Hello All — I was on a 1 1/2 hour flight this morning between Washington DC and Atlanta. About an hour into it, I felt palpitations and soon after we landed, I had a racing heart rate and what felt like Afib. I take 25 mg/day of Metoprolol to control ectopics, blood pressure medication and Xarelto. I took an extra dose of metoprolol and exchanged texts with my cardiologist. He said my symptoms were likely caused by the high altitude and reduced oxygen level and suggested I take 50 mg of Flecainide which I had with me as a pill in the pocket. I got on my connecting flight and about 15 minutes later my heart rate subsided and I began to feel normal. I have had Paroxysmal Afib for about 10 years (I am 71 with infrequent bouts of Afib and none, until today, since I zeroed out alcohol 5 months ago). A recent heart CT scan showed only moderate plaque in one of my arteries and an ECG identified no structural issues. I may have been dehydrated this morning and I had had only 3 1/2 hours sleep the night before. This happened to me one other time, about 12 years ago, but in that instance I had had a glass of red wine and a cup of coffee on the flight. I’d love to read if others have had a similar experience and get suggestions on what I may be able to do prophylactically to avoid repeat occurrences. By the way, I’ve spent quite a bit of time in Oxford the last year since my daughter and her family moved there. Love the city and its inhabitants. I also appreciate so much what I’ve learned on this forum and how well the British express themselves in their native language. You put us Americans to shame!
Commercial Airline Flight Triggering ... - Atrial Fibrillati...
Commercial Airline Flight Triggering Afib
Interesting viewpoint which I cannot relate to at all.
Absolute opposite experience and advice. I have boarded planes in AF and converted to NSR within an hour of the flight. It could depend on the altitude the plane was flying at but with a pressurised cabin I would really question the low O2 theory. I undertook HBOT therapy and studied the affects and being in a pressurised cabin is very similar affect - it increases O2 saturation so unless there was defective air flow through faulty or contaminated air circulation I couldn’t go along with that theory at all. I would monitor my O2 sats and I never saw them dip during a flight.
More likely stress induced - navigating airports these days………. Hydration is crucial and you will automatically be dehydrated during flying so if you didn’t compensate, that could trigger?
Although I avoid flying now for reasons other than AF, I have had plenty of long distance air miles under my belt with no ill affects due to AF. The only concern one of my doctors had was flying less than a week after ablation but although I was fatigued, no lasting ill affects.
The only time I have been concerned about flying with AF was in a small plane without pressured cabin which was going to be flying at +5,000 feet which a friend flies and I occasionally go up with. Anything over 3,000’ would be questionable.
I would be interested to hear other responses as we all react very differently.
I concur completely with CDreamer's comments. Much more likely de-hydration and stress than anything to do with altitude. Commercial airliners are pressurised to an equivalent altitude of around 9000 feet rather than the 35,000 they may be flying at so very unlkely to be hypoxia. From my experience the single most likely thing to bring on an AF event is de-hydration. (After alcohol of course.)
This article discusses arrhythmias, including AF, and flying:
ncbi.nlm.nih.gov/pmc/articl...
The conclusion of the article: " It is extremely rare for significant arrhythmias to occur during air travel, and air travel itself does not cause clinically significant arrhythmias. Patients with arrhythmia can travel by plane safely if they are asymptomatic or clinically stable." I tend to agree with the others, therefore, that this was more likely to have been caused by other factors which might have included the general bustle and stress involved in flying.
Very relevant and informative article. Thanks fir linking it!
My personal experience is that I have never gone into Paroxysmal Afib during a flight even when consuming small amounts of alcohol. I was in Paroxysmal Afib before I boarded the plane for my last flight out so I abstained from alcohol and drank plenty of water, it remained during the 11 hour flight until after I reached my hotel. I must say I do not suffer as badly as some but I can feel as soon as I go into Afib. Cabin pressure for most passenger aircraft is 8000 feet when cruising at altitude, however, newer aircraft such as the A350, A380, B787 and soon the B777-X fly with a cabin pressure of 6000 feet.
I probably have flown at least a million miles since I noticed paroxysmal AFib. As far as I know, I’ve gone into AFib just a couple of times in connection with a flight. I think a combination of dehydration, lack of sleep and the altitude may have contributed to the cause in each of these isolated cases.
I have flown only once (2019) since being in PAF. I have taken Metoprolol for about 10 years for rate control. During that flight (about 2 1/2 hours total), my heart rate increased about half way through and gave me more pronounced symptoms. I got nervous (which didn't help) and I decided to take another Metoprolol (I might have taken a half table, I don't recall) and a few minutes later it subsided. I think it was the altitude as well. I was so happy it helped. I wasn't sure what I would have done if it hadn't. I thought it made sense to try it. Whew...
My cardiologist said in his forty years of practice he has seen instances of AFib which he believes were triggered by altitude
I agree. I had never realized that a plane flying at 30,000 ft only adjusted the pressure, etc to reflect around 9,000 ft. I was challenged with breathlessness at elevations at 4,000 to 5,000 ft and was at a U.S. national park that was 9000 ft and stayed 2 days. I struggled to walk and to sleep. It was frustrating because it was SO beautiful...but I was never so happy to leave and get down to a lower elevation. AND that was 6 years prior to my AF kicking in. I may have been having early signals of it earlier (and I was only in my 30's at that time (AF didnt start until I was almost 50). Probabaly too much information (sorry), but thought it might be helpful.
I had a similar experience hiking in the Grand Tetons in Wyoming at 7,500 feet — and that was 5 years or so before I had symptoms of AFib.
I have had issues with a racing heart on commercial airline flights, especially mid-sized planes like Boeing-737's, despite being extremely careful to remain hydrated, drink no alcohol, etc.. And several times after flying, my Kardia showed very odd EKG waveforms for several hours after landing (and I felt like crap). My oxygen sensor always show a decline in oxygen levels and an increase in heart rate at cruising altitudes, but the decline seems to vary from one flight to another (I assume depending on what altitude the plane is pressurized to). I also attribute my issues to high altitude because I have a history of altitude sickness in the mountains (terrible headache at 8,000 ft and major swelling of face and severe breathlessness at 10,000 ft which required immediate descent). My doctor prescribed diamox for my last airline flight (the drug hikers take to avoid altitude sickness) as an experiment to see if that helped. I had no racing heart on that particular flight, but don't know if that flight just happened to be more highly pressurized or if the drug itself prevented something from happening. No question that stress and dehydration are other potential factors that could cause a racing heart, but if you are sensitive to altitude changes then a plane pressured to 8,000 or 9,000 feet could be a trigger for you. It certainly seems to be for me.
Diamox takes several days to work for altitude sickness. A days worth of high dose steroids would work much quicker. I used to take them if flying from sea level to skiing at 10,000 feet. Definitely eliminated symptoms I had at the time, nausea, headache, difficulty sleeping..
Very interesting. I’m going to look into diamox. Did it help maintain your oxygen level?
Is it possible that resting is a trigger for aFib?
Really low heart rate
AFib/Atrial Flutter Burden
Why I stopped metoprolol 
