I've just realised I'm still confused about what AF actually is. Is there always an increased heart rate? I was taken into A&E with pounding heart and breathlessness, bpm was 160. I really felt that, so knew something was wrong. I was told it could be atrial flutter but subsequently the arrhythmia nurse said PAF. I now have a smartwatch which does ecgs and most of the time I'm in sinus, rbpm 60-80. I had a very short episode of AF again last week (pounding chest, bpm 129) which I managed to catch on my watch but which resolved itself quickly - less than 10 mins.
My question is - do all AF episodes involve increased heart rate? Is it possible to be in AF without the rate noticeably increasing? I often feel tiny 'blips'/brief palpitations, but I've had them for as long as I can remember and was told they were harmless. I'd really like to make the case for starting just PIP instead of permanent beta blockers, but obviously don't want to be missing episodes.
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Dwts20
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Yes, it is possible for AF to occur with the rate not very high, although there are other arrhythmias where the heart rate is pretty normal, e.g. ectopic beats (palpitations), slow rate, flutter with a normal ventricular rate, and others, which are often all mixed in in a wider case of AF.
The key thing with AF is that it is irregularly irregular. The heart "rate" that results depends on the ventricular response and whilst it's often fast, it can be normal. I am someone for whom my ventricular rate in AF was pretty mch normal.
Smartwatches have a limited ability to differentiate the various rhythms and may just say "possible AF - see a doctor"
l have had episodes of both high heart rate and normal heart rate. I notice that with the higher rate l am always more anxious, so could possible contribute. Staying calm does help, but sometimes this is difficult if you are in a stressful situation at the time. For me hospital appointments etc. are a killer.
AF is an irregularly irregular heart beat, that is almost every beat is different rate to the last one and no real pattern. It can be high or low rate and high rate alone does not determine AF.
Have a read of the AF Fact File on the following link heartrhythmalliance.org/afa... and anything else of interest, knowledge is the key to managing the condition in my opinion.
I'd really like to make the case for starting just PIP instead of permanent beta blockers,
Case is already made for PIP rate control medication (beta and calcium channel blockers) in the majority of afib patients.
The problem is many doctors are lagging behind and just prescribe them like candy because they've always been prescribed.
I had afib for close to 40 years and only took rate drugs to bring down my heart rate during an episode. That meant 40 years without the side effects of beta blockers that so many of us get.
In most cases of paroxysmal afib, the only time rate drugs are justified on a daily basis is when they're taken in conjunction with antiarrhythmic drugs. Here they act as nodal blocking agents for safety reasons.
I'm not a medical professional, but i suspect preventing episodes of AF could be better for your heart than responding to an episode. An ounce of prevention......In addition, PIP approach also requires you to know when to respond, which itself can be problematic when symptoms are mild and/or when you are sleeping.Certainly something all of us should discuss with our medical professional as part of individualising our treatment, noting we're all different.
preventing episodes of AF could be better for your heart than responding to an episode.
It depends on the frequency of your episodes. An ep is unlikely to put you on a daily anti arrhythmic, such as flecainide, if you're only having episodes a couple of times a year.
But further to my original point, Beta blockers are primarily rate drugs snd are only weak antiarrhythmics. They certainly have a role, controlling your rate during an afib episode and for some other conditions. But a very questionable role on a daily basis if you're not having an episode and need to control your rate.
An ep is unlikely to put you on a daily anti arrhythmic, such as flecainide, if you're only having episodes a couple of times a year.I suspect a new diagnosis of paroxysmal AF is rarely accompanied by a reliable history of AF episodes that occurred in the preceding 12 months. So although what you stated might make sense it certainly wasn't my experience. I was started on daily metoprolol and flecainide within weeks of being diagnosed with paroxysmal AF (based on an episode being captured on ECG in hospital emergency dept). I'd had a few events of unknown cause prior to that but 24 hour holter suggested ectopics were one cause and my previously diagnosed GERD, another.
So cardiologist didn't wait to get a reliable read on frequency or duration of episodes before starting flecainide
Hard to comment on someone else's treatment approach without knowing the facts, but if I was treated exactly the same way, I would've needlessly been on both Flecainde and Metoprolol for 40 years.
When my Afib burden did increase that's when I went on daily Flec and finally had a successful ablation as I did not want to be drug dependent anymore.
I think you mea "but obviously want to be missing episodes".
AF stands for Atrial Fibulation meaning your heart is getting irregular electrical signals.
Then this happens you could have low or high heart rate but I read usually rapid.
Together with high or low BP.
You can be controlled by meds or if heart is structurally normal your cardiac specialist may take you down the track of cardioversion, ablation or an anti-arrhymc journey.
Some folks can live with it. Some get little or no symptoms.
If you follow the main crowd suffering from this affliction you will eventually have persistent AF. Often it is said that persistent AF is easier to live with.
I found eventually that going private I got someone interested ready t listen and who acted.
With AM Diltiazem 120mg CD CCB med for comtrol of rapid AF a godsend.
PM Bisoprolol 1.25 med for control of BP.
Diltiazem as a Calcium Channel Blocker works on both rate and BP lowering. Also acts as a safer anti-arrhymia med.
But the above cannot be used if your heart has venticle or valve abnormality.
As you are now discovering there are different versions of AF. The irregular heartbeat can be fast or steady or slow. Many progress from occasional (paroxysmal) episodes to persistent (up to a week) or eventually permanent.
I have a perfectly normal heart but along the way started faints and blackouts from my rate going low (and even stopping for up to 14 seconds!)Beta blockers keep me under control and should my HR drop the pacemaker takes over. I am totally unaware of all this going on now though I still get short of breath and gave up marathon running twenty years ago!!
Apart from the beta blockers and eventually the pacemakers (on my second now) I was never offered or given cardioversion or ablation as many AF owners frequently and repeatedly are.
My normal resting HR is 60 and I have never experienced the fast HR that many do so it shows that we are all different so read lots, listen lots, take the beta blockers and anticoagulants if offered and stop worrying - that will kill you but AF wont😉
I’m not sure of things I have been told I have an irregular Herat beat which is AF ..but no one seems bothere..I’m on medication for HF and therefore assume AF ..don’t know if I should pursue AF with whatever medic is available?Any thoughts on this Cheers
No point in PIP if you convert to normal sinus rhythm spontaneously in 10 minutes. Question is whether you need a beta blocker at all if you’re not suffering from heart failure. As others have commented on this site, Bisoprolol 2.5mg daily seems to be the automatic response by cardiology to a diagnosis of PAF, at least until an echocardiogram is performed.
My occasional bouts of AF involve heart rate of around 200bpm for less than 30 minutes. Bisoprolol 1.25mg daily reduced heart rate to around 170bpm during PAF episodes but took my resting NSR down from 60 to low 40s. I decided to take an ACE-inhibitor for blood pressure and abandoned betablockers altogether once I’d had an echocardiogram showing a healthy heart. I prefer to put up with occasional AF rather than the side effects of betablockers when I’m in NSR.
AF is chaos at the top of the heart, and it only has noticeable and important effects because it can cause the bottom to beat rapidly or irregularly. This happens as the AF blocks the usual natural pacemaker signals from the SA node at the top of the heart (where the chaos is happening); instead, another pacemaker node just above the ventricles (the AV node) takes over and allows only some of the AF signals through to activate the ventricles to pump blood around the body.
How well it keeps these signals down to mimic a "normal" heart rate differs between sufferers as also does the way the ventricles are able, or not, to remain efficient in pumping (i.e. the so called "ejection fraction", or EF). Some people keep close to their normal "ejection fraction" while their AF is on and feel fine; other suffer a drop yet somehow still feel fine; yet others suffer a drop and feel varying degrees of discomfort, a very few requiring hospitalisation because of a potential collapse in such as BP. Again, no one seems to understand the reasons for the variation.
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Bisoprolol and arrhy
In A&E again low heart rate and blood pressure all over the place .
A bit disheartened and confused
AF, ablation and odd heart rhythms
