I have episodes of PAF roughly every two months always at night. These usually terminate after about 6 or 7 hours, often after taking a morning dose of 10mg bisoprolol.
I woke up this morning at 0430 in a slowish AF (75bpm). However, the episode has still not terminated after 14 hours. My biggest worry is that this may now be persistent/permanent AF. I rang 111 and they want me to go to A and E. Has anyone who has gone from PAF to persistent/permanent AF acquired it in this, or similar way? By this I mean a fairly abrupt transition from shortish (6-7 hour) episodes to ones lasting for days or permanently? I really was not expecting this.
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Samazeuilh2
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You must remember that persistant AF is termed as events lasting longer than seven days and or needing intervention to revert to NSR. Permanent AF is an agreement between doctor and patient that no further atempts to attain NSR are to be made.
Considering all that you are a long long way from either. Please be positive. .
As for persistent AF, what types of intervention do you refer to? Do you mean medication taken at home, or do you mean procedures in a hospital or clinic setting?
As for permanent AF, once the "permanent agreement" has been made, would "no further attempts" include stopping some medications (other tban anticoagulants)?
Mine always lasted 12 to 24 hours and I never went to A&E. At that slowish rate as you put it I would sit it out unless you have chest pain or shortage of breath. The more you think about it the longer it can last in my experience, distraction was always helpful to help revert to NSR. Stay well hydrated.
How are you determining your heart rate ? 75 bpm is not bad unless it greatly exceeds your average.
Would be good to ask doctor to prescribe a holter monitor to evaluate and alleviate your concern. Also, may want to ask the doctor about time to take bisoprolol and possibly split the dose.
Splitting the dose is a good idea. By chance I have a Holter monitor in the near future. My usual rate is in the low fifties at rest going to about 65 walking.
If your HR alone was 75bpm that's at the low end of the normal range ( 60 to 100). If you are in AF at the same time it may be a different thing. If your HR dropped to around 44 bpm or rose well above 100, say to 140 -160 range or if it bobbed around like a cork in water in a gale then I'd get to A & E.
i've been in AF for anywhere from an hour to 60 days sometimes revert to sinus with exercise other times wait for cardioversion. To use as an example the 60 day episode i was also low heart rate of around 75 then took beta blocker and Flecanide daily whilst waiting for CV to steady the rhythm. Following CV i was in sinus for nearly 11 months. Its an interesting thing AF in the way we are all different.
What do you mean by "wait for cardioversion"? To me, cardioversion often refers to a procedure you get in a clinic or hospital setting. But your use of the word "wait" makes me think you are using the word in a different sense.
what I meant was sometimes it would not revert into Sinus by itself and I would need a CV. Sometimes I would have to wait a week or so and one time I was overseas and had to wait until my return to have the CV. Each time my AF was really well controlled especially with drugs and HR was steady 60-70 in AF so doctors believed waiting for CV would not be an issue.
CV is carried out on patients who have waited weeks or even months; usually at a hospital clinic or department.
Typically the patients all attend at the same time early morning and are arranged into a schedule. From the reception area they are taken to their own cubicle to change and be briefly interviewed, then taken down to be anaesthetised and CV'd.
A few mins later they wake up on a recovery ward where they are monitored and given refreshments before being sent home.
It is also performed in the way you refer to, followung admission to A&E, and sometimes as part of an ablation procedure.
My paroxysmal AF episodes were variable, lasting anywhere between one and three days, every six weeks or so, for a couple of years, then one day, a month before I was due an ablation, an episode started and didn't stop. The ablation went ahead, and no regrets since (though it's been an interesting ride).
As others have said what you describe wouldn't be considered persistent or permanent and I hope for you that perhaps by now you're back in sinus rhythm. My experience of attending A&E when in Afib was that their concern was with my heart rate. As soon as that was lowered to circa 100bpm they discharged me whilst still in Afib.
Don't think you could assume that the slightly longer episode means you would now have persistent or permanent AFib.It could be a one off , maybe with worse or longer symptoms on this occasion because you are run down , you've been under more stress or you could be about to have an infection.
You can get longer than usual episodes when you are generally unwell for other reasons.
They should be able to help at AandE.
Only time will tell if your AFib has developed into persistent AFib now.
My PAF used to come every 2 to 3 months, I used to wait for them. They also lasted 36 hours but I never went to A & E as I am on meds and knew they wouldn't do anything other than monitor me with lots of bleeping machines making my anxiety worse. I was told by my EP to sit it out and not to go to hospital unless I had chest pains or fainting. I always reverted back to NSR. I had an ablation back in March last year so I am hopeful the beast has gone to bed at least for the foreseeable future. I now feel I have my life back and rarely think about the AF. Have you considered ablation?
I discussed ablation at my last cardiology appointment. They said that it would be an option, but in general (unlike 5 years ago when they were all for it) that “there are some risks”. I asked if there had been a change in policy from 5 years ago and they indicated that there had been; but they didn’t say what this was . They were adamant that the state of the NHS was not the cause. They reiterated what Bob says, that an ablation doesn’t cure AF but may alleviate symptoms.
There are risks with everything and every operation and procedure. I would think that these are less now as technology has moved on. The risks explained to me were: 1 in 200 chance of a stroke during the procedure but this risk is now reduced because they keep you on the anticoagulants. 1 in 200 chance of a bleed around the heart requiring drainage and 1 in 1000 of an oesophageal fistula and of course a risk of death which is pretty much on every operation carried out. I was terrified but it was the best decision I made as I have had no episodes that I am aware of since, in fact the last one was January 2024 when I had covid. I waited over 12 months for the ablation in Glenfield, Leicester
Mine always starts in the night and lasts between 7 - 12 hours then suddenly stops. Last month when it went past the 12 hours and was very erratic I was advised by 111 to go to A&E. They took my pulse and said it was all over the place. My fit bit showed ranges between 37 - 179. By the time I had the ECG it had slowed to about 137 and by the time I saw the doctor, 5 hours after arrival it had slowed to 88. So I was sent home, with the doctor telling me the fit bit isn't an accurate recording. I know it was as I could feel it. So all a bit of a waste of time really.
Your symptoms sound rather similar to mine: it always starts at night and lasts around 7 hours (apart from yesterday). It’s almost certainly vagal. Have your symptoms got worse over the years (i.e. are episodes becoming more frequent and/or longer)?
Every individual's AF experience/path appears to be different so I'm not sure how much we can learn from each other, but, for comparison: I've been afflicted by Paroxysmal AF since early 2007 and over that time the number of episodes per year has increased from 8-9 to around17-18, with the average duration increasing from about 4 - 8 hours to 8-18 currently.
Following the advice of my Dr I went to A&E for episodes 2 and 3 in 2007 (when AF was confirmed), and have never gone back since. In late 2015, following an unexplained cardiac episode I was put on 2.5mgs of Bisoprolol daily (though most of the time these days I take only half a tablet because of side effects), and in 2020 I was started on anticoagulants (edoxaban then apixaban).
Numerous ectopics were a daily affair throughout until just over a year ago when I started drinking more milk, which slightly improved (but didn't fix) ongoing indigestion issues, increased my potassium intake (which may have been significant too?) and seems to have drastically reduced the number of ectopics.
In the grand scheme of things my AF burden (percentage time I'm in AF) is small, but I'm aware that somewhere down the line, if I live long enough, permanent AF is a possibility. My fairly intensive weight training and shot putting activities, plus being a couple of stones overweight, actually make my condition worse than it is when I'm slim and moderately active.
I take about 400mgs of Magnesium Glycinate and 3000-4000ius of D3 daily and that seems to be beneficial. I'm nudging 70 and male.
I've no idea if any of this is relevant to your situation of course.
I’m about the same age. Quite a bit of what you say seems relevant. In 2023 after a bypass I had no episodes for a year, but last year I had 6 episodes. In 2023 I was at more or less my ideal weight but have put on a few kilos since. Apparently it’s possible for even a minor weight gain to make a difference to frequency of episodes, but, of course, that isn’t certain.
Hi , I have had simular irregular AF for 15 years or so , mine used to last between 12 - 20 hours around every 2/3 months, it seems like I could have 2 in a week and then nothing for 4 months. After starting to get 3 a week for a month I ended with consultation with consultant , which by then I had controlled it back to what could be termed normal. The consultant asked if I was using the fleconaide , I said only when necessary after say 16 hours , he said why wait after 1 hour of AF hit it with high dosage ie 200ml of Flecanaide and then another 100ml after another 1 hour, this seems to have worked well with most times reduced episode down to 2/3 hours.End of day always think about consulting docs they may find an answer to help you
Its my experience is that it is not uncommon to get longer and sometimes shorter bouts of Afib. Yes, often there is a length of time that is most common, but anomalous bouts are more common than uncommon from what I’ve seen. But Afib can be progressive, so it’s also common that eventually we have longer times spent in Afib overall. Often when it gets to a point we consider an ablation, or consider medicine like Flecainide to fend off this progression.
HI Crumbling, AF does not have to be fast. Many of us might start out with a higher rate, ie., 120's or more, but mine, for example, then quickly gets & stays slower, 80's or 90's (though irregular). Some of us can tell immediately that we are in AF because we are highly symptomatic, ie., we feel every beat in chest & throat. I can count my beats very easily... tho I also have a pulse-ox and a Kardia 6L if I want to confirm it. Flecainide stops mine within 4 - 14 hrs depending on whether I'm moving around, working, sitting quietly, etc.
Thank you, I have no idea how to distinguish AF from simple ectopic beats or SVT so I suppose I could be in AF loads of the time and not know it, as I gets lots of irregular beats but I’m was pretty certain they’re not AF.
Hello, You haven't mentioned if you've tried flecainide PIP, but if not, I would recommend a trial of it. I'm another one whose episodes vary from 2 - 15 or 16 hours, but 150 or 200 mg of flec PIP always works eventually, sometimes within an hr or 2. I've had no side effects from PIP flec in 5 years. (Since I'm vagally mediated, small meals are a must, and avoiding acidic, greasy, overly-spicy or heavy food. Also, eating small dinners at least 4-5 hrs before bed.) All good wishes!
Have you ever had a monitor on to record your heart rate whilst asleep?? My AF happened mainly at night time and whilst doing an ablation my rate went down to 30. Turns out this was recorded on a monitor too and I was told by the consultant that thought that the slow rate was partly responsible to the episodes of AF. I was having them weekly most of the time occasionally managing a fortnight between. I now have a pacemaker and can take the medication and the number of AF episodes has greatly reduced.
I’m having a 48 hour Holter monitor in a couple of days, so this should shed some light. A rate of 30 is certainly slow. When the heart slows down, yes, AF is more likely.
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