I have recently been in continuous a/f for 7 weeks with HR of on average 130 but peaking at 200 or so. I have seen a cardiologist who has increased Bisoprolol from 1.25 to 5 daily and introduced flecanide( since Monday).I also take warfarin. I feel dreadful! Very out of breath very tired and my B/P has dropped to 95/72. Apparently I may need a cardio version and I’ve been booked for a cardiac CT scan and an echo . I’m terrified at the thought of a cardio version with the stroke risk. Do I need to have the Ct scan before the cardio version or doesn’t it matter.
I also may need an ablation. Does anyone have experience of Dr Rob Bowers - I understand he is an electrophysiologist at Southampton.
I would be grateful for any advice!
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Since you are already anticoagulated your risk of stroke is greatly reduced so please don't worry. So long as you have been anticoagulated for at least a month there is no need for a CT scan before the DCCV but they may decide to do a TOE (trans oespohageal echo cardiogram) to check there are no clots in your heart if there is any possibility.
Thanks so much for your reply. If they do decide to do a TOE is one sedated ( or preferably unconscious!) I’m not very good with things down my throat! Would the CT scan show blood clots ?
TOE normally done whilst sedated prior to zapping. Not sure what CT scan can show. I have normally only had these prior to ablation .The scan is projected onto the screen to aid navigation.
I had a CT scan to look for possible clots before my ablation. If they did à TOE it must have been while I was under GA .I hope you get sorted soon - 7 weeks at that rate must be exhausting for you .
You would definitely want to be sedated if you have a TOE but if you've had continuous anticoagulation for at least 3 weeks, they wouldn't do one as the norm prior to DCCV.The only cardiac CT I've had is a CT angiogram to check for blocked arteries in which case, I would say it would show up any clots.
Try not worry about a DCCV. I'd rather have one than a tooth extraction (or a TOE but that's another story!)
I can hear the panic in the words you've written which is quite normal. I'm here to hopefully soothe that away for you.
I understand totally just how dreadful you must be feeling with your heart at the rate you say is averaging 130bpm. What is the range your beats are covering? I think what I would do is call your cardiologists secretary and tell her how dreadful you are feeling and what your heart rate is doing. If you can't reach her, then dial the NHS 111 advice no. Hopefully what they will then do is send some paramedics out to do an ECG. With your heart rate averaging 130bpm they will hopefully take you to A&E.
Cardioversions are very straightforward and certainly not to be feared. You are sedated before being giving the shock to your heart, so will know nothing about it. You will think me mad but I love having them. I go in for one feeling dreadful and come out cured and feeling that I could kiss the feet of those who did the procedure. We have one member on this forum who has had something like 23, now she would never have had all those if there was anything bad about the process.
We are here for you, you are not on your own and we understand totally how you are feeling right now.
Speak to us and ask as many questions as you like.
You asked about my heart rate range. 126 is the lowest 202 highest. ECG at hospital Monday recorded it at 177 hence why my bisoprolol was quadrupled and I was put on flecanide. It hasn’t made any difference at all tho - except I feel worse!
I’ll ring the secretary on Monday if I feel no better . Fingers crossed I’ll start picking up over the weekend!
Do you know anything about the royal Brompton for ablations?…
I would feel dreadful with the heart rates you're putting up with and know I would be kept in a ward by my local hospital at those rates. Have you taken Flecainide before? It's usual to have an ECG a few days after starting that drug as it can sometimes cause more problems than help the heart.
Once when in hospital I was advised to drink water to bring my BP up. You could try that.
Still awful - I’m going to lie down for a bit. I have taken flecanide since Monday 2x a day - tho they didn’t say anything about a repeat ecg - my B/p 95/60 and oxygen (90) is also quite low which I think is due to the increased dose of Bisoprolol.
Kardia says I’m ticking over at 160 at the moment!
Thanks for your replies - it’s good to speak to someone who has experienced it!
I am surprised they are not supervising you in hospital at those rates, you must feel awful. I'm lucky so far that I've always converted without needing a cardioversion. I'd be tempted to turn up at A and E for help, they normally give a drip and a whole lot of blood tests .
Royal Brompton and at George’s are part of the same group so you are in really good hands there. I had an ablation in St George’s snd no problems all straight forward
Regarding cardioversion as others have said so simple and any TOE done whilst asleep and all takes so very little time. First time I had one I said when are you going to start and they said all done snd over. Then I realised I could breath and no fast rate heart thumping .
All the best to you. All I would say if your heart keeps racing so high you might call 999and they might fast track you in through A&E
I hve AF and sorry, but stating of someone who has needed 23 of these, does not instil me with any confidence in the procedures success rate long term. clearly these are just a temporary fix, but i too have heard on these forums that its not always successful.
A cardioversion procedure is not generally seen as a cure for AF. If one can get your heart back into normal rhythm it's a good sign that an ablation can help. I had about 10ish (mine all worked) and 3 ablations and then was told I wouldn't be offered any more of either. In general Jalia is unusual with the amount she has had. My mentioning how many is a statement to let Elizabeth know that she doesn't need to fear having one.
When our hearts are beating at a high rate constantly for weeks on end and making us feel really ill, then having a successful cardioversion is like the most wonderful blessing. Have you ever experienced that constant fast rate AF that makes you feel so poorly? I have and when you come back to consciousness after a successful cardioversion you almost want to cry with the relief of having a normal heart rate again.
How long it lasts is anyone's guess and can be hours, months or years.
Hello Jean, all i hope for is that i survive a bit longer, i an now 77, and only this last year developed PAF, i try to keep well in myself, keep walking and not overweight as i would like for my family history to be my downfall.
My Mum, her father and her Brother all died from Mum age 42, her father 45, and brot her at 55, 2 in sleep massive MI's and last one just fell off his chair dead on the floor. seems family heart history, all had short lives. but i would be hard pushed to have any sort of invasive procedure on my heart, my Cardiologist said he only suggests anything invasive when the heart is worse, i take Apixaban, and just half of one Bisoprol a day 1.25 mg tablet halved, this tends to keep my h.rate in its normal 50 mark, i will worry if i continue to get AF attacks, at presnet they appear to be around one in 8 weeks. The worse i have even felt in my life was recently when the hospital did the EKG, drug induced stress test for my heart. instantly it sent me into the worst AF ever had, was ill for 2days following. i wouldnt have another EKG ever, when my time is up its up is how i look at life now. Pacemakers are offered but he told me only last resort too if my heart was a lot worse. We all hang by a thread, when your time is up i am a fatalist, procedures will begin to fail only my own opinion. Its all in Gods hands.
I agree with you totally. When we get to a certain age we can't help but wonder how much longer we have on this earth. So must make the most of each day and keep ourselves well.
It's good to hear you keep up your walking. I think the more active we are and the more stimulation our minds get, the better that is for us. I have a friend who is 86 and she goes swimming every morning and belongs to so many groups that she is kept busy constantly. At the moment she's off visiting her daughter in the states. Yes travelled there under her own steam.
I go along with what Jeanjeannie has just written. I'm the member who has had 28 cardioversions, last one about 5 weeks ago.
I would certainly phone cardiologists secretary and if no luck then 111. You can't continue in that rate. If I presented at my local A&E in your condition I would almost certainly be admitted and cardioverted.
I can assure you that cardioversions are nothing to worry about. Having said that I understand your concerns as I was petrified at the idea in the early days!
It was firstly to say Thankyou so much for troubling to reply. Second I was wondering if you’d ever had an ablation ?
I did see a consultant cardiologist on Monday which was when he changed the drug regime - but I’d be so grateful to be out of A/F - I feel dreadful and very “lacking in breath”
Do you think it will matter that it’s been 6 weeks since it all started before they do a cardio version - so worried about a stroke ..
As long as you've been properly anticoagulated you should be OK. I see that you're on warfarin (same as me). They don't normally like your INR to fall out of range ie below 2.0 in the preceding 3 weeks.
Have I had an ablation? Ha! I've had my 5th one just over 4 weeks ago. I'm quite an experienced AF er as you may have gathered by now 😁 ( I'm due to return to my Cardiac Centre quite soon to have an Occlusion device implanted in my left atrial appendage. Now I expect I'm blinding you with science so I won't say anything more 🤔)
I notice that you asked about the TOE procedure. I'm not going to lie to you. It's not the most pleasant of procedures but if you have one done just tell yourself how vital this is to detect unwanted lurking clots. You will have your throat sedated with a banana tasting spray and often given a light sedation through a cannula in your arm as well. I think this last one may be optional but I take everything I'm offered. I've had several and will be having at least one more with my next procedure I suspect.
23 ? and someone else has had 28, sorry bur clearly these are not long term fixes. I have AF paroxysmal type, but my husband had permanent, he had one shocking whatever the medical term is in hospital and on a med, that he gets no AF at all. but has heart failure now.
No these are not long term fixes and have never claimed to be. Myself, I'm an unusual case in having so many dccv s. They were spaced out over 31 years and some have lasted 3/4 years and many 12 months. They gave me back quality of life when drugs failed to work.
As you say every case is different, it all makes me quite grateful as i got to 76 before having anything like AF or heart issues, which in itself was good, as i lost my Mum at 42, her Father at 45, and Mums Brother he was 55, all with undiagnosed heart problem, causing each of them to die withoutwarning, 2 in their sleep with massive MI's. clearly hereditary, but as you say all are different, i tried to keep well, not overweight, walked daily with dogs all my life, did smoke for a while but gave up in late 30's, but i dont rest on laurels as where hearts are concerned, things can turn on a sixpence. but hopefully you are fine now, we have two of our main organs in the main, sadly only one heart though.👍
I just had a cardioversion on Tuesday. They did the TOE and I WAS under sedation - didn't feel or rember a thing. My response was immediate and I woke up feeling grooggy but otherwise fine. I had excellent monitoring and care. For me, they reccomended no driving, serious decision making, heavy exercise, etc. That is only my experience but the process is simple, effective and most times safe. It is not a cure however. Afib can return at anytime and most ikely will. I was in afib for four months so I am deighted to be back in NSR. Good luck and stay positive.
If your rapid heart rate is continuous and averaging 130 peaking at 200, would suggest going to A&E. Your medications are not working to control your heart rate.
They will reduce your heart rate to an acceptable level by cardioversion or medication.
Is it possible to speak to your cardiologist to inform him ?
I only saw the cardiologist on Monday when he changed the meds - I guess he was hoping they would reduce the heart rate but I do feel aweful. I will try to make contact with someone tomorrow. Thankyou for troubling to reply.
From what i read cardioversios once deemed neccessary, continue to be the short term ffix from then on. my afib hopefully will continue to be controlled on meds, but the most important med, is the blood thinner for anyone with AF. It would worry me tremendously if mine became permanent AF, but these things are out of our control.
it's horrible being in such a high rate for so long to be honest I would have gone to ED in your place but if you want to wait it out try some vagal maneuvers like blow very very hard into a syringe for 30 seconds then lie down tilting your head back over the end of the bed or sofsofa it should slow the rate down don't be scared of the proceedures your not awake for any though I didn't like the TOE without being put out so if like me you don't like things down your throat ask for proponol the Michael Jackson drug of choice then didn't feel a thing,
Sounds like a trip to ED though that's what I'd do
For me, being constantly out of breath, plus persistent A/F, signalled heart failure, fluid overload etc., so my drugs were adjusted to include a diuretic, my Bisoporal was increased to 10mg daily and Propanafone 150mg twice a day, I was already taking 180mg NAOC which, when turning 80, was reduced to 110 mg. This together sent me back into sinus, the Bisoporal, formerly 5 mg was increased to 7.5 then ultimately the 10mg. I am pleased to say that so far so good, this was roughly a year ago. As for ablation, I had one 8 years ago, under sedation, uncomfortable but no pain, drugged but aware of what was going on. This, for me, was unsuccessful, refused further and now have a trusty Pacemaker. I hope everything goes well for you x
I’ve had numerous cardioversion with the pads back in the day for atrial flutter. In Liverpool on one occasion the anaesthetist ask as he was putting the mask over me ‘ are you red or blue ‘ . I said ‘ ‘red ‘ . ‘ Wrong answer ‘ he replied and shook his head as the mask covered my mouth.
On another occasion they had to do me in the ward and the other patients were in shock as they said ‘ It was like casualty ( bbc) in here mate ‘ , as I was tucking into two plates of food.That’s the worst part you can’t have anything to eat before! As the operating team were leaving one patient was kicking off! They said ‘if your rate keeps going up like that we’ll do you next’. That shut him up !
On another occasion the doctor who was doing the zapping was late turning up and the anaesthetist threatened to punch his lights out. The nurses had to break it up !
The other cardioversions were none event’s really except one were the consultant would not give me one , the sister asked on the next shift what’s happening with you? As the consultant had gone home . I replied ‘he was organising a cardioversion ‘ which I got 6 hrs later . The look on the consultants face when he came in the next day was something to behold! Amateur came to mind.
All cardioversions were successful but only lasted a year at best ( had about a dozen or maybe 10) over a four year period. 2006 /10 before I finally got an ablation.
On another point bysoporol made me ten times worse than the flutter I felt like a zombie. 46 y.o over 6ft well built and I had trouble walking 30 yards . A little old lady asked if I needed help!
Gees sounds like a horror story, which hospital gave you all this grief, sounds like one of the prisoner of war camps. punching lights out and and doing your own cardioversions it seems. are you sure you werent in a dream state and dreaming a lot of this, but i know the NHS is on its uppers, but never thought punching lights out between staff is what its come to.
The anaesthetist team only had this small window of opportunity between major operations so I fully understand where he was coming from . The Doctor was a bit of a Jack the lad and needed putting in his place . The hospital was Liverpool Royal and Broadgreen. It started going down hill a couple of years after that .Do you recall ‘ The Liverpool Pathway’ if you were beyond a certain age or only had a slim chance they basically left you to die ‘ nil by mouth’ . Any one around here over a certain age were frightened to death staying in hospital . More recently a medic was charged with putting plastic backs over old dears heads at Broadgreen . Whether this was because they had to cease the pathway who knows?
If it eases your worry at all. I had only been on Warfarin for a week when I had a cardioversion and it was absolutely fine. - Came round, had a chicken sandwich , got dressed and got a lift home !
Hi Liz, Those symptoms you're experiencing sound to me like the Bisoprolol. I was told it was the high heart beat that was making me feel so tired and out of breath but as soon as I was off them I felt as right as rain. Has going to 5mg had any effect on your HR? The EPs tend not to care too much about how the drgs make you feel, just as long as your HR comes down to below 100!
When I get AFib,I get a fast heart rate and high BP and the Doctors have told me to go into A&E if my AFib doesn’t stop after an hour. When there, they give me an ECG and take my BP within 20 mins and when they see the results, I’m always taken round to the Majors dept and given a drip with medication to stop it.I’ve never had a cardioversion. I’ve been told by the Doctors, it’s best not to let AFib go on too long. They are always very good when I go in. Fortunately, I’ve only had 10 or so episodes since I started with it in 2014, after a nasty coughing virus. I think it’s because I always get treatment for it. I had an ablation last September, so I’m hoping it’s done the trick and the nasty AFib won’t return. Good luck with your treatment.
Don't worry it's all ok, I've had 3 now. 66 and never been ill or in hospital..... I was so accredited. You'll be just fine. I have AF where I keep coming out of sinus rythum and heart rate just sticks. First time it happened I had to be hospitalized but now just call an ambulance and have cardioversions. My problem is I also have Bradycardia when in sinus rythum so because of meds lowing it even more I will be fitted with a dual pacemaker soon so they can sort afib out. Good luck and hope you feel better soon.
Hi Jalia ( and everyone else who has replied - I’m most grateful for your advice and support. )
I feel a bit better this morning - I felt very unwell in the night - dare I say it I felt too ill go to A&e!
I didn’t take last nights dose of flecanide nor have I taken this mornings as I was feeling ( and being) very sick and my heart rate kept going up not down and the rhythm was no better. The palms of my hands also weirdly had gone yellow! That seems to have stabilised now. HR is still 140 but has come down from last night so I think flecanide doesn’t suit me!
I’m taking it very easy and in bed atm and tho I don t feel up to eating I am drinking. If I can last til Monday without getting any worse I’ll go and see the consultant again - he has a Monday clinic and if necessary I’ll sit outside his door till he sees me!
Thanks again for everyone’s help I’m a bit less scared about a cardio version - I just want to be back to “ normal” whatever that is and able to function properly !
Flecainide doesn't suit everyone and it does sound like it was offered as a quick fix. Rest up and try to stay calm over the weekend. If you start to feel dizzy, nauseous or have pain I'd be inclined to go to A and E regardless. Get yourself a little "hospital ready pack" so that you'll feel relatively comfortable whilst there. I had one of these in my bedroom for about 3 years. PJs, a book or reader, eye mask, face mask (lots of bugs in hospital waiting rooms sadly), medical notes from appointments, a travel cushion and anything else that spells comfort to you. I recommend chatting to the lovely Arrythmia Alliance people on Monday - they're there to give you practical advice and guidance. Look them up and give them a call.
I still don't like the idea of you being at home. If you start to feel breathless or any chest pain, which hopefully you won't, then please don't hesitate to dial 999.
I will reiterate that cardioversions are such a quick, streamlined procedure these days that there is no need to worry. You will feel so much better afterwards.
Of course you need an ECHO or CT Scan before cardioversion, ablation or Flec being an anti-arrthymnic med.
If your heart is abnormal then its a NO WAY.
I can't.
AND
bbs did not bring my Heart rate of 186 on Metoprolol or 156 on Bisoprolol.
I was left!
I was encouraged by my locum to see a private cardio specialist.
Tried me on CCB Diltiazem. 180mg to high dose so I'm on 120mg less than 1/2 normal.
Within 2 hours on 180mg it went from 156 to 51!
I take 120mg AM Diltiazem AM for heart eate control. now 60s
" 2.5mg Bisoprolol PM for BP control
I was diagnosed with rapid amd persistent AF. WITH STROKE
4 days later they found thyroid Papillary cancer during a carotid arteries scan. A SHADOW ON MY THYROID.
So thyroid cancer first which caused the AF and the AF caused the stroke.
My rapid heart rate Day is now 60s and my Night avg stays at 47bpm. I had pauses with Metoprolol at Night.
It's good to have 24hr Heart Monitor before and after changing meds even dosages.
I had 3 x in 2021 to proof what was happening.
Flec... is a risky med. Sometimes it makes things worse.
I chose PRADAXA 110mg twice daily.
I also take Synthroid due to my thyrodectomy with 12 lymphs removed with desection.
Breathless is due to your rapid heart rate and needs immediate control under 100 at rest.
BP you are takng too high a dosage of Bisoprolol. Increase will make it worse and I wonder what the specialist is thinking. Mine was put up to 10mg with no heart rate control!
Drs will nly put up the meds or reduce those given by specialist.
As you learn to be interested in what is happening to you, I get copies of everything. I belong to different research places, Radcliffe videos are helpful and knowledge is poswer.
You are going through a bad time—physically and emotionally. Lots of us have been where you are.
There are ways you can ease off—but one almost has to learn those things through experience. Which is why this forum is so valuable—we learn from others’ experiences. I sure do.
I’ve been, in the early stages, exactly where you are now. I don’t go there anymore. You don’t need to either, as you’ll learn as time goes on. Please try real hard to take deep breaths and get all the reassurance you can from this forum.
Physically, 130-150bpm (I’ve been there for extended periods) can make one feel crummy. And what makes me feel double crummy is the drugs.
Right now, today, my HR hovers around 115-125bpm. I’m scheduled for a DCCV Wednesday. We are in similar situations—except this will be my 9th CV and I’ve had 2 ablations
I don’t feel crummy, just a little sluggish and lightheaded, and am getting on with life as normal while I await the CV. I even hosted a casual dinner party on my patio yesterday evening.
One big reason I don’t feel crummy like I used to in this situation is that I’ve said No to drugs. My HR is not life-threatening. I’m not in crisis. And in my experience with drugs (BB’s and CCB’s) is that they often don’t work—don’t keep me in NSR—and they only make me feel worse.
Then, after a CV and I’m back in NSR, I feel great! For as long as it lasts, whether a year, months, weeks, days, I’m in good shape. Another responder to your post said something similar. I look forward to CV’s and how I’ll feel afterwards
I think CV’s are the cat’s meow for making me suddenly feel like myself again—when especially I’m off drugs that are full of side effects and don’t seem to work for me anyway.
By now, I know many on the CV staff where mine are done. We get on well and enjoy our conversations. We know all about each other’s dogs. (-: I know the routine. I know the questions to ask. It is not an unpleasant experience. Would I rather be in my garden? Yes! But as things go, a CV for me holds no fear and I actually enjoy parts of the experience, especially when I have good people about me.
For me, a CV is a way for maintaining my QOL while I’m waiting in queue for an ablation. An ablation is the only possible real solution, cure if you will, that I see, so that’s where I single-mindedly head.
I hope sharing my experience can make things a little easier for you as you go through your first CV. I wish you the best!
I should add that I AM on Eliquis. The drugs I’ve said no to are beta blockers, calcium channel blockers, and the worst of the all for making me feel awful, amiodarone—which I now consider to be a drug only of last resort should I be in a life-threatening.
Arrhythmia tachycardia at modest levels is not wonderful, but it is not life-threatening, especially is one is taking stroke prevention caution.
And there’s nothing to a TEE/TOE. It’s done while you’re under anesthesia. You won’t feel a thing. The anesthesia is short acting. I’m awake and walking around within 15 minutes, ready to get on with my life.
Hi …. There are some excellent comments and advice given by caring members of this group above.
May i suggest a couple of non medical interventions to help calm down the heart. Firstly try taking some extra mineral supplements - magnesium and potassium are good for normal heart functions as well as zinc and iron. I take magnesium taurate everyday and handful of pumpkin seeds that has electrolytes mentioned above. Secondly try some vagal manoeuvres like blowing into a syringe. There’s lots of information on YouTube if you haven’t already searched. Look up Dr Sanjay Gupta, everything you ever needed to know about AF and other heart conditions. Hope that helps
Are you sure you're not in A Flutter vs AFib? Flecainide can actually be proarrhythmic is some cases and Flutter is tough to get out of with drugs. Flutter is easy to ablate though. Sometimes lowering heartrate in Flutter does not work with beta blockers either.
Either way it sounds like a DCCV is in order. A trip to A&E may be something to think about.
I've flipped between Afib and Aflutter back and forth at times. Kardia will show Possible Afib when in Afib but with Flutter (for me anyway) it will show as NSR or possibly Tahycardia because it's a higher rate but steady rhythm. A 12 lead ECG will show definitively.
Of course re 12 lead. Always best, and a good reason to sit ot put in A and E in my opinion because at least its on record. I think with more modern version of Kardiamobile you can get Advanced Determination function. I've not had Atrial Flutter so I've never seen it, but I think it's one of the ones on their list. Things like ventricular tachycardia and Flutter are not.
Dear Elizabeth, so sorry to hear about what you’re going through. That is certainly’fast AFib’ and I am glad that you’re being proactive.
I’ve had six cardioversions and all was well. I’m on Apixaban, but yours is similar and I felt reassured by that…
I have also had two ablations and although the first one triggered another arrhythmia (atrial tachycardia) I was so pleased to have had them!
My last ablation was on May 3rd this year and I can tell you that it’s so fantastic not being aware of my heart beats and the gaps, thumps and quivering etc and no longer (at the moment 🙏) having no fast heart rate, feeling dizzy, breathless and queasy etc
thank you all so much for your advice - I’m not feeling so very unwell after stopping the flecanide but still have a very high heart rate - currently 152 . ECG on Monday said it was A fib but previously I have had flutter - but I’m not very sure of the difference so I’ll have a look at Sanjay’s videos. I’ve also e mailed the consultants secretary . Fingers crossed he’ll get back to me soon
Thanks again to everyone for your caring and help and advice
I have had several cardioversions. You won’t feel a thing , they are over in seconds and apart from feeling a bit tired you will feel immediatedly better! I have also had 2 ablations . The first one did not work and my recovery time from the second one was less than a week. Apart from a few ectopic beats I had no after effects. I had both ablations in my mid seventees. Since then I rarely have AF . If I do have an attack then it is caused by stress or something which has upset my digestion system. So dont worry all will be fine!’.
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Cardiac issues
Atrial Fibrillation
CT Scan prior to Abalation 
Low heart rate ?
