During an AF episode, how long does it take for blood to pool in the upper chambers of the heart? I can't seem to find much information relating to this topic, and I was just curious to find out what some of you guys know. It seems unlikely that short (under 10 seconds) episodes of AF could lead to a stroke, unless they were happening many times a day.
Blood pooling in the atria due to AF. - Atrial Fibrillati...
Blood pooling in the atria due to AF.
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John3333333
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BobDVolunteer
There is no"minimum" time known which is why anticoagulation is so important when you have AF.
So if you were in my shoes, - CHADS score 0, lone AF, aged 44, prone to short episodes of AF (always under 10 seconds, maybe 3 or 4 times per week) - would you take Apixaban? Or would you go along with the NICE recommended guidelines, and NHS heart consultants, and take no anticoagulant?
I wouldn’t take an anticoagulant and I don’t think a doctor would prescribe it.
Looking at your bio, you previously had an ablation. So the afib must have been worse ?
Regardless, discuss the need for an anticoagulant with your cardiologist/EP who is familiar with your heart and health. Best in lieu of guidelines published for the general public.
I'd agree there , it's more complicated than just looking at your present scores , present symptoms and present circumstances.As we know an Ablation isn't always a long term "cure" , short episodes of AF symptoms can be an early warning of things to come.
Often , things like a lower dose anticoagulant is considered in these circumstances as a Preventative, especially with more up to date ideas about not just popping the odd aspirin or blood thinning supplements.
Even if they still believe an anticoagulant isn't required , it's important to get the symptoms down on your medical records for evidence of your recent history to help the doctors make better choices for you in the future.
Plus, they may also be able to give some more up to date diet , pacing or lifestyle tips to help prevent the progress of current short episode events as a Preventative instead.
Why are you asking this, if your cardiologist puts you on blood thinners, then you should be taking them. personally i dont class the 10 seconds of a heart flutter as proper AF. when i go into AF, it takes 2 bisoprolol and around 3 hours to go back to normal h.rate. People get flutters all the time, many of them with no diagnosis of AF. so not sure why you are asking this. if you have AF you will be under a cardiologist surely.
Well I'm not giving advice just personal experience. I've had AF on and off for some years. Sometimes runs for 24 hours but mostly shorter although still hours. I've never taken anything because, well, I don't see the need. I've had a couple of echocardiograms which didn't find any defects in the heart or valves which reassured me. I don't like the idea of taking blood thinners for an occasional problem and I was only once offered bisoprolol which was a tiny dose and ineffectual during a bout of AF. I'm curious why you think you have AF if it's only a few seconds, how are you measuring it? Hearts can beat more quickly if there's a stimulus, fright for example.
A stroke only takes a tiny amount of time to do its worst so with 24hr bouts of Afib I would be having a rethink if I were you, only my personal opinion mind.
I was referred for investigation, I waited and waited for an appt. I was notified of a telephone consult. The Consultant rang and we discussed my history and symptoms. On the back of that he said I had AF and should have an ablation and anticoagulation. I expressed concern because my mother had been on Warfarin, her second stroke killed her because she had a catastrophic bleed, clearly not helped by taking a blood thinner. He said they tended not to use that now. So, without seeing me he put me on the list! I mentioned I used a Kardia which showed possible AF, he asked me to send the readings to his secretary. He sent an outcome letter saying ... "when I saw her in clinic..." ! He also said I'd refused blood thinners, not true. He said he would be sending a follow up appt. It never arrived. Months later a second outcome letter said he'd looked at the readings and they didn't show AF so he concluded I didn't have AF and wouldn't need an ablation. So a Consultant I'd never seen diagnosed me and contradicted his diagnosis! Are you at all surprised that I just decided not to bother with the doctors? I've never heard from him again.
No I am not surprised giving that catastrophic excuse for medical competency. The only thing I will say is that you really need to protect yourself from the outcomes of atrial fibrillation. Can you afford to see a cardiologist privately as they will sort you out and you can relay your fears about your mother and any other fears or anxieties you might have and should not cost you an arm and a leg as they are quite reasonable about 200 Euro in Ireland so I would think about the same in the UK. He will advise you on your risk factors and may refer you to the NHS for an ablation, will probably put you on the new DOAC anticoagulents say Apixaban which has a much lower bleed risk that warfarin, or he may say your risk is low, but either way it will give you peace of mind and adaquate protection which to me is priceless. I hope things go really well for you.
Funnily enough I started with a private cardiologist, he also said without any tests etc that I should go on an anti-coagulation drug. The only benefit I got from seeing him was the Echocardiogram. Tbh I didn't like him at all, he works with the NHS too and his outcome letter was riddled with inaccuracies one of which was that I'd refused anti coagulants and statins. I'm 73, fairly fit and healthy, I'm just going to take my chance. I've been battling to get my thyroid problems treated, that's been a no too because I'm "in range" despite the symptoms, familial hypothyroid and PA so I'm self medicating now. Thanks for your concern ❤️
Your CHADS score is 0. You say the NICE guidelines don't recommend thinners. Nor does your NHS heart consultant. You also say these episodes last under 10 seconds and are "afib-like" activity which is not necessarily the same as afib. You're a young man with a lot of life to live. If your doctor says you do not need thinners, please just listen to them.and stop worrying.
Jim
That’s the million dollar question we all debate. No easy answer.
How would you know you had AFib for 10 seconds?
As my EP once told me, " anything less than 30 seconds doesn't need a name!"
My cardiologist has said something similar. He told me not to be overly concerned about short bursts (seconds) of irregular rhythms providing you have no other symptoms. This is my dilemma though, if short bursts of AF can increase the likelihood of a stroke, maybe I should be concerned.
Think you should listen to the professionals who you are under, and stop worrying, it wont help the situation. Sorry but i dont beat around bushes just say it how it is.
Apparently the incidence of stroke caused by AF is 25% which means 75% don't have a stroke. Those odds seem more in favour of someone not having a stroke.
Doesn't it mean that 75% of strokes are NOT caused by AF? Just asking. The odds of having a stroke go way up with age, which is why age is a big factor in CHADS.
I wonder why they go up with age? All cause strokes probably have a pretty wide span, smoking, obesity, atherosclerosis and more. Is age a factor more than lifestyle? I have no figures but I'd think probably not, eg if you don't own or drive a car, the chances of you dying in an RTA must be very slim compared to the group who both own and drive cars. If you take care of your physical health I'd think the chances of you being healthy and living longer are a given so you shouldn't have an age feature as part of your CHADs score. I wonder why there is a CHAds score, what is it used for? Maybe to decide who should be treated over those they don't think should, clearly using age as a factor. I think that's very wrong.
Perhaps the better description would be 'AF-like activity' for 10 seconds.
l can’t really see how you would know this answer as we are all different, but l would imagine every time the heart misfires the blood is being whisked like my kitchen tool when it’s whipping cream to thicken. It makes you aware of how important taking an anticoagulant is.
If this were the case, surely people who suffer from pac/pvc couplets and triplets, bigeminy and other various ectopic beats would all be at a higher risk of stroke too. Yet, anticoagulants are not regularly prescribed for ectopics.
I was told by my Cardiologist that ectopics are not serious. Anticoagulants are not prescribed for ectopics as they are not classed as a serious arythmia. Everyone gets them. It really depends on the individual and his health symptoms. I am sure if a Cardiologist feels it necessary then he would prescribe the appropriate medication. We are not medics on here so can only pass on a small amount of knowledge. If you are worried perhaps you need to speak to your GP or Cardiologist.
Ectopics are just missed beat and everyone gets some but most are not noticed. AF on the other hand creates weird fluid dynamics within the heart so even a few seconds of AF can mean blood pooling in the LA appendage where it could cause a clot.
A couple of studies I've read showed that it is age, genetic or other related changes in the "atrial substrate", as well as in the size and shape of the left atrial appendage, that underlie the increase in clotting potential. These studies seemed to suggest that the fibrillating in itself might not be the actual cause of the increased potential of the blood to clot.
I have read, too, that short bursts of AF might be more common than realised with one study terming these "micro AF". I get these reasonably regularly and have caught a burst recently on my Apple Watch of under thirty seconds.
For me, clusters and runs of ectopic beats and AF don't feel much different but I gather the former are "benign". There has been some work that hints otherwise, but, as with so much in this area, there is a lack of knowledge with work still ongoing. Studying the heart, safely protected as it is by the rib cage and especially looking for changes that take maybe half a lifetime to form, seems to make understanding what leads to what very difficult.
Steve
It doesn't to me lol.
Blood does not work like cream being whipped
If it worked like that after four years of permanent AF my blood would be like butter
Ok. I was just trying to give an imaginary example of how the blood thickens when it pools around the heart in an episode of AF. It must thicken if a clot can form. Are you not taking an anticoagulant? (Some people refer to them as “blood thinner”). How would you describe the blood forming into a clot? No offence was meant. 😂😂😂
No offence taken, just a funny picture you drew
Actually it is exactly the other way. Blood is too SLOW inside the atria during AF. That is what may cause clots. Also size of the atria matters, large is bad as far as clots forming is concerned.
Yes, you are absolutely correct, but it has to have some movement to form a clot. The blood is difficult to circulate so pools and thickens and must churn somewhat to try and move.
It was a weird picture l gave. I have a vivid imagination. Thanks for your reply. Keep well.
I don’t know but I was told my EP that if I had afib for five hours I needed to start anticoagulants. After my initial 44 hour episode I had an echocardiogram of my heart-if there were signs of bruising in the appendage then I was to start anticoagulants but there were no signs.
I read a peer reviewed paper that suggested 48 hours or more of fast AF is a tipping point. This was for patients with lone AF.
Yes. That is for the first episode. That is what I had and they were going to cardio convert me but there was a query as to whether I had had it before in which case the odds were i had already had blood pooling. I didn’t go to the Doctor until 44 hours of rapid hr and afib because I read on the internet it wasn’t a medical emergency but to see a doctor if it hadn’t stopped in 48 hours. Apparently that wasn’t correct and I was taken by ambulance to ER -my doctor called the ambulance. I regret not going sooner because it rewired my electrics and I haven’t been the same since …
Anyone with fast AF for 48 hours would be in hospital, as soon as a person with AF goes into AF, (like myself), i act and take my pills to get it back into rhythm usually takes 3 hours or so, but just sit quiety, and dont panic or think its time to call the undertakers in. You should read less stuff and listen to your cardiologist if they feel you need one
Can you please post (or PM) a link to the 48 hour article you have referenced. bob
BobDVolunteer
That would tie in well with the 24 hour cardioversion fine but 48 hours let's think about it.
Perhaps consider asking your GP to order a Zio monitor? I imagine this would give you an idea of your AF burden. The company will presumably tell you what the monitor can and can’t tell you, with comparative costs vs a Holter, which the GP may find persuasive.
In most cases A/F deteriorates, becomes more frequent as time goes by and the need for anticoags becomes stronger. Initially, I was given 375mg of soluble Aspirin a day because my cardiologist felt that at 54 I was, at that stage, too young to have to faff around with Warfarin (i'm going back over 20 odd years), as memory serves me I think I was on that for about a year, then the A/F caused a stroke and as a consequence put on Warfarin. I have now been on anticoags the rest of the time. Whether you should be taking them I don't know, this is a discussion between you and your cardiologist but we know that when we go into A/F the heart is not pumping blood around the body efficiently and it pools, how quickly would depend on each individual I guess, its a bit like playing Russian roulette!!!
If you had Afib before and had an ablation and it has reduced your episodes that is great. But I have been told and read numerous times that you need an anticoagulant. It seems Afibbers still have the risk of stroke after the ablation. Must be part of our plumbing and pumping issues. I don't understand the logic of it. Wear headgear when playing sport if you go down that track. I am always worried about bumping my head.
maybe the answer is in my cardiologist’s protocol. If your having a cardioversion and your AF is less than 24 hours then no TOE procedure on the other hand if my AF has gone longer than that even a day or so a TOE is done. Unfortunately this is not black and white but he explained to me they believe it takes a couple of days for a clot to form. His advice is when I go into AF start Apixiban and when back in sinus continue taking for one month then stop.
I have a friend with chronic afib. She has been on eliquis for several months. Twice before cardioversion she has had a clot when they did her toe/ or tee as my cardiologist says it. Same thing. I have been in aflutter and afib, jumps back and forth since 3-22 and one EP I saw was not going to allow me to have one prior to my cardioversion. I am like it's my heart, my life I'm having one. He got mad and said fine they will do one. I told him the last time I was cardioverted in 2013 the Dr said I would have one bc I was maybe a couple hours over the 48 hr window. They gave me a lovenox injection the night before and right as they pushed me out of my room to take me for the cardioversion and I'm like wait a minute what about the TEE?,, And they said we don't do them in this hospital and you have had your 2 doses of love lovenox. I was scared to death but it went fine. I asked the nurse when she came in to schedule this cardioversion if they really did them at this hospital now and she said no... something with anesthesia. I said well this Dr lied to me too. I am finally seeing my old EP in 6 days who has done 4 ablations(none for afib, I had other electrical issues and extra pathways) he now lives in another city further away but I will drive bc I trust him. The other 2 not so much. When you are a nurse and have knowledge of this stuff it is almost scarier....especially when you know they are not being honest. Then I sure don't want them doing anything to me!!!
Thanks sharing your experience yes lots don’t do the TOE but I like my guys thinking better not risk doing CV in case there’s a clot there so do a TOE if over 24 hrs in AF
Since you are asking just for personal opinions, mine is 'If in any doubt at all, take the anti-coagulant', From what I have read, they are generally well tolerated by most people, nut a stroke can be catastrophic
"they are generally well tolerated by most people"
Being tolerated is definitely something to consider but you usually only find out the answer by taking them. However, before doing so it's a risk assessment. That's what CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk tries to simplify as there's benefits and risks for taking AC and benefits and risks for not taking AC.
My worry would be the AF attacks you may not notice, particularly when you are sleeping, so when you're not checking your watch or taking your pulse. 🤔
John, on the basis of the info you provided you are nowhere near the criteria for taking an anti coagulant. It's that simple.
I suggest you follow the guidelines. With lone PAF and a ChadsVasc2 score of 0 the risks of taking an anticoagulant outweigh the risk of stroke.
Interesting question - it’s also likely to be the case that the mechanism that potentially creates a clot leading to a stroke may, in some instances, lead to the formation of microemboli which may lie behind the additional long term risk for AF sufferers of dementia ….
What length of AF episode may generate these tiny clots ?
The newest research out is 5 1/2 hours or more. That’s when we at a larger risk of throwing off a clot. No one is positive though as to an exact amount of time, but that’s what my doctor showed me was the latest research. In fact, there is a world renowned Cardiologist who says if you have a fib for more than that time to use Eliquis for a week once you convert back to NSR. Doctors have varying opinions on when to anticoagulate. You are young and with a zero score, so you don’t have comorbidities, ask your doctor about that and why they would want to anticoagulate you. There might be things we don’t know about your health so you can’t really take medical advice from a forum who doesn’t know your history about such a serious decision. All the best.
That is in line with the timeframe my EP gave
As your risk of a stroke is increased when going off NOACs (not as before NOAC, more so because of having taken them), I think this on/off idea is bad.
I agree and mostly because of the black box warning and it can’t be good for our body. Maybe he only does that with someone who gets a few a fibs in a whole year. I get them a few times a week so I wouldn’t be an on/off candidate. But if I got them very infrequently I’d consider it.
You are one of the few people who knows this including doctors! I was so upset when I found out we are at more risk of stroke, heart attack and death from being on them if you go off. I was never told that prior. If I was ever able to go off with doctor’s approval due to procedures, I would start a natural blood thinning protocol. Take care.
I had to go of them due to side effects. I tapered. Even though no doc told me to, I had no help whatsoever. But I tapered and all went well. So far
So glad to hear you are doing well. I would be very interested to hear your story.
In my last appointment I asked if I could go off apixaban. My history is two ablations for fast and debilitating AF. I have needed propafenone to convert (it takes a couple of hours), meanwhile I'm bedfast. However, I am AF free since the last ablation (soon a year) so I asked the question. He didn't agree and said I never know if/when I'll have another episode and it is at the time when the heart converts that it is the riskiest time for throwing a clot. (Of course, the pooling goes on while the heart fibrillates.) Just throwing it out there as an FYI since I didn't know that.
And neither did your doctor know, as it is still not exactly known when the most dangerous time is. There are no studies telling you.
Sorry, I was reading through and left my reply as an answer to mav7s reply to you instead.Just thought I'd let you know in case you want to read it and missed it.
Take care , Bee
I found this very interesting. It basically says that subclinical AF is may not the cause of strokes. And that inflammation and myopathy are more likely to cause them. I was interested, as I know a little bit about the connection between the heart and the thyroid. So my advice would be to get those thyroid levels checked and adjusted until YOU feel good, no matter what your doctor says. Even a slight hypothyroidism can lead to myopathy and Hashimotos does raise your inflammation levels.
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