hi you lovely people. I’m Just needing a little casual advice if possible.? My Afib episodes are becoming more frequent this last month especially unfortunately. They don’t last long ( so far.?) which is good but I have noticed a big increase in frequency.! My ecg gadget is showing AFIB with a Heart rate of 130s to 160s. My cardiologist that I spoke to recently on my phone appointment doesn’t seem very eager for me to undergo another ablation I don’t why.? It may be because Iv already undergone three.? My next plan is to see my GP for a referral to cardiologist but at the same time ask if I need anything to keep my heart rate down whilst in AFIB with a view to pill in the pocket approach.? Has anyone been in the same position.? If so has the meds given kept the rate down.?
thankyou all. Ron.👍
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Thankyou bob.👍im hoping I can get to see GP within in the next week.?? I’m having no pain or discomfort or breathlessness when in AFIB but I’m not over happy at the Heart rates and wondering how long one’s heart can withstand a high rate.!!
My episodes which last 24 hours ( have had 3) heart rate top rate 187 and doesn’t really respond to rate control drugs. On list for ablation asap. Obviously doesn’t do your heart any good but only really makes me feel a bit weak and wobbly . Am knackered for days afterwards though
Yes I was same at one time too. Really tired after an episode.! But weirdly enough it doesn’t seem to tire me out like it once did probably because the episodes are short.?
Like you my Afib has become more frequent over the course of this last year. My HR is about the same as yours during a typical episode. So far bisoprolol has always brought down my HR. I have not had an ablation and I have not been referred to Cardiology. For some reason the episodes have been less frequent over this last month, hopefully this this reduction in frequency will continue.
An EP is the specialist in AFib. Ask for the referral. My GP in Ireland told me an EP couldn't do anything for me. I'd probably had four episodes by the time I asked her. By the time I saw the EP ten months later I had ten hours of 180bpm every three days. Three weeks later I had an ablation in Dublin. It gave me my life back. I found bisopropol nor sotalol (anti arythmic with beta blocker capabilities) just caused big conversion pauses. So unfortunately the meds don't slow my heart but they stop it altogether when it's trying to convert to nsr.
Thanks joy, and have a lovely time and let me know what your up to👍 yes Iv been fairly quiet of late. I think it’s because my worry/anxiety mode kicked in and I do become a little withdrawn. Iv been same at work and with my family too. I don’t like it when I get like this because it can last for months.! I’m either up in the clouds full of positivity or flat out full of worry.! I know it doesn’t do me any good but i just can’t shake it off until it decides to leave.👍
Be aware that beta blockers and Flecainide may impact your ability to do any exercise where you need to raise you heart rate significantly. For me, running became not just hard work but far less enjoyable. Cycling less so. Sometimes though, there is no reasonable alternative.
The longest I’ve been in AF rate of 130-190 (but for the main part around the 130-150 end of things) was 3 days, and by the end of that I was getting very worried. I had used the max Bisoprolol I could, and I can’t take anti- arrhythmics.
First time this happened I took advice from 111, and was admitted from a&e when they couldn’t bring the rate down. Cardioverted after a couple of days. Second time was during the winter of 2020 and I sat it out at home until the symptoms were too worrying. After a very long and dehydrating wait at a&e I was seen (in the waiting room, not even wired up) and the moment my heart rate dropped momentarily to around 120 I was sent home. Of course it was back up to 170s immediately but I sat it out at home a further day or so til it self converted, and thankfully survived. I don’t recommend doing that! I wouldn’t do it again.
It’s definitely good to have a rate control lined up. My EP has said to take extra Bisoprolol as a pill in the pocket in an AF event, as mine are always fast. But if the rate is consistently above 130, not dropping lower at all, he said best to get checked out after a few hours. (Sooner if chest pain, fainting etc, of course.).
How long are your episodes?
I’d really just like a rate control that works, as the extra Bisoprolol doesn’t seem to touch mine! Several people have mentioned diltiazem and I plan to ask my EP about it next time I get the chance.
Hi Jane, my episodes have been lasting around an hour mostly. Sometimes half hour. Mainly in the small hours but sometimes early evening. I’v got an appointment with the GP next week hopefully for a referral to the cardiologist to see what he suggests.?
It’s good they’re short, but you’re very wise to get on top of it now - and I agree that to get back on the books of an EP if possible would be good, I think? Might have to be via a cardiologist referral, as you say- Hopefully your GP will refer you to wherever will be most appropriate. The fact you’ve had an EP before might mean you can be referred back directly to them? Thanks for letting us know what happens Jx
I have developed say twice daily AF episodes for average say 5 mins at a time. My heart rate increases possibly over 100 don't measure it as no discomfort to speak of. Asked and got Bisoprolol from my cardiologist to be used as a PIP if increased HR becomes uncomfortable.
Yes for sure, but don't forget there are positives it has stopped me going crazy on the ski slopes when I am far too old to do so 🤣 but seriously due to AF my lifestyle choices are far better for my longterm wellbeing.
That’s a great way of looking at it. Thankyou, it’s cheered me up somewhat because I’m already worrying about what I’m going to be like in the near future unfortunately.!! Worrying doesn’t help things at all I know but I just can’t help it sometimes.!
I’m very much the same as you but only have had one ablation for AFl. My AF episodes last a very variable amount of time but often many hours. My heart rate slows often to 85-120bpm or so, which is less uncomfortable.
I know of no way to help except an extra 1.25mg bisoprolol, which might help - I can’t really be sure. I have been given flecainide, too, but am reluctant to take it.
I would ask for more information about why a further ablation isn’t considered the way forward.
I think that’s a good idea Steve. My EP did say a fourth was on the cards a couple of years ago if afib started playing up again.! But I was then discharged a while late because I was doing fine.
I started having bouts again a year or so ago so was sent to a cardiologist who has now told me he doesn’t think an ablation will be beneficial.!! So I looks like I’m going to have to ask him why, and see what he has to say.??
Yes - I can have a stab at his reply: because of their effect on the atrial cells, arrhythmias tend to self perpetuating and eventually become permanent.
My elderly friend, now 91, has permanent AF but with a fairly low heart rate (c. 85). He copes marvellously, really. If mine would drop to that rate, I would - maybe - ask if treatment, outside of apixaban, was worth it.
I'm wondering if you have tried Flecainide PIP. I am also generally reluctant to take but given the choice between lengthy AF episodes or cutting them short I prefer to take Flecainide.
The lead cardiologist at my County hospital did say to take it as soon as possible within the first half hour after AF starts because that's when it works best. I think if the AF sets in it's harder to shift. Flecainide usually returns me to NSR within 1/2 to 3/4 of an hour. It is strong and on subsequent days I have short bouts of tachycardia which I think are a side effect of the Flecainide, however I have highly symptomatic PAF and would much rather be without that.
I do always try to return to NSR with breathing first, for about 20 mins, and sometimes that works for me ...
I took just one, not as a PIP, but intending to be a regular daily dose, as it was prescribed by my specialist. It worked and that day, indeed for several days, I had the least number of palpitations I had had for weeks, and no AF. But... during the day, I had some unusually "heavy feeling" beats that just set me off worrying. I reported these to my GP, who said it can cause this and that he would like me to go back to the bisoprolol and to email the cardiologist, which I did. He was all for my starting it again, but, those heavy beats stayed in my mind, and I haven't done so. My AF has since become much more frequent and I am back to considering restarting it.
I was initially prescribed daily Flecainide but the cardiologist said I could take it as a PIP if I preferred to do that. I have low resting HR so beta blockers and calcium blockers are not recommended. My AF episodes are every month or two months.
Much the same. My average heart rate is quite low and I’m said to have bradycardia. I find a small dose (1.25mg) of bisoprolol helps and can cope with two occasionally. I never know if it does much, truthfully. My AF rate is lower than it used to be but I gather that happens naturally. It’s all an unknown in a way.
i was prescribed 100mg Flecainide PIP but I usually try 50mg after 15 - 20 minutes of AF (after trying the breathing first) and if that doesn't work another 50mg 15 minutes later, but it might be more efficient to take the 100mg straightaway. I always hope to get away with 50mg but doesn't always work.
Needless to say your Cardio or GP will know what's best for you 🙃
I wonder if the earlier you use it the better could be applied to most of the drugs,? I have virtually symptomless infrequent PAF - I confess I do not have very much gadgetry, just not very accurate wrist BP monitors because I have thin arms and I battle to get the upper arm cuff correctly placed over the artery - I have read there is an Omron one now available which can go anyhow on you upper arm, but here in South Africa they do not import much Omron stuff, it's mostly Beurer or unknowns! However, I do have a habit of taking my pulse manually when I'm sitting, and if I feel it's a bit fast - I check it and if it's in the 90s I take 1,25mg Biso - Cardio says I can use it on an as needed basis, the rate quickly lowers to the mid sixties- mid seventies with which I am happiest, and no irregular heartbeat comes about. Maybe it's just how the condition works in me !
The Cardio says I can take the Biso on an 'as needed' basis and I have decided I need it when my HR gets to the 90s ( I'm a follower of the Astronaut, Neil Armstrong who said when asked if he jogged ' No, I believe that we are given a certain number of heartbeats per life and I, not wasting any of mine.') - I think when they get into the 90s they are being wasted 🤣
You need to see an EP, the cardiologists who specialise in electrical problems in the heart. I had to see one privately, who prescribed Flecainide for me to take as a PiP after introducing me to having a smartphone and Kardia and seeing a reading of my heart in AF. Now that I take it regularly I haven’t had an episode for ages.
Flecainide takes a while to work and with such short episodes they’d be gone before it got going, however taking it regularly might prevent the episodes altogether.
In the UK, I believe an electrophysiologist (EP) is no more expert on arrhythmias than a cardiologist would be. The former is the latter with training in catheter ablation - a procedure . Each major hospital has teams with both.
I was once told that cardiologists don’t tend to like EPs because of there extra knowledge and skills regarding the subject of the heart. Whether this is true I have no idea.? It was a retired cardiac nurse who told me this only a few years ago. I would like to think they both work in harmony together to be honest and I hope they do.👍
I should think that's reflecting a specific experience?
I suppose also that the reality of a heart arrhythmia is that it is a fault with what some call the "plumbing" rather than the "electrics". i.e. the fault is at the physical cellular level. After all, where are the "electrics" in the heart - there really aren't any, just cells through which chemical ions flow.
What I wonder whether what might happen - and which would worry me - is that a "pure EP" (where such exists) might feel more inclined to carry out an ablation because that is what they do and from which they make their living. My own "EP" is a cardiologist first and foremost, I would say.
My cardiologist told me they have a whole arsenal of drugs to lower heart rate - the problem is finding which one(s) suit the patient best. I didn't get on with Bisoprolol - it made me depressed - but I was fine on Diltiazem. During a medical episode (long story) I was also given Digoxin which, I understand, is very effective and it worked for me to keep my heart rate under control.
Thank you for your post on the Atrial Fibrillation support forum, we would recommend you speak to a medical professional about the 'pill in the pocket'
I have download our information sheet 'Pill in the pocket' for you to have a read through.
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Jx 
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