Afib with RVR questions

[Iamfuzzyduck]

Is it common for those with afib to have it with rvr? Because I was told by my cardiologist that if I have it again and it carries on for more than 30 minutes I need to go to ER but from what I read in this forum many have afib and carry on with their daily business. I think my main concern is that if I am on a plane flying over the Atlantic on the way to visiting my family in England and I suddenly have an afib attack like my last one what in the world would I do?? Because it is a 9 hour flight...Do people (afibers) just carry on as if it isn't happening? Same with if I was in a remote location. This concern is actually putting me off flying to see my elderly mother which is sad..

[mjames1]

Most of us with afib have afib with RVR. I certainly do.

What you need to deal with it -- be at home or on a plane -- is a Home/Away plan.

There are basically two types of plans. The first is a rate plan. The second is a rhythm plan.

I started with the rate plan many years ago. At the start of an episode, I was instructed to take a rate drug at specific intervals until my heart rate got down to around 100. At that point, my rate was controlled and I could go about my daily basis until I converted. How much and how intense daily business, is a very individual thing.

A couple of years ago I was switched to a rhythm plan. With this plan, I take an anti-arrythmic drug, Flecainide, at the start of an episode. It has always converted me within 1-4 hours.

Both these plans are useful if you don't have too many episodes, say no more than one or two a month. If you have more than that, probably best going on a daily anti-arrythmic to prevent the episodes in the first place, or have an ablation.

But the takeaway, is that you need a plan from your doctor. A specific plan which will allow you take care of your RVR quickly so you can continue life without being interrupted with a trip to the ER. I haven't been to the ER with afib in over 30 years, since I've had these plans.

So unless your case is very special, your cardiologists's plan of going to the ER/A&E for an episode of over 30 minutes is a very poor plan. I suggest you get a second opinion on all this, preferably from an ep who are more knowledgeable and are more likely to set you up with a good Home/Away plan than a general cardiologist.

You want to control your afib, you do not want to let your afib control you. With the right plan, you will be able to fly out to see your elderly mother without worrying about your afib with rvr.

Jim

[Iamfuzzyduck in reply to mjames1]

thank you for the informative answer. The EPs plan was ablation ‘so I can travel’ 🤷🏼‍♀️. I think I need a more practical plan like you are suggesting I do know my heart can act up on the plane but now I know I have afib my plan is not to drink alcohol/caffeine but altitude and lack of sleep could still play into it…

[healingharpist in reply to Iamfuzzyduck]

Hi fuzzy, Jim's advice is excellent. I have a similar story, but kind of a "combo plan". I take 50 mg (divided) metoprolol daily for rate control, but I also keep flecainide PIP handy, which stops an episode in 1-4 hrs. My vagal episodes usually occur at night, so I take 150 mg of flec and fall back to sleep. Since my AF episodes are responsive to the meds, I do not want an ablation now, hoping newer/safer and improved procedures arrive (& I suspect re EP's offering ablations, "To a hammer, everything looks like a nail" ). Flec works well and quickly, and I have flown repeatedly and never gone into AF while in the air. I also drive 14-hr car trips to Fla. with animals on board, without issues... I'm just grateful for the meds which have kept me out of ER's for years! All good wishes & NSR to you! Diane

[Iamfuzzyduck in reply to healingharpist]

Hmmm, maybe I should wait for an ablation? Thanks for the information!

[AAJJTt]

Hi, I have PAF with RVR too. Currently my treatment plan is only rhythm control - daily Flecainide (150mg). No rate control as my heart rate is quite low anyway unless in Afib. So far, this has kept me quite stable (since 2020) with no detectable sustained arrhythmia. Though I do have bouts of pesky ectopics.

I also have the option of an ‘emergency PiP’ should it be required. In the event of episode, I’m instructed to take an extra 100mg of Flecainide and 2.5mg of Bisolprol ( to protect my ventricles). To date, any episodes have spontaneously synced back to NSR within 4/5 hours with me pretty much asymptomatic during that period. The idea is the PiP will help me nudge back into NSR quickly without presenting at A&E. The duration for me to leave before presenting is a little more vague. My Afib has a vagal tone and usually occurs late evening/early morning, I am advised to take the PiP and ‘leave it until morning’. I kind of interpret this as I have several hours. Clearly my cardiologist is aware of my condition too - my heart is structurally normal and I have a high exercise tolerance.

I love travel and I won’t left Afib affect this for as long as I can. The pandemic curtailed it but I am now making up for lost time. I have no qualms about flying long haul and this year took a 13 hour flight to the far east again (and to some remote places too). I don’t think this is hubris but I believe I know my condition/state, as it stands now, and i am confident with a backup plan (PiP) in place, I should be able to manage the situation. So far, it has all been fine and I’ve never had to use the PiP ever (flying or at home).

With respect to the long haul air travel, I

- stay hydrated and avoid too much alcohol but, for me, a beer or wine with a meal is usually fine.

- eat but I never over eat or eat too late. Tricky sometimes on a flight changing timezones but I manage it. Eating late and being over full is generally not good for me anyway; something I avoid.

- to try and avoid jet lag, I always adopt the time zone of my destination as soon as possible.

- get some sleep / relax in tune with my destination.

- medication. I am on twice a day medication - 12 hours apart. Normally, I set a 12 hour timer on my watch after my last dose in local time. It is then just a bit trial and error were I blend my timings to reflect my destination +/- a few hours depending on the situation. This is very much a personal approach, I am sure others may do it other ways but it works for me, so far.

Then there’s just general things.

- good travel insurance - make sure all conditions are covered.

- check destination’s law/rules on importing medication and adhere to it. As a minimum, I take my last prescription and enough meds for trip in their original dispensing packaging.

- research medical facilities at destination.

All we can do in this forum is share our experiences, and offer support and not advice. I clearly don’t know anything about your case but I agree with the previous comment that a 30 min plan sounds limiting. I would certainly discuss this again with your medical team, telling them of your desire to travel and explore the possibilities of what might be available.

Best wishes, I hope you are able to visit your Mother.

[Iamfuzzyduck in reply to AAJJTt]

Thank you, that is informative and helpful! I do think I could handle a beer too but if I was traveling alone I wouldn't want to go into afib on the flight (I have a sneaky suspicion that perhaps this has happened before but I didn't know what it was, but remember wondering if my heart was about to stop). So it sounds like I need to have some meds with me and I should be ok. I really don't know if they gave me antiarrhythmic meds initially or how I would react to them if they didn't. I am the same with late evening eating and haven't done it by choice for many years except when on a plane!! The biggest hurdle will be trying not to worry about afib mid flight..

[Aegean56 in reply to AAJJTt]

Excellent advice !

[Buzby62]

You’ve had a couple of great detailed answers here which there’s little to add to. The bottom line is Controlled AF, whichever method or methods above are used to control it.

I had an episode start while in the departure lounge before a five hour flight this summer, my control is daily beta blocker which keeps my rate under control usually, the exception being if I am unwell with a virus or infection. If my rate is under control then my symptoms are under control. I reverted to NSR midday the next day while strolling along the sea front and enjoyed the rest of my 2 week holiday. This was after over two years experience of my monthly episodes.

We’re all different, best wishes.

[Iamfuzzyduck in reply to Buzby62]

Thank you!