About 15 years ago (age 21) at the University, I first started having atrial fib episodes. They would last for several hours and then resolve on their own.
The episodes became more and more frequent, until I was having them about once a month. I basically just sat on the couch and waited until they would go away.
As time went on, I got married, started a job, and the episodes became less and less frequent, where I would have an episode maybe once a year.
About 10 years ago, I went in and caught the AF on an EKG, which confirmed it as AF. I was assigned a cardiologist and went through a range of tests to confirm that my heart was otherwise healthy. I was prescribed Flecanide as pill-in-a-pocket but never had to take it as the prescription expired before my next episode. And honestly, I don't like taking medications so I'm not sure that I would have taken it anyway.
2013-2015 were my worst years as I had multiple episodes and multiple panic / anxiety attacks, though it all ended abruptly with several breakthroughs where my AF and anxiety flipped off like a light switch and basically went away.
From 2016 to 2021, I had a total of two AF episodes, one in 2017 and one in 2019. In either case I simply waited for the symptoms to cease. These would usually take around 10 hours to resolve.
I got COVID for the first time in December 2021 and had an elevated heart rate around 100 BPM. I was prescribed Propanolol which made me dizzy and at first seemed to help reduce my heart rate. But then I was dizzy for days after taking it.
Since then, I have had two AF episodes, one in March 2022 and one as I write this post in May 2022. I'm discouraged because I feel like the clock has started over for me again. I haven't had two AF episodes so close together in 15 years.
So, I have a few questions:
1) Has anyone else experienced a resurgence of AF symptoms since having COVID? I'm not sure if that is the catalyst here but the timing seems more than coincidental.
2) I have always been nervous about taking specific medication or having any procedures done because my episodes have (until recently) been so few and far between. It seems less invasive to deal with them as annual nuisances, and staying as healthy as I can. Is there anyone here who only has one or two AF episodes a year? If so, what is your experience with "pill-in-a-pocket" medications?
3) Does it make sense to take anticoagulant medication "only" when I have an AF episode? It seems unnecessary to be on it for the entire year when my episodes have been so infrequent.
With these two recent episodes, I'm dreading the round of cardiologist visits, tests, and expenses that will all end up in the same place where they always do.
Any thoughts or encouragement appreciated.
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remixer21
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Some here would doubtless tell you how lucky you have been with such a light AF burden but I know how distressing any event can be.
You must, I'm sure, be aware that AF is known to be a progressive condition so increase of events is quite normal. It is also well documented that Covid 19 in some cases produces AFalthough I suspect that this is dependent on pre-disposition to AF.
It must also be accepted that any and all treatment for AF is only for quality of life as it is not considered life threatening. That said, at your age taking trouble to terminate symptoms would be a good idea as you should have a long life ahead of you and drug therapy tends to lose efficay as prgession occurs. I would seriously consider ablation if things continue to develop as recently.
Regarding anticoagulation, The CHAD2VASC2 scoring system gives you a guide to the need for anticoagulation using a number of co-morbidities including such as diabetes. age, high blood pressure and prior heart conditions and I suspect that your score is zero unless you have not mentioned something. In such circumstances taking a/cs is not generally recommended . The idea of pill in pocket use of anticoagulants is rejected by most experts as many people are unaware they have AF and clots can form at any time.
Thank you for your thoughts! It is true that while active in AF (like now), I would give almost anything to get out of it. In these moments, ablation feels like it is worth looking into, but my AF episodes have been so infrequent I haven't wanted to risk causing anything worse. As in this case, I don't want to overreact. Again, thanks!
Yes, the devil that you know. Don't want to overreact or under-react. You're quite young compared to many here and better alternatives to current ablation techniques may be on the horizon. For example, keep an eye out on Pulse Field Ablation, which is just coming out of trial in Europe, I believe. Not an easy decision, but sounds like you have a little time although things can change quickly with afib. I went from one episode every six months to one episode every 4 days. It happened within a year. Now I'm on daily flecainide trying to decide if I will have an ablation.
Jim
Hello and welcome to the forum. Thanks for outlining your history which doesn’t seem to follow the usual sequence of events normally associated with AF. I am not medically trained but in my mind it raises a couple of questions. Have you ever been involved in extreme, competitive sporting activities as this is known to be a possible cause of AF. Similarly, drug and/or alcohol abuse has much the same affect.
The need to take anticoagulants is determined by an individual’s CHADsVASC score (Google for information). Unless you have other health issues which can impact on your score, at 36 you would not normally need to take anticoagulants but this should be discussed with your Doctor. As you probably are aware, anticoagulants significantly reduce the risk of having a stroke. If you have been diagnosed with AF, then the risk remains with you regardless of frequency and intensity so if your CHADs score is 1 you should consider taking an anticoagulant but if it’s 2 or above it’s highly recommended.
Not many folk enjoy taking medication or relish the thought of medical intervention but if AF continues uncontrolled, the consequences can be very serious, ultimately resulting in heart failure. There are lots of things you can do regarding lifestyle changes which often improve and reduce symptoms but I’m afraid there are no easy answers and seeking advice from an Electrophysiologist (EP-a cardiologist who specialises in arrhythmias) is the best route forward.
Flecainide is a very effective drug when used as a PiP and it has worked extremely well for me in the past but after two ablations and thyroid treatment, I have not had any episodes for over a year 🤞
Under normal circumstances, AF is a progressive condition but from what you have said, your situation seems unusual but I think you should have it thoroughly investigated because treatment can be far more effective if taken sooner rather than later…..
Thanks, why are you not tucked up in bed? I think I know the answer if you are in AF now…….suggest you get you thyroid checked, if it’s out of normal range it can bring on AF…..
Hi and welcome - may I say how well you have done coping with your AF and thank you for the history, which I have to say, pretty much echos my own although things changed with age - I am now 70.
To answer your questions:-
1. YES. Any infection viral or bacterial will be a trigger for your AF. Inflammation is thought to be the main catalyst and there is always inflammation with an infection so worth keeping a diary. There is also a LOT you can do regarding anti-inflammatory diets and encouraging a healthy gut biome.
The good news for me was that although it took me a long time to recover from COVID as the weeks went by the AF turned to tachycardia and finally my heart settled after about 3 months to pre COVID levels.
2. AF often starts with 1 or 2 episodes a year, sometimes mine were 3-4 years apart but they have a tendency to increase with age. PIP - Pill in the Pocket approach does work for many people but my view, very personal, is that if you self convert within 24 hours and cope well with AF and are not very symptomatic, then less is more and focus entirely on Lifestyle.
The time to start to think about interventions is IMHO when AF starts to interfere with your everyday life and/or when you become symptomatic. May I suggest you read Dr Day’s book about AF called the AFibCure - it outlines all the options with very sensible suggestions of how and when to monitor.
3. You are either ‘on’ anitcoagulation or not. PIP approach I feel is completely inappropriate and ineffective as the risk of stroke does not diminish after your AF episode ends. It has also been muted that coming off anticoagulation actually increases the risks.
The need for anticoagulation is calculated by something called CHADSVASC score - you can do it for yourself here chadsvasc.org
Read as much as you can and another good source of info is of course heartrhythmalliance.org/afa... but if I’m honest, you may be better at this stage to focus very much on Lifestyle and prevention.
Others will undoubtedly have different views and there is no one solution here, just many different paths to choose.
I appreciate this very much. Your experience and reasoning resonates with me. These two recent episodes have hammered home the importance of eating well and being intentionally healthy. I also have autoimmune issues in my family history and have dealt with that as well. (Hashimoto's, psoriasis, etc). AF episodes that restrict me to bed are not fun at all and it's worth sacrificing other things to maintain my heart health.
I've used two different pill in pocket (PIP) strategies when I've gone into afib.
The first strategy was to bring my heart rate down to normal with a combination of diltiazem and a beta blocker. After my heart rate stabilized at 100 or below, I was able to go about my business until I naturally converted which was usually between 12 and 36 hours.
Second strategy is using Flecainide. If your heart is structurally sound -- they should stress test you, etc -- it can convert you a lot quicker.
So, depending on how frequent your episodes are and how long they last, one strategy might be more appealing to you than another.
Until recently, I was on "as needed" thinners (NOACs). That meant I only took them when I went into afib and for a week or so after. Now, because my episodes are more frequent, I'm on daily thinners. My doctors (ep and cardiologist) were fully onboard with my "as needed" strategy. That said, a second opinion ep suggested daily thinners. I should also add that I'm very attuned to when I'm in afib or not, plus I have both a Kardia and Apple Watch ecg device to confirm. If you don't know when you go into afib, then maybe daily thinners make more sense.
You will get differing opinions here and with doctors on "as needed" thinners, but you're a relatively young man here and you have to weigh the rewards vs risks of thinners for the rest of your life. A good place to start is the CHADS score. If you're a zero or one, a good case can be made to only do "as needed" thinners. Chad 2 is borderline.
But it's not body, or anyone else's here. It's yours. So do your homework and make the best choice for you.
Your experience of panic attacks is similar to my own in my early thirties, and a cardiologist I saw recently for atrial flutter postulated that they might have been AF attacks rather than purely anxiety since the arrhythmia itself can create the self same effects. It's interesting to think that since those days, and I am now 68, I have always labelled myself as an anxious sort, when, in truth, I have always been able to face life's events extremely well.
In your case, I would be guided by a cardiologist. The reason I say that is because the cause of - and the course of - early onset AF seems to me to be different from late-onset form (i.e. age related) and it also seems to be very individual in its course. It is true that it is a condition that tends to become more frequent over time, and also it seems many viruses, including covid-19 can worsen it.
My advice would be that if you can afford it, and if necessary, then consider paying privately for a longer and more in depth consultation than the NHS will allow for.
Best of luck with this. It's a worrying time for you, but it's also true that AF often feels far worse than it actually is, and that for many people it is something that can be put up with. I haven't read any solid work that shows that treating it improves eventual outcomes and that treatment is purely for relieving symptoms (except for the need for anticoagulation, of course).
You've got some great advice here to follow. I second the John Day book as it'll arm you with information. Only thing I can add to the mix is I think there's a trend of intermittent anxiety in the history you've given here. Have you considered a talk or body therapy to help with this? It could be a factor in your case. Stress and anxiety definitely contribute to my own AF.Keep us posted. Lots of wisdom in this group.
Stress and anxiety = poor sleep = potential for PAF attack in my case. I am told by medics that I’m wrong and it’s the other way round. That makes me stressed and angry and then I don’t sleep and then ….. 😂
You mention both afib and panic attacks and that you finally "went in and caught the AF on an EKG".
How do you tell now whether it's an afib or a panic attack or perhaps another type of tachycardia like aflutter or SVT?
The only way to definitely know is with an ecg. I use the Kardia, as well as the Apple Watch. Both take ecgs that can confirm afib that can be read by yourself or your doctor that can take the guesswork out of an arrhythmia.
My a-fib episodes slowly increased after a mediocre cryo-ablation, until I got Covid in December 2020 where I had two a-fib episodes in the three weeks I had the virus. After that, episodes continued frequently until I had a RF ablation last April with good results. That's not to say your experience will be the same as mine, but in answer to one of your questions, yes, Covid increased my a-fib episodes. I know your reluctance for tests, pills and appointments, but it's best to learn as much about your condition as you can and find the best solution. I see you're in the US. Are you anywhere near Cleveland Clinic? They did my RF and were marvelous.
You’ve got plenty of very good advice here, so my recommendation will be on point relative to my experience which is not dissimilar from yours, especially the latest five years. Get RF ablation. My view early was that I could beat AF on my own. Took five years to realize I couldn’t. QOL was in the toilet. It’s not a total picnic, but two months after ablation I was very well healed. A year later, I barely notice my heart rate or rhythm. That’s the way it should be right?
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