitely if this goes on for days longer, I would go to A&E and discuss the possibility of cardioversion to bring you out of this. Paroxysmal AF isn't paroxysmal when it goes on for longer than a week, so don't tolerate it for too long without trying to get it reversed!
Thank you for your reply. That’s pretty much my thoughts, if it worsens or doesn’t improve by Monday then I’m off to A&E! Meanwhile I’ve pretty much exhausted all the DIY techniques to try and reset your heart yourself apart from a really cold shower which I’m about to try! I would say I feel the discomfort but no sweats or dizziness or difficulty breathing? Ive not taken another beta blocker as I believe the effect last 48 hours or so and frankly I’m not a fan of the side effects of cold hands, feet and feeling a little woozy! The one
I'm Sorry You must have a better health authority & a & e than to lead Motov to hope for Cardioversion so easily .Went to a & e a few months ago for something else and had a hr of 190 on admission but quite dropped to 160 within 15 mins .I was released when it dropped to about 130 as already on waiting list for cardiology .I suppose it could be because I said I came for head not my heart.I am now on list for Cardioversion Nov or Dec .I went into Persistent 1st Feb.Motov hope you feel better & you soon revert to NSR.Monitor & keep notes.Be a nuisance with your doctors.
What I say below is what I would do, I can't give you advice as I'm not medically trained.
At the rate you are right now I would sit it out, especially as it's having no great effect on how you feel. To be honest after 16 years of AF, 3 ablations and numerous cardioversions I'm now in constant AF around the rates that you are now. I've accepted it, when I used to go into PAF my life was made hell and I could struggle to stay conscious. If I were you I would be pleased to stay as you are right now and hope that, like me, this is the worst you'll ever be and you can lead a normal life.
Personally, I would never go to A&E with a top pulse rate of 103. Perhaps constantly over 130 - then yes.
A normal pulse rate is considered to be between 60-100 beats per minute.
My sister went to A&E with gallbladder pain last week and it was 5 hours before she saw a doctor. She was admitted to hospital and had her gallbladder removed a few days later. She said A&E was horrendously busy. I'd have to be dying before they'd be able to get me there!
Let us know how your heart behaves please.
Jean
Unless you have chest pain or are short of breath the general advice is ride it out. With the rates you quote there is no risk to health as normal HR is between 60 and 100.
Hi Bob. By chest pain you mean anything that creates a discomfort (like feeling some kind of pressure or tightness) or by chest pain you mean severe pain, like stabbing ?
I don't know when I should worry.
Any pain that extends into the neck or arms is generally a bad thing as is feeling faint or dizzy.
General discomfort may well be digestive but since everybody has different levels of acceptance it is not black and white. What must be avoided is wasting A and E's time with indigestion as that will not be popular and do it too many times and they won't take you seriously if there is something wrong.
I have never been to A and E directly although my first ever attack about 28 years ago I was sent by ambulance after visiting my family doctor. At that time I had not been diagnosed with AF and it took a further 11 years and a change of house, location and doctor before it was.
I was told by various EP's to go to A and E if either my heart rate was over 100bpm for more than 20 minutes or an episode was more protracted than usual ("unusual for you"). One thing to discuss would be whether PIP is the best treatment for you. Originally, my GP proposed this, but the consultant was dismissive of this approach.
Who knows what's the best way forward ?
My personal take is 125bpm for 4 hours or more is an A@E or check out job.
Good luck.
Paul
I’m now on day four, still in afib but heart rate is sitting between 79 and 100bpm. I still don’t feel particularly unwell, just aware that my heart isn’t beating correctly? My INR is sitting at 2.5 and I’ve started taking two 1.25mg of bisoprolol, one in the morning and one in the evening. I’m going to sit out now until after the weekend, simply because I know that if I ago to A&E today on a Sunday that I’ll probably still be sitting there this evening waiting to be seen! Tomorrow morning though I’ll be rocking up until I’m seen as that’ll be five days in afib!
Sure Motov. You must do what you think is best for your health. Maybe call 111 ?
I've been in afib for about 3 months now and your body does get used to it. However certainly contact a medic to discuss your concerns.
Good luck.
Paul
Wife suffers from PAF which normally last a few hours. Her longest episode was 2 weeks but the second week was in hospital as she was experiencing chest pains at end of first week.
For what it’s worth I’ve been in AF since Thursday when when we were away for a few days staying with friends. As originally planned I drove back home Friday, including a ferry crossing. I don’t have a ‘PIP’ but take an extra 25mg of metoprolol daily, as prescribed. My resting HR is wobbling between 48- 100 (avearage about 70 - normally 55 - and my HR can blip to 120/30 or so when I have to move about for essential reasons. As usual I’ve sent an ECG from my Apple Watch to the arrhythmia nurse by email. I’ve an appointment in person with my EP in Portsmouth on 27 October as these episodes are occurring now on a monthly basis after a lengthy time AF free after my second ablation. No intention of going to my local A and E unless something untoward happens. I normally revert to NSR with about 5 days - if that doesn’t happen I shall seek advice. I am fully anticoagulated with 5mg Apixaban twice a day. We’re all different but this is now fairly routine for me and although unpleasant is bearable if I mainly rest up.
Hope that helps as we can only write from our own experiences.
I appreciate your reply and your approach makes sense as it sounds like you’ve been here before. For me, my episodes used to be once every month or so and the longest previous episode was about 48 hours. This current episode is the longest for me but also doesn’t feel as debilitating as the previous shorter episodes. I have little faith in the NHS since all their focus these days seems to be on covid! I’ve and even less faith in my GP surgery where two separate doctors advised two different things! One said take 1.25mg of bisoprolol as a pill in pocket approach and the other said take one tablet daily? I have an appointment with an NHS cardiologist but not until March next year! For £250 I could see a private GP and get a referral to a private cardiologist a lot quicker but obviously at a cost!
Yes I’ve been on this journey for at least 11 years now - your story sounds very familiar. It took me several years of talking to my GP, A and E visits and cardioversions before I got referred to an EP and had 2 ablations. Frankly I wish I’d forked out for a private EP consultation and got ‘into the system’ much earlier. Since then I’ve never been technically discharged - I remain under the care of the EP’s team, even though I went two/three years without having to bother them. I’d advise anybody in the same position to ‘ get into the loop’ and stay there. After all, it’s to their benefit to know how successful or otherwise their treatment has been - they need the data to monitor outcomes in the long term.
I can understand your worries and possibly the frustration of being able to do anything about it.After 7 months of Persistent not fast Afib you sort of learn to live with it.I had months of worrying if my heart rate went above 120 on excercise or walking.Now I stop if 140 or if my body tells me.You you can get paranoid .If you can afford it go private.Raid your savings if you have them.It can give you peace of mind.If not pester gps or specialist.Tell them how anxious you are.I wish u well on your journey
You could ask your GP to do you a referral letter to a private Cardiologist. You don’t need to see a private GP first.
I’m making a direct appointment with a cardiologist not a private Doctor 👍
Hi almost identical to what happened to me. I read on the good peeps on this great forum its best to ride it out at home unless of course you get chest pain and breathlessness. My a fib has turned presistant now and I'm waiting for CV and Ablation. It does feel easier than the coming and going of a fib. I take Verapimil for the high hr and of course Apixaban. A few other meds unrelated to a fib. Best of luck to you.
Hi Motov sorry to hear of your plight, I know what it's like. My longest episode was a 48 hour affair and I just rode it out. Good luck.
An episode once a month doesn't sound right to me; firstly I believe the heart can remodel over time and secondly anti-coags don't protect you fully. I would consider A & E or seeing a cardiologist urgently privately and discussing regular daily Flecainide or similar to improve your future QOL.On DIY techniques, I posted a list I have made up recently (includes gulping down a cold drink from the fridge if your AF is vagally mediated) but all these are probably most effective if done immediately the episode starts. Best wishes.
Hi Motov.Prior to my ablation in May this year I had AF probably once every two months. On average each episode would last between 24 and 30 hours with a heart rate around the 70 mark.
I never went to A & E in part due to Covid and as you say the horrendous prospect of sitting around for hours on end, although my GP did say if it lasted more than 12 hours to go to hospital.
That was my choice, but as you know we are all different and have to make our own decisions about our health and of course when unsure we should seek professional medical help and advice.
I’ve been in a similar situation several times. Once I went to A&E after several days because my heart was ‘revving up’ (168 bpm) and I felt faint just sitting. They did take that seriously but my cardiologist has since decided it’s not safe for me to have a chemical cardioversion or extra meds so not to bother with A&E unless I’m in a state of collapse/have severe chest pain. If you phone 111 they book you an A&E appointment or send an ambulance - that’s in our area, others are different.
PS As you have an appointment with cardio coming up a full ECG while in AF would probably be useful to them so I would go Monday morning if still the same, though apparently that’s the busiest time of the week as everyone else does what you are doing and can’t get through to GP on Monday 😀
What do you expect that A&E might do for you? My experience tells me they don't know what to do with you, as they can't send you home in that state, and they can't 'cure' you, and they can't find any beds on a ward of any kind let alone in cardiology. They'll leave you on a trolley for many, many hours and just monitor your heart rate, after the initial ECG to verify AF. They may try chemical cardioversion with metoprolol, but that didn't work for me.
Are you checking your heart rate by using a smart watch or similar? If so, you should not trust that while in AF as they can't see those beats which don't result in a full regular pulse.
I think the most logical way forward would be to ask your GP for a referral to an EP.
I have episodes of AF every 7-8 days usually lasting about 48 hours. HR 100-120 but don't feel unwell so just sit it out.
As others have said this is purely my individual experience. I suffered from Afib and each episode was around 160-190 bpm. Each time they went over 3-4 hours I presented at A&E until by the 20th time I had presented at various hospitals both in London and my home town - ALL of whom were kind, professional and tried their best to regulate it and send me home with a possible solution. Eventually, tired of me presenting I am sure, the kindest cardiologist in the world arranged an ablation for the following week at Broadgreen with the head EP at what is arguably one of the best units in the country. That was 2 weeks ago and FOR NOW no episodes of AF whatsoever. I am afraid to say it has worked but the relief is sheer heaven.
Sorry to sound thick, but what exactly is an EP?
Electrophysiologist but a cardiac surgeon who specialises in Electrophysiology, You really need an EP to talk to. Might be worth speaking to one privately. Dr Boon Lim said to be one of the best in the country.
I have found that my regular cardiologist is really good at plumbing but does not know a lot about the electrical goings on. I agree to get referred to an EP. I finally did after my cardiologist wasn’t particularly response to my problem, I think because she did not know what to do.
Very early in my AFib journey I had an episode that went on for three or four days. I too, only had bisoprolol which slowed my heart down but didn't get me into NSR. Later, I was prescribed flecainide by the hospital consultant which I initially took daily and then, as I was only having two - three episodes a year and with the agreement of my GP I stopped and only took as it a PiP along with 1.25mg bisoprolol. That arrangement never failed to work. It is a pity you are having to wait so long to see a cardiologist, if you were in the position to have just one private consultation s/he may well prescribe rhythm control medication to avoid the sort of scenario you are having to go through right now. Best of luck.
I’m still in afib and although uncomfortable I’m not totally wiped out. I’ve decided to forget the A&E approach and instead phone my local Spires healthcare tomorrow morning and try to get an initial appointment with either a GP or even a cardiologist and try and get prescribed some kind of rhythm control drug as like you have said the bisoprolol simply lowers my heart rate slightly. I can’t wait around until next March for my NHS cardiology appointment and would like to get on top of this a lot sooner! Right now I’m constantly checking my heart rate with a phone app called “FibriCheck” ever optimistic to see I’m back in NSR but nearly four days later and I’m still in the wonderful world of atrial fibrillation!! 😣🙁
If you have decided that then my advice would be to see a cardiologist or an EP. I believe a doctor can't prescribe flecainide as a new drug, only prescription renewals, and you don't want to pay a GP only to be referred on to a cardiologist.
Three things:- 1. Get yourself an EP -insist. GPs are not experts with treating AF . 2 Your episodes of AF might get more frequent and longer.3. Sometimes prescribed medication as PIP just don't work for some patients. Been there, got the T shirt.
When I go into a fib I take a channel calcium blocker (dilitiazem) to bring down my resting heart rate and a beta blocker (metoprolol) to bring down my ambulatory rate. I usually convert in 12 to 36 hours, but once it took seven days. I'll admit I was about to give up at that point, but just before I called the doctor I converted!
Hi,
My visit to A & E was initiated by my GP in response to a dramatic and fairly rapid fall in blood pressure - 136/80 ish down to 76/50 in a few hours. That was the sign for him that it was AF and the team at A & E confirmed paroxysmal AF. Wonder what your BP is doing ? If its doing nothing and staying stable ish then ride it out.
BP is between 130/79 and 114/79 which is pretty usual for me? Still in Afib this morning though!
This has happened to me recently. It lasted 4 days. Never before has it lasted so long. It seems for me that the flecanaide may not be working so well after 12 years of paroxysmal atrial fibrillation. What I do is take the 200 mg flecanaide and 1:25 bisopropol and give it at least 7 hours to work If no joy I take another 100 mg at bedtime. However on that occasion having done all that I was still blipping after 4 days. That night I took 200mg flecanaide 1:25 bisopropol and it worked. Thank goodness. After a few days it happened again and I did the same but was so fed up hubby was ready to call the emergency services but fortunately it corrected itself. I realised that I was burping a lot and started a course of esomeprazole which seems to have helped. Now I'm just trying to stay fit take mag glycinate do yoga and cross fingers. Not on anticoagulant. Waiting for appointment with Cardiologist. Ha ha to that. Good luck. Experience is a great thing in Afib as we are all different. Mein tends to be centred around food intolerance and digestive issues.
Interesting that you take omeprazole, I was prescribed this previously for acid reflux and stopped taking it as I didn’t believe I was actually symptomatic and had no further issues but I have started taking it again as I have bouts of indigestion and I have since read a really interesting article where they are suggesting there’s a a connection between both reflux disease or GERD as it’s known and afib? Anyway, I’m now day four, still in afib and after sitting on the phone for over an out, I have my GP calling me later this afternoon to decide if I need to be seen! It’s hilarious l don’t know whether to laugh or cry, they’re obviously still “overwhelmed with covid”!
Omepraze and cardiac meds lower your magnesium. May want to consider taking magnesium tartate
Yes I seem to have silent reflux, the only symptoms burping and little gurgles, however it definately triggers the a-fib when that happens so am getting on to it but I do hate taking pills. I'm looking into better quality probiotics as I just take Holland and Barretts 3 billion culture at the moment Any information on controlling GERD by natural means or strengthening the gut - is it possible to do this with exercise? - I would welcome. Hope you get sorted quickly. At least we have the blogs on this site which helps so much.
Mine never revert without an electrical cardioversion and I'm gasping for air usually so I just go to A&E asap and get it all over and done with. Tedious
I too have been getting afib once a month at 11:30 pm lasting 8-12 hours. My pill in pocket is flecainide. From my reading I have vagal mediated a fib which flecainide works wellWith. it has happened the past three months and the last time I didn’t even need the pill in pocket as taking the am flecainide made it stop in 1 hour. I am also reading on magnesium and it’s importance for the heart. Thinking daily magnesium tartate may be the answer to stopping these episodes and hope to reduce the afib meds. I’m reading the book the miracle of magnesium. I also go to chiropractic once a month to correct my spinal posture which I think is helping I no longer eat late at night and hydrate 90 oz a day take turmeric an anti inflammatory 1 tsp and honey in almond milk every am. Prayer meditation and proper breathing also r a part of my life with a fib
Little update, still in afib and now day four! Spoke with GP this morning who has put me on digoxin now to take alongside bisoprolol. From what I have read so far this seems to be just another rate controller with nastier side effects? I’ve taken the initial dose but my heart rate seems to hover sub 95 and occasionally 103-105 and I’ve been advised to take another 1.25mg Bisoprolol at bed time and my next digoxin in the morning with the caveat that severe chest pain, breathing difficulty or heart rate north of 120 to call 999 or drive to A&E myself if able lol! My A&E is 25 miles away so that won’t be an option! I’ve another appointment at the GP tomorrow for bloods, BP and an ECG, apparently they need to check I’m tolerating this drug and that kidney function isn’t affected? My personal plan is still to see a cardiologist privately with the hope I prescribed Flecainide or similar rhythm drug as my GP thinks it sounds like I’ve “upgraded” from Pafib to persistent afib…. deep joy! She did suggest that the digoxin might switch me back into NSR but nothing has happened so far! 🙁 Feeling pretty despondent and anxious just now! 🙁
A very recent episode lasted eight days. Rate control with diltiazem and
metoprolol. I was about to schedule for electrical cardioversion. Not that
I was that uncomfortable but my ep was concerned about remodeling. Most previous episodes 24-48 hours but another recent one for seven days. Hope this is not becoming
a pattern. Starting to consider ablation or at least a pill in pocket so I will convert sooner.
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