A bit of a Dilema!

[FSsimmer]

Hi, would appreciate any advice.

Just over 3 years ago I was diagnosed with Long standing persistent Afib.

First episode was out of the blue when I ended up in A&E with a HR of 167.. They got my rate to below 100 and sent me home with a referral to our local Cardiac Unit as 'urgent'...Well after a telephone consult some weeks later with an EP I was listed for an Ablation. This took place almost 12 months after my A&E diagnosis.

I was in Afib all that time, but had minimal symptoms so it did not really effect me. My pulse was hovering around 90bpm.

I had been a runner, so stopped that but just did brisk walks. I also travel a lot, and I was told also this was fine, so got travel insurance and went off to Greece. Before the ablation I was told I had persistent Afib, and following the procedure went back into NSR ( for about a week, then back into Afib )..Tablets at that time Flecainide, Bisoprolol and Edoxaban. No issue with any of these.

Was then listed for a cardioversion 6 months down the line. Still minimal symptoms, still traveling ( went off to Iceland )

Had my cardioversion 11 months ago and it put me back in NSR. Fl;ecainide stopped, and after 6 months I was discharged from the cardiac unit ( I still am ). In June I was in Iceland again ( no issues, no trouble with travel insurance ), still in NSR. 2 months ago I was ready to step on an aircraft to Athens when I went into rapid Afib again and missed my flight and subsequent cruise around the Med. Was taken to the local A&E and after two hours went back into NSR on my own. I needed no treatment and it was put down to stress and sent home!

Well insurance covered the ruined holiday and I am back in NSR as if nothing happened. Phoned the cardiac unit nurses specialists (who have been great in the past) and I am still discharged and they hare happy for me to travel. GP was not particularly concerned, jut upped my Bisoprolol to 5mg once a day...My issue. When I was in Afib all the time there were no issues in traveling, but I am now terrified of going away and needing to go in to an A&E abroad if I go back into Afib and my HR needs sorting!!!!... Have not had the courage to see about further travel insurance since my claim as well

I have lost all confidence from this one incident and feel like I am living on a knife edge despite being in NSR...I have reduced all my possible triggers as well....

Anyone else in this situation. and if so how do you cope?. I am 70 this year, don't drink. smoke or do drugs!!...My one luxury is that I like to travel

[BenHall1]

Hi FSsimmer,

It would be very interesting if you could say what your running exploits were, what they involved and how many years you practiçed this sport.

John

[FSsimmer in reply to BenHall1]

I was a runner for about 5 years. Normally 5-10K ( non stop ) 2-3 times per week. Excercise does not seem to be a the trigger for me!

[wilsond]

Why did you go to A n E ? They just monitor you and send you home.It sounds as if the fear of AF attack is driving you into it.

Lots of people on here find meditation techniques very useful( I'm useless,can't focus!)

When we have symptomatic AF or what was worse for me, Aflutter it's very unsettling but not life threatening. Bob D on here recalls starting an attack en route for a driving holiday in France,and carrying on.

The betablocker upgrade may well help in two ways,calming the rate and also calming yourself.

Happy travelling!

[FSsimmer in reply to wilsond]

Went to A&E as they called the paramedic at the airport and he called an ambulance. They also did an ECG. Once in A&E I settled down...Never had this before apart from y first episode and initial diagnosis. Consultant in A&E suggested relaxation if it happened again

[mav7]

May be best to contact the EP who did your ablation (or another EP) to inform them of your recurrence and concerns. He may want to monitor your heart and medication therapy.

[CDreamer]

I’ve had PAF for many years but it never stopped me travelling even when in fast AF which I’ve had in trains, planes, boats and cars. I’ve never had to go to hospital abroad with AF, a few other things but not AF. When AF hit I just relaxed, deep breathing practice kept well hydrated, had an electrolyte drink or salty snack (tip from EP) and sat it out - I always self converted within 48 hours. Ensure you have your meds with you wherever you are and carry in hand luggage.

It’s curious that your lack of confidence is because you are in NSR and I guess that’s about the uncertainty fear of ‘what if’ whereas in persistent AF you had certainty, it’s the living with uncertainty which takes some coming to terms with. What ifs are best dealt with I find with though experiments by imagining the what if happening in various scenarios and thinking through what you would do.

Don’t allow AF to stop you enjoying your life.

[secondtry]

I totally understand your loss of confidence despite the probable irrationality. I am the same with going skiing to Austria my passion and where I had some significant AF episodes. Haven't been back since.

No experience but maybe you could try these new OTC medical cannabis based supplements, which evidently are very relaxing - sorry I was told the name but have forgotten. I understand they are available in big stores but have never looked for them.

[Singwell]

CDREAMER is spot on about the 'what ifs'. I became more anxious after my first ablation because I was waiting to see if it would last out. We can't enjoy life if we do that! People here helped me.For me - knowledge is power. I'd invest in a private appointment with your EP for a reality check and advice on possible additional pill in the pocket strategy for if AF kicks off inconveniently. There are also excellent breathing strategies you can do that will at least slow down your rate. Message me if you'd like to try the technique I use.

[Outsidethelines]

I was also going to suggest a chat with your cardiologist/EP about prescribing you a ‘pill in the pocket’. It sounds as though your heart tends to go back into NSR by itself, but having an emergency drug to take just in case it doesn’t might be reassuring

[Auriculaire]

You have to ask yourself what exactly are you anxious about? Are your symptoms in paroxsysmal afib totally debilitating ? If not why bother going to A&E? Just take it easy and carry on with the holiday . I never go to A&E with episodes . I have learned to relax and distract myself and take it easy till I revert to NSR. I have had several episodes while on holiday. They have been no worse than episodes at home.

[Redactrice]

For what it's worth, I was in persistent AF for probably 12 months from 2023 into this year. It did not respond to drugs, hence the very long duration. While I was waiting for treatment I went abroad to see my mother because she's in her mid-80s and in failing health. It was not my preferred scenario but I needed to make that visit sooner rather than later (and am about to make another one). As long as you have adequate travel insurance, you should be fine.

I agree with other posters about the futility of going to A&E unless you are having severe symptoms, although other countries (where they still have a functioning health service) have different protocols for fast AF -- if you went to A&E in the US, for instance, they would be likely to offer cardioversion. The US is a special case because it's for-profit healthcare (PAY ATTENTION, UK) and therefore the sky is the limit for treatment as long as you're fully insured. The one and only time I've had cardioversion at home (UK), I had a six-month wait for it. That was this year. If it had been ten years ago, would I have been offered cardioversion straight out of A&E...?

[WildIris in reply to Redactrice]

as a US resident, I just want to add that our health care system here is not only broken but corrupt in that it a high percentage of money paid in, maybe 25%?, goes to insurance and hospital executives and practice owners and shareholders, and we have by far the most expensive health care in the world. I am amazed when I watch British TV shows where nobody even worries about the cost of medical care, though I surmise that treatment delays and lack of practitioners are a big problem.

[RVine3 in reply to Redactrice]

I am from New York and when I went to my EP and met him for the first time (after AFIB diagnosis from cardiologist) he had my cardioversion done 2 days later. I have had good experiences with healthcare here so far. Let's hope it continues...

[Youngatheartnow]

I do understand how you feel. I used to dread going into AF. Talk to your cardiologist who ablated you. It’s not unusual to need two procedures. A second ablation may be necessary. Take all the above advice and live life to the full. AF must not define you.

All the best.

[FSsimmer]

Thank you everyone for the advice..I just have to get over my fears!!

[Kimmieblue]

Yes, getting over your fears is the hard part but it really can be done (says she...)I'm exactly the same with the 'Whatifs' they run your life, but if you can just brave it out, I think you'd be fine, maybe try a very short flight to a close European country perhaps, it'll be worth a go.

Anyway, all the best to you.

K.