The sensation signaling an oncoming AF episode was unmistakable, like a heart pause or a swelling around the heart. It was very transitory, maybe a full second or two, and then my heart would begin to beat erratically, and I felt the thumping through my chest wall. The sound of it kept me awake if it didn't stop by bedtime. This interferes with sleep, and the ensuing fallout is probably well understood by you. This can go on for days.

There is shortness of breath, a sense of unease, a sense of foreboding and dread because the beast has a mind of its own. Being paroxysmal, an early stage, it comes and goes seemingly for no apparent reason, and it stays for as long as it thinks it is welcome. But, it isn't a sensitive or well-bred disorder, so it ALWAYS overstays its welcome...period.

In the latter days just before my first and second ablations, still well-ensconced in the paroxysmal stage, people told me I looked grey. Nobody looks like that, and sufficiently so that others are concerned and let you know of your appearance, unless there is a distinct malady that is sapping strength and well-being.

And yes, the dread lingers and leaps into prominence at the first signals that an AF episode is just a few minutes or hours away. The feeling of tightness or swelling in the tissues surrounding the heart, maybe some belching, a bit of reflux, and then.....chaos. So, more directly, the malaise is constant, even when not in AF. It is an irregularly irregular beat that comes and goes, persists for hours, may or may not respond to medication or to a cardioversion (only my second cardioversion lasted as long as 16 hours; the others less than four hours), and that makes its presence, at least in my chest, a chaotic and lumpy sensation, almost like I have bowel gas moving right to left along the transverse colon. I could even feel it in my carotid arteries without touching those places.

I have an enlarged heart, a very fit heart, due to living at altitude in the Andes Mt. in Peru during my youth, and then for being fit while in the military, and for having been a competitive runner all my adult life. My heart, at least, is a powerful muscle that can make my whole body shake when it is beating. At full rest, when in my 30's, it beat at only 24 BPM, and that made my whole body move in rhythm to it. This doesn't happen during AF, but the sensation of its chaotic beats can be felt easily in the thorax and up into my neck. Trying to sleep like that is almost impossible.