Nasty episode but what was it?

[Garaidh]

I had SVT many times in my late teens and twenties and had an array of meds. Looking back, I think I'd be treated very differently today! But I survived. I dealt with the SVT, which at some point had morphed into AF, mainly with anti-anxiety meds and whisky. I got on with things and pretty much knew what not to do so that I generally avoided episodes.

Forward to now, and I'm 64. Large build, male. Over the past 12 years a more clearly defined and diagnosed AF has been in my life. But, by and large, I maintained an active life (I walk a lot and swim as regular rhythmic exercise causes fewer issues) and dealt with it through other meds - until it became more troublesome, and an EP prescribed Flecainide. I was very unsure about taking it but eventually did so, along with a small dose of Bisoprolol.

All was good at my checkup this year. BP, cholesterol, etc. I'm not on an anticoagulant but cleared to start this year when I get to 65 as I'll then have 1 point on the chads score.

I've been immensely grateful to this group for tips and advice.

As we know, AF can be frustrating. Out the blue, apparently, it can be "irritated". Usually I can figure out the trigger - or, most likely, trigger combination. And things settle.

Plus we keep discovering, don't we? I hurt my back in December and again in January and was talking ibuprofen without realising it was such a no no! In combination with reduced exercise, a bit of weight gain, stress, less good diet, my 2 x 50mg Flec was not holding back the AF tide.

I always know when I'm in AF. It wakes me immediately as it almost always starts 4am-8am.

I've managed to get things settled down again through taking a bit more Flec with one at 4am.

My AF before Flec was becoming frequent, but generally not severe. I could easily get on with things. Walk miles. But episodes were stretching out to 5 days.

Since starting Flec 2 years ago, my AF burden or time in AF has fallen by at least 90% and I've had months on end with complete calm. Bliss!

But occasionally, something tips me into AF, and I've been aware that while on Flec the AF was a little worse or different. I had a couple of tachy episodes and a couple of uncomfortable conversion moments when going into NSR.

So, almost a year ago I completely stopped drinking alcohol. Not a step I wanted to take as a large whisky was frequently my "medicine" when Afib hit!

A year on from that, I'm happy I stopped drinking from a whole body health perspective. I'm quite proud of myself that despite the fear when AF strikes, I've dealt with it calmly and sensibly.

So my position is pretty good at the moment. My heart has no structural issues and I am grateful to have fast, easy access to my Scottish NHS EP in the local hospital in Edinburgh.

We also do not pay for any medications here so, I read with great sympthathy about others who need to find large amounts to pay for Elquis or similar.

Anyway - my question is this: I had AF on Saturday, an early morning slip into it while having a late snooze before getting up (a danger moment!). It was frustrating. Despite it being a freezing wet day I set off for a good long walk to try and nudge it back into NSR.

After about 2½ miles of feeling fine, I suddenly started to get jumpy feelings in my chest and very soon realised I needed to sit down. Happily I was near a pub where I sat near the door and they kindly brought me water. My heart had gone full on tachy. I think it was SVT. I sat very calmly to ride it out. It was extremely unpleasant, just as I remember the completely out of control situation I had when young. I knew calling an ambulance would make things worse even if sensible in other ways. After ten long mins it subsided back into AF.

I was very shaky after this. My heart, for an hour or so, felt it could go back into the much more serious feeling arrhythmia. But I got home, relaxed, warmed up. I took an extra 50mg Flec and Bisoprolol and very gently converted into NSR. And all has been fine since.

I've known Flec can make things worse but it's been very effective overall for me. I've realised, including Saturday's experience, that I need to treat any AF while on Flec more gently.

Has anyone had this experience of AF going into SVT?

Are there things we should not do while in AF and on Flec?

I know Flec is used to stop / treat SVT but does it make it more likely?

Is there a hazard in using too little Flec? Today I'll take 125mg and I am a tall, heavy guy with muscular rugby build legs. I'm trying to use the lowest dose possible.

I guess overall I'm just wondering about your experiences of AF while on Flec as compared to before taking Flec. Have you noticed a difference and any limitations?

Thank you! 😊

[Ppiman]

Well, I can't help but I dd enjoy reading your story and background. I hope someone here has sufficiently similar experience to help! The anxiety this conditions causes is its worst aspect in some ways. My own AF and arrhythmia are implicated with gastric issues and I am never sure which is which and that adds much to the anxiety as, if I could be sure how I was feeling was gastric , not cardiac, I would be much less concerned.

Steve