Is Afib binary?

[Czech_Mate]

Apologies if this is a bit basic. I have a lot of uncertainty as to whether I'm in Afib or not. Is it possible that it's not absolute? Is there a definite point where I can say: OK this is Afib, before this it wasn't.?

[BobD Volunteer]

Only by looking at an ECG where P waves are missing in AF. Many people confuse ectopic clusters with AF

Remember that AF is just one of many arrhythmias though admittedly the most common.

[mjames1]

SHORT VERSION: Yes, in the basic sense, afib is binary. Meaning you are either in afib or you are not in afib. The most definitive diagnosed is by ekg.

HOW DO WE TELL? Due to afib's sometimes paroxysmal (intermittent) nature, it may not show up at your doctor's during the 10-30 seconds when they run your ekg strip. So if in doubt, I highly recommend a medically approved home ekg device, like the Kardia 6L. It has been a blessing for many of us -- and our doctors -- as an afib detection and management tool.

BUT NOT EXACTLY BINARY: Back to "binary". Not all afib's are the same. We have paroxysmal afib, persistent afib and permanent afib. We have fast afib. We have slow afib. We have afib episodes that can last seconds. We have episodes that can last days or weeks. So, in that sense, it's not binary, but again, in all these cases, the ekg is best in showing the unique characteristics of afib.

BUT CAN WE REALLY BE SURE? Even the best electrophysiologists (ep's) can look at the same ekg and sometimes come to a different conclusion whether it's afib or not. I've seen it in person. That's because at times, afib has attributes, or can be confused with other arrhythmia's such aflutter, Atach, SVT, etc.

Just remember, our heart did not go to medical school, nor read medical text books And while doctors like to give different names to different diseases and in this case, different arrhythmia's, it's not always so clear cut to our body

Jim

[Czech_Mate in reply to mjames1]

Thanks for taking the time to write this useful reply. I'm not sure why you've shortened it. I found what you said about the heart not following what text books tell it to do the most helpful part.

I am still coming to terms with whatever is wrong with me physically and psychologically. Some days I'd describe it as breathless, sometimes as fatigue, sometimes as weak, sometimes as just plain grotty. Then sometimes I think it's more psychological. It's impossible to plan things or even try to set goals, I feel I'm letting people down so making commitments is not a good thing to do.

Sorry I'm waffling, perhaps I should edit the end of this.

[Omniscient1 in reply to Czech_Mate]

Did you have fatigue.... before you were diagnosed or since? Might be a consequence of medication rather than the AF itself.

[Czech_Mate in reply to Omniscient1]

Fatigue and breathlessness were the two symptoms I had that made me go to the doctor in the first place. She diagnosed the problem and sent me to the cardiologist.

[CDreamer in reply to Omniscient1]

what you describe are very common experiences, especially when in the first few months/years. You learn to adapt, to learn to ‘listen’ to your body, to not worry about ‘letting people down’ but put yourself first so you can look after yourself. Explain to your friends that sometimes you may not feel up to interactions - if they are true friends they will understand and help. If not you don’t need them in your life. Took me a while to get that.

Keep goals really specific and achievable. Mine would look like- the ONE thing I must do today is………. Anything else is a bonus. This requires a mindset shift but you will be much more accepting of yourself, kinder to yourself and therefore less stressed = fewer arrhythmias & fatigue.

[Czech_Mate in reply to CDreamer]

Thanks for this; some useful ways to look at our lives. I very much identify with what you are saying.

[JOY2THEWORLD49 in reply to Czech_Mate]

Hi

AF is an IRREGULAR HEART BEAT.

I have this all the time. Naming mine RADID PERSISTENT AF and H/R.

My symptoms before control were excessive sweating and stopping in exertion.

Breathlessness can be better described as 'short of breath' or 'loss of energy' due to 02 not getting around your body so you stop.

Now controlled on meds, CCB for H/R and Bisoprolol for BP.

Metolprolol gave me breathlessness. Also 2 pauses x 2 secs at night. Banned for me. Also fatigue!

Controlled has given me back exertion without stopping, no sweating etc. Not all quality of life back but I am heading there day by day.

cheri JOY. 74. (NZ)

[Gertsen in reply to JOY2THEWORLD49]

what is CCB?

[John3333333 in reply to Gertsen]

Calcium channel blockers

[JOY2THEWORLD49 in reply to Gertsen]

Hi

Yes. A Calcium Channel Blocker. It relaxes the heart muscles, valves etc.

To me BB did not bring down H/R it was rapid and persistent HR with AF.

Metoprolol brought it down RESTING - DAY to 186! I was struggling with actual shortness of breath and fatigue but also 24-monitor showed 2 pauses x 2 secs at night. Night was always slow at 47 whatever I took.

Bisoprolol down to 156.

Private H/Specialist found resting @ over 120. Uncontrolled.

So CCB Diltiazem settled at 120mg AM and 2.5 Bisoprolol PM for BP

was what I needed.

18 months later 47 Night H/R. now 62-69 Day between 7am - 7pm. It rises later but bisoprolol keeps in check 7pm - asleeptime.

But CCB be very cautious with as it affected H/R within 2 hours and 1/2 dose 180mg was too much. Brought me down to 51.

My Dr said it should cover me for 24 hours but it doesn't with me. 7pm it

rises.

cheri jOY. 74. (NZ)

Very interesting how CCBs work. Go to Google and ask how they work.

[mjames1]

By special request, I brought back the long version

As to describing what you're going through, I think many here can relate. I certainly can. The physical can affect the psychological and then vice versa. Afib is a real journey and not always a pleasant one.

Jim

[Ppiman]

I wonder, do you mean is atrial fibrillation (AF) "absolute" as opposed to other atrial arrhythmias, such as atrial flutter (AFl) and so on? Or do you mean that general feeling of palpitations and chest discomfort, etc., that might be AF or runs of ectopic beats, mostly ventricular (PVCs)?

A home ECG device isn't entirely foolproof but can generally differentiate well between these by looking for irregular ventricular beat and a missing ECG "P wave" (i.e. the electrical signal from the heart's pacemaker which gets lost when the atria are quivering). My favourite of these currently is the new little Wellue device that has an AI algorithm and gives a good deal more information that my Kardia (which also costs a tenner a month for that information). There seems to be a 20% off offer at present. There's also one that can run for up to 24 hours and is more likely to catch the AF if it is intermittent. An Apple Watch works well, too, but is only able to pick up AF as an arrythmia.

Steve

[Czech_Mate in reply to Ppiman]

Hi Steve

What I mean? That's not an easy one.🤔 I guess I'm looking for a simple definition of Afib. I read that the symptoms vary so much and some people don't even know that they have it. So the atria have to be quivering for it to be Afib. So I think I mean: "Is it easy to say: 'Yes they are quivering' ,or, 'No they aren't' ?" Of course all sorts of other arrhythmias may be present to complicate things.

I think we also have to be somewhat careful that all this trying to work things out doesn't just leave some of us behind so we get more stressed and make things worse.🥴

[JOY2THEWORLD49 in reply to Czech_Mate]

Hi

An acquaintance who had episodes of AF after years and lots of meds! He finally had an ablation. Recovery of two rogue electrical responses at the same time. He is cured he says no AF, quivers etc for 18 mths.

Whereas I dont feel my rapid, persistent AF &H/R. Uncontrolled I was sweating profusely on any exertion and fatigued. Controlled I can sleep well at night or latter time of day with no sweating or little when I am exerting.

I remember back in 1980s I had palpitations but said nothing.

However in 2019 Sept had an Embolic Stroke (ischaemic) with AF and within 4 days diagnosed a shadow on my thyroid - no lump. Following Feb had it removed with 12 lymph nodes (2 affected).

After me they might do a routine scan of carotid arteries and thyroid.

I was hyper so when the surgeon removed it I did not go into toxic suppression.

I refused RAI Radio active Iodine which was routine to give after operation and

into suppression which I declined. Now in 2022 they say that anyone in low risk can be left alone re above. Its a strain on your heart to be in suppression.

Daily on Synthroid 125mg TSH between 10-2. T3. 4.0. T4 total 21-22.

The synthetic hormone thyroxin is working well.

So my AF was caused by the thyroid cancer and hyperthyroid. We are hoping it vanishes one day and it is documented that it might.

cheri JOY. 74. (NZ)

My energy level has improved with the above thyroid level and controlled H/R in 60s best.

[JOY2THEWORLD49 in reply to Ppiman]

Hi Steve

It sounds like you have a lot of gadgets.

I have a BP and H/R with memory monitor.

I'm lucky is I use it more than 10 times a month. And if the 1st BP and H/R Ok that's it.

There is a risk of a subconscious worry.

I say if you are feeling 'off' take readings otherwise enjoy life.

Live for the beauty that surround you and not the gadgets' readings which can change.

cheri JOY. 74. (NZ)

[Ppiman in reply to JOY2THEWORLD49]

Ah well, Joy, I've said before that the wonderful NZ air and climate have combined and brought you to be a carefree type! The damp British air and weather have colluded with genes to bring me to be the worrying type.

The gadgets are fun for me, really. I do like to know what is what and have the latest gizmos. It's the same with my bird watching, photography and computer gear- I just love technical innovation and high-quality engineering. We've just bought an all-electric VW car and it's a constant thrill to me to drive it! The ECG gadgets have never increased my anxieties, only the opposite, really.

Steve

[JOY2THEWORLD49 in reply to Ppiman]

Hi

Oh well, you are super sure that to see these gadgets monitor you, you aren't subconsciously worrying.

I like to see how things work but as I have my AF controlled I don't bother checking.

I am 4 years in September past the stroke,AF,thyroid cancer diagnosed, I look back at my monitoring in the first 3 years when not controlled and wish that CCB Calcium Channel Blocker had been offered.

Plenty of rain and wind in my lovely birth place. But 6 years on UK I loved it there and damp, rain, snow or sunshine - I felt at home. Both grandparents on both sides were born in Devon. I was working and took weather in my stride.

cheri jOy. 74. (NZ)

[Ppiman]

Good points. I suppose there can't be simple explanation for something so complex, which is why people use analogies instead (e.g. with words like "quivering" or whatever)? Some people seem to like the analogy of "flopping like a fish" but I never feel like that remotely and no one I know with this (all of five people) does either.

I've read that what most people feel if they feel anything at all is the effects from the increased (ventricular) rate rather than from the altered (atrial) rhythm. The pulse feeling we get is not even the heart, I gather, but the effect of the heart valves shutting and opening on distant arteries in other parts of the body, and even then not the arteries themselves but the nerves in other tissues around them. In fact, I am sure I've read that there is no sensation from the atria or heart itself at all, whether in NSR or other, although I know that some swear they can feel the actual fibrillation. I certainly can't feel anything except the fast rate and the symptoms from that - things like chest discomfort, a ton of anxiety and a need to breathe more deeply.

If you haven't seen this little gadget, it's worth a look as it gives a pretty good report of what it records, much more detailed than anything else I've seen apart from their more expensive version:

getwellue.com/products/port...

And this, the 24-hour version with an even more comprehensive report:

getwellue.com/products/hear...

Steve

[JOY2THEWORLD49]

Hi

You need tests to prove it. 24-hr monitor, Echo, ECG.

Your doctor taking your pulse physically should be able to detect unless you have episodes of it.

Before meds you need to be clinically diagnosed.

But some people have it without meds as the symptoms are few are far between with no symptoms much. Its how you feel.

Cheri JOY. 74. (NZ)

[lingooz]

hi, I had symptoms for over a year, never showed on gp visits, was told to call ambulance when happening to get a recording , well I did was 184 bpm could barely breath, doctor in A&E diagnosed it. Hope this helps