First episode of AF

If I recall accurately, my heart rate after being admitted to hospital wavered between 90-100 while sitting, but would spike at 160-170 when I got up and walked around. Pretty sure my BP was close to normal @120/85 or so. After the electro cardioversion, I woke to heart rate of 75 and was happy to see a regular rhythm return.

When I first was diagnosed with irregular heartbeat many years ago, after completing the stress test I was advised I had a “heart of an athlete”. Fast forward 40+ years after being diagnosed with A-Fib and telling him I ride 30 miles a day on my bike, the cardiologist told me many of his A-Fib patients are endurance athletes and like you said, is very common.

Thanks for the heads up on the Kardia unit; I will check it out. And yes, my knowledge base is rapidly expanding while I continue to research this condition and get good advise from folks like you who have “been there and done that”.

Lastly, FWIW, I stopped drinking alcohol on New Years Day in an effort to lose a few pounds (my New Years resolution!) and to get my elevated BP down. A couple years ago I moved to a new location and use a new trail for my bike rides. For good or bad, my new trail has several local craft breweries along the way and I became a huge fan of the Porters and Stouts on my regular pit stops. My pants started shrinking and I put on about 20 lbs. since moving here, which elevated my BP. I replaced the beer with green tea and apple cider vinegar/cayenne pepper tonics and cut back on the nighttime snacks.

I have since lost 12 of those lbs. and interestingly enough, the cardiologist recently advised I have no dietary restrictions and gave me a green flag on moderate alcohol and caffeine consumption. YAY. I will still lay off the brew until I lose a few more lbs. (I am 6’ and 216 now) but am happy to know I can have my favorite brew when the spirit strikes as well as my morning cuppa. I know both are triggers for some here, so I will proceed with due caution in this regard.

Thanks again Jim for your most excellent continued responses which are most welcomed and helpful!👍

Expanding your knowledge base is the key especially in this particular field where there are so many gray areas. You might want to check out Dr. John Mandrola's website and twitter feed. He's a cardiologist, and like yourself he's both an avid cyclist as well as an afib patient himself. He also wrote a book "The Haywire Heart" which specifically deals with exercise and afib. I do not hold him up as the bible of the field -- there really isn't one with so much gray area -- but I think you might get something out of following him given your shared interests.

Jim

Hi Patrick,

I hope you don’t mind me butting in with my two pennyworth. I was diagnosed with atrial fibrillation (AF) 4 or 5 years ago. I’m 66 and have a chequered medical history, suffice it to say that I’ve had and an irregular/ectopic heart beat for 20, 25 years, possibly longer. I barely noticed it. I was diagnosed with cancer in 1994, had a course of chemo and in 1995 had the remaining mass removed from my mediastinum. When recovering from the op in the high dependency unit I had what I think was my first bout of AF, pulse was up high at 200 … that sounds high but my memory may be a bit vague here …. but it was enough to warrant corrective action. They threatened cardioversion but gave me some drug that I can’t remember the name of and put me on amiodarone, the AF went away. I was informed that it was not unusual for this to happen when you’ve had your chest opened and your innards mucked about.

In the mid 2000’s I began to notice increased shortness of breath (I had aortic incompetence so that was a factor) and the occasional palpitation, the irregular heartbeat had never gone away. I just ignored all this, it didn’t happen often and when it did I would just sit calmly and it usually went away after a few moments maybe 10 or 20 at most. Now whether all this was AF I have no idea but it was not debilitating. Coincidentally in 2005 I had a prosthetic aortic heart valve fitted which meant I was on warfarin for life, so any risk of stroke if it was AF was presumably minimised.

Eventually I was diagnosed with AF and put on Slozem (dilitiazem). This improved things in that it slowed my heart rate down and I was less breathless. Once again I just ignored any so called “events” which were mild.

Subsequently as a consequence of doing some research on AF I found this forum and became mightily confused. Here am I diagnosed with AF, now in permanent AF and reading about folk who are taking way more drugs than I am and getting rushed to A&E on a regular basis; did I really have AF? Is what I am diagnosed with different from what I am reading about? As I say, confusion rained.

The reality is that I am getting off lightly. These days I have accepted that I am in permanent AF, that I need to take dilitiazem and warfarin ad infinitum, that there are limits to how much I can ask my heart to do, that by and large although I feel the odd palpitation and never get more than 10 or 12 heart beats in the right place, that’s the way it is; live with it.

Patrick, I hope you come to make wary friends with your AF (know your enemy), that it does not get worse and that you can find a way to live with it whilst actively minimising your “events”.

Phil.

Hi Phil,

With afib you can treat rate alone if it's high, you can treat rhythm either with drugs or ablation, or you can do nothing if your rate is not high. Mortality statistics seem about the same.

In your case, assuming you're in permanent afib, it sounds like they decided to treat rate with the dilitiazem. Being on a thinner (warafin) would then be the prudent thing whether or not you were fitted by a heart valve.

That said, some folks do better/feel better in normal sinus rhythm and that's where electro cardioversion, rate drugs and/or ablation comes in.

"Friendship" aside for a moment, have you considered ablation at all? It could get you off the dilitiazem and potentially get you back into normal sinus rhythm. I think that would be more of a lifestyle decision than a medical one in that again mortality figures are about the same but some people feel better in normal sinus rhythm.

Jim

Hi Phil,

And thanks for sharing your experience with our common “friend” AF. FWIW, I have also made friends with tinnitus which visited my house about the same time my BP became elevated and this whole adventure began just over a year ago. As you suggest, sometimes it’s better to make friends rather than be haunted by stress and anxiety without a known cure.

That being said, it appears that unlike tinnitus, with AF there ARE reasonable solutions which can make our lives easier, as Jim has suggested. The more I expand my knowledge base about AF, the more I see there is SO much gray area with many of us having such different responses to our common condition. Snowflakes, indeed!

Best of luck to you going forward and let’s keep this dialogue going with hopefully more chiming in to share their experiences!

Best to all,

Patrick

Thanks for the heads up on the book and website which I am delving into...so much to learn! Mixed reviews on the Kardia unit...do you use one? Hesitant to pull the trigger on a device that may bring more stress and anxiety...🤔

Hi Jim,

Thanks for your thoughts. Maybe I need to be more assertive in my relationship with AF, I think next time I visit the cardiologist I'll mention ablation and we'll see if that's an option. If it is then I'll go for it!

Thanks again.

Regards,

Phil..

Hi Patrick,

Thanks for your response.

I learnt about making friends with my condition when I had the op to remove the mediastinal mass from my chest, which left me in some pain; I think they must have cracked a rib when they splayed my chest open. One of the guys I was in hospital with then had previously had some pain management training and he said he was taught to befriend the pain, talk to it and to pity it. I have put this in to practice a number of times since and it has stood me in good stead.

Keep spinning those wheels Patrick and let's hope our friend AF doesn't visit you too often if at all!

Regards,

Phil.

 

Hi Phil,

Ablation is not a panacea, but it is an option. And it doesn't always work the first time, may have to be repeated. I believe there are threads on ablation here and elsewhere. Definitely do some homework. Again, probably no different in life expectancy whether you ablate successfully or remain in afib with rate control. However, you may feel better in normal rhythm, I know I do. But I've also read that many people really can't tell the difference symptomatically when they're in afib or not. So in that case, maybe less motivation for ablation. Another alternative to rate control and ablation is rhythm control through drugs. Some people tolerate these drugs well and some don't. Speaking to your cardiologist is a good idea, and getting a second or even third opinion can also make sense. If you go this route, I'd get at least another second opinion from a cardiologist and maybe one from an ep. Just keep in mind ep's love to ablate (puts their kids through college) but that said they are the experts in the procedure.

Jim

Hi Patrick,

I have the Kardia Mobile unit. There is also a newer Kardia Band that you wear with your Apple Watch. The Kardia Mobile is about the size of a big stick of chewing gum and pares to an Iphone and I believe Android phone through Bluetooth.

As far as "mixed reviews", from personal experience, online research, and speaking to an ep, two ep nurses and a cardiologist -- I haven't heard anything negative in terms of its accuracy. In fact, one ep nurse said their practice prefers the tracings (readings) of the Kardia over the standard medical event monitors that cardiologists have been using for years. That's quite an endorsement!  So accuracy wise, you don't have anything to be concerned about. The Kardia generates an ekg just like the one you get in your doctor's office. Then a computer alogorithm instantly analyzes the ekg. The three results are: normal sinus rhythm, possible afib and unclassified. If you get "possible afib" you probably want to email the tracing to your doctor to confirm. "Unclassified" just means that the machine's alogorithm isn't confident enough to make a call and wants a doctor to decide. It doesn't mean the tracing is inaccurate. You also get "unclassfied" if your HR is over 100 or under 60. But again, the tracing is perfectly fine, the machine just wants a doctor to look at it.

In addition to emailing the tracing to your doctor, you also have the option to email the tracing to one of their techs for I believe $20 for a 1 hour turnaround reading. This is great if your doc isnt available, like after hours, or if you just don't want to wait, not to mention a second opinion. You also have the option to email it to one of Kardia's board certified cardiologists for I think $40 or $60, with a 24 hour turnaround.

Back to the Kardia Mobile. Most people purchase it to find out if they're going into afib. I purchased it for the opposite reason. I ordered the Kardia the day I came back from the hospital after a failed cardioversion. So I was already in afib, and was being treated with the rate control drug dilitiazem plus a blood thinner. The plan was for me to take a rate control drug (flecainide) for a week and then to try electro cardioversion again.

After a few sleepless nights and a lot of research, I decided not to take flecainide and to hold off on another attempt at electro cardioversion for at least a few weeks. My hope was that I would come out of afib naturally and having the Kardia mobile let me confirm I was out of afib without rushing to the doctor every time I thought I may be out of it.

Long story short, the Kardia arrived two days after I left the hospital. I tried it as soon as it arrived fully expecting to see "possible afib" because that's how I left the hospital only two days before, not to mention that my HR was highly irregular with palpitations felt both in my chest and throat.

Because of FDA regulations, the first time you use the Kardia you will not see the results as they are sent to Kardia's cardilogist to be read. No fee involved. This can take up to 24 hours. So I took the reading, and it was automatically sent to Kardia.

You can imagine my surprise when i got an email at 6am the next morning saying I was in normal sinus rhythm! I didn't believe it! So, I took another reading and 30 seconds later it said, "unclassified". I sent that one off to their tech ($20 fee) and within 30 minutes the result came back "normal sinus rhythm with Pacs" PACs are a benign atopic beat I've had before but not afib.

I still wasnt convinced so I got a next day appointment with my ep and had a regular ekg. He told me I was no longer in afib. Now I trust the device!

Since then I have used it only three times and that was during the first two weeks only. Each time, I was convinced I slipped back into afib, again because of the heart palpitations and also because of some data I was getting from my Fitbit. And each of the three times the Kardia told me I was in normal sinus rhythm. By that time, I not only trusted the device but had learned how to read the tracings myself and sure enough, my tracings had distinct "p" waves and looked nothing like afib.

So, in my case, the Kardia, and the way I used it, decreased stress and anxiety, because it let me know immediately that I was not in afib when I thought I might be.

Now, I'm off rate control drugs, so I don't think I would need the Kardia to tell me if I'm in afib, as my episodes always have very high (over 160bph) heart rates. So the Kardia is collecting dust next to my fitbit but was worth every penny and should I ever really be in doubt, it's there to use.

That said, using my Fitbit experience, I could see someone using the Kardia obsessively and causing more stress than relieving it.

Kardia's other model is the band for the Iphone. This has one additional feature that alerts you when the alogorithm thinks you "might" be in afib. (The alert is based on an unexpected elevated HR when not exercising). The idea is that when you get the alert you then push a button and do the actual tracing to see if you're actually in afib or not.

Frankly, the Band would drive me crazy like my Fitbit finally did, but I'm sure it serves a very useful purpose for some. Afib cases are all so different so it makes sense that a monitor that works for one person may not work for someone else.

Jim

If I didn't make it clear in my previous post, the Kardia Mobile is a small device that pares with an iphone. You place two fingers on it and within 30 seconds find out if you are in afib or not. The Kardia Band for the Iphone you wear like a watch. In fact, it's a special band that you use with the Apple Watch. Instead of getting a finger reading like the Kardia Mobile, on the Band you just push a button on the watch and it takes a reading from your wrist. It also has that "alert" function that tells you to take a reading if the computer thinks you might be in afib. For me, the Band is a little too much monitoring but your mileage may vary.

Jim

Excellent info Jim, thank you. To my knowledge I have had only three episodes of Afib, and at the time I had no idea what was happening. On each occasion I was "exerting", twice cycling, and by far the worst episode beyond any medical assistance, hiking in the Himalayas in Bhutan. Each episode was characterised by rapid HR, and fatigue, breathlessness. Only after returning from Bhutan was I able to see a doctor,

Other than those three episodes, I had quite regularly had palpitations which felt quite different, thumps, missing beats, PVCs, but not rapid at all, and always put down to digestion. In sinus rhythm and at rest my HR is 99% of the time less than 60, quite regularly below 50, and hence the Kardia mostly gives me Unclassified. Most of my palpitations, which are now under control via dietary changes, come up as Unclassified, not "Possible Afib".

I have had one ablation last June after seeing an EP consultant, following the diagnosis of Afib on return from Bhutan. I have had no further Afib after diagnosis, either before or after the ablation, and a recent 48 hour holter recorded only sinus rhythm, during a period that included both 90 minutes brisk cycling and some walking.

My Chad score was one (over 65), and from just three Afibs over a period of nine months, the last late 2016, I had a stroke Dec 2016 and have been on Eliquis ever since. I did use the Kardia regularly, but use it only sporadically now, as it seems things are settled currently, for which I am very grateful, especially on hearing of the experience of others here.

If I have had other episodes of Afib, then I have been unaware of them, or assumed they were just palpitations caused by vagal irritation due to stomach. I am certainly not hankering after coming off the Eliquis, quite the opposite given the supposedly low risk of a stroke, but I do accept some risk due to bleeding should I fall off my bike in pothole heaven UK.

A very interesting thread, thanks to all who are contributing, it helps considerably.

Sherpa Al

Hi Al,

As to the Kardia and "unclassified" with your normal heart rate under 60. The easiest thing for you to do, if you aren't already,  would simply to walk around a little till your HR was in the 60's or 70's and then sit down and run the Kardia. Either that or if you're not sure, just email the tracings to your doc (preferably an ep or cardiologist and not a GP) or to Kardia itself for a paid reading. Or, as I mentioned earlier, spend a little time on YouTube and learn how to read the tracings yourself. The tracings of normal sinus rhythm are markedly different from afib because of the pronouonced "p" waves before each beat.

If I read your story correctly, you weren't on thinners when you had your stroke in Dec 2016 but you went on thinners after that and are still on them? Or did you go off Eliquis?

Curious about the spacing of your afib episodes and how you resolved each of the three. What years did you have them and did you come out by yourself, were you cardioverted, etc?

Jim

 

Hi Jim,

Thanks for the additional information on the Kardia; I will have a look further  into how it may help me. FWIW, the “mixed reviews” I referenced were on the Amazon site so maybe I’ll look for a more authoritative resource. And I want to be sure my cardiologist will accept the emailed Kardia readings.

Cheers and good health!

Patrick

Patrick,

The majority of the negative reviews on Amazon had to do with the fact that after a free trial month, Kardia then charges you $10 a month to save all your ekg's online. The reviewers make it seem like this is a big deal or the Kardia is useles without this service, but they aren't very knowlegeable. If you don't want to pay the $10 a month, you can email each ekg to yourself and keep them in a folder. The way it's setup, that takes about five seconds extra time! I have my first month's ekg saved from the trial period but didn't pay the fee after that. First, I don't intend to use it all that much and second, like I said it's no big deal to email the tracing to yourself.

Jim

Thanks for the "athlete" accolade Jim, slightly overstates the case, but I'll take it!!

The first Afib when cycling (April 2016) stopped of its own accord, after an hour or so, but did require my wife to come and pick me up when I could cycle no further; as I said had no idea what was going on, and didn't see a doctor after.

The second in Bhutan (Nov 2016) started on rising one morning, and continued most of the day, a day when we had to hike, it was a difficult day, complete fatigue and breathless most of the time. The day ended with a camp at around 4,000 metres followed by two rest days while my companions did some out and back hikes; again I didn't know what was going on, still thought my stomach was playing up.

We curtailed the trip and returned back to lower altitude on the third day, and eventually came home to the UK a couple of weeks later. Before an appointment with my GP back home, I had a third minor episode of high HR and breathlessness just walking around my local town. That lasted just a few minutes before regaining breath, that was late Nov 2016; stroke was Dec 2016 whilst waiting to see a cardiologist, and as you say no thinners prescribed after seeing my GP, just a long wait to see and EP guy. No mention of Chad scores, but I had worked that out myself after the diagnosis of an arrhythmia, my score was 1.

I did ask my medical practice why they failed to prescribe a thinner, when the GP diagnosed atrial flutter. They explained the CHAD risk assessment, by which time I had worked that out myself and realised that a stroke was a very low risk in my case. 

In hospital after the stroke I was on aspirin for a week or so before starting Eliquis; I was never cardioverted, and waited nearly six months for the ablation on the NHS.

After the stroke I had no further episodes before the ablation (June 2017), or since. Given that I have had just three episodes, but have had a stroke against nearly all probability, I am loathe to come off Eliquis, and which is why I bang on about it.

In all three cases I did not immediately attend a hospital, and have never been cardioverted. Maybe these episodes appear minor compared with the experience of many folk on this forum, but they did cause the stroke, so it's difficult to know whether I've been very fortunate, or very unfortunate!

In hindsight I was completely ignorant about my condition, and clearly did not know the right questions to ask, or have access readily to an EP doctor. 

I have since read a lot on the subject, and have read a bit of John Mandrola, maybe I'll get the book, I've a couple of weeks coming up with time to read it.

Thanks again Jim

Best Wishes

Allan

Hi Allan,

Maybe I missed it, but given the very short duration of your AF episodes, have you ever had afib or atrial flutter confirmed by an EKG?

Jim

Hello Jim,

Yes, when I saw my GP on return from Bhutan (pre-stroke), he did an ECG then, and although I felt OK at that particular point in time, he looked at the trace and said, "atrial flutter" if I'm not mistaken, but did not prescribe thinners at that point.

I then had quite a wait (four weeks) to see a preferred cardiologist, an EP specialist (one week post-stroke), who also confirmed flutter after a second EKG, and recommended the ablation; I chose to wait and have it on the NHS. Post stroke to ablation, and post ablation I have not had any further serious episodes of Afib (i.e. ones with elevated HR) that I am aware of, although I had palpitations quite regularly until September 2017 when I removed dairy from my diet, and now virtually no palpitations either.

Fortunately I can tolerate a daily coffee, and a daily glass of wine or G&T, so now I feel fortunate. Follow-up Holter has confirmed sinus rhythm. Interestingly I did get on the bike turbo this morning after reading your previous post, and after a 45 minute work-out, HR was 88, and Kardio said "Normal", although I was sure there were a couple of ectopics in there.

Using the Kardia through 2017, I probably had the "Possible Afib" reading half a dozen times, but always felt this was palpitations as opposed to Afib, manly because HR was usually no higher than 60. It's good to hear your Kardia experience, and that you have developed trust in it. I guess when I did get the Afib reading I was sure the palpitations would subside, as they always tended to happen after eating, plus I was on thinners by that time, and knew that another stroke really was highly unlikely.

Right, off to Amazon, see if I can find John Mandrola's book

Best Wishes & Thanks

Allan

Happy days

Allan

 

@sherpa al: Using the Kardia through 2017, I probably had the "Possible Afib" reading half a dozen times, but always felt this was palpitations as opposed to Afib, manly because HR was usually no higher than 60.

--------------------------

Did you have the "Possibl afib" tracings read by either AliveCorp's doctors or your own? If you have them saved, you might want to. My understanding is that palpitations may give you an "unclassified" but not "possible afib". However, the answer should be in the tracings themselves which can be read by an ep or cardiologist. Keep in mind that you can have afib either with an elevated rate or a normal heart rate, so a low heart rate alone isn't definitive for not being in afib.

I have confidence in the device but if I kept getting "unclassified" or "possible afib" I would email it to my ep and/or to Kardia's cardiologist to confirm.

In summary, and I hope this is correct, one has to differentiate between the actual tracings of the Kardia unit and the interpretation by Kardia's computer algorithm. The algorithm may not always be perfect but even in those case where you receive "unclassified", the ttracings themselves should be good enough for any ep or cardiologist to make a call. Based on what I've read, I would not let a GP make that call as today's GPs rely too much on algorithms from their own ekg machines and aren't versed as much as they should be in reading an ekg. A really good ep or cardiologist trusts his expertise over the algorithm, many GPs just look at the algorithm.

Jim

Don't know why my post went into moderation as there were no links. I'll try and re-create it later, but it not it should pop up in a day or so.

Jim

@Sherpa: Using the Kardia through 2017, I probably had the "Possible Afib" reading half a dozen times, but always felt this was palpitations as opposed to Afib, manly because HR was usually no higher than 60.

------------

Here's an abbreviated version off what got "moderated" --

My understanding is that in the scenario you mention the Kardia would be "unclassified" and not "possible afib", could be wrong. Did you show any of those tracings to a cardiologist or ep? If not, and if you still have them saved, you might want to. In my case, my afib always goes with a high HR, but I've read that is not always the case.

JIM

Hi Jim,

Just checked back and although I binned a large batch of readings, I have some PAFs in a batch going back to September last year, the most recent early Jan 2018; I always email the trace back to myself to archive. I haven't shown any of them to my EP, perhaps I'll take them with me to my review in April. In each case HR was no more than 62. The three episodes in 2016 were characterised by a significantly higher HR.

From memory, when those readings occurred, the palpitations (I thought) don't last very long, probably no more than an hour worst case, and then disappear, which is why I associate them with digestion, they always co-incide with stomach bloating/belching; I've certainly never felt the need to show them to my doctor or EP, maybe I should.

Non-dairy food for thought.

Allan

Personally, I'd want "possible afib" confirmed by a cardiologist or ep, especially if I felt I wasn't in afib. If you don't want to bother your doc, as you probably know AliveCorp will do their own reading for a fee. I used their tech once ($10) and their cardiologist once (more than $10) in the very beginning when I was very new to the machine. Their interpretation, plus my ep's gave me more confidence in the readings moving forward. Also, as I've mentioned, there are several decent YouTube videos on how to read ekg's for afib. Afib and normal sinus rhythm (PACs or not), look very different. Not rocket science.

Jim

I guess the "virtual moderator" has it in for me today but my post should come out of moderation in a day or so. As to the food, a lot of people mention that. My afib trigger has traditionally been very cold drinks or ice cream and the last time perhaps too much coffee, or perhaps some overly spiced foods, not sure on that. But I have noticed a lot of PACs since my last afib episode and diet might be an issue with those.

FWIW, I have had two PALP episodes since my electro cardioversion and both followed meals within a few minutes. Maybe a diet diary might be helpful to identify triggers?

That's not too bad. Since my last afib episode, if I take my pulse for 30 seconds, half of the time I will get at least one PAC. They say they are benign, but everything being equal I'd rather not have them! A food diary could be very helpful to identify food and beverage triggers. In the past, I've also found exercise a trigger for PACs. If I do too much, I get them. If I'm sedentary for too long I get them. In general, do best in the sweet spot in between. That said, as long as it's not afib I'll live with them!

Jim

How do you tell if it’s a PAC or palpitation?

By definition a heart palpitation is an awareness of your heart like when it's racing or skipping a beat. A PAC (premature atrial contraction) is a common cause of palpitations but it's benign. PVCs (Premature ventrical contractions) are another common cause of benign palpitations. Afib is another cause of palpitations but afib is not benign.

If you know your history and symptons very well, sometimes you can tell what is causing the palpitations, but sometimes the only way to tell is with an ekg.

For example, when I'm in afib I have a very fast (over 160 bph) but faint pulse (hard to find) and a significant drop in blood pressure.  This is very distinct from a PAC where my pulse is strong, the rate and blood pressure normal, but the beats are irregular. However, when I was put on rate control medications for afib, it was very difficult then to distinguish afib from PACs.

This is just my example. A lot of folks have normal rates and bp while in afib even off rate control drugs. In those cases, I would think an ekg would be needed to tell.

Jim

 

Hmmm...so a palpitation could be a PAC? Are they one and the same?

Even before my recent AFib diagnosis, I had a few events where my heart would race, usually in the early morning while still in bed. These would usually last 10-20 minutes and go away. 

PACS or palps, or does it matter as they are both benign?

And how do you tell these from a PVC?

Trying hard to avoid confusion but not entirely successful...🤔

Patrick

A palpitation is just when you feel your heart racing or beating irregular.

So, yes, a PAC, PVC or even afib could be a palpitation. Or, a palpitation could just be a fast heart beat you feel that is regular. While with some experience you may be able to tell them apart but often you can't without an ekg.

Jim

I'm not sure about the terminology either, and as you say they are all benign, but variably disconcerting. In my case what I fear is the very high heart rate, and fortunately as I have previously said, I have only ever had three, the last end of 2016. Other than that an irregular/thumping beat has been regular company albeit massively reduced by change of diet.

I chose to see a nutritionist, and after a simple blood test she identified dairy as the main intolerance protagonist, but it could be many things, and I even had a mild intolerance to ginger (always thought ginger was good for the stomach). Since then I have removed dairy from my diet, and palpitations/PVCs/PACs, whatever, are over 90% reduced. Coffee and alcohol in moderation are tolerated, but late or spicy meals are definitely not.

I kept a food diary for a few months, comparing the Kardia readings, and how I was feeling, before and after the dietary change, using a traffic light notation (yes, nerd, fair cop), and the improvement was glaringly obvious.

Notwithstanding the winter here in the UK, I have been cycling again, and walk virtually every day, and have had no further high HR episodes on exertion, so again either the three episodes were "one-offs" or the ablation has been successful. However I also note the longish time gaps between some folks episodes, so I don't rule out it happening again, but fingers crossed!

Best Wishes

Allan

Jim, I had another bout of palps on my bike ride yesterday and stopped for a pit stop to rest it out. HR was elevated (pulse) but came down at rest and I continued home where I had dinner and later took my BP and HR which were normal.

While I assumed these were palps and not AFib, is it safe to say once one has had AFib, one is more prone to palps than before onset of AFib?

Sounds more like palps but then again afib can present differently. After my last afib episode, my palp episodes really stressed me out and the only thing that calmed me down was the Kardia Mobile device which showed that the palps were PACs and not Afib. Now that I pretty much know the difference I don't need the device any more.

Don't know if afib makes one more prone to palps or not, but I definitely have had more palps (PACs) since my last afib episode OR I'm just more aware of them. And that's an important point, many people have PACs and PVCs and are either unaware or just write it off without giving much thought. I think afib definitely makes one more sensitive to anything going on and therefore increases the awareness and stress level of palps. For example, since my last afib episode I'm noticing I have more palps on arising and after meals. I wonder if that has been going on for years and I just never took notice.

Jim

Thanks, Jim. When the palps settle down into a regular pulse and BP can I assume it was palps and not AFib? My last AFib never settled down on its own and my pulse was irregular and HR elevated. This event stopped on its own and BP and HR returned to normal after a few minutes rest after the bike ride.

Still resisting purchase of the Kardia unit to fret over but if that’s the only way I can be sure maybe I should go ahead and pull the trigger? I tend to get obsessive with devices...🤪

Jim

So let’s say I get the Kardia unit and have an episode where the Kardia says it’s aFib...what’s my next move? To the ER? Wait to see if it stops on its own? How long to wait? 

As as long as I’m on thinners, the stroke risk is minimal, correct? 

When I first was diagnosed with aFib, I had no symptoms so really can’t tell how long I had been in aFib.

So how long is it safe to wait to go to ER after Kardia indicates aFib?

Patrick

As long as your on thinners, "yes",  you're perfectly safe when in afib in terms of stroke risk.

So to answer your questions, if your're in afib and your rate is normal, you really don't have to do anything right away. Options include: waiting it out for a period of time and hopefully naturally converting, going to the ER for immediate electro cardioversion, setting up an appointment for electro cardioversion as an outpatient, or doing the pill-in-pocket strategy with flecainide. There are other options as well but probably not what your doctor recommends such as exercising your way out of it, taking an ice cold shower, etc.

If you're in afib but your rate is sky high, then you want to get the rate down irrespective of being on thinners. No real stroke risk but you don't want your heart racing for too long. Options here are: going to the ER for rate control, going to your cardiologist for rate control, or taking care of it yourself. I have dilitiazem (cardizem) at home for this purpose and it brings my heart back down to a normal rate within an hour or so. I used to go to the ER before I realized the Cardizem pills work for me just as well.

The Kardia simply tells you if you're in afib or not. Different people are going to use that data in different ways.

Jim

 

Thanks again, Jim! 😊

So can one buy the Cardizem over the counter or is it prescribed?

Patrick

Dilitiazem (cardizem) is calcium channel blocker which you need a prescription for. It comes in several time release and regular forms. The one I use to get my rate down quickly are the 60 mg tabs, not the time release. Usually one 60mg  gets it down although you can take a second dose an hour or two later if it doesn't. After that, I was able to maintain a normal heart rate by taking it every six hours (240mg/day). Maxium daily dose is 320mg/day so you have room to add if the 240 doesn't work. Unlike pill in the pocket (flecainide), diitiazem just gets your rate down, it's not intended to get you back into regular sinus rhythm. That said, if you're on thinners and you get your rate down, then you're safe even if you stay in afib indefinitely. Of course you should discuss this particular strategy with your cardiologist or ep. For me, because afib sends my rate up so high, it's either taking dilitiazem at home and then deciding on next steps, or rushing to the ER and letting them get my rate down.

Jim