What do people do when they have a Afib episode?
AF episode : What do people do when... - Atrial Fibrillati...
AF episode
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Myflowers2
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Hi Flowers.
You are in PAF judging by the the sound of it. So what do you do? First off don't panic - it won't kill you. Try breathing technics such as deep breathing - it can help. Stay calm and know it will pass.
Relax when it happens and think I'll beat this. Get that inner energy once and you'll do it every time.
Cheers Paul
As it happens I'm in the middle of an an episode at present
. I went into fast AF at 1.10 am this morning much to my dismay. My chest felt like it was burning with all the fluttering I took 2.5mg of Bisoprolol to no effect I tried breathing forcefully into a syringe....no effect . I tried to stay calm and propped myself up in bed and practised long slow breathing to calm myself down. I took amother 1.25mg Bisoprolol and tried to sleep.
I had about 3 hours sleep and woke still with a rate of around 140+ bpm.
Long story short I'm feeling decidedly unwell, can't reduce my rate or rhythm so will present reluctantly at my A&E in a couple of hours time as i have been advised to do in the past.
Oh dear sorry to hear that. Only been diysince October had a Cardioversion went back to normal rhythm. But get a lot of flutters. A couple of times felt really unwell my machine just said AF. But never been told what to do when this happens. I am on 10 mg of Bisoporol.
It is amazing how they don’t give advice . I asked my cardiologist what do I do if this happens again ? She then gave me advice on taking the pip and how long to leave it before presenting at a&e. I am somebody who needs a plan . You would have thought they would give everyone a protocol automatically . It’s not one size fits all either it depends on your individual circumstances
Peony. May I ask what your PIP is please, I've only been told to take 5mg bisoprolol , last episode lasted 12 hours which was my longest ever.
I am only on 5mg morning and night also.
My flowers. I only take 5mg when in AF, I have a naturally low heart rate so doesn't suit me.
My heart rate is really low also the bottom number on the blood pressure machine they are both in the 40's but still told to take 10 mg of Bisoporol.
Hi of course . Cant tolerate beta blockers. My pip is to take 50mg flecainide Wait 2 hours if still in AF take another 50mg. If still in AF after 24 hours total come into hospital . The two episodes I have had two and a half years apart had HR of 170-180 and I don’t think anything they gave me made any difference . I went back into NSR after 24 hours both times . It’s a year since the last one, I am being very careful re triggers and not pushing my luck as I did after two years last time
Thanks Peony. I carnt tolerate Bisoprolol, spoke to my GP about Flecainide and have to be referred to Cardiolagist which I will do, episodes still average 2 a year . Pleased your doing ok . M
Haven’t taken it yet and feel very apprehensive . Husband is wanting to holiday abroad but thought of taking it on a plane or possibly in a country without our medical protocols etc worries me . Glad you are doing ok also
When I was first diagnosed 8 years ago I still went to Spain but never give my AF a thought, just got on with it but as I'm getting older I think it bothers me more mentally and feel safer being at home but you carnt let the beast win can you .
No indeed . And when you read about that couple in their sixties mown down by a car walking their dog you realise you can’t hide from such things. But there is no doubt I feel more vulnerable as I get older and want definite back up plans . I have refused to go to a wedding in Cyprus, 5 hour flight then hectic when we get there. But am contemplating Corfu . 3 hour flight and I have checked they have a hospital there with both cardiology dept and ITU 🤣 My daughter is an intensive care consultant and gets holiday illnesses mishandled abroad disasters in, she says stick to Northern Europe but husband likes to go to Greece and he is very much an optimist whereas I am plagued with what ifs. Not least because AF makes you pee every two minutes and I would rather not handle that situation on a plane !!
I'm the same never seen a cardiologist only had a phone call. Went to A &E with a high H R. Got medication put on blood thinners waited 6 weeks then had Cardioversion. Still have more bad days than good . Been just over a month now since Cardioversion thought I would be back to my old self but don't want to arrange anything got no get up and go. Is it going to be like this for ever 😭
AF takes a lot out of you . After my episodes I was completely washed out for over a week and it badly knocked my confidence . You have been through more for longer . Start small and gradually increase what you do
in reply to Myflowers2
I have to mention that I just discovered only last week that actually it is the anticoagulant that's been making me feel so rubbish with AF. I had wondered before if it was the AF that was making me feel so bad or the meds. I was convinced that it was the Flecainide but I tested that theory (by not taking it when I was in AFib) and no, it wasn't that. Did the same with the beta blocker I take - Propranol (I can't tolerate Bisoprolol) - and it wasn't that , so I assumed it was the AFib.
It never occurred to me that it was the Apixaban. I hadn't taken it for a while (long story) but took it last week while not in AFib and not taking any of the other meds.....a a a n d half an hour later....there was all the usual 'AFib' symptoms. Nausea, light headedness and suddenly bone tired. All I wanted to do was lie down. I looked it up on the NHS website and they were three of the five most common side effects of Apixaban! I was shocked.
I don't think this is widely known. There's very little discussion of the side effects of anticoagulants on this forum that I've seen.
I've since switched to Edoxoban but I see that the common side effects are the same as Apixaban so we shall see if my body reacts to this one differently. I can only hope!
Myflowers2 in reply to
That's interesting. I am on Edoxaban. I just feel not right all the time and not calm inside. Weird.
Horrible damned thing isn’t it!! When I was in AFib I would relax and breathe in through your nose and out and it does sometimes help - Advise as to what to do varies massively - I told my EP what I did and he said he thought I was doing exactly the right thing and why go to A&E if it always self-reverted so that’s what I did. He did say to go if I felt different and worse than normal in AFib then A&E an option. I’m nearly 6 weeks post ablation now and hoping this provides some lost lasting relief from it
Do hope things improve soon, sometimes putting my wrists under cold running water or cold flannel on face works ( or just gives me something todo??) GP told me to swallow crushed ice but have never tried it. Sometimes things that trigger an episode also stop it. I'm NOT suggesting a slug of gin or caffeine though!
Thanks. I wish it was as simple as that for me.I was last admitted in Nov, all set for dccv and went back into nsr whilst being given final talk with anaesthetist! I really don't want any more dccv s but unfortunately it so often ends up that way.
How are you today?
Afraid I'm still in A&E. Went at 5pm yday....horrendous number of people but they took me in straight away. Had to wait ages to actually see a doctor and spent the night on a trolley in Majors 🙄....at least I had a cubicle, others not so lucky. Waiting to see consultant today for next course of action. Just praying I revert to sinus before then but flipping heart monitor is jumping all over the place😬
in reply to Jalia
So sorry to hear that - what a rough night you've had! Having AFib is bad enough without the added traumas of A & E as it is these days.
Sending positive vibes and a virtual big hug! Hope you revert very soon ❤️
Oh dear fingers crossed 🤞
I lie on the bed and breathe in for count of 7 and out for 11. Just try and make out breath slower than in breath. That seems to work best for me, see my reply below to Jalia
Your question is very general, so answers may or may not pertain to your individual case.
But in general, the most important thing to do when going into afib, is to get your rate controlled as soon as possible, assuming you have afib with a fast heart rate.
This can be accomplished either at the hospital or at home. At the hospital they will either give you drugs to lower your heart rate and/or convert you. They might decide to convert you with a short procedure called elector-cardioversion.
Since running to the hospital for every episode is less than ideal, there are medications you can take at home to lower your heart rate and/or convert you into normal rhythm. You will need to speak to you doctor about this. Preferably a cardiologist or electrophysiologist (ep). GP's are not as well versed in afib and how to treat it.
Jim
It depends how I feel. If I can I carry on with my usual activities, but slower, not terribly active anyway. If I feel dizzy/faint I sit down and rest while doing something soothing like watching Great Pottery Throwdown. If I have pain in my chest or neck I might phone 111 who will send an ambulance but hopefully not take me to hospital!
Hydrate, take electrolytes in some form or another or salty snack, rest with feet up and wait for it to pass.
But I have had 20 years of practice and learning by lots of trial and error.
When you say electrolytes, do you mean like the capsules athletes (runners, cyclists) take? coconut water? pedialyte?
Yes.
Another vote for Great Pottery Throwdown. I have pip so take 1.25mg bisoprolol and 50mg flecanide. Last time was my first go with flecanide and it didn’t do anything. I went to bed and was back in NSR by the morning. Cardiologist advised to take another flecanide next time if not back in NSR after an hour. Whilst I don’t feel completely terrible, I don’t feel like doing anything either so inclined to sit it out.
50mg of Flecainide as a PIP is quite low. I’m advised to take 100mg and then another 100mg 2 hrs later (approx time for med concentration in body to max out) if not resolved. I often need this 2nd dose. Note, max dose in rolling 24hrs is 300mg (including any taken as regular daily meds)
in reply to Sixtyslidogirl
Yes, I second Speed s comment - 50 mgs of Flecainide is very low for a PiP. I take 200 mgs and it stops in about an hour. I have tried a number of times taking a lower dose (100 or even 150) and it has never worked, after several hours anyway; I don't leave it any longer than that. Each of those times, as soon as I 'topped up' to 200 it would stop almost immediately so I don't bother any more - I just go straight to the 200mgs. It's never failed me yet (fingers crossed!).
Panic.......then I get my notes out of all the possibilities to revert to NSR mentioned here over the years plus what I have learned myself. Eg Bagrat mentions swallowing crushed ice and I have stopped an episode by gulping down a cold drink straight from the fridge. There apparently are many things to try before A & E, provided your HR does not go too high.
Different people's hearts vary in how the left ventricle responds to the atrial hyperactivity of AF, and people vary in how their body and mind responds to that same thing, too. Add to this, the heart's ejection fraction, level of tachycardia and rhythm irregularity will vary individually to AF and this all means that some people carry on as best they can, some feel the need to rest and even lie down and a few feel impelled to dial 999.
There can be no answer. So far, except for the first occurrence, and even when my rate is 150+, I have coped and carried on, once while driving. My first episode of fast AF, however, which was a week or so after my ablation for atrial flutter, I was utterly debilitated and in fear. That first time I felt no option but to have hospital treatment to bring back NSR and to convince me I was, essentially, not about to die.
Bob, here, often calls this a "mongrel condition". That's about right.
Steve
I take my PiP meds (200 mgs Flecainide, 10mgs Propranolol) and do some deep breathing (full breath down into belly then slow outbreath to the count of 10). I usually watch something engrossing on tv to take my mind off it while I wait 'til the meds kick in, and do the breathing on and off while watching.
TracyAdminPartner
Hello, I am sure the members of the Forum will offer their tips and advice on how to manage an AF episode, if you would like to speak to a member of the Patient Services Team, please feel free to contact us; heartrhythmalliance.org/afa...
Go to A&E pronto as I always need a cardioversion urgently 🙄
I was told to rest when I had one by the lovely EP cardiologist who prescribed Flecainide (100mg) for me to take at the outset of an episode, until things were back to normal. Now that I take it twice daily, it has virtually put an end to episodes- just one at the time I must have been infected with covid ( with no other symptoms- just a positive test the next day)
Hi Myflowers2
Ugh!! Flipping AF, I guess I’m lucky and at the moment only have full blown AF about two to three times a year, but have symptoms of it most days. ( ectopics, short bursts of tachycardia, flutters etc)
When I get an attack I literally can’t do anything and land up sitting or lying on the settee feeling dreadful. Typical heart racing and bumping with breathlessness, needing to drink then needing the loo, 😅 BUT my biggest problem is bad pre-syncope! It’s awful and very debilitating (as mist of us know) landed up being blue lighted to hospital with heart rate about 220bpm. Always difficult to know when to go to A&E
I’m taking Apixaban 5mg twice daily, and 10mg bisoprolol daily. I don’t have side effects from either apart from how the bisoprolol make me feel, it drains me completely, have no energy and feel breathless with them.
Hope you’re feeling better and continue to fight off the AF
I sit it out, just after a 36 approx hr bout ,happens weekly, i take an extra 1.25 bisoprolol , and try to carry on as normal, which is uncomfortable , rather do this than sit in a and e , probably returning to nsr in the meantime and been sent home.
The two I heard about is hold your nose tightly and press down as it you're trying to force a bowel movement. The other is cold water shock... sink full of icy water and plunge head in. Its do with the vagus nerve (check spelling)
I'm on 10mg Bisoprolol daily which I tolerate well but I have a lot of other health problems e.g. HBP, Vasculitis, kidney transplant and I've also had a heart attack (treated with 2 stents). I went to Portugal last year for a week and I was neither up nor down in fact it was the best I've felt for a while. I had been in hospital the previous week with PAF, I asked the cardiologist if it was ok to go on holiday, she replied certainly go, it will do you the world of good and so it did. When I go into PAF I take Bisoprolol early (depending on the time ) I've tried deep breathing but to no avail but what helps me is magnesium and potassium which I have on prescription. I regularly have blood tests to check the levels. So really what works for one person doesn't always work for another, there's no magic cure.
Prior to my super-successful cryo-ablation in 2018 I was experiencing an A-Fib episode (with rapid ventricular response) about every two weeks. For the most part I would simply lie down and remain very still until the episode passed (typically 8-12 hours later). At that time I was taking metoprolol (50 mg twice daily) and flecainide (50 mg twice daily). At the onset of A-Fib I would take an extra flecainide 50 mg as a PIP. On those occasions when I would go to A & E suffering with a 16+ hour A-Fib episode the attending caregivers would always give me extra metoprolol, which did nothing for me at all - my heart rate would always remain 150+. On my last A & E visit (about two weeks prior to my cryo-ablation), the attending staff gave me a calcium channel blocker (i.e. diltiazem). Within 15-20 minutes my heart rate went from 150+ to roughly 80 bpm. At that point I was released from A & E and I went home and had a good long sleep. When I finally awoke I was in normal sinus rhythm (NSR).
What I learned from that last A & E experience was... if flecainide doesn't prevent an A-Fib episode from happening or convert you back to NSR, it's important to take an effective rate control drug to make A-Fib much more tolerable. In my case diltiazem was pure magic.
As info... since my PVI cryo-ablation in Aug. 2018 my heart has been in continuous blissful NSR, and I'm so very grateful. 
Best wishes,
Richard
If it's not a violent one, I usually try to get on with my daily routine. Sometimes when my mind's off it, it seems to resolve on its own. Mine usually come in the early hours of the morning (as it did yesterday), and breakfast (maybe the digestion process?) seems to return me to NSR.
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