misdiagnosed or misinterpretation

[FraserB]

Has anyone ever been misdiagnosed with an incorrect arrhythmia by a medical doctor of any of the tachycardias, e.g.: sinus tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia (SVT or PSVT), POTS, Wolf-Parkinson-White, atrial tachycardia multi-focal atrial. In other words, it's not the test or the ECG that fails, but rather a misinterpretation of the test results?

[Oldforge73]

Probably, but more in my case the type of AFib I have. I am told it is persistent but no episode lasts more than fourteen hours and self converts to NSR with a sort of shudder in my heart. The definition of persistent AFib does not correspond to this at all but can get no coherent explanation from my Dr at all. My AFib was detected after I took part in a clinical trial, I was sent a hand held device and took 30 second readings four times a day for three weeks. This is what my diagnosis is based on. Regards Kathleen

[Chinkoflight]

Hi Fraser BI wondered why you were asking this question so I did look at your bio.

I'm not sure why you have posed the question seeking a negative confirmation ie you think you have been misdiagnosed and want to check out with others who might give you some confirmation bias. I'm sorry if I sound sceptical.

So for me having a similar health pre condition to you, except being overweight I had a stroke out of the blue. All the heart tests and scans came back normal for my age (M70 at the time). I had a previous referral to cardiology at around 64 years of age because a routine screening at the GP surgery identified a low heart rate cut a 40bpm which was judged unusual given white coat syndrome!!!! I had full stress tests then, treadmill etc but was judged normal with a diagnosis of Bradycardia in sinus rhythm.

Moving to my stroke, no explanation could be given, so I went on to antiplatelet meds and further Holter ECG screening and tests/scans etc. NICE have updated guidance for Afib screening so in Feb this year I was offered an ECG implant to monitor my heart 24/7/365. 2 months later a very short Afib burst was detected and my medication was consequently changed to anticoagulant meds EDOXABAN similar to Apixaban.

Like you I was asked what happened before the Afib occurred. The implant is remotely monitored and the time of the event was precise! I could look back to the day and time and I was likely sat at home maybe having a coffee! I have absolutely no awareness of my heart beating even under running exercise, when it might typically go up to 150 in extremes on my watch. My implant has never shown my heart beating above the alert level set for me of 158bpm.

So looking back at your earlier post and your synopsis I see no reason to not accept what your Drs are saying. Quite the opposite, you should be glad you have been investigated and are being offered treatment. The ID of Afib event , even just one, means you will have had an increased risk of a stroke relative to the population using epidemiology studies. The prescribing of anticoagulant reduces this risk considerably.

Had I been treated for Afib it's one of this imponderables but I might not have had the stroke which was severe and life threatening. I am recovered mostly now. I am taking much more responsibility for my personal health by way of helping the ambulance team, Drs and nurses whose intervention have given me this opportunity.

I hope this helps. I also hope it helps others who might not understand why you phrased the question in the way you did. Please don't take that as criticism but occasionally on this forum people can be quite anti-medical health interventions without much evidence base.

[Autumn_Leaves]

AF on an ECG tracing has a distinctive appearance, as does AFlutter. It’s unlikely that AF is going to be confused with SVT, or sinus tachycardia or WPW. They each produce a distinctly different tracing, so confusing one with another is unlikely for someone with an experienced eye.

It’s also possible for someone with paroxysmal AF to have SVT, SVE/VE as isolated beats, couplets, trigemeny etc, at other times. This does not “undiagnose” AF. The person still has a diagnosis of paroxysmal AF. In AF, the atria are beating chaotically. This does not happen in SVT or sinus tachycardia and is obvious on the ECG.

It’s also possible for someone to experience one episode of AF and not have another episode for years.

I don’t know if you are seeking to “undiagnose” yourself in the belief that the person interpreting your ECG was wrong, but this is very unlikely because an AF tracing is very distinctive, regardless of whether it is fast AF or slow AF. A normal ECG taken sometime afterwards when the heart is not in AF at that moment does not reverse that diagnosis. It just means that the AF is paroxysmal.

Someone posted previously on this very subject. I don’t know if it was you, but essentially the person didn’t accept that an ECG showing AF was correct and wanted to believe that the doctor had made a mistake.

If you want to self-undiagnose yourself of AF, that’s up to you, but it doesn’t materially change anything. If AF has already happened, you can’t undo that reality by wishing it away. If you have been prescribed medication that you don’t want to take because you believe the diagnosis is wrong, that’s entirely your prerogative. Other people here have themselves and their loved ones to take care of, they’re not invested in your situation. That may sound a bit harsh, but it’s true. None of us here wanted a diagnosis of AF but c’est la vie.

[FraserB in reply to Autumn_Leaves]

I should have added more to my question to everyone. A year ago I was diagnosed with atrial flutter and after having confirmed by a cardiologist I'm more than relieved to take my medications for it. The rhythm in flutter is more organized than afib. Been doing well (paroxysmal) until this last week I now had a reoccurence. I was told flutter is progressive even crossing over to afib but nobody knows just how and when it will progress. Unfortunately my heart rate three days ago went off again instantly to 135 bpm and after 5 hours I decided time to go to emerg. After a 12 lead ecg and bringing down the atrial flutter with bolus medication (similar to a year ago) the emerg doctor said it looks like an SVT which completely confused me but he said to keep up with the medication since I still need to be protected from a fast rate and stroke. I now have a referral once again to the cardiologist but it's months away and it's left me perplexed, I'm wondering if flutter can go into an SVT and then back or is the emerg doc misinterpeting SVT for flutter?....until I get a more thorough investigation by the cardiologist I'm confused.

[Responsable in reply to FraserB]

I know that it was 8 months ago, but hope that it is not late to respond... Since a long time, I suspect that people may be wrongly diagnosed when having an arrhythmia, but I did not dare to talk about it. Yes, AF may be perplexed with SVT and it happens rather frequently (IMHO).

As for your question regarding preventive examinations at DRs, a periodic ultrasound of the heart would be the way to know if arrhythmias have altered the structure of the heart, what may be or may not be the case. My ECHO, from before 7 years, has shown no structural changes of the heart (believe to have had AF bouts for about 10 years at that time, maybe longer). So not worried and not making any other examinations until it shows to be necessary (male, 72 yo, almost no symptoms when in AF, bouts almost every night, nothing during the daytime).

[FraserB in reply to Responsable]

Thank you Responsable, I'm glad you responded to my post. I also realize that a single diagnosis of the arrhythmia type could be mixed up with another and most don't want to talk about it. Since then I have had only a few very short episodes a year. They are still regular fast rate (no irregular). Start and stop fast.

Going forward, I have now decided to be proactive and go for another echo and further tests as well as smart device. I will than have something to compare. Another concern I have is being place on an incorrect medication that could make what I have worse. Or worse yet, a life-saving medication that an overworked doctor not being thorough decides to remove.

[Responsable in reply to FraserB]

May I send you a personal message? I have a special approach to arrhythmias, so not everybody here would be glad to listen about it. Despite being 72 yo, I do not take anticoagulants. Also, despite living with BP at the level of 160-180 / 70-90, I do not take any BP medication. I feel perfectly well for my age, am fully physically capable and active, am in a perfect health condition in every sense.

If you are not interested in a chat, would you be so kind to tell me your age? I have read all your posts and most of the replies, but was not able to find in which age group you may be...

[FraserB in reply to Responsable]

I was diagnosed flutter in emerg end of 2022 on a 12 lead ecg at the age of 67. Currently age 68, age 69 this September. What may be of interest is I have two family members who present with atrial fibrillation. An older sibling was diagnosed also in hospital but at a much younger age (55 yr old) and that was of course years back. My mother we suspect also has AF with maybe SVT (she told us on many occasions her heart was erratic) but her blood pressure was periodically high and doctors focused solely on that and not her potential AF. Sadly she had a stroke and did survive but for years I cared for her as best as possible before her death. Unfortunately at the time hospitals did not share with private specialists her medical records and there was confusion about the direct cause. Honestly and these are my own personal thoughts only, I thought all of it made her suffer more.

[Autumn_Leaves]

You’re obviously a different person from the one who was convinced their doctor was wrong. My apologies for being confused!

You did the right thing, and the emergency doc is right in that it’s not good to have such a high HR, even if it’s SVT. There are a few people here who have had AFlutter and had an ablation for it. The problem with these arrhythmia problems is that some people have a lot of other niggling problems like persistent ectopics in many different guises, like bigemeny, trigemeny etc and sometimes SVT happens too. I had years of ectopics before AF, and when I had Covid, besides it provoking an AF episode, I also spent five hours in constant bigemeny the day after the AF episode. I’d never had that before.

Some people have posted their watch or Kardia ECGs and it seems that Aflutter has a distinctive “sawtooth” pattern. You’ll probably find out more when you see the cardiologist. It’s not easy when things kick off and you’ve got a long wait for an appointment. I hope you can get some answers then.

[Easternmost]

Hi,

I know exactly why you feel confused. I am female, 56. I have always had palpitations and used to lie down and they would stop. In 2020 things changed and I had an episode of 240bpm, not self-rectifying. I was put on Bisoprolol and Rivaroxiban and was ok until August when it happened again and I was left with a heartrate of 130/140bpm. What was originally diagnosed as SVT was then diagnosed as Atrial Flutter. I had an ablation in October 2020 and came off Bisoprolol until Feb 2023 when another episode of 230bpm hit me. This time I was told Atrial tachycardia/ SVT. Various checks and told to remain on Bisoprolol twice daily - possible touch up ablation in the future. The arrhythmia nurse referred to it as Afib, however all previous consultants/ nurses said I did not show signs of Afib, just flutter/SVT/atrial tachycardia - ie very fast, but regular, not erratic. Therefore I am also confused by the definitions and wish I could pinpoint exactly what it is…..however, it is a curious and evolving condition it appears and so I try to not overthink it, stay calm, avoid triggers and take my medication!!

Best Wishes.

[Omniscient1]

Do you have copies of your ECG results? If you're in the UK you can ask for these - they may already be on your healthcare app (my last one is). It might give you something to look at. As has been said AF diagnosis is based on a distinct wave pattern. Flutter is different.

[Jajarunner]

The arrhythmia nurses at Papworth say the ECG machine results are not accurate and an EP needs to interpret them to distinguish the difference between the arrhythmias. So my last few afibs were actually aflutters.

[Cat04]

I was diagnosed AFib by a consultant cardiologist at one hospital yet when they sent my ecgs to the hospital I normally attend, my own cardiology consultant did not see any AFib on the ecgs but Atypical atrial flutter and atrial tachycardia with 2:1 block. I never did understand how 2 consultants can read the same ecgs so differently.

[Cookie24 in reply to Cat04]

I have atypical flutter. Did you have an ablation?

[Cat04 in reply to Cookie24]

I had a catheter ganglionated plexus RF ablation in October 2018 for AFib which held until April 2022 when I caught covid and went into atypical atrial flutter for 6 months. Finally stopped after an ever increasing drugs regime. I then needed AVR by OHS in Jan 2023, and had a surgical PVI, with division of ligament of Marshall and an Atriclip fitted on LAA.

[Cookie24 in reply to Cat04]

What was the regimen after Atriclip on LAA? Did you take aspirin for a while? Are you still taking an anticoagulant?

[Cat04 in reply to Cookie24]

I took aspirin for 2 weeks post-op but received an emergency telephone call to stop taking it as I was also taking apixaban. I discussed stopping Apixaban but as I have strong family history of AFIB and thrombosis/stroke in both parents, plus a percentage of strokes are caused by clots other than in the LAA, I am continuing with the Apixaban.

[Cookie24 in reply to Cat04]

Can you tell me more or why the aspirin was discontinued?

[Cat04 in reply to Cookie24]

I'm not really certain, it was following my return home from hospital after OHS and I wasn't clear-headed enough to ask why! I had been taking both soluble aspirin and apixaban as prescribed by the hospital. My surgeon had then checked my discharge drugs and I was contacted to immediately stop the aspirin, presumably because of the increased risk of bleeding.

[Snowgirl65]

My first EP misdiagnosed me with sick sinus syndrome, to which I disagreed. It seemed that after his first ablation, and things went downhill, this new diagnosis was to wash his hands of treating me, saying there was nothing more he could do. I quickly got a new EP at Cleveland Clinic who vehemently disagreed that that diagnosis -- much to my relief. So yes, there are misdiagnoses out there and second opinions are crucial.