Nightly vibrations following Afib treatment with Flecainid and Burnout Syndrome diagnosis

[AndyKiss]

I'm 44, otherwise healthy, exercise a little (2-3x a week, not nearly as much as my wife for example, who always challenges me to work out more), some sports (wake-boarding, sailing and other water-sports, skiing, a little tennis - nothing on a competition level), no drugs (not medical, not recreational), no nicotine, but some alcohol and caffeine intake. All very average. Nothing of the extra-ordinary, no health issues aside from a cold once a year on average.

I was submitted to a hospital in May 2019 after having fallen unconscious at 2 am in a hotel while traveling overseas for business. I had woken up after about 3 hours of sleep in the hotel room, feeling pressure building up in the chest, a creeping nausea, and the strong sense that something was significantly off. A minute later I was gone and after reaching consciousness again, my body shivered uncontrollably. The ambulance took me to ER at a large, nearby hospital (LKH Steyr, Austria) with superb doctors and cardiologists on duty, where the EKG showed atrial fibrillation. Blood laboratory and all other vitals checked out fine. In order to "reset" the heartbeat and get rid of the Afib, I was treated with the agent Flecainide Acetate (Aristocor was the name of the drug), to which I responded so heavily, that it led to three syncopes at the hospital within 30 minutes under the doctors' and nurses' watch, with heart stops between 5 and 20 seconds each. That caused a bit of a buzz, resulting in the transfer into ICU, the implant of a stationary pacemaker (which was removed again after two days), and lots of following examinations, from heart ultrasound, lung x-ray, CT scans, to epilepsy exams (which were all really good to go through in order to rule out as much as possible, and narrow down the cause).

Now, since all exams, vitals and values checked out fine, the final diagnosis was acute stress, and in sessions with psychologists who specialize in burnout diagnosis, low-and-behold, apparently I was in an "early stage burnout" (a term and type of condition of which validity I was always quite sceptic and suspicious of). I have never felt uncomfortable with 12+ hour work days, weeks without a full day off, email checking in restrooms, while waiting on elevators, daily phone calls with staff and email checking during vacation days, and with my brain working 24/7 - even in my sleep. It was just a lifestyle I had chosen and the speed in business, multi-tasking, diversity and challenges kind-of fueled me, as if I needed it. Running on high speed and striving for maximum productivity and efficiency has always been the way I've been wired. I did not mind it, or complain about large work loads, or multitudes of parallel responsibilities. Rather the opposite: I really enjoyed it all. I really love what I do, love my employees and customers, projects and companies. From my perspective, a "burnout diagnosis" was something someone wanted whenever they were unhappy at work and were looking for a way out without losing face with friends, family or business acquaintances. I did not seek a way out at all and was very happy all around. It was entirely unthinkable for me to fall victim of some kind of "burnout" which ends up affecting vital organs. I was told by burnout psychologists that the body geniusly produces disruptions like syncopes under ongoing, persistent stress (even if not experienced as "negative stress"), in order to the person's attention, to slow them down, in order to avoid a bigger, more dangerous, health incident down the road. It sounds plausible, but I am just not sure what to believe.

Anyways, I did follow the psychologists recommendations and cut my 12-hour days in half, working only 6 hours a day, for a maximum of 6 days per week. The doctors urged me to take a sabbatical if at all possible, which unfortunately, currently isn't, so I promised to at least follow through on a reduction of work hours and better attempts to delegate more to key employees, and to accept slower growth and expansions as a result (or less perfect results and even losses). So my agenda was: delegate - reduce - accept. I did follow through on that for about 2 months as long as employees and people around me understood the situation and had compassion for it, until work hours increased again and I found myself in the constant struggle between trying to slow down, and trying to move the businesses forward, and the urge to accelerate expansions again.

Since then, a brand new symptom: nightly audible, fast-beating vibrations in the chest (I can only imagine that this is what Afib must sound like if one can hear it), which wake me up. They go away as soon as I get up and move around, but come back after laying down and falling asleep again. Keeps me up at night for hours often. Fitbit shows shows heart rates consistently in the 50-60 during any of those many incidents, and a recent 24h holter EKG did not show anything alarming either.

So, my question to the community is three-fold:

- Has anyone been treated with Flecainid and then started to experience similar strong, rapid beats (vibrations or ongoing flutters) during sleep stages?

- Has anyone been diagnosed with burnout (or similar stress-sickness) which produced similar symptoms (syncopes, heart-stops, chest vibrations during sleep) and any of these symptoms have been deemed to be a result from stress-anxiety-burnout?

- Has anyone been diagnosed with a "surprising" burnout syndrome (meaning: it was not noticed as such prior to the diagnosis)?

[Hidden]

Hey Andy,

That's quite the story, and thank you for sharing it.

These vibrations that you speak of, may be similar to what I started to experience about 2 years ago. I never knew how to properly describe them, and I still really don't. The best that I could initially described them as was a vibration in my brain, because that's what it felt like. And then I realized that perhaps it was my heart vibrating very quickly. I too would get these vibrating sensations while I was sleeping and many times they would wake me up, and other times they would start just as I was at that twilight stage of losing consciousness when going to sleep. To me they seemed like if I didn't do something to stop them that something bad was about to happen. I initially realized that if I sat up, or at least moved my head up, and coughed that they would go away almost instantly, and later I discovered that if I remained still and took some deep breaths that they would go away as well. I was convinced for a while that it was my heart because I felt that I could feel my heart beats, and when I breathed deeply and the vibrating stopped it was if my heart had slowed down and I could hear my rhythmic beat after that. I went to a couple of different doctors, and one of them put me on a 24-hour Holter monitor to see if he could capture one of these events. I A captured two of them while I was wearing a Holter monitor and recorded the time that it occurred and pressed the button to mark it on the recorder. I was surprised to find out that the Holter monitor recorded absolutely nothing abnormal in my heart rhythm or its rate during those two episodes, with my doctor completely ruling out that the vibrations I was feeling we're coming from my heart. I had a very difficult time believing this and asked for a second Holter monitor however he did not allow that.

Another doctor I went to see was concerned about it and I ended up having a brain CT scan to see if there was anything abnormal or weird going on inside my head. That too did not turn up anything that would account for the fairly intense vibrations I was getting.

Much like you, there is nothing on the Holter monitor, nor on my Fitbit, however keep in mind that whatever your Fitbit is showing usually takes a good 10 seconds to display it so you're probably always at least 10 seconds behind.

Neither of my doctors could provide an explanation of what what's causing these vibrating sensations, other than to say that it was not my heart, and it was not something that was going on in my brain. I can't really say that the vibrations are in my brain or where they are actually originating from but to me that's where they felt they were originating from however apparently not. And because the heart is not responsible for the vibrations that would be my second description of where they were coming from but apparently not there as well either. As I have explained to both doctors, just trying to explain the sensation and where I think it's coming from makes it sound like I'm half crazy.

After doing lots of Internet research, I thought perhaps that I might be suffering from some undiagnosed sleep apnea or something like that. I did take a preliminary two night study with a pulse oximeter to see if I had the hallmarks of sleep apnea, and although there was some slight indication that I might have very mild sleep apnea, it was later actually ruled out by a respirologist a couple of months later.

Over the next several months, I lost some weight, about 20 lb, and at some point, the vibrating sensations seemed to go away. I have, however, noted that they have started to come back again, and have infrequently woken me up at times. At present, I seem to be able to get to sleep properly and I usually wake up properly, and the vibrations only occur occasionally now when I go down for a nap in the afternoon, if I do, and I don't always have a nap. So I have discovered a couple of things since they started to reoccur. When they have woken me up, I allow them to continue and I find my radial pulse at my wrist and feel my heartbeat. And my heart beat has always been steady and rhythmic which supports the Holter monitor results that the vibrations are not being caused by my heart. It was also during this time that I discovered that if I laid still and instead of sitting up and coughing like I did before, if I just purposely took several big deep breaths that they would almost always diminish within a few seconds. So perhaps, if you are conscious enough when these wake you up, try taking your pulse at your wrist while the vibrations are occurring and see if you can feel that rapid vibration in your pulse at your wrist, or if your pulse is just steady and rhythmic. That should tell you that it's not your heart as well which would support your Holter monitor results. And then perhaps try taking several deliberate deep breaths and see if they diminish and go away by doing that.

I still don't know what caused this, I don't know why they went away, I don't know why I'm still getting them occasionally but only when I have a nap in the afternoon. I don't believe that it has anything to do with my atrial fibrillation as this started several months before I got my single episode of AFib, and that was about a year-and-a-half ago.

The only thing that we may have similar here, is something to do with stress. These vibrations occurred in me after I had quit a very stressful job that included working both day and night shifts with quick turnarounds for many years. It started several months after I finally was able to start sleeping a regular sleep cycle, and the stress for me was probably diminishing as opposed to being steady or increasing. I often wondered if it had something to do with having years and years of continual stress like you have described, and then going to near nothing. I don't know the answer to this for sure but not a whole lot else changed in the way of drugs or medication or anything else so I don't know what brought this on or why I still get it occasionally.

So I'm not sure if any of this sounds familiar to you, as far as these vibrations go, and as I've said it's been very hard for me to even articulate to people what it is that I'm experiencing and feeling, without sounding like I'm a nutcase.

I know this might not be of any help to you, because like I said, I don't know what caused it, what is causing it, or what it all means. But I saw you're heading with the word vibration in it, and what you describe is somewhat similar to what I've been going through, albeit I don't know why or what the reason is or how to get rid of it.

[Ernest76 in reply to Hidden]

Try totally eliminating all caffeine and alcohol. There is growing evidence they are responsible for arrhythmia disorders. Also meditation to help with stress.

I had post ablation ectopics etc but since adhering to the above am completely free and do not require beta blockers etc.

Sounds dull I know but a small price to pay for good health!

[AndyKiss in reply to Ernest76]

Absolutely true. I am certain alcohol and caffeine are unhealthy triggers for various symptoms. Maybe for these pulsating vibrations as well. Certainly healthier to avoid both caffeine and alcohol altogether. Will start another complete abstinence period to see if they‘re triggers.

[AndyKiss in reply to Hidden]

Thank you for your post. Sounds like you’ve been through extensive examinations, too. Good to know the vibrations weren’t connected to your AFib episode.

[KRG13]

Hi Andy,

I hope you are well. I want to answer your queries as a Psychosomatic specialist who deals with cardiac psych patients and also as a patient diagnosed with arrhythmias of multiple kinds.

From what you have described, burn out doesn't seem to fit in. We all have different speeds at which we function optimally and simply because you work a lot does not mean you have burn out. Maybe you need a specialist in psychosomatics who can help you handle your symptoms while at the same time, not giving up what you really enjoy; your speed.

I have tried flecanide in the past but it came with too many gastric issues and had to be discontinued. I know the feeling you have described and usually drinking iced water helps me.

As for the fitbit, I wear one too. During my stress test though, my cardiologist showed me how it was not even close to the real heart rate. So please dont count on it. Instead, get a handheld ekg device and take a reading when the symptoms show up. It will give you and your cardiologist more clarity.

I hope this helps!

[AndyKiss in reply to KRG13]

Thanks, yes, fitbits aren’t all that accurate. Which handheld ekg device would you recommend?

[Ajataj]

Hi, Not sure if this will help but I got the vibrating feeling starting in 2010. I do not go to doctors as they scare me and just want to give me drugs. I get massages regularly and told my massage therapist about the feeling and she told me it was my psoas muscle going into spams. She did a release and show me some excerises to do when it starts and it works every time. Has nothing to do with the heart or stress. Might want to look into it.

[AndyKiss in reply to Ajataj]

I agree. It is possible that it roots in muscle tension/spine alignment of some sort. I need to investigate that further.

[HamishBoxer]

Kardia is a well rated easy to use device and from Amazon UK.

[NeelaB]

Hi Andy, I know it's been a year, but did you ever find the source of your nightly vibrations?

I've been experiencing similar, and found that they reduced dramatically after taking off my Fitbit. (No idea if that was the cause of my issues).