Over the last month I went into Afib 6+ times. The first one lasted about 12 hours. The next 3 I ended up in emergency and they had to cardiovert me. The 5th time lasted 24 hours. The 6th time, however, lasted 5 days. But I was so fed up with sitting in emergency for 12 hours and getting my chest blasted, I decided to just wait it out.However, I think I read somewhere that waiting that long does damage to the heart. And/or it reduces the chance of an ablation working. I am on apixaban (10 mg per day), and Hydrochlorothiazide (lowers blood pressure - 12.5 mg per day). And now I just started Sotalol (160 mg per day) - and this has made it much better. I am no longer in almost permanent Afib.
Is it bad for you to just wait out an... - Atrial Fibrillati...
Is it bad for you to just wait out an Afib spisode.
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dave22222
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BobDVolunteer
As another member once commented, if I went to A and E every time I had an AF event I would live there. It is not an accident nor emergency, it is a chronic condition which should be treated as such. Of course any chest pain or dizzyness/ fainting needs investigating but so long as rate is well controlled and you are antcioagulated stick with your regular medication and get on with life.
I think it is a personal decision. I think I went to A&E a few times at the start of my AF journey and then gave up. My longest time in AF was about 4 days. I think we need to remember that AF with HR within normal range and without symptoms such as extreme breathlessness when at rest, feeling very unwell or chest pain is not normally considered life threatening and therefor not an emergency and if you are being treated as an out patient.
Also every country has different protocols and offers varying services. From what I understand Canada is not well served regarding AF specialists and choice of treatments and treatment centres. You are correct in that the sooner AF can be treated the lower the risk of long term damage to the heart but in the UK treatment would never happen in A&E unless it was immediately life threatening. You would get a report to your GP resulting in a referral from your GP to a cardiologist/EP outpatient clinic for treatment.
You really need to take advice from your cardiologist as to when you need to either call paramedics or go to A&E because they will know your full medical history.
I nearly always sat episodes out at home and only when at the insistence of my husband or very good neighbour who was a nurse would call a doctor. Since treatment thankfully my episodes are now few and far between and much less bothersome whereas at their worst I would have 4-5 episodes a week, worst lasting up to 72 hours.
BobD , have you ever had AF that makes you feel really ill? You often say you carry on working on cars and ignore your symptoms. I can assure you I could never carry on when I had a lot of my attacks. Just moving made me feel really ill. Also the symptoms are terrifying for some new to the condition.
After my first attack calmed I was sent home from A&E knowing nothing about AF and was given wrong information from the duty consultant. I won't repeat it here, but I wondered if my heart was just going to stop beating.
I was quite often admitted to a ward when I went to A&E. My heart rate would go up to 160 plus. I was once told off by a nurse for not going in earlier. I think it depends on your heart rate and how you are feeling. I once asked a GP when I should go to hospital and he said if my heart rate was over 130bpm. If someone knows their heart rate usually calms in a few hours, then I'm not saying they should wait it out at home, but I would.It's odd because I sometimes read on here of people's hearts misbehaving for minutes and it causes concern. I once had a young lad in the next cubicle to me in A&E and his heart had raced for a few minutes. The docs gave him a lot of attention and I wonder whether the younger the person the more concerned docs are. I guess it's maybe their first bout of arrhythmia.
Jean, I would completely agree with your opening paragraph addressed to Bob. There are others on this forum who give similar advice. I can only say that their experience of an AF episode must be very different to mine or yours.
Jean your experiences must have been very different to mine. I think you know that my hospital experiences were absolutely terrible and my HR was a lot higher than 130! 8 hours sitting in a crowded waiting room without even triage, monitoring or anything else put me off going and I was the one saying if I gone to A&E every time I had been in AF I would be living there. I was much more comfortable at home, yes I felt terrible and yes I couldn’t do much but that was much preferable to being very uncomfortable in A&E.
I do think that worry plays a huge part and if you are on your own, that is much more difficult - which is why I say it has to be personal decision but AF is not an emergency, though it feels like one.
I agree with the comment 'You can't go to A&E every time you have an AF attack''. However, from what I read here I think some people have debilitating attacks of PAF while others have mild and can carry on with what they're doing. Some people think that PAF is only as bad as they have experienced and don't seem to understand that others suffer far worse and feel disabled by an attack.
Honestly, when at my worst I could hardly walk from one room in my house to another. Once pre my 3rd ablation I had to struggle to keep conscious and poured with sweat. By the time paramedics arrived I was feeling a bit better and my heart rate was down to 160, goodness knows what it was at the start when I felt so ill. My BP machine was saying my heart rate was 60bpm and when paramedics took my wrist pulse it was the same, but once connected to an ECG machine they saw it was 160. It was the cause of a great debate amongst them as they'd never seen that before. When at hospital I asked the consultant whether he'd seen this before and he said he had but it wasn't usual. This is why I've never bought a Kardia as my radial pulse doesn't always match what my heart is actually doing.
These days, with my heart rate much reduced, like others on this forum I hate A&E and have to think I'm dying before going there.
Jean
It’s interesting what you say about checking the pulse and an ecg. I often read advice like ‘ you can tell if your heart rate is high or low by checking your pulse’ …… but that is not necessarily the case, as you have experienced. When feeling the pulse, all the little abnormal beats are not always detectable and it can feel normal even though there is Afib present. You say you won’t have a Kardia, but that at least distinguishes the difference and shows up irregularities ( don’t I know it st the moment ! 🙄 ). You have certainly had some bad experiences - hopefully all calm for you now, and for a long time.
Annie.
I agree, I'm new at this, so ... But I measure with kardia, an apple watch, and a regular sys/dia/pulse monitor. Of the 3, kardia is the only one where you can see the incredible number of little beats. and is the best measurement overall. The regular monitor is almost useless at detecting problems , and pulse is never high even when I am in Afib and the heart having a party at 150+. Worse, I have been having the same pains, chest pressure for 25 years plus, and the Dr said monitor your rate. I even had fainting spells. But the monitor never picked up a problem..... So for me monitors are only useful for sys and dia - their pulse measures are useless at detecting all the smaller beats.
I have had the same experience regarding heart rate and pulse being vastly different. The doctor I was seeing in the hospital at the time said it can happen when you are in AFIB. If your heart is beating normally, they should be almost the same.
Martha
What I was told was to go by symptoms such as breathlessness, dizziness, fainting or feeling faint.
I measure with kardia, an apple watch, and a regular sys/dia/pulse monitor. Of the 3, kardia is the only one where you can see the incredible number of little beats. and is the best measurement overall. Pulse is absolutely useless at measuring Afib and the bpm. I would seriously buy a kardia. According to my regular monitor my pulse was fine for 25 years +. And my Afib episodes were very far apart so never detected by the short ecgs Drs do. And my monitor still does says my pulse is fine even when i am in Afib with a bpm of 150+.
If I had a Kardia it would make my life a misery. I'd be looking at it all the time and getting anxious and making my AF far worse! I know by how I feel if my heart is misbehaving. I'm in low level permanent AF 60-90bpm now and life is good, there's nothing I can't do. I've had AF for 18 years, 3 ablations and numerous cardioversions.
Jean
Jean can I cut in here please if it's OK, What is the best way to evaluate your heart rate as its all over the place in fast AF, many thanks.
Go by how ill you are feeling. If you read my post above that will explain why I say this.
Frequently back in the day, with rates sometimes 200+ until initially the flecianide kicked in but as I was told by my EP " AF Won't kill you" . After six months he changed me from Flec and atenalol to Propafanone full time but whilst that kept events below 200 and often as low as 150 it never stopped them even at 900mg daily (3x300mg) which is the max permitted. .
Between my second and third ablations, atrial tachycardia became the bigger problem with rates usually around 140-150 which needed cardioverting but I often had to wait a couple of weeks to get that done. On one occasion I was booking into O'learies mob at Stanstead to fly to France to see my sister when it kicked in but I wasn't going to waste the money and carried on. E mailed my contact and she booked a DCCV for the week after I got back. That was third time and the second from last DCCV I had, the last one being the one that nearly killed me so not keen on repeating.
I do stress with my posts that any chest pain, fainting or dizziness must be investigated but firmly stand by my comments that AF is nether an accident nor an emergency and must be treated as a chronic condition.
I have accepted in the past that we all have different levels of acceptance and ability to deal with these things but surely knowledge should reduce the possibility of anxiety which as we all know exacerbates the problem.
I think bob meant if it’s causing you to feel poorly or accompanied with pains etc then yes get to hospital of course. I myself nearly lived at A+E in the beginning of my Afib episodes but as times gone on I no longer visit hospital because I’m lucky enough to be able to sit it out at home as Iv never felt ill nor has it ever give me pain etc because then yes I would go to hospital definitely.
Generally speaking a persistently fast irregular heart rate which is not responding to your usual beta blocker/anti arrhythmia drug requires medical attention. How long you sit it out is up to you and how you are feeling.
With my last 2 episodes , 6 months apart, I left it several days before I presented at A&E due to a feeling of guilt . I was on the point of collapse, was questioned why I had not come in sooner and was duly electrically cardioverted before being discharged. I would also mention that I am treated as urgent when presenting at A&E with minimal waiting.
Good thing you got yourself to A&E. Rather than most of us being anxious wrecks over “not an accident not an emergency” I would say there are many more people who avoid going to hospital, who.don’t want to be a burden and don’t think they’re bad enough to receive proper medical care. Sometimes it is absolutely the right thing to do.
If your rate is controlled, then ok not to go to the A&E. However, what you don't want to do is to leave your rate uncontrolled for hours and hours or days and days. Over time, that can lead to heart failure.
Before I self converted at home with Flecainide, I would use Diltiazem, a Calcium Channel Blocker, to get my rate down to around 100, then I would wait to naturally convert. Many do the same thing with beta blockers like bisoprolol.
If you don't have such a plan with your doctor, you need one.
Again, the key is to have your rate controlled while in afib.
Jim
How much Diltiazem do you take when in an episode? I currently take 2 flecainide and one Diltiazem once daily. If I have another AFIB episode will the Diltiazem help keep my HR lower than the 220BPM When my first episode happened?
Thank you!
When I was on 50mg Flecainide, twice a day, I also took 120mg Diltiazem a day. The Diltiazem was for safety reasons. When I went into afib, my instructions were to take another 50mg of Flecainide. Then if not in normal rhythm within an hour, take another 50mg. I did not take extra Diltiazem and always converted in 1-4 hours. That said, if I didn't convert, I probably would have taken more fast acting Diltiazem tabs to get my HR down close to 100. Keep in mind, these were my instructions, based on my individual history and yours may be quite different. I also should add that my HR was closer to 150-160 rather than 220. So in your case, maybe xtra Diltiazem would be needed. All something to speak to your doctor about.
Jim
Thank you Jim, I didnt realize that Diltiazem helps with heart rate.
Thank you for the input. When you say controlled, what exactly do you mean. Is controlled keeping the rate below 100?
That was my target. To get my rate close to 100 and ideally below. That rate would be both for at rest and walking around slowly. I used mostly Diltiazem with a very little bit of Metoprolol to accomplish that. Once my rate was controlled, then I went about my daily business until I naturally converted. That was usually between 1-4 days. When my afib episodes got longer than that, I switched to daily Flecainide and then used extra Flecainide as a Pill in Pocket. That's because even though you want to control your rate when in afib, ideally you don't want to remain in afib more than a few days, or eventually your heart can start to remodel.
Jim
I am into my 13th hour of Afib as we speak. Normal resting HR late 50s-early 60s. In Afib late 80s-early 90s. once it settles to being in it. When I move it shoots up to 118/122. I only take Flecainide 50mg bd and apixaban. I’ve been in this game 18 years and only been to A&E twice (apart from in the beginning when I was being sorted) and that was because of chest pain.
Over the years my Afib has changed. I use to be extremely symptomatic. I still am going into it when HR is 115/120. Nowadays if I am just sitting or in bed I can barely feel it if at all. Once I move it’s a different story though and feel quite under the weather.
As usual I will sit it out today as it’s not an emergency. I average 12-18 hours. Longest was 57 hours. I’ve bought an Amazon fire stick so will have plenty to occupy me. If there was chest pain or shortness of breath then I wouldn’t hesitate to go to A&E.
Take care.
P.S. Just had a bit of eureka moment. I’ve had 2 failed ablations. I know Afib has a mind of its own but thinking about it I’m sure my changes have only happened since medical intervention. I will need to check my records.
I guess we're all different tolerance and symptom wise. I just wait it out, I don't have any medication and the bouts vary in length, some last only a couple of hours most stop overnight, one or two have gone on longer but no longer than 24 hours. Heart rate has been up as high as 165 but seesaws up and down. Symptom wise I have a hot flush followed by just generally feeling uncomfortable, no pain or dizziness so I tend to sit still and try to relax or carry on as normal. I've never been to A&E as so far it's reverted on its own.
My wife's been in AF since March. On Nebivolol which is keeping her resting rate between 70 and 120. Booked for a cardioversion but informed wait could be 10 -12 weeks. Consultant seemed quite OK with waiting it out.
I gather that the potential issue is having a long-term racing heart (i.e. tachycardia) that AF can bring in its wake. This can weaken and damage both valves and ventricles, over time, I have been told, reducing output and bringing symptoms, perhaps permanent ones.
Protecting the lower chambers and valves by keeping the ventricular rate below 100bpm is, therefore, said to be far more important in the long term than controlling the atrial rhythm, so your new drug sotalol should do that trick admirably well. My elderly friend has been in permanent AF for years now, but at a normal rate, and remains well for his age (nearly 90). I was told that sotalol is older and less specific in action compared with flecainide, so you might ask your doctor about that. I can't take either, sadly. for some reason. I was told that anti-arrhythmic drugs carry greater risks of side effects than, say, beta-blockers, so ask about that, too, maybe. That's perhaps why sotalol has been selected as it also combines the two actions and is well tolerated.
As for whether an ablation is less likely to succeed if the rhythm is allowed free reign for a long time, well, there are studies that suggest this to be true, but it seems hard to be sure statistically since the actual cause of AF is often left unfound and is individually complex that an individual's prognosis can never be accurately worked out anyway.
Steve
I am in my third day of P-AF and expect the episode to last 4-5 days, I have just a couple of days which are AF free between these long episodes nowadays.
I am symptomatic feeling ill with breathlessness, headache and hot sweats that make my life a misery, my EP is aware of this , flecainide didn't work , I was offered Amiodarone while I wait for an ablation but declined after my experience with flecainide and I am concerned about taking such a powerful 'temporary' drug for months to come .
I have been on a waiting list for an Ablation since Dec/January when I had a telephone conversation with a nurse and said I can't go on like this I have no quality of life , I attended a clinic in January and it was confirmed I am on a waiting list for an ablation then 8+months long . Since then my local hospital 40 mins away has stopped doing ablations.
I recently had a text from another hospital 1.5 hours away saying did I still want an ablation because I had been referred there so my guess is I have gone to the bottom of their list .
My EP seems totally unconcerned about my symptoms and suggests I go to hospital if I have chest pain or faint , if I went to the local hospital which is in 'special measures' I can expect a wait a of 15 hours before being sent home because there is nothing they can do for me, cardioversion is not an option because my 5 day episodes of AF are not deemed long enough and there is a 10 week waiting list for cardioversion .
So I wait at home knowing there is little help to be had from the NHS in my area.
When in AF I do what I can to keep going restricted by my symptoms. Slow breathing helps me to do my household tasks , to walk my puppy a mile very slowly with the help of a stick and to do the excercise I must do daily to try to stay mobile because I also have painful severe osteoarthritis in my spine and both hips.
Edited to Add
My heart rate varies when in P-AF , from 150 bpm to the 120's usually around 130 . I take an extra betablocker (nebivolol) when an episode starts and that sometimes brings my heart rate down a few points.
I asked my EP who has all my details if my long episodes are adversely affecting my heart, he said no my HR was not continuously at a high enough rate for long enough.
When first diagnosed with P-AF 6 years ago it was suggested by my GP that I call an ambulance when an episode starts , that advice seems to differ from that of the EP .
I was in AFib for 3 months after my heart attack. I also had a cardiac arrest and when they defibbed me it put me into AFib. I’d no history of it before ( but now have the substrate for it). The chemical attempt to revert me into NSR had no effect so I had a cardio version after 3 months. They said a cardio version is more likely to work before you’ve been in AFib for 12 months ( obviously there’s no guarantee anyway), I’ve had a few very tiny episodes of AFib since ( but have bits of a SVT and nsvt - so far only short episodes). So I’m mainly in normal rhythm and my heart attack was nearly 2 years ago.
I was told to get a Kardia to check what your heart is up to and, if in AF, take 100mg of Flecainide as a PIP. If your heart rate is over 140 twenty minutes later, take Bisoprolol ( 1.25mg in my case) and the occasional episodes I get are always over in a few hours. Of course, as we all know but doctors don’t seem to, we are all different and you must find out what works for you. I now take the flecainide regularly am and pm and and only have very rare episodes which never last more than a couple of hours with an extra flecainide. Good luck finding something that works for you!
Surely riding it out as Bob always suggests with tachycardia which can go on for days damages your heart, which puts you into heart failure, which happened to me and l am now in 3rd/4th stage. I am always very ill with it and incapable of doing anything , even reading. My resting pulse rate can be anything between 130 and 250 , normally 60/63. I have been to A&E sometimes with it as l feel safer there.l am attended to straight away but all they do is monitor me. I believe some hospitals do try to get your pulse down with various methods but not my hospital. It appears that the hospital staff won't do anything without the cardiologists approval and he/she is difficult to get hold of. So a.fib can damage your heart as well as taking away your quality of life.
Hi Dave, I am on sotalol and although I have breakthrough episodes they have been a bit slower in heart rate after the first 12 hours (yes, mine usually last around 30 hours plus).I always sit them out which is what my EP told me to do unless I felt particularly unwell, dizzy, chest pains or breathlessness etc. I think the stress of being hooked up to machines makes it worse.
I usually convert to NSR.
I trust my top man EP with what he tells me to do
The GP sent me to A&E because my heart rate was spiking at 150+, and that seemed to be their criterion for needing to be monitored. If the heart rate is lower, things might be different. Worth discussing with your doctor.
I was told not, hence, I suppose, why doctors are so very relaxed about the condition one anti-coagulation is in place. My elderly friend, now nearly 90, has had permanent AF for years and remains well and my son's colleague, much younger, but similar. I would think that you would have been told if you were one of the few where AF can cause long term issues, so I would not be overly worried if your symptoms are tolerable.
In terms of "damage" I was told that it is the tachycardia that does this, causing deterioration in the valves and the lower chambers over time. I have read that AF itself can cause dilation of the left aorta, but I gather that is not often of consequence.
Steve
Doctors are never very clear on this. I had the same question. My primary care doctor said she wanted me to go in after 4 hours. Frankly, I can't afford to go in and pay hospital bills and be off work for however long they decide to keep me. Insurance only pays so much of the stay. I go by how I am feeling. If I am fine with my feet up watching tv and not feeling to much stress I wait it out. If I am feeling tightness in my chest or neck or getting a headache or short of breath, I would go in.
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