Is it arrhythmia or is it Afib?

[headwind]

If a person has an irregular heartbeat and pulse remains within normal limits, i.e., 60 to 100 bpm does that person have Afib?

[Bagrat]

Afib can be slow but diagnosis is by investigation, ECG, holter monitor maybe echo cardiogram etc. Your doctor is the best person to ask.

[mav7 in reply to Bagrat]

headwind Bagrat's excellent advice is the way to know. Also, afib can be silent thus the need for a holter monitor.

[BobD Volunteer]

Atrial fibrillation can present as fast or slow. Not all arrhythmias are AF though it is the most common. Remember that AF is not just irregular. It is irregularly irregular IE chaotic with no rhythm.

[headwind in reply to BobD]

Sorry, Bob, but I didn't get much out of that reply.

[CDreamer in reply to headwind]

Atrial Fibrillation IS an arrythmia. AF is about rhythm not only rate therefore AF can be at any rate but your pulse will always be irregular eg: fast, fast, pause,slow,fast,fast,slow.

Some arrythmias have a regular rate such as Atrial Flutter or Tachycardia so that is termed a regular, irregularity (outside of normal rate/rhythm which is constant) with a pulse intervals which is either too slow or too fast. Whereas AF will present with an irregular (pulse) with irregular and very chaotic rhythm as well.

It’s much easier to see the difference on an ECG trace.

[localad]

i think the classic confirmation of AF in a varying irregular pulse is no ‘p wave ‘ on the ecg ?

[frazeej in reply to localad]

Yup!

[Ppiman]

I have just this. and regularly. with AF much less often. A normal beat is called "normal sinus rhythm" or NSR. What this means is that the heart's two natural pacemakers or "nodes" are working properly with the first beat of the upper chamber being started by the "sinoatrial node"; this contraction then triggers the second node (the atrio-ventricular node) a fraction later which contracts the bottom chamber. On an ECG these show as spikes, the first being called a "P" wave and tiny; the second an "R" wave and huge.

The heart rate, or pulse, is a separate aspect of this rhythmical contraction. This means that you can have an arrhythmia at any heart rate. I get arrhythmias that are runs of frequent ectopic beats and my heart rate can be quite normal, or in the range 50 - 135, for example. I can have AF, too, at the same rates.

Below is an ECG showing an irregular heart rhythm at normal rates (i.e. what you call "beats"), You can just see the little "P" wave on these. which shows NSR. The second trace is AF, which means the upper chamber is quivering and not able to trigger the bottom chamber, hence, there's no clear "P" wave.

Steve

ECG of ectopic beats.

[Ppiman]

This is the second graph that wouldn't post. It shows no P wave so is AF:

AF ECG trace

[Goosebumps in reply to Ppiman]

I’m not sure that this is correct for everybody. I am persistent Afib and back in 2020 my Kardia recorded no P wave and showed up as Atrial Fibrilation as you would expect. I was on Amiodarone for 3 months for a cardioversion and my P wave returned but the beat was still irregularly irregular ( although better than before) and so still showed up as Atrial Fibrilation on the Kardia.

[Ppiman in reply to Goosebumps]

That’s interesting. I can’t always see a P wave on mine even when it reports NSR, or at least I can’t separate the tiny bump from all the others that Kardia creates between the two R waves. Some AF traces I’ve seen online seem to have multiple P waves as it were.

I’m never quite sure what these home ECGs do look for in their algorithms but the cardiologist I saw said that two of the Kardia traces I sent him with reported AF were actually runs of ectopic beats.

If the atrium is quivering from the SA nodes misfiring, though, I can’t see how a P wave would be able to get through the myocardium to fire the AV node, regularly or otherwise. If some NSR type beats do get through then you’d expect an irregularly irregular rhythm though as you say.

Steve

[Sebhel in reply to Ppiman]

thank you so much for info 🙂

[oscarfox49]

I have permanent AF diagnosed by both the cardiologist and GP, but it is controlled by a beta blocker and therefore my pulse rate is normally between 55 and 65. I do of course have plenty of ectopics or irregular beats inside that range, and from time to time episodes where the pulse increases to 120 or so for relatively short periods. No simple heart monitor nor taking your pulse can confirm that you are in fibrillation as the extra beats may be weak or not picked up on the monitor. It is only when you are on an ECG that the true extent and nature of your AF can be determined accurately.

[Desanthony]

I have permanent AFib but my resting heart rate without any rhythm control medication or beta blockers is in mid to high fifties. This is known as low rate AFib. My heart rate even on exercise rarely goes over 120 - 130 - probably because exercise has been my career and my life.

[2learn]

My understanding is this. Lots of people have irregular heartbeats, but are not in AF and Docs may comment but generally ignore. AF is usually higher pulse, maybe with palpatations and dizziness, My doc can usually tell when I've gone out of sinus rhythm and into AF just by feeling my pulse, but then does an ECG to check /confirm. If your concerned ask your doc for ECG.

I found some of the answers hear too technical and not understandable and I've had AF for 10 years.

[headwind in reply to 2learn]

Thanks 2, best response I've read. My ECG shows NSR but I still have an occasional irregular heartbeat, which I presume is paroxysmal arrhythmia but not Afib. Trying to determine my need for anticoagulation.

[Buffafly in reply to headwind]

If you have Paroxysmal Atrial Fibrillation diagnosed by ECG you generally need to take an anticoagulant if you are over 65. The irregular heartbeat you mention could be AF or it could be runs of ectopics.

[2learn in reply to headwind]

Again only personal experience, so always check with your doc. I had first bout of AF age 63 and was put on warfarin asap. If not AF but somekind of arrhythmia, will probabaly depend on your CHAD score and Docs view/recommendation

[JOY2THEWORLD49 in reply to headwind]

Hi

Consider for an anti-coagulant specialist's direction.

Latest PRADAXA gives one 33% risk of heart attack!

Sounds like without it it will be god's Will or side effects taking it - bleed internally as well.

PRADAXA has a 110mg x twice day. I look forward to updates on this medication.

cheri. JOY. 73. (NZ)

[Buffafly]

AF (AFIB) can be below 100bpm. AF with a rate higher than 100bpm is Atrial Fibrillation with Rapid Ventricular Response (RVR).

[JOY2THEWORLD49 in reply to Buffafly]

What's the difference.

We all shorten our Atrial Fibrillation to A Feb.

cheri JOY. 73. (NZ)

[Buffafly in reply to JOY2THEWORLD49]

In the UK it’s AF, in USA Afib

[frazeej]

It has been jokingly said that a Holter Monitor is the best "cure" for afib, as all episodes miraculously disappear during the Holter time frame! Get a Kardia one lead-look for the classic "irregularity" of the heart beat, and look for the absence of P waves. You can check this when you are actually having an "episode". I wish I had stock in the "Holter company" for the number of times I've been "hooked up" with negative results. One look at my Kardia printout by the cardio guy "confirmed" the afib diagnosis. I am not emplyed by Kardia, but I love it!

[JOY2THEWORLD49 in reply to frazeej]

Um.

I have had 3 24-monitors and 4 eCGs and they ALL SHOW that I have

Atrial Fibrillation.

Persistent means just that.

cheri jOY. 73. 9NZ)

[JOY2THEWORLD49]

Hi

YES!

An irregular h/b is just that. Whether slow or fast your H/B is.

Both put you at risk for a stroke due to a clot.

cheri JOY. 73. (NZ)

[localad]

sometimes when I was in constant AF, I could feel my atria vibrating between the pulse beats. A sort of low ‘humming’ feel,

Fibrillation !

[frazeej]

I've attached 2 screen shots from my Kardia ecg's. (I might have to immediately reply to you second time if both images don't appear in this reply. In the a-fib ecg the irregular rhythm is clearly shown. The large QRS complex, followed by the t-wave is also apparent, but note the lack of small p-wave before the QRS complex. This is a classic a-fib presentation. In the NSR trace, note the very regular heartbeat, and also the very clear p-wave that occurs before the QRS complex. This is the "happy" trace!

Kardia ecg showing A-fib

[frazeej]

This is the NSR trace that I wanted (but couldn't) include in my first rply.

Kardia trace showing NSR-normal sinus rhythm.

[headwind]

Fraxee, thank you for the beautiful pictures and thanks to everyone who responded to my very basic question. It generated many inputs so I guess it was not so basic after all. Still not sure I totally understand the separation between the terms and Afib and arrhythmia but this makes me better equipped to query my EP.

My "irregular heartbeat" has been with me all my life so maybe I have been in and out of Afib all that time and somehow I have managed to make it to 77 y/o without anticoagulation. The majority of respondents said things like, "I would insist on anticoagulation from my cardiologist." I have tried it and the bruising and profuse bleeding from small cuts on the outside make me wonder what is going on inside. With considerable osteoarthritis I can hardly function without 200 mg. of Celeberx twice a day. It has its own internal bleeding warnings. After testing for Polymialgia Rheumatica an arthritis doctor, knowing I was on Apixaban and Celebrex, (he also takes 200mg Celebrex twice a day) offered a follow up appointment, "...if you don't bleed out in the meantime." How's that for a confidence builder?

The arthritis necessitates frequent epidural steroidal injections (ESI) and these require ceasing the blood thinners/anticoagulants for at least four days prior. Last ESI was early August '22 and I simply did not resume taking the Apixaban. Still here, no stroke. I am taking some krill oil and nattokinase. It is nice to no longer see a trail of blood behind me.

I expect many to respond that I am a fool but we can get into a discussion of quality vs quantity of life later.

Thank you everyone. This is a great forum.

Doug Clinton

Pickens, South Carolina