I've learned so much about AF from this forum. Thanks a lot.
I have PAF. At first an episode would terminate naturally after a few hours but at the moment I'm finding that I can self terminate them.
So, a typical episode for me starts with a HR around 100 and over 4/5 hours will decrease to upper 60's/70s. At that point moderate excercise ( Power Walking/Rowing ) usually gets me back into Sinus pretty quickly. Exercising too early from the start of an episode doesn't work for me.
Just curious for people's experiences, do their PAF episodes feature decreasing HR or do they stay at more or less the starting HR before ending?
Thanks
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dobid
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Have to say your AF burden is very low so lucky you. Many people find exercise can be helpful but just as many find it the cause . AF is such a mongrel condition there is no normal.
I've had a couple of episodes triggered by playing Badminton ( or maybe they would have happened anyway ) but I certainly do feel lucky in that respect.
Not so lucky though in that I have had night time episodes with its attendant sleeping problems.
It’s odd that I prefer mine to happen during the night as I panic less and just manage to go back to sleep. Daytime episodes especially at work worry me the most though, I’m still a work in progress as like you I’m fairly new to PAF .
I'm fortunate in that I'm retired and don't have the stress of getting up for work with an AF episode. However, I had several weeks of ( unrelated ) insomnia in the Summer and I can't help thinking that night time AF might trigger insomnia. Fortunately, I've found that going to bed late helps as I can get very tired and so will get some sleep before an episode. It seems to push the onset time later as well. That tends to suit me as so far I've been able to stop an episode with exercise. In fact I had an episode at 8am today. I went for a short power walk at 12.30pm and returned to NSR after ten minutes.
You mentioned things have changed, so the question is could your arrhythmia have changed? At least in the United States, a two week ekg patch is fairly standard to document electrical changes over time where the EKG in the office only does it for less than a minute. Alternatively, or an addition, you could get something like the Apple Watch or Kardia and do it at home.
Yes, I'm thinking of getting a Kardia. My original question was out of interest as I have never seen any reference to what I mentioned - on this forum or the internet.
But, I was also was thinking that there might be people who don't know that it could be possible to stop an AF episode with moderate excercise if their HR decreases to a certain level. When I had my first few episodes I just assumed that my HR stayed at the same high level and that I simply had to wait and hope that it to would self terminate. It seemed counter-intuitive to excercise when my HR was high.
Converting to normal rhythm by exercise is not uncommon, although something not recommended unless cleared by your doctor. However, I don't remember anyone saying it was easier to do that at a lower heart rate.
At least with me, my heart rate does not decrease in atrial fibrillation, unless I take a rate control drug to bring it down.
My PAF was faster at the start of an episode and slowed down before reverting to NSR with similar numbers to you. I usually sat episodes out but I had one episode end earlier than expected when I rushed upstairs for the toilet and another when when I was preparing for some workmen to arrive moving things around instead of sitting down. Could be coincidence but I can definitely relate to your findings. Triggers and coincidences I found difficult to distinguish at the start or end of episodes.
In the beginning a small dose of bisoprolol appeared to reduce episodes somewhat but then they were all early hours of the morning 20ish hours in to the 24 hourly dose. When my dose was increased, I split it morning and evening 12 hourly, again episodes were reduced slightly and the times were more random and rarely while in bed overnight.
As you will have found, everyone’s experience is different and we all take comfort and reassurance when someone else has the same experience.
Regarding the moderate exercise, if I do nothing, a typical AF episode for me would self-terminate about 7-8 hours after starting. However, I found that exercising (jogging) would terminate my AF almost 100% of the time within about 10 min. Similar to your experience, if I started running right after going into AF it wouldn't work but if I waited about 20 min, it would almost always end within 2-10 min.
Interesting that you are able to do it so soon after the start - I'd love that. I learnt from grim experience that its no good me power walking or rowing at 3am, it ain't gonna work, I just have to try and relax till the HR is more favourable.
I always check my HR if possible when an episode starts ( typically round 100 ) do you know what your starting HR is typically? I'm wondering if you have a lower starting HR and therefore your exercise reset might be quicker for that reason.
So before I had an ablation, my resting heart rate was relatively low - like maybe in the upper 40s, especially at night. So my HR was probably not too high when I was in AF though I don't think I measured it. I would assume it wouldn't have been too high as I probably wouldn't have been able to tolerate a run if it was. Interestingly enough though is that I would usually wait until I started having to pee a lot before going for a jog (which usually started about 20 min after I went into AF). If I went before that, I would often not convert and have to try again later. As I've read, that is probably due to Atrial Natriuretic Peptide which is released due to atrial stretching in an attempt to reduce blood pressure (by eliminating sodium from the body among other things). So maybe reducing blood pressure was required before I would self convert? Not a medical diagnosis and I'm sure there's probably a lot more complex stuff going on.
Yes, I've read about ANP and I've experienced it myself - with the night episodes anyway. That's an interesting theory in its relation to BP and self terminating. I can't recall seeing anything on the Internet which attempts to explain how self terminating might work - either anecdotally or scientifically.
My afib normally establishes a flat baseline of around 90 bpm (nsr baseline would be mid 50s). It reminds me of a mesa with steep up and drop off when I convert to nsr. A couple of times, when my heart rate when to higher values (above 110 bpm), it behaved differently, but that hasn't happened enough for me to recognize any pattern.
When I decided one day to just do my normal morning exercise despite an afib episode, it pushed my heart rate up above the age calculated maximum heart rate, where it stayed for the whole time (unknown to me until I returned home and checked my Garmin Connect on my phone). I didn't think that would be great for my heart, but maybe I shouldn't worry so much about it.
I play badminton doubles ( 3 x 2 hours per week in an over 50's session ) and fortunately I've only rarely had an afib episode during those sessions. I have generally stopped playing when I get an episode but on one occasion I carried on ( at a slower pace ) and went back into NSR a couple of games later! They are very energetic games but its moderate compared to gym work so my HR doesn't get up to my age max.
I'd be curious to see whether you go into NSR without the exercise. I suspect the lower HR just prior to you exercising might be an indication that your AF episode was in the process of ending i.e. was ending anyway and exercise is coincidental to AF ending rather than causal.
When I first started getting AF episodes I didn't know about self terminating so I got used to them lasting for a similar duration. Nearly all my subsequent episodes have been ended relatively quickly with excercise well within the duration that I was getting originally. Then again perhaps the newer episodes would naturally terminate quicker than the original ones! I have had one episode which started during the night and ended just before I got up ( when I would have tried to self terminate ) so I definitely see your point.
I also have PAF and the longer episodes have self terminated on doing something (going upstairs, walking down the road, picking up the shopping), after a long period lying down either asleep or just on the sofa.
I have found that I can convert back into NSR by cycling up a hill. Sometimes only takes 5 mins sometimes half an hour. Often converts back after I have done the hill and am relaxing going down the other side.Does not always work if I try it immediately I have gone into AF but normally have to wait a few hours or try the next day. I have not checked whether this relates to blood pressure. My normal blood pressure is about average and pretty stable.
I'm just curious to compare what you describe with my own experiences. Do you know what your HR would typically be at the start of an episode and would typically be before attempting to self terminate?
When in AF I wait for a few hours or even overnight, then hop on the bike and pedal reasonably hard and pulse rises to 130ish. Then when I back off I revert to NSR. If not, I push it again.Has worked for me around 100 times over the years. My EP was interested in my approach and did not say stop. I think being fit helps my AF. If I over do it on the bike it can also be a trigger. Hence electric bike.
Right, got it. That's some record you have! My GP seemed rather surprised when I mentioned about self terminating. Mind you he said that most of his AF patients presented with permanant AF, which surprised me. I suppose a fair few are asymptomatic and he simply prescribes a COAG and refers them on if necessary. I'm relieved that he's never mentioned exercise restrictions.🤞
my first episode 1993 then once every 4 or 5 years till 2022. My HR at rest in AF was 85-90 then I’d did some vigorous exercise within a few hours and self convert. Unfortunately I’ve tried since 2022 to self convert but no luck.. I’m thinking the beta blockers may subdue my HR too much and the exercise doesn’t do the trick anymore!
This is something that I have read helps some, but it doesn't for me. There has come about an idea that there are two "kinds" of AF based on the known innervation of the heart muscle by the autonomic nervous system (i.e. the side of the nervous system under central control, a balance between the adrenergic and cholinergic nerves systems).
The vagus nerve, wrongly often associated only with the cholinergic nervous system, is often seen as the source of AF triggering since its trunk lies close by the heart and it innervates that organ, as well as many others. It has received extra special interest, at least in the lay public's mind, although not so much from the medical side, except perhaps those who see opportunities to exploit the association for personal gain.
In some people, AF seems to start most when their sympathetic nervous system is dominant ("adrenergic AF" - during activity or high emotion), while some find their AF starts when the parasympathetic nervous system ("cholinergic AF" - during rest, or digestion) is dominant.
I think mine is mixed but more the latter as my arrhythmias seem worse either during a meal, while sitting resting after one, or just after getting into bed. That said, they have also started when bending and during activity. I cannot identify a "trigger" at all, in truth.
Yes, I've read and watched so many you tube videos ( particularly by Sunil Gupta of course ) about what you describe. I wonder if there actually are any people who have identified one trigger and have stopped most, or even all, of their episodes by avoiding that trigger. Just a thought.
Mine decrease, like yours start at a higher rate, then go up and down for a few hours then usually remain around 80bpm. My episodes last up to 36 hours though.Not always been like this. On the beginning my heart rate would be around 170bpm
Yes, my HR goes up to 130-90ish at onset of an episode and then comes down. Nowadays I take Flecainide as a PiP (pill in the pocket) which has thus far stopped the episode in about an hour but prior to having a PiP my episodes would last about 10-14 hrs and by the end my HR would be barely above normal - 70s maybe.
My episodes were very well controlled by Bisoprolol initially but I couldn't stand the breathlessness/chest ache so I have switched to Diltiazem. My episodes had returned but during this second week I'm seeing real signs of improvement. Hopefully the drug is now working to its full potential.
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