I wanted to share with you something that worked for me a couple of weeks ago for my paroxysmal Afib. We had friends over and I took a risk, of not only a very spicy Indian takeaway meal, but it arrived very late and I went to bed just over two hours after eating it 😳 so a double risky combination.
I woke up at 4.30 with the familiar feeling in my chest, looked at my watch and sadly saw my HR was already 147. Although lower than I’m used to, probably because of the Bisop I take, I tried to stay calm, went downstairs and took another 1.25 of bisop and 200 mg of magnesium glycenate. Then, instead of taking a very hefty dose of fleconaide, which is my PIP for these occasions, I remembered a video I saw on YouTube months ago of a chap who had SVT and did a vagal manoeuvre to get back to NSR. I don’t have SVT but they said it would work for Afib.
You need a prop! So I’d bought myself some cheap plastic syringes months ago on Amazon for this very ocassion ( hoping I’d never need them) and they’d been languishing in the medicine cupboard. I sat on our floor in the living room and blew into the small end, with my fingers holding my nose, for a few seconds, as hard as I could comfortably, without doing myself a mischief! I think it was probably 4 or 5 seconds. In the video, the idea was to move the sucker part a little way, but it’s very difficult believe me and I didn’t get to move it. I’m also not sure if you had to hold your nose as I couldn’t entirely remember it all, but at 4.30 in the morning, you try anything, so I may have added that for good measure 😊
Then I immediately lay down and put my legs up at 90 degree angle against the sofa for 15 seconds. In the video, someone held them up for him and he was on a hospital bed. I then lowered them gently (sort of moving them out of the way to the side and shifting my body up the floor). I then sat on the sofa and for added good measure, I pretended to strain as if going to the loo.
I really didn’t expect it to work, but immediately I realised that magically, I was back in sinus rhythm. It would have been far too soon for the bisop to have worked. I’d been downstairs just over ten minutes. I had taken a couple of Kardia readings already whilst in Afib , so I took a third, to check and yes, NSR. I was amazed. The last episode I had took two hours to resolve with a PIP. Not sure if it was the lying in the floor, or the straining that did it, or a combination of the two and it might not work for me again, but I’ll certainly try 🤞
I just wanted to share this with you all, as something to try if you can, in case it helps anyone.
NOTE: only try this of course, if you feel it’s safe to with your particular condition. I’m not saying it will help everyone of course, but it certainly helped me 😊
Teresa
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Valsalva manouevre (that is what you described) works quite well for tachycardia but lucky you if it stopped your AF. You don't need a syringe if you can keep your mouth closed whilst blowing very hard with nose pinched.
I'm off for a curry this evening , Afghani chicken with sweet potato vindal is my choice and chilli paneer for my wife.
Yes, I felt very lucky it worked for my Afib. I don’t think it’s put me off curry entirely , but I won’t ever eat it late again. It was a particularly hot vegetable dansak. Enjoy your curry Bob 😊
What you are describing is called the modified vagal maneuver. The "modified" part being when the legs are raised. In the US, it's first line treatment for SVT in many A&E's, replacing drugs.
That said, limited studies show it has very little efficacy for afib, but if it worked for you, great!
Personally I have had some success with the modified vagal maneuver for both SVT and a flutter, but not afib.
Again, great if it worked for your afib and no harm trying, however it does beg the question if you were actually in afib, or perhaps aflutter?
Did you take an EKG with a home device like the Kardia? If not almost impossible to tell what the arrhythmia was. And at a HR of 147, sounds consistent with afkutter with 2:1 block, which is a common flutter and what I usually get.
PS I take daily flecainide as well as PIP flecainide during an afib episode. My EP told me not to treat an aflutter episode with Flecainide, but rather use rate control drugs only. Another reason to get a home EKG device like the Kardia.
Of course, your doctor may tell you different, so always good to consult with your doctor before taking (or not taking) action on your own.
thanks for coming back. I do apparently have Afib. I was diagnosed with it last year at our A&E as that was the only way to get it caught on an ECG after suffering ocassional episodes for many years. Two weeks ago when I had this episode, my applewatch Told me it was Afib and I also did two seperate Kardia readings, which also said it was Afib. I’m on Advanced Determinations with Kardia too snd also sent an ECG off to them for further analysis and they came back saying it was Afib. I’ve also seen a cardiologist twice and they keep telling me it’s Afib. It was a cardiologist who told me to take the PIP regime of the fleconaide dose, which I’ve only taken once so far.
I used to be in the HR range of 180s but since being on daily bisoprolol, I think it was the effects of that, that made it in the 140s. That’s not a normal rate for my episodes.
To be honest with you, I have doubted too whether I have true Afib and I think there is something else going on, as I also have had long periods of fast, regular NSR during some previous episodes ( caught on applewatch only). I’ve also shown an EP some print outs taken from my applewatch of my episodes but he didn’t really want to look at them ( long story) and said he ‘didn’t like applewatch ECGs’ but also said it didn’t look like Afib…but wouldn’t say anymore 😳
Thanks for coming back. My next plan of action is to take my latest Kardia prints and past Apple ECGs along to my next cardiologist review and make them look at them, but with everything going on in the UK with the NHS at the moment, I have no idea when that will be unfortunately 😞
Excellent that you could resolve your AFib so quickly. It’s always going to be impossible to know whether it was the techniques or whether it would have resolved by itself anyway, but so quickly is very impressive. My episode the other night went on for an hour or so and I’m relying on the Kardia reading to have it confirmed as AFib but it certainly looks like it. Looking online, Aflutter has a completely different pattern to AFib to my untrained eyes, so what would I know? When these events happen in the middle of the night you just want to fix it yourself without going to hospital. If you can, that is. Brilliant that you could.
Thankyou, yes, I was pleased and thought I’d mention it in case it helps others. I certainly did a few things that night and something I did stopped it. Whether it will do it again is another thing, but we all try what we can, to stop ‘the beast’ 😊
I hope you don’t mind, but I’ve taken a photo of part of my Kardia ECG…please can you tell me if there are any similarities with your flutter or SVT on your ECGs?? I do understand you’re not medically trained of course and nothing you tell me is conclusive, I’m just curious, as I mentioned, I haven’t always been 100% convinced it’s always pure Afib.
With the understanding this is way beyond my pay grade and that you should not act on anything said without consulting with your doctor, I'll give it a go.
The ekg you posted would be read as afib by most doctors and apparently Kardia's cardiologists did as such. However, especially on the second lead, there is some regularity with a sawtooth aspect to it which also suggests aflutter. This is not that unusual and it doesn't mean you have been misdiagnosed with afib. It just means that you might also have aflutter. Many have both, I do. It could also be because of the flecainide which tends to induce aflutter, which is why most take a nodal blocker such as a beta blocker or calcium channel blocker with it.
So how does this translate into moving forward. Well, if you are planning an afib ablation, I would imagine they might try and induce flutter at the same time and if so ablate the flutter line as well, or perhaps do it anyway if an ep thinks you have both arrythmia's.
In my case, most of the time it's pretty clear whether I'm in afib or aflutter, that's why I have different PIP instructions for each. For afib, I take extra flecainide. For aflutter, I was advised not to take extra flecainide but rather to treat the rate only which in my case means taking diltiazem but it could also mean taking a beta blocker. In the case of someone presenting with both afib and aflutter at the same time, which you may or may not be doing, I have no idea whether you should take flec or a nodal blocker. A good question for you ep although even the best ep's sometimes have trouble distinguishing one from the other without a 12 lead.
So in summary, it seems that your afib diagnosis is correct but you may also have a bit of aflutter with it, either because of the nature of the beast or perhaps from the flecainide. And also, that there's probably nothing highly unusual about that.
As to the successful modified vagal manuever, if it works, go with it. Certainly better than popping more flec or an electro cardioversion. However, statistically, the modified vagal manuever works better for SVT and aflutter, which again suggests that the ekg you posted may be mixed.
Have you ever had an ekg with pure flutter? The Kardia would probably read it as "tachycardia" or something else because Kardia is not presently programmed to make an aflutter call.
First of all, huge thanks for coming back with such a detailed response. I am truly grateful - and for taking the time to read my snapshot.
You’ve verified what I thought and that there was something else going on. I don’t actually take fleconaide daily, only bisop (1.25mg) & I’ve only ever taken flec once, last Nov, as a PIP. I’ve actually had this fast rythm in my apple ECGs long before I took the flec PIP, so I have probably always had this flutter going on. I made sure I didn’t take flec without a beta blocker too last Nov.
Unfortunately I’ve only got Apple ECGs with “fast heart rate” showing and detecting no Afib during previous episodes as I only got the Kardia this year. I could be 2 hours with fast NSR in previous episodes. I haven’t shown the cardiologist those, but I’m certainly going to. I imagine there must be a P wave in them, as suspect Apple watch’s algorithm says afib when it can’t detect a P wave, but I don’t know.
Certainly a lot to think about. I am very appreciative Jim for your help. Thankyou again.
So much for Flecainide as the cause! Would love to see those fast HR Apple EKG's if you still have them. Like Kardia, Apple will not make a determination for aflutter and probably would just classify it as a fast heart rate. And definitely show them to your cardiologist but an ep really is the one to read them. That said, I've had several ep's look at the same single lead EKG's without consensus as to whether it was SVT, Aflutter or Afib!!! The "book" determinations (p waves, saw tooth, etc, etc,) don't always work in real life.
Thanks for offering to look at my fast heart rate Apple ones, here is a typical one. It’s really interesting as when I looked back at them all just now, they are all below HR 150 and mainly in the 130s and 140s. This was before I ever took beta blockers and diagnosed. (I do have other Apple ones showing afib in the 180s of course)
So very regular and doesn't look like afib at all. As to what tachycardia it is -- aflutter, atach, SVT, etc -- I'll leave that to the experts but would not be surprised if they said aflutter.
I did wonder and it’s nice of you to confirm my doubts too. I’ve had this in every episode. Perhaps it will strengthen my case for an ablation as I’ve been told by an EP that I can’t have one until my episodes are worse. I did see the EP privately, but he didn’t like Apple ECGs so wouldn’t look at them 😔
Hopefully I’ll be able to see my cardiologist again in the near future and get him to check them out - and properly this time. The frustration of getting a proper diagnosis adds to the challenge 😊
Yes, AFL regular and AFIB irregular therefore the determination of afib. However when I showed a similar ekg to an ep and asked if there was some flutter in there, the response was "maybe". Again, hard to tell without a 12-lead and even then there might be some disagreement among ep's and not sure how much significance it has until one has an ablation and then hopefully it will be sorted out in the ep study. Not sure why lead 1 seemed upside down either but maybe a setting somewhere?
Ah, I see your reasoning. When I had AFl, the doctor had to inject adenosine (?) to show the flutter on a 12-lead machine, if I recall. I was told it can be hard to separate from AF and other arrhythmias without that.
It wasn't just me regarding Lead 1... Perhaps the Kardia was held upside down accidentally? There also seems to be several "P" waves showing which wouldn't normally indicate NSR or am I reading them wrongly (I am an utter amateur)?
You do well to keep well with fast flutter. It floored me, although, looking back to those pre-ablation days, I have come to suspect that fear accounted for much of the state I was in.
Best wishes and thanks for your helpful replies which are always most interesting.
Interesting about the injection. My aflutter episodes generally only last minutes so no time to get to a 12 lead. I just did an upside down Kardia reading and lead 1 was indeed upside down but some of the other leads seemed ok, so dunno.
Well, you're more diligent than I am, upside down or not. I usually only take a single lead ekg with my Kardia 6L although the six lead tracing def has more info.
I see you’ve asked Jim - thankyou 😊 Now you’ve got me worried lol. I just looked at all my ECGs and I wonder if it’s that particular snapshot on the Kardia…though I see what you mean. I think a few looked the right way up during the 30 seconds of ECG….😳 Jim may know…..
Hi Teresa - I wonder whether you held the device upside down for that one? I've done the same! Your story of your 'conversion' was fascinating! I don't envy you getting fast AF. Mine is an unusual event these days and except for just after my ablation, it is usually at a much lower rate and far easier to cope with.
I hope that a possible additional flutter might strengthen my case for an ablation, but with the way things are with NHS at the moment, I have my doubts, but I can but try. I know ablation isn’t always a foregone conclusion or cure though, which plays on my mind, but I just want to try and make it all go away 😳 I’m glad you don’t get yours very often since your ablation these days.
My son’s colleague - now 76 and still working a little - has had, if I am right, five ablations but has been told he can have no more. Unfortunately after years free of problems he’s recently started with atrial flutter, although is still coping well.
That’s a lot of ablations. He’s doing well still working at 76 though. The Pulsed field ones look promising, if they ever get to be performed more in the UK. I can live in hope that one day, it might be gone🤞
I’ve used the Kardia upside down too! I wondered why the tracings were upside down. I think the Kardia has an option for flipping the tracings the right way if that happens. But the important thing is that you managed to record it. I lost a reading because I wasn’t logged in and couldn’t save it. When I did log in it had vanished. That was another lesson learned.
I shall have to try and remember to have it the right way up next time. I wish it had something intuitive on the front that could clearly identify it being the right way up, rather than a shape that looks like a V but isn’t meant to be a V😳 doh!
We have a forum member here who works on the Kardiamobile App. He might kindly look at it for you. I think he's cakked Dr Dave but I'll check in my messages for you.
My Applewatch ECG when I have my almost monthly PAF for 1-3 days shows clearly the irregular periods between beats, the HRV . As you know the Applewatch also measures and reports the HRV and in my case goes from the SNR HRV 20 to 50 msec to over 200 = 250 msec when in PAF. My normal resting HR is around 50 BPS and in PAF goes up to 150 BPS. Your periods between beats looks very regular to me. I am 74, on 100 micro gram Thyroxine, 1.25 mg Bisoprolol and of course 20 mg Xarelto (Rivaroxiban). When in PAF I continue my normal daily activities, just out of breath quickly. I will definitely try your described procedure and report back. In my case, when in PAF, and load up my van with 65 bags of 15 kg wood pellets , I seem to go back in SNR every now and then.
Thanks, yes, that applewatch ECG was saying I was in sinus, even though fast and I get a mixture of that and irregular ones during my episodes. It’s the regular parts that I need to get some formal diagnosis of-somehow. Hope the procedure might help you, no harm in trying but do be careful with it as the blowing part can take a bit of puff.
That often worked for me - taught to me by the Paramedics but not instantly for AF. What would happen would be HR would reduce and then AF would cease.
It’s knocked my confidence a bit though. As I hadn’t had one for so long. I think I’d become complacent. Whatever it is, it’s always lurking, it seems.
Thank you for sharing this information Teresa. It sounds like you did a combination of some well known procedures. The thing is that combination worked for you and that's what's important, let's hope the combination will work for others. I once did the legs up the wall procedure in my nightie while lying on my bed and it made me come over very faint. I couldn't help but laugh wondering what people would think if I was found dead with my legs up the wall!
Yes, you’re right, I’m glad nobody came in and saw me 😃 I had my pyjamas on thankfully. I will certainly try it all again next time and do the whole regime in the hope it might do the trick again. It saved me taking 300mg of Fleconaide as I don’t like taking such a large amount in one go.
Keep trying, you never know, it might work one of these times. I honestly didn’t think it would and perhaps that was the key, as I didn’t expect it to work 😳 or perhaps I was just lucky…
Initially Valsava manoeuvre worked for my wife who used to suffer from SVT (over 200bpm) however it didn't work on second occasion of SVT so we had to go to A and E for drug induced cardioversion. Scary times then but my wife has since had a sucessful ablation approx 4 years ago at St Barts Dr S Sporton) and has no more SVT episodes.
Hi Nick, yes, chances are it won’t work next time, but I’ll give it a go. So glad to hear your wife had a successful ablation, she must be over the moon.
Im so glad it worked for you! I will give it a go too. I do love a curry but stay away as they trigger my afib as does alcohol 🙄. Im a cheap night out!
well done same thing happened to me mid week after late night rich food and drink. I lay on the floor with my legs up against the wall, sure enough I went back down to 80-90 … I woke up with the dreaded feeling of unwell and a racing heart x
I have stopped Afib on two occasions using a Vagal maneuver (holding mouth and nose and blowing while bearing down followed by a deep exhale), I have taken Kardia traces directly before and after both times. It doesn't work every time though but is worth a try. I got my last episode to terminate by going down and back up 10 flights of stairs.
I use the Valsalva maneuver a lot to get back to NSR. It is most effective if you use it as soon Afib begins, I have had occasions where I am back in NSR for only 15 minutes or so then need to try the maneuver again. If I can't get into NSR then I need to take Flecainide.
I have a French made Withings Scanwatch, a dedicated Afib watch that tell if you are in Afib or not. It provides ecg reports that surprised my cardiologist as to how accurate they are.
Another vagal maneuver to try is one where you insert your thumbs in your ears for 20 seconds and move them up and down, here is the video. youtu.be/gn5gihOWuv8
I find just the thumbs in ears part works well. Just don't do it in public as you look a bit silly doing it. This stimulates the vagus nerve directly as it branches out into the ears.
I can do this in bed while lying down and it is very effective in getting back to NSR.
Thanks for the link to the video and I hope this helps others too.
This looks like an interesting one and I like that you can also do it whilst lying down. I didn’t know how many organs are connected to the vagus nerve. Yes, I would definitely need to take Flecainide too, if I didn’t get back into NSR. I’m glad it saved me that as I really don’t like to take such a large dose in one go.
Hi Teresa. Same idea worked for me without the props. I held nose and blew really hard. Have always been a bit scared of trying it but was so frustrated at having another episode that I went for it. And guess what it worked. I was ecstatic..yes have solved it.
Of course did not work next time.
I understand you completely. It’s never knowing when you will take one. But good luck. Linda
I’m glad it worked for you 😊 though sorry it didn’t work the following time…did you lie down straight after with your legs against a sofa though? 😃 if not, perhaps try that next time? ( 15 seconds)…you never know.
Yes, I will feel gutted if it doesn’t work next time….I’ll try anything to avoid a PIP 🙄
I will try the legs up bit the next time unless I am outside in the shops or something lol. Like you I try everything before resorting to an extra pill. Let me know if it works a second time. Linda
Just curious, my OH has Afib and takes 1.25mg Bisoprolol daily along with Apixaban anticoagulant. His PIP is one 5mg Bisoprolol, never heard of Flec. He sometimes takes a couple of days to return to normal heartbeat. Also one poster mentioned a magnesium supplement, does that help shorten the episode?
I meant to add, fleconaide is an effective anti arrhythmic medication. It’s prescribed initially by cardiologists only, usually following an echocardiogram of the heart and is given only when there are no structural problems in the heart. It’s really effective and usually taken with other medication ( like a beta blocker) and can help keep the heart in Sinus rythm. Some people take it every day and some take a larger dose only as a pill in the pocket.
Taking Magnesium isn’t guaranteed to shorten the episode, but many say it can help alleviate symptoms and some people have said it can help lower heart rate. They sometimes give it intravenously in hospitals for afib too. A lot of people are very low on magnesium. Getting electrolytes balanced when in afib certainly can’t do any harm and diarolyte sachets can also help. I take magnesium daily anyway now since being diagnosed and it has certainly helped me. It has to be a ‘good’ magnesium though, as some ( cheaper) ones do very little and aren’t absorbed. I take a mix if magnesium glycenate and magnesium taurate throughout the day.
it wasn’t the magnesium that shortened my episode that night though as I’d only taken it ten minutes before I went back into NSR.
Thanks so much for the information. Please could you give the name and brand of the magnesium you use - or even a link to the seller, as remember OH saying he was put on a magnesium drip in hospital. Many thanks.
I get my magnesium from Revital - a UK company on line, they do loyalty points and also have good prices…I buy Nutri Advanced Magnesium Glycenate (120 tabs) and Viridian magnesium taurate -90 tabs. I take, in total 300 mg (3)the magnesium glycenate a day and just over 100 of the magnesium taurate (2 pills) - ( they’re quite large pills and can be a bit tricky to swallow, but you can break them in half which helps) …you can just buy the glycenate and take taurine seperately, which some do as it’s cheaper…I stick to this now though as my body has got used to it, so I’m a bit hesitant to change. I started off on about half this amount and upped gradually over a couple of months….I could probably increase more as my Leveks still aren’t really very high, but higher than they were, but they are now in the normal range. It can take a long time to raise magnesium levels and I’ve been taking it about 9 months now and it can take that long. I take it after food, but in the evening about an hour before bed,
It is worth your husband asking for a blood test to check his magnesium levels and also vitamin D, if he hasn’t done that already. I noticed you said it can take a couple of days to return to his normal heartbeat, has he seen anyone to ask about taking something extra to help him return to sinus rhythm faster? Is his heart rate really high for two days? Does he record his episodes on anything so they’re captured? Does his GP know?
This is the advice he was given by the specialist AF nurse when he was discharged from hospital. Hasn't seen a GP about it, but then trying to see a GP where we live is virtually impossible.
Many thanks about the magnesium information. I may well try taking some as well because I get terrible night cramps in my legs and feet and have read that magnesium can help with that.
Apologies…I missed the fact that takes an additional 5 mg as a PIP. It’s a shame though that it’s not settling the rhythm until after 2 days. It’s entirely up to you, but I’d really push to get a GP to refer him to a cardiologist to discuss how long it’s taking for him to get back into rhythm as the PIP doesn’t sound like it’s working very well. Hopefully the magnesium will help and yes, it’s certainly supposed to be good for cramps too. Some say the magnesium spray works well for that, as it gets absorbed by the skin in those areas. I’m not sure if Revital do a spray, but other sites certainly do I think.
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