Quick Update- ATRIAL FIBRILLATION

intermittent (paroxysmal) Atrial Fibrillation

by Gemita - 2020-05-11 15:30:20

Hello Alejandro,

Are we really getting closer to learning why you have been feeling so poorly ?   I do hope so, although I wouldn't necessarily wish Atrial Fibrillation (AF) on anyone.  It is a real pest to control.  I hope you get some positive feedback from your EP and that the Zio Patch has clearly confirmed what is happening.  Keep your own diary notes too of any symptoms, date and time so that this time these symptoms can be correlated with any rhythm disturbance.  I have always suspected an arrhythmia, but let us not get ahead of ourselves just yet.  Let us wait for the confirmation.

AF can occur at any heart rate, either at a very slow rate or at a very fast heart rate and it can occur at any time, during rest or exertion.  AF has a mind and a will of its own.  Sometimes no cause for AF can be found which can be very frustrating.  At other times, hypertension, sleep apnea, heart disease, chronic kidney disease, respiratory disease, heart valve disease, older age, thyroid problems, diabetes, infection, stress both physical and emotional, electrolyte disturbance and many other conditions can all cause AF.

AF usually goes through several stages, it starts intermittently (called paroxysmal AF) which means it comes and goes and then it either progresses slowly over months or even a few years until it becomes more persistent or permanent.  Its progress will be different for each one of us, since we all have our own unique health conditions.  Initial treatment is aimed at controlling the heart rate during AF, particularly a fast heart rate, and protecting those most at risk from an AF related stroke if they have risk factors.  You would get a full assessment from your doctors Alejandro and lots of information about treatment options if AF is confirmed.

AF can be managed well but initially you have to be patient because so often it is trial and error until a suitable medication can be found.  AF is a journey and a learning process but the more you learn about it and your treatment options, the better you will be able to manage it.

Good luck Alejandro 

Gemita!

by arent80 - 2020-05-11 15:41:37

Wow! I can't thank you enough for your articulate, thorough and very detailed response. You sound like an EP with 30 years of experience! I read and understood everything you said. I will not get ahead of myself but I am doing more research on AFIB and have been keeping a detailed log within the Zio Patch App. If this is my future, so be it but I plan to control this beast. With God by my side anything is possible! I am so thankful for this site and each and every one of you who has commented on my posts. It has made me feel better and gives me a sense of hope. May god continue to watch over us all! Amen!

Alejandro 

Agreed

by AgentX86 - 2020-05-11 20:12:25

I think you're getting close to the bottom of this.  It's surprising that you haven't felt this before.  Symptomatic people tend to stay that way and asymptomatic, same.   Of course, there are no rules here, except that it never gets better (unless it's transient caused by a temporary electrolyte imbalance, or similar).  Where to go from here is another question.  I'd recommend nipping it in the but as soon as possible.  The heart tends to learn from its mistakes and make them worse.  As is often said, Afib begets Afib.  Proxoxymal will become persistent if it's allowed to continue. 

Drugs may work.  Until they don't.  ALL antiarrhythmics are toxic, generally in proportion to how well they work.  Most will also become proarrymthmic at some point.  You're probably well down the path to persistent or even permanent Afib by this point.  The further down this path, the harder it is to take care of it surgically.  Talk with your EP about all of your alternatives.

Afib is normally a lot faster than this (150ish bpm) but it can be slow, as well.  Like yours, mine was very slow as well.  There are two things that are a must for anyone with Afib. Your (resting) heart rate has to be kept below 100bpm.  So far, that's not a problem, though your doctor may want you on a beta blocker anyway.  The other essential is an anticoaguant.  Afib is the largest cause of stroke.  You don't want to go there, it can be worse than death.

Good luck.  If you're symptomatic, you have my sympathy.  It's a RPITA.

FALSE ALARM!

by arent80 - 2020-05-11 20:52:53

SIGH..... The docs called and went over my Apple Watch EKG and transmissions from my Zio Patch. What the Apple Watch caught was pacing, not AFIB. She went line by line and told me what was what. She said I'm super sensitive to pacing and the reason the PM kicked in was because of a delay with the P-Wave coming in. All of my transmissions from the Zio Patch have been in Sinus Rhythm. They noted two or three fast heart rates from the bottom chambers but nothing out of the ordinary. They want to start me on metoprolol 12.5mg and they've ordered another complete blood panel along with a full echocardiogram. Let's see where this goes. I should have my blood work and echo results by weeks end. I'll keep everyone posted.
 

AgentX86- thank you for your detailed response. I appreciate you taking the time to comment.  

Keep up the pressure !

by Gemita - 2020-05-12 05:42:59

For the moment that is very good news Alejandro, but I would definitely keep the pressure up for further answers and continue to build a picture of what is really going on to cause your troublesome symptoms.  I note you are sensitive to pacing.  I certainly am too (to right ventricle pacing alone when this kicks in).  Do you have a single lead pacemaker ?  Mine is a dual lead.

I would press for continued monitoring - the longer the better - and certainly ask to keep the Zio Patch for its planned duration.  Remember too that a one off reading will not give them the full story.  They may say on this occasion you were in normal sinus rhythm throughout the period of monitoring but on another occasion this may not be the case.  They need respectfully to be reminded of this and of your need for frequent monitoring to build up an accurate picture of what is going on and whether rhythm disturbances may be the cause of your symptoms.

Rhythm disturbances can take months if not longer to detect and doctors know this only too well.  They are clearly picking up a few fast rates already.  Nothing long or significant I accept but this is how arrhythmias may start (with short bursts - mine did). I even got short bursts of AF which without long term monitoring would never have been detected in the early stages.  Short bursts of AF I was told may still be dangerous and need treating with anticoagulation if we have risk factors for an AF related stroke, so something to think about.

So yes for the moment breathe a sign of relief but remain watchful Alejandro !  Wait for your further tests and see where they lead.  I hope you will find the addition of a low dose beta blocker like Metoprolol will help calm your symptoms.  This is what my EP did for me in the early stages. I tried Bisoprolol and am still on it.

I sure will!

by arent80 - 2020-05-12 10:46:09

Yes I will definitely keep pressing them. One of the most concerning symptoms that I have is the horrific symptoms I feel when I do the most trivial of activities. I took out the trash yesterday. It's a 20 foot walk with a trash bag in my hand and when I return my body feels in such a state of stress. I don't even know how to explain it correctly. I feel awful for the next 30-60 mins. It's a hit or miss. But lately it's been more of a hit. A shower can do it. It almost feels like my heart is failing me. I don't know how else to explain it. My body just goes into this state of stress/agitation it's awful. I looked up right sided heart failure and I have a lot going on that matches it. I sure hope this echo will reveal more. I feel completely different now compared to when I had the first two done. I noticed a decreased urine output at night. Sorry for the details! I used to always wake up to use the restroom at least once. Since the PM I rarely wake up during the night and when I do In the morning it's not even urgent for me to go. So strange how much my life has changed these past seven months and I'm still without answers. That's the hardest part for me. Giving me an answer will help in ways I can't even explain. Thanks again for your comments you guys! Means a lot!