68, male, no underlying conditions, relatively fit, not overweight.
Afib diagnosed 2019. 2 cardioversions in 2020, 3 months apart. No problems since until recently.
Irregular heartbeat returned 2 days ago, after overworking on a diy project then stupidly rewarding myself with alcohol.
On Apixiban 5mg x 2 per day since December 2019
On flecanide 50mg x 2, Bisoprolol 1.25mg daily since June 2020
Have maintained same dosage since onset 2 days ago. Blood pressure now slightly lower than my average 120/75. Pulse irregular and recording at 40bpm on armband monitor as opposed to my normal average 55 at rest.
No distress but get fatigued with less exertion than before.
Just querying if I should wait for few days to see if return to NSR or attend A&E?
Many thanks for forum advice from those with similar experience.
Written by
gtkelly
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Pulse rate is a bit low but it might be worth checking your pulse manually for 15 seconds and then multiplying by 4. Blood pressure when in AF is almost impossible to check accurately with a home monitor so maybe take the average of 4 readings with a 15 minute gap between readings. Unless you are experiencing chest pains or feel faint or close to blackout I think I would be inclined to hold off going to A&E and see how things are in the morning. Be very careful not to miss your Apixaban doses. Not sure what the treatment situation is like in the South but I guess it’s NHS in the north. Regardless, try to find out from your medics the feasibility of having another CV asap. Try deep breathing exercises and or the Vasalver Manoeuvre (Google search) as they may help you back into NSR. Good luck, over 2 yrs is a good run and should bode well for future treatment…….
I’m normally someone who sits things out and monitors at home because if you have a cardiologist A&E have always told me that if it’s not an emergency then out patient clinic is the place to go. HOWEVR - we all know how that doesn’t play out these days! AND you have already been in AF for 48 hours so the sooner you can be converted, the better.
I would go by how you feel ie: symptoms rather than numbers on a machine and echo what FJ said about HR and BP fluctuating widely when in AF.
I would be inclined to see how you are in the morning but if still symptomatic with lower than normal for you resting average HR be first in the queue at A&E in the morning - if for nothing else - you will be registered and an alert copy sent to both your GP and cardiologist so can ask for a follow up out patient appointment.
I'm on daily Flecainide of 100mg (slow release capsule). I've been advised by cardiology nurse that I can take PIP Flecainide (these are 50mg quick absorption) if I go into AF. I can take either 1 or 2 of the 50mg tablets. I'm allowed to take a maximum of 200mg in total in 24 hours. I suggest you ring your Dr or cardiology department and see if you are allowed to do the same. In my case a little boost of Flecainide puts me back into NSR within a couple of hours of the PIP. Blake
have you had a device say it’s AF? If not get it checked. I had Ectopics for 5 days bumping around everywhere. Had way too much sugar the day they started. All good now after get holter monitor on to confirm it was ectopics
I have always informed my GP and Cardiologist/Electrophysiologist immediately when I have gone back into AF after a Cardioversion. My Gp initially and then the Cardio Nurses who work for my Cardio and EP on the day of the clinic - which is a Wednesday. I have then been seen usually within a couple of weeks at the clinic.
I have no medial knowledge whatsoever, so maybe treat this with a grain of salt but I was on bisoprolol too and I was getting a very low resting HR (around 45), feeling tired and very mildly light-headed. My cardiologist took me off it, leaving me just on apixiban and flecainide and my HR moved up to an average of around 60 and symptoms disappeared. I was given another betablocker, almost like a PIP to use when in AFib if my HR went too high which worked well. I've since had an ablation in Dublin and am now only on apixiban. I'd contact your cardiologist and have a review of your meds sooner rather than later even if symptoms have eased.
I suspect the too low pulse recording is not accurate; try to verify another way. I have found even taking it manually yourself like Flapjack suggests can be difficult. I once rushed to A & E when I could only count a pulse of 30 odd, but as CDreamer says usually more reliable is how you feel and I was told you will feel very weak if your pulse drops that far.
Fleacinide 100mgs/day didn't stop my AF but 200mgs (a medium dose) did for many years.
When commenting here, I try to persuade AFers not to look for a silver bullet of either pills or ablation and instead accept that you need to include comprehensive Lifestyle changes to keep the devil at bay eg on DIY projects, seek help to stay well within your capability and reward only with a non-carbonated non alcoholic drink aka filtered water 🤪. Relaxing after exertion, stress or emotional experience is the trap only avoided by moderation and a slow wind down.
Thank you everyone for the advice. When I used the armband pulse/bp monitor this morning it gave 116/82 and pulse rate 60 (beeps regularly spaced)
So I believed all good.
Played 18 holes of golf on a fairly flat course (4 hours)
I usually play 2 to 3 times per week comfortably.
However for the last hour of the round today I got breathless on any gentle climb and felt quite faint couple of times. Also perspiring quite heavily although air temperature only 17C.
So obviously NSR has not returned.
The only time I ever felt that way before was when I first had same feeling during exercise session in late 2019 which was diagnosed 2 weeks later as Afib.
Today is a bank holiday here in Northern Ireland so GP surgeries closed.
My plan is to fast from 6pm this evening then report to hospital A & E tomorrow morning. Hopefully they can do relevant testing/measuring and proceed to treatment/advice.
I've been on Flecanide 2 x 50mg daily and Bisoprolol 1 x 1.25mg since June 2020
Feeling ok as I sit here composing this update but know that I'm not.
Should I take extra dose of Flecanide or Bisoprolol? Any advice welcome.
Thanks so much to everyone for taking time to respond to my initial query.
I don't suppose you, or anyone who lives close by has an Apple Watch or an Kardia device to take an ECG and see what your heart is really doing?
I don't see any benefit in fasting, that will only make you feel worse IMHO.
60 bpm sounds normal to me, could you just be fighting off an infection? Bisoprolol keeps your HR low so if yours is 60 I don't think an extra dose will do any good.
Flecainide is for rhythm control, are you taking 100mg total a day or 200mg total a day? For some people an extra dose would help, for other it wouldn't and might make it worse. Really hard to give advise on this without an ECG, once again IMHO
Disclaimer: I am not a Dr, this isn't medical advice, just my personal opinion!
Thanks for the update. We are not medically trained or qualified therefore unable to offer advice on medication but picking up on KiwiBlakes reply, because you take Flecainide as a regular daily maintenance dose, you should ask your doctor if you should take an enhanced dose as a one off, Pill in the Pocket (PiP). This could be the quickest way to return to NSR but must only be taken if approved by your Doctor. As has been mentioned, 300 mg must never be exceeded within any 24 hour period. Certainly do not increase your Bisoprolol without consulting your doctor as this is likely to reduce your heart rate further.
Once again many thanks for advice. Very much appreciated. I take 50mg Flecanide in morning then again 12 hours later. Will attempt to get response from GP by telephone tomorrow morning for advice. Failing that I’ll go to A&E expecting a long wait.
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