Paraxysmal afib

Paroxysmal AF can be controlled

by Gemita - 2023-02-07 04:29:06

Zoe, firstly I am so sorry to hear that you are in the ER for Atrial Fibrillation (AF).   Even with a slow heart rate during an AF episode, AF can still cause some of us difficult symptoms, so don’t blame yourself for your reaction to this miserable arrhythmia.  

I am super sensitive to AF and depending on my symptoms I have also had to go to the ER in the past.  I have AF sometimes at a very rapid ventricular response rate which can be dangerous, so I am more prone to getting worsening symptoms when my heart rate cannot be well controlled with beta blockers.  My pacemaker has a programme which prevents the tracking of any high atrial rates and switches my mode of pacing until the rapid rates and AF stop.  It may be that your pacemaker settings need to be finely adjusted to help more with your arrhythmias but settings and treatments for AF will be trial and error until you find what works best for you.

Doctors are generally more concerned about a rapid heart rate than a slower one, particularly since you now have a pacemaker to protect you against a fall in heart rate beneath your lower rate limit.  AF can be at a slow, normal or fast heart rate.

Yes anxiety can be a major trigger for an arrhythmia like AF but it is unlikely to be the “cause” for your AF alone.  Is your sleep apnea under good control, since sleep apnea is a major trigger (and cause) for AF?  I expect in ER they will check your electrolytes and do other checks to rule out other causes like infection, thyroid and to check your heart function with an echocardiogram/ECG.  They may even give you some meds to calm your arrhythmias or to try to stop your AF.

How to manage AF?   The good news is, it can be managed with a variety of treatments.  A high heart rate definitely needs a rate control medication (like a beta blocker) to calm things down quickly.  Also, if you have risk factors for an AF stroke, you may need an anticoagulant to protect you.  Otherwise, especially with a slower heart rate in AF as you seem to be experiencing, you may just need to learn ways to relax (a subject for another post) when you become super aware of your irregular palpitations.  This might help prevent AF.   It is the "irregularity" of rhythm when in AF that causes me difficult symptoms.

I personally found the more I threw at my AF, the worse it got.  In other words for me personally fewer meds, fewer interventions (like a cardioversion), meant fewer episodes of AF.  I had a bad episode a few days ago when my heart rate hit around 200 bpm at 3pm after receiving some sad news, so emotions/stress can be a most definite trigger.  But with extra fluids (tepid water), slow, controlled breathing I was able to calm my symptoms and to continue my activities preparing a meal.  The episode lasted for hours, but I stayed calm throughout Zoe.  My blood pressure was bouncing around a bit too but I am no longer afraid of my AF, since I have learned that with the help of my pacemaker, my beta blocker, I am always in control of this nasty pest.  AF no longer has such a firm hold on me, but it takes time to get to this stage.

My pacemaker is set at 70 bpm and this higher setting helps to outpace many of my premature beats which often lead to AF, but I am still working with my pacing clinic to adjust my settings.

I hope your ER doctors can reassure you, stop your AF and that you will return home soon.  Please keep in touch and we can help you with some relaxation ideas.

Sleep apnea

by Penguin - 2023-02-07 05:09:20

Hi Zoe, 

I was just reading through your previous posts from some years ago.  Sorry to hear that you're in ER with AF.  At least you're in the right place and there are people there to monitor and reassure you. 

If I read correctly you've had AF suspected before with the trigger being sleep apnea. There were questions as to whether or not the feelings (raised heart rate) were actually anxiety or whether it was AF and triggered by anxiety? Did your doctors ever get to the bottom of this? 

When you last posted you were taking Lexapro. That's a pretty strong anti-depressant with an anti-anxiety effect.  Are you still taking it? If you are you might like to explore with your prescriber why the Lexapro is ineffective if your doctors are still suggesting that anxiety is the cause of your tremulous cardiac feelings. 

As you probably already know AF can feel like anxiety when it raises your heart rate and produces that uneven tremulous feeling due to disrupted heart rhythms. It's very important that you recognise the difference between this and anxiety so that you don't get over medicated for anxiety and so that the AF is controlled.  A Kardia mobile which you use to detect AF at home might help you with this, because it should detect AF when it happens.  This might help you exemplify what is AF and what is not AF to your doctors as you can print out the ECGs. 

This pacemaker manufacturer produces a device which specialises in sleep apnea. I've enclosed a link in case it might be useful. The link is to their Eno device, but there are others in their range.

https://microport.com/healthcare-professional/cardiac-rhythm-management/pacemakers/eno

I hope this helps a little and that you can explore all of this with your doctors to get a more concrete idea of what is going on and how to manage your symptoms.

Best wishes

Thank you for the input

by zoe123 - 2023-02-07 11:25:51

Thanks so much for your comments, I am waiting for my doctor to give me a call so we can try and tackle this. Gemita, right know you are my hero how you handle your afib with such valor. I, unfortunately have much anxiety which I need to control because no one should go through this. Penguin, yes this is exactly what happened when the detected that I needed a pacemaker because of many years of undetected sleep apnea, which unfortunately could of been detected had I had sleep study. I just left emergency room at 3 this morning and I'm trying to get my bearings together but the input really helps my nerves and made an appointment with cardiologist tomorrow. Fingers crossed. Many thanks 

basically same symptoms ....

by lukerbee - 2023-02-07 12:53:45

I figured if no AF standing, lots AF laying flat, how about in between. Using a 30 deg (approx) wedge to support upper half, no moe night time AF. Sometimes I sleep on my recliner, no AF. :)

Afib

by AgentX86 - 2023-02-07 15:03:43

Afib can be scary but as long as you have a doctor treating it there absolutely nothing to worry about. Unless you're hypersensitive to Afib, it's better just to follow your doctor's instructions and get on with life.  The key here is your doctor's treatment.  You're relatively young and your rate and BP are low there may not be any treatment needed at all (see CHADS-VASC score).

I used to run to the ER when mine started but all of a sudden it hit me on the way home - Why?  Why did I go the ER? They've immediately cardioverted some peope I know who are persistant Afibbers.  They've never done that with me they just patted my head and sent me on my way.

However, if you're highly symptomatic you'll have to work with your cardiologist (I highly recommendan finding an EP at this point) to minimize the impact on your life. The CHADS-VASC score will give you more information.  From what I can see on your BIO, you should be good.

comforting words

by athena123 - 2023-02-08 17:58:44

thank you agent for your sound advice and my hats off to you  for being a supportive mentor and  all around nice person. This group is such a blessing. Gemita, they upped my metropopol to 12.5 mg twice daily. At this point lots of fluids and continue living life. all my blessing

Paroxysmal AF

by Gemita - 2023-02-08 19:05:53

Zoe, I hope by now you have got some answers or at least some reassurance.  I have not always been so brave, believe me, especially when my heart rate used to get out of control and I became unstable, but now with a beta blocker, my heart rates are really well controlled, so my symptoms are milder also when I am in AF.   Additionally, I know with a few clever manoeuvres (positional changes) I may even be able to stop my AF before it gets going.  You will soon find ways to control your AF too.

Athena, 12.5 mg Metoprolol, twice daily still seems a fairly low dose, but no doubt enough to keep your heart rate and any arrhythmia calm which is really all you need.  A beta blocker is certainly much safer than going onto an anti arrhythmic medication.  Yes this Group is a real blessing and we are very lucky to have each other xx