I have endured PAF for decades and seen many different medics in that time. At almost 76 the cardiologist tells me that it won't kill me, although I think it might sometimes and as I get older the episodes will be longer and more frequent. He said that with any episode over 4 hours I should consider going to A&E. Yesterday afternoon I had my longest PAF ever lasting 7 hours. This may be a very short time for some on here but it was the longest for me and got me worrying. Should I go to A&E as suggested? I felt ok, no chest pain or breathing difficulties, so I stayed at home. The worst part for me is the conversion pause. Sometimes I hardly notice I have reverted to NSR but at others and as I have got older the gap can be enough to make me feel as if I am going to faint although I have never lost consciousness. Am I putting my heart under strain with longer episodes? Would you have stayed at home or gone to A&E?
Should I worry?: I have endured PAF for... - Atrial Fibrillati...
Should I worry?
Hi, my afib episodes usually last about 12 hours now, they used to be about 5 hours, I don’t go to A&E now but have done in the past when I first started having episodes.
I always reverted back to Nsr without any medical intervention so for me it was a wate of time! Everyone is different though and must decide for themselves what is best.
The reversion pause is horrible and I wonder if you have told your GP or Cardiologist about this? I have had a pacemaker fitted and this will now stop that from happening to me again (thank goodness!) I had the pm fitted for low heart rate after afib episodes.
I can’t say that my PAF has become more frequent with age, I have learnt what triggers to avoid and my last episode was because I stupidly ate a small chocolate/caramel biscuit, it was so sickly sweet and about an hour later went into afib!
Thank you for your reply. I have a follow-up appointment due soon so I will mention the reversion pause, which has only started happening in the last 6 months, to the cardiologist who has mentioned pacemakers in the past. I always revert back to NSR spontaneously too. I much prefer to manage at home if I can but I cannot identify triggers for my PAF. It just starts and stops when it wants to.
AF is neither an accident nor emergency, it is a chronic condition which should be treated as such UNLESS you have any chest pain of fainting in which case of course seek medical attention.
Provided that you are anticoagulated for stroke prevention and your rate is well controlled there is no risk . Remember many people on here are in permanent AF and live long and happy lives. Of course common sense is important so trying to run a marathon in AF would be out!
Thank you for your reply. Despite the cardiologist's advice I would rather stay at home and ride it out. I appreciate that a 7 hour episode is a mere blip to those in permanent AF. I wonder how they cope with it.
It is, apparently, easier to manage because the system adapts to it when persistent. My brother is now in persistent AF and barely notices it. I sympathise re reversion pauses though- I used to get these (currently in remission from AF) - and they're frightening. Talk to your cardiologist about this, especially if you live alone.
Thank you for your reply, I hardly noticed the reversion phase until recently when I definitely notice them! I have a follow-up appointment soon so will have a chat with him.
How I have coped with persistent AF is because it is a less dramatic and severe experience than for many with paroxysmal. It hangs there in the background causing symptoms in some, not in others, but rarely kicks off an emergency. Since my ablation 8 weeks ago and being back in NSR I’ve come to understand what living on a paroxysmal edge must be like!
I am pleased to hear your ablation went well. PAF is a sneaky condition. I try not to put myself on tenterhooks waiting for the next episode. Thanks for your reply.
Difficult question to answer for you.
In your shoes - I would not unless I was very symptomatic, assuming I was on anticoagulants and I was monitoring and pacing myself regarding heart rate and O2 stats and I knew I had an otherwise healthy heart structurally.
There are times when you may need to go to A&E but at best my experience has been you might be monitored, you might receive a saline drip and if your HR was considered high +120 and had been for some time then offered rate control.
A&E is for accidents and emergencies and controlled AF is neither however times when you reach for 999 is AF with any chest pain, you feel very ill, clammy and nauseous, dizzy and syncope or near syncope (fainting).
I am assuming that you have not received any treatments such as anti arrhythmic drugs or cardioversion or ablation?
The ‘gap’ when converting back to NSR I have not experienced but I know many on here have and found it very disconcerting.
Thank you for your reply. I haven't had a cardioversion or ablation but I am on an anti-coagulant. The medics consider me allergic to beta-blockers so after swallowing a cocktail of them over the years I do not have any heart medication at the moment. I would prefer to stay at home until the episode is over but when a cardiologist says different it makes me wonder. I had an echocardiogram recently which he said was 'reassuring'. I will take comfort from the lovely people on here.
PS - to answer your question regarding your title I refer you to the song - What’s the point in worrying? It never was worthwhile……..
And anxiety always exacerbates AF.
Very true.
If you feeling unwell with AF, or if you’re HR is going too high, then by all means ring 999. The paramedics will be able to check your heart and advise you whether or not to go to hospital.. If you’re feeling OK-ish but worried, you could ring 111 for advice but you may need to wait for a callback. You know your own body so don’t let anyone else decide whether or not you’re making too much of a fuss, certainly not a stranger on the internet who doesn’t know your history. They can only speak for themselves. The hospital staff would far rather see you to check you over than not, and I’m sure the paramedics would do the same.
Thank you for your reply. That sounds a sensible thing to do. I am reluctant to go into A&E when I actually feel ok and prefer to be home.
You can certainly wait it out at home or take a PIP to self manage, but if your HR is very high compared with your “normal” when in AF, then you may need to go to A&E to have treatment bring your HR down. Or if you are feeling dizzy, nauseous, hot, shaky, can’t stand up without feeling whoozy or faint, absolutely pick up the phone and call 999. This condition can throw up the unexpected even if you’ve been OK in all your previous episodes. If you’re feeling like your usual self (more or less) and you’re not symptomatic then you can probably just wait it out. If your symptoms are worse than usual, or you are feeling very unwell, then don’t hesitate to pick up the phone and dial 999. You’ll probably know when it’s necessary. You won’t be wasting anyone’s time or resources.
Thank you for your reassuring reply. Good advice.
It might have been helpful to be on a monitor at the time of conversion. Then there would be a record of the length of conversion pause. I used to have pauses as long as 5 secs and was offered the option of a pacemaker or ablation. I had the ablation which fixed the pause problem but may still need a pacemaker because my heart slows too much. You could push for a long term monitor if your cardiologist isn’t concerned by the pauses.
Thank you for your reply. These longer conversion pauses have only happened in the past 6 months so I haven't mentioned them to my cardiologist. He has muttered about a pacemaker from time to time because like you I have a naturally low heartbeat. I will ask about a long term monitor at my next appointment.
What does your doctor consider to be too slow of a heart rate? One time my doc said 50 to 90 is ok. I told him I feed sluggish below 60.
In your shoes, I would get a private appointment (if funds allow) with a trusted cardiologist and discuss all things Pacemaker.
Thank you for your reply. The cardiologist has mentioned a pacemaker. I will ask more about it at my next appointment due early in the New Year.
Hi, sarniacherie, You don't mention having access to any meds like flecainide, but if they're possible for you, it might help with your concerns. Sometimes I wait a few hrs & try natural methods, breathing, walking, music, etc., but if by 5 or so hrs it doesn't convert on its own, I take flecainide & it stops w/i 1-4 hrs. Once, about 7 yrs ago, before I had flec, it went on all day long, and I finally went to Emerg., where the dr. said rather jovially, "Well, it's like you just had an all-day stress test--and you passed!" I assume he meant, because I was still standing upright and in apparent control of my brains and senses. 
I think most of us w/ PAF avoid the ER unless we have pain, breathing issues, feeling quite ill, or very high HR. May your heart choose NSR! Diane
Thanks for your reply. I used to have flecainide but was taken off it due to my age (75) but I notice others on here who are older still take it, so I will ask at my next appointment. Nasty, sneaky condition, isn't it?
Can I ask why taken off flecainide because of your age????
I’ve been on flecainide for about 6 years snd nesrly 80. I recently had a pacemaker and wow ehat a difference, BUT I am still on regular low dose flecainide
All the best
I have no idea why I was taken off it but when my 70th birthday was coming up he took me off it due to my approaching age, in his words. He thinks I am allergic to beta-blockers as I have a naturally low heart rate anyway and Bisoprolol was reducing it to 33bpm. When I see him at my follow-up soon I will mention all this to him and get some answers. I will ask about a pacemaker too. His Registrar recommends one but as the Consultant doesn't think it's necessary at the moment, his opinion trumps everyone else's!
Yes bisoprolol is a rate control drug snd does lower heart rate, but flecainide is a rhythm control drug.
I still can’t understand why he thought your age was against taking it. I would be interested to know what he says when you see him
All the best.
At your upcoming appointment, do ask about using flecainide PIP (pill in pocket). This method keeps a LOT of us out of A&E (Emerg, here in the US). I've never heard of stopping flec due to age! but that was when you were taking it daily, I assume. If you just use 150 mg on occasion, ie., after you go into afib, I think you'll get results, and you won't have it building up in your system. Yesterday morning (2 am) I converted within the hour or so w/ 150 mg of flec. And it relieves anxiety, because you know you have something to stop an episode. Hoping the best for you, sarnia... we've all been there. Diane
With the ever increasing pressures on the NHS the thought of sitting several hours waiting to be seen is enough to put me off. I am almost 80 with an 84 year old husband so again my hesitation in going to A&E. You can of course call an ambulance but when I broke my hip last year playing table tennis the Ambulance picked me up at 11.0 a.m. I was finally admitted on to a ward at 4.0 a.m. the next day so go figure, as they say. Personally, I am on anticoags after having an A/F induced stroke in 2000, and through the years spent many hours in A&E, I have a Pacemaker, I am on relevant drugs and I was also ablated just prior to the Pacemaker 8 years ago.........so no I wouldn't go to A&E unless forced to do so....... ps Just after having the ablation I went into the longest dose of A/F and had to go back to the hospital for a cardio inversion...3 hours drive away, got there and was prepared for the procedure and, at the 11th hour, I returned back into NSR so no cardio inversion, think my heart said 'enough" lol
Thank you for your reply. I share your reluctance to go to A&E. I would rather manage at home unless I had chest pains or breathing difficulties. I take an anti-coagulant but no other cardiac medication as I have a naturally low heart rate and beta-blockers would reduce that to 33bpm. I am due a follow-up very soon so I am making a list of queries based on some very good replies to my post, yours included. Thank you.
yes, make a list of all of your questions, it certainly helps and good luck x
I have often sat out 12-24-hour episodes and one 40-hour one. I went to the ER a couple of times early on, when I first began having Afib episodes, and their response was, "Why are you here?"
I didn't want the paddles, risky meds or ablation, so they had a point. I went in recently when I also had covid, and my BP was 60's over 40's with several second pauses between heartbeats.
I am much better now, thanks to changes in diet and more exercise. It is a hard call to make, but watching for the symptoms you described seems to be our main guide for going to a medical facility.
Thank you for your reply. I don't relish tinkering either so I would prefer to stay at home unless chest pain or difficulty in breathing is present.
Just a note, include dizziness or longer than a few seconds of light headedness as another cautionary.
I haven’t had my paroxysmal AF for nearly as long as you but have been prescribed Flecainide, originally as a PIP when it stopped episodes in a couple of hours and now taken regularly twice a day I hardly ever have episodes and I’m 79!
It's strange why my cardiologist took me off it when my 70th birthday was coming up. I have a follow-up appointment soon and I will ask him why he made this decision. Thank you for taking the time to reply.
Mine only developed four or five years ago so I was already well over 70 and it was prescribed for me by a private EP I saw after the lowest dose of Bisoprolol proved too much for me to take daily and my surgery didn’t come up with anything else! But, of course, we are all different. I wonder why your guy didn’t think it suitable for over 70s?
Dont worry about the conversion pause. During my last one my heart went down to 40 bpm and too felt faint! I went to see my cardiologist who confirmed that it was fine and it has not killed anyone!! But I agree you do feel weird when it happens! Just relax next time
Thank you for your reply. I often wonder if the many medics I have seen in my PAF journey have ever experienced anything to do with arrythmia. It may not have killed anyone but you really feel it might.
Every time I have an episode I feel I am going to die!! Its just like a bird fluttering in my chest. I think its normal to worry but not necessary!!
I gather not and my 90-year-old friend with permanent AF and my son's 76-year-old colleague with PAF would surely support that view. I would ask your GP about the "conversion pause" as anything of that nature needs to be carefully considered but, again, I expect you are fine there, too.
Steve
Thank you for your reply. Sometimes you just need reassurance from the lovely people on here who are experiencing the same condition. I am due to have a follow-up soon and will mention the pause, amongst other issues. Thanks.
It’s a frightening condition. If there was a way to reduce the fear it brings me, well that would be something special!
Steve
I think those of us on here would heartily agree with that.
There are some who post who seem to cope well and not feel anxiety. I’m certainly not one of them.
Steve
I have been told by Doctors, in Leicester A&E, that if I get an AFib episode, they want me to go in there, as my heart rate and blood pressure go sky high and they want to keep an eye on me and try and stop it, or transfer me to the heart unit at another hospital. I have had 9 episodes of AFib, since it started, after coming down with a nasty virus in 2014. I think it may be best to get advice from NHS 111, if you’re not sure what to do, when you get an AFib episode. We’re all different.
I had an ablation in September, so a I’m hoping AFib won’t re-occur, but who knows. You just have to keep your fingers crossed and hope for the best.🤞🤞🤨
High HR and BP definitely justifies going to A&E. Nobody actually WANTS to go but it can be the wise thing to do if symptoms are bad like that because you’re not going to be “haemodynamically stable”, and you’ll certainly feel unwell. I feel this message of “carry on regardless” needs to come with a few caveats. I hope your ablation continues to be a success and prevents any of those awful AF episodes happening in the future.
Thank you, 🤞.
hi sarnia, I went to A+ E at the start of my Afib journey but haven’t been In years now. I just sit it out at home. I’m like you as in I don’t get pain etc, but If I ever get any pain etc in the future then yes I would attend the A+ E. 👍
Thanks for your reply. After reading the helpful posts on here I feel much more reassured.
There are a considerable number of us who are in longstanding PERMANENT Afib, and we have to live with it!!.
I have not been out of Afib for over 3 years. People live years with it. its chronic and progressive.
The inmportant thing is to get the correct treatment/medication. If they cannot control Rhythm., then they can work on rate ( Below 100 bpm average ). Up to 3 years ago I was a distance runner, now, although I have hardly any symptoms I do brisk walks. I am almost 70, and of course its increasingly common as we get older. Be guided by your cardiologist for the best treatment option ( Ideally see and EP ) and they are the experts...All the best
Thank you for your reply. I will add the question of rhythm and rate to my list to ask at my follow-up appointment due in the New Year.
Although I was only diagnosed 3 years ago, my episodes last between 34 and 40 hours. Was told by my EP to sit it out as I am medicated and only go to A & E if I experience chest pain, breathlessness or fainting as all they will do is hook me up to bleeping machines making me more anxious which increases the problems with Afib. I have not been back to A & E since 2020 and I try to ignore it when it starts
Thanks for your reply. Common sense advice.
Hi everybody,
Some of this might be pertinent and some might not but I felt I should tell you about my experience with permanent AF. There are a few things to note: 1) I am anticoagulated on Eliquis and rate controlled with 3.75 (am) plus 1.25 mg of bisoprolol (pm). After taking some of my meds in the morning I always experience discomfort in the chest and stomach after eating cereal and a banana. If I feel bad, I sit around for an hour or so it eventually diminishes , however if I get up and do light chores, the discomfort naturally goes away. For example, I went shopping today around 11am. Felt breathless and uncomfortable walking around the shops for about 15 - 20 minutes and HR went to 92; usually 77bpm. I had to rest a lot. I kept going and eventually I found after a period of time I could walk much further before having to rest and my pace had picked up. I just wonder if there is a link between moderate exercise and rate control and if in future I should not rest after breakfast but do some moderate exercise. Anybody else experienced this?
l have PAF and l will not wait five minutes before going to our emergency room. I am in the US (Texas) … l see someone immediately and l am back in sinus rhythm within thirty minutes and back home l go … l am sooooo symptomatic that l would be terrified if it lasted any length of time whatsoever when l am at home. I would not take chances if l were you. Best, Jan
Thanks for your reply. Sadly the UK's A&E Dept's are mostly under severe strain and it would be some sort of record to be in, seen and out within 30 minutes. The advice on here has been really helpful and reassuring and I have a list of questions to ask the medics at my follow up appointment in the New Year. Keep well.
Sarnia, you're not alone. I'm in No. Kentucky, near Cincinnati which, hard to believe, has 11 hospital systems in the metro area, many congregated in an area known as "Pill Hill". But I, too, can't imagine getting out of one of those ER's in 30 minutes--feels like it takes that long to walk from the parking lot, then register! However, just a fun fact, to my surprise, they built a free-standing ER (had never heard of those) in rural Williamstown, Kentucky about 25 min. from my house. I went there for stomach pain last yr, & they had me in a CT scan w/ a diagnosis & discharge within the hour! I was shocked. We have all become so used to waiting for procedures like scans. (Kentucky is full of farms, horses, & rural towns, so I'm glad they're trying to improve services in our under-served areas.) Hope you get answers at your follow-up apptmt. Diane
That sounds like a good idea having a free standing ER (A&E here). I have a granddaughter who has recently moved to Brisbane and they have specific places to go for bloods, scans etc meaning the emergency departments aren't so congested. Thanks for your reply. Keep well.
Any Advice for the newly diagnosed?
Change of meds from Bisoprolol to Sotalol . I have asthma and copd so very scared. 
Should I go to A and E? 
Should I have a catheter ablation? 
Should I push for more help
