I was diagnosed with PAF 36 years ago and in a 12 month period I would have 4-5 episodes lasting anywhere between 1-6 hours.
On Saturday I went to bed at midnight and as soon as I laid down PAF started. It stopped 2 hours later and I fell asleep. A little later I needed to go to the loo and again, laying down in bed, PAF restarted, this time for 30 minutes. I got off to sleep again but when I woke around 8am on Sunday morning I was in PAF and here I am 24 hours later still in PAF at around 137-145bpm although one reading showed 72bpm.
After a cocktail of meds over the years my present cardiologist decided I was allergic to beta blockers so I do not take any cardiac meds. I have rivaroxaban and ramipril for borderline high blood pressure.
Reading this forum mentions atrial flutter, which I have never had to my knowledge but this prolonged episode isn't irregular and thumping like PAF is with me. Flutter describes the current situation very well.
What is the difference between PAF and Aflutter? Is it dangerous to have such a high heart rate? Any tips on trying to stop it and what's the doc likely to suggest? Invasive procedures, pacemakers? What may be in store for an elderly coward like me?
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Thank you J. I am trying to reach my cardiologist secretary to get the ball rolling. This continuing episode came completely out of the blue. Not sure if it's AF or Aflutter. I will look up Maze Procedure. Thank you.
The maze procedure is open-heart surgery and highly invasive. In almost all cases, the only people who have a full surgical maze are those that need open heart surgery for other reasons, so while they're in there anyway they do a Maze for afib. I wouldn't spend any time looking into this.
After my stint in resus yesterday it seems I have a left branch block in a ventricle. I will ask for a referral to an EP because I usually see the cardiologists. Thanks for that good advice.
You need to get your rate under control. If it were me, I would not wait any longer and head to the A&E. They will take an EKG and sort out your rhythm and bring your rate down. You can then follow up with your doctor, but at this point, you should probably be seeing an electrophysiologist (ep).
What you're describing is not uncommon and doesn't except in very few cases require a pacemaker. Depending on what they find, they will probably prescribe different medications and/or give you the option of a catheter ablation.
But before you do too much thinking about this get your rate under control now.
Hello Jim. Thank you for your reply which I followed. I went to A&E and the ECG showed an usual heart pattern which resulted in me being whipped into resus quickly and wired up to the machines. It turns out that this prolonged and unusual (for me, at least) episode was a mix of atrial fibrillation and atrial flutter. They brought my racing hb down to the 80's and the cardiologist who came to see me has put me on the lowest dose of Bisoprolol daily and will send me an appointment for an echocardiogram to check the lower ventricles of my heart and to see him in his clinic. Thank you for your good advice. It goes to show that although I have been told by many medics not to go to A&E unless I had chest pain and/or breathlessness, something concerning can still be going on without those signs. Thank you so much, Jim.
I don’t go to A&E when I have an episode but can lower my heart rate with beta blockers, I think it’s better to be safe than sorry though and never worry about going to A&E with a heart rate that high, so glad you got the help you needed.
I had the same experience last year, a mix of AF and AFl. I waited half an hour before getting OH to take me to A&E as my resting HR was 150bpm. I was triaged immediately and it took 15 hours for medics to get my HR down to an acceptable level. This sort of episode is not the wait out and see type as it can do damage to an otherwise healthy heart. I've also had an echocardiogram, they found damage to the tricuspid valve (which I already knew about) had deteriorated slightly but structurally apart from that my heart was pretty good for my age. Hopefully, yours will be the same. Good luck and pleased your back at home and safe again.
I have been told by many medics not to go to A&E unless I had chest pain and/or breathlessness, something concerning can still be going on without those signs.
Unfortunately, they left out an uncontrolled and sustained high heart rate, which you were having.
After you get things more sorted out with further testing, etc., do ask about a PIP (pill as needed) plan to safely lower heart rate at home with medications that can hopefully prevent future A&E visits. Also many of us find a home ecg device like the Kardia 6L useful in both identifying, managing and documenting episodes.,
Good luck and glad things finally worked out getting you safe.
I took your advice and spent a good few hours in resus. Af and A flutter both visible on the ECG plus a left branch block in a ventricle. Drips and meds reduced the heart rate and I am back on lowest dose of Bisoprolol. I will ask for a referral to an EP at my cardio appt. Thanks for your advice. It really helped.
Hi, you have pretty much the same issue as I do. I also have LBBB and could only tolerate the lowest dose of Bisoprolol or my resting HR was too low. I had a pacemaker fitted last May because I needed a higher dose to control the arrythmias and that has been pretty successful. Don't worry if at some time a pacemaker is mentioned as an option. It is really a lot less scary than it sounds and can greatly improve QOL. Good luck I hope you continue well on your current meds.
That's reassuring Borderterriorist. I was taken off Bisoprolol pretty smartish after a 48 hour tape , pre-Covid, showed my heart rate at around 33bpm. I felt like a zombie and had so many ectopic beats, that I felt quite unwell most of the time. A pacemaker was mentioned then but the registrar and cardiologist had differing opinions on whether I needed one and the cardiologist, being senior, said I didn't need one as I wasn't having blackouts! I have pottered along with no cardiac meds except an anti-coagulant for the last 5 years. My regular face-to-face appointments became telephone consultations which are not nearly so thorough as there was no ECG or physical examination being done.
I suppose this episode at the weekend has been a blessing in disguise as it has shown the LBBB issue and atrial flutter, which I have never experienced before. I am doing my research on these and the implications they may have for me, going forwards, so that I have my questions ready for the appointment that is being made for me. From others I have had mixed reactions to ablations but those with pacemakers appear to have a more positive and longer lasting outcome. I am waiting with bated breath to see how I react to the dreaded Bisoprolol again, although I am on the lowest dose. Like you, I can't see me tolerating a higher dose than that.
Thank you so much for taking the time to reply to me. I was very concerned and still am, if I am honest but I always find the advice and reassurance on here very settling. Thank you for yours. Keep well.
Thank you for sharing your experiences with the members of the Forum. I am sure many will offer advice based upon their own experiences. If you have noticed a change in your episodes, please keep a 'diary of events' before making an appointment to see your doctor.
If you have any questions, our Patient Services Team are here to help, so please feel free to contact our Patient Helpline or contact us via email: heartrhythmalliance.org/afa...
I have atrial flutter and have been advised that any episode that is putting the heart rate over a 100 bpm for a prolonged time should be treated as an emergency. As MJames has said in his post, please get to hospital.
I went to A&E and spent several hours in resus. ECG showed my usual Afib was joined by atrial flutter which I have never experienced before. A left branch bundle block was also noticed in a ventricle so what good advice I had from people here to go to hospital. Back on a low dose of beta-blocker and appointments and further tests coming up. Thanks for your help.
I agree with MJames as well as needing support from an assessment at the hospital they will also be able to diagnose whether it is AF alone or a flutter and give the appropriate medication for that , as well as being able , on your request , to contact your named Cardiologist let them know the situation and request them to fast track an appointment. If you are in the UK , call 111, if you do the phone triage you won't have to sit for hours in discomfort in AandE , you usually get taken through quickly with a pre-booked appointment. Hope things improve soon , Bee
I rang 111, got a lovely A&E nurse who told me to get to A&E. Atrial flutter and Afib on my ECG and a left branch bundle block in a ventricle. Drips and meds slowed the heart rate and I was sent home with a low dose Bisoprolol and appointments and test coming up soon. Thank you so much for your advice. I appreciate it.
Glad to hear things have been settled down for you.It can be really confusing to work out if your symptoms are caused by AFib that you've had for some time or Atrial flutter , and the treatment can vary between the two so it's always better to be safe rather than sorry and go to AandE. Especially if there are other cardiac conditions involved as well.
I am prepared to have a go at anything. Next time it rears its ugly head, I will have a go at humming. A&E and resus sorted me out. Slowed the heart rate right down and I now have a low dose of Bisoprolol with appointments and tests coming up. Thank you.
77. A&E and resus on drips and meds slowed the heart rate down and showed the problem. As well as my usual Afib, atrial flutter was also seen on the ECG along with a left branch bundle block in a ventricle. Home now with a low dose beta blocker and appointments coming up for the cardio and electrocardiogram. Some very good advice on here as usual. Thanks.
I’m glad things are under control. I’ve had the switch from AF to Flutter and had to have a cardioversion to get back to sinus rhythm. I’m now on low dose Metoprolol and low dose Flecainide and seems to have given me some peace from AF. I also am on Magnesium VitD3 and CoQ10 which were all at low levels prior to supplements. Hope you too can have good long periods with no AF
Getting your heart rate stabilised and establishing whether it is. AF and/or flutter is important so I agree with James that A&E is a good place to start as they can do all the relevant tests.
As already stated in your comments the maze procedures is open heart surgery so not one I personally would ever consider unless there were other cardiac issues going on which necessitated it.
There are lots of options to look at during your research on what may be the best for you and it is very important to do that research. However, if your condition makes you an eligible candidate, it is possible to have a thorascopic procedure done in the UK called a Mini Maze which is minimally invasive.
Good luck with your research and hope you feel better soon.
Thank you for your reply. I went to A&E and ended up in resus for several hours. ECG showed my usual Afib but also atrial flutter which I have never had before and a left branch bundle block in a ventricle. Sent home with a low dose Bisoprolol and appointments and tests coming up. Thanks very much for your advice. It is much appreciated.
do look up mummyluv. She had a mini maze and hadn’t looked back since. She is so informative. I believe she had Mr Hunter in Sheffield. Many on this website have had a successful mini maze. Good luck
Oh dear - bad luck. You have so many replies, too, meaning there’s little to add. Life’s twists and turns seem to mean there’s rarely a breathing space between this health worry or another.
I’ve had both of these and flutter (AFl) was worse as it gave me a persistent very symptomatic rate of 155pm. Mind you - anxiety likely added enormously to my feelings. That rate is called AFl at 2:1 conduction, meaning the ventricular pacemaker manages to halve the upstairs flutter rate in two. The heart rate from AFl is always regular (unlike AF) and a fixed ratio of c.300bpm (i.e. 2:1 = 150bpm / 4:1=75bpm, etc.). Your rate doesn’t seem to be any ratio of 300bpm, which suggests it is not flutter but some other “tachy-arryhthmia”. A friend gets this and can often stop it using a modified Valsalva manoeuvre. Your doctor will be your guide on this.
It was the regularity of this episode which alerted me to something other than my usual, very irregular rhythm, Afib going on. Both showed up on my ECG plus a left branch bundle block in a ventricle. Drips and meds slowed the heart rate down and I was discharged with a low daily dose of Bisoprolol with appointments coming up with the cardiologist and electrocardiogram. I had a try at the cold water Valsalva method without success but I am willing to try anything at all. Thank you for your reply. I appreciate it.
I'm glad you got it sorted. It's interesting to read of the number of people on here who were able to go to A&E and get it sorted out quickly. I usually have 1 or 2 episodes a year where my heart rate can range between 37 - 170 for up to 12 hours. The last time this occurred, after 12 hours I rang 111. They told me to go to A&E and said I should be seen quicker as they had referred me. This didn't happen. The nurse took my pulse and said it was" all over the place". I waited about 3 hours for an ECG, then another hour and a half to see the doctor, by which time it had calmed down. So I just got sent home.
Beta Blockers did not control my rapid H/R. It brought it down to 186 on Metopolol and 56 on Bisoprolol. The former I had breathlessness fatigue and sweating so I couldn't exert myself.
My BP was controlled.
Night H/Rate normal was 47bpm avge.
Enter private cardiologist. He showed interest.
Introduction to CCB Diltiazem 180 CD 1/2 dose. Too much as it brought it down from 156 to 51 in 2 hours. So it does not interfere with low night rate Diltiazem early morning 120 CD ng is used up by late afternoon.
I stopped low Bisoprolol as my BP went low. 108/60. That stopped the fatigue, dizziness etc. BP back 133/79. With it H/R 60s rising but no Bisoprolol H/R 80s.
As you are not on H/R med I suggest CCB trialled carefully.
After many years of PAF and countless tries at different drugs I was offered the Pace and Ablate procedure. I had this done in 2022 at the age of 84 and am free of AF and on BP and anticoagulant drugs only ever since. Wish I had gone for it earlier.
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PAF and tiredness. What's the connection? 
Atrial Flutter, PAF and another visit to A and E.
Is this A Fib
Three and a half years AF free....and then.....
