Afib with Rapid Ventricular Response

Hi, @soliloquized. Welcome to Mayo Clinic Connect. Sounds like you have been through a lot over your lifetime related to your heart.

Though we are not medical professionals, I'd like to call in some of our members who've talked about atrial fibrillation for any thoughts they may offer related to your rapid ventricular rate and whether it may be common with afib, like @kenny48 @cynaburst @hopeful33250 @menotpvcs @kancha.

Meanwhile, I'd like to offer some Mayo Clinic information on atrial fibrillation https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624.

How are you feeling about the potential one-time shock conversion and the sotalol your cardiologist is discussing?

I trust him. He spoke with my family doctor on the phone while I was standing there, and called the University of Pittsburgh and spoke to a Pharm-D pharmacist while I was there, too, about medication conflicts. I watched a video on YouTube of a man given that procedure, but apparently he wasn't sedated, it wasn't nice to see but was over in an instant. My family doctor said it was probably an Emergency Room visit. When I was in the ER after my hospital stay, but at the hospital my cardiologist has privileges and is part of my care, the ER Cardiologist said they do Electro Conversions in the ER for patients that were in sinus rhythm but have problems going back into afib. He says they can tell the doctor the exact time it happened (afib).

I went to school to be a pharmacy technician, just basic stuff, but never worked in the field, I do read drug literature quite a bit and understand some. At a peak number of PVCs, historically, I was having 5 PVCs per minute, 24/7 for a few months. My PVCs kept me from drinking, from smoking, from doing drugs (I never tried illicit drugs, it's extrapolated from not being able to take many OTC drugs for colds, etc. LOL).

I have a Vagal component to my PVCs, at one time, in the evening, years ago, everytime I swallowed, I'd get a PVC. It was documented but not thought a concern. Now, when I eat, my afib goes nuts, mostly lunch and later. My cardiologist wants me to lose weight, I'm down 15 lbs from refraining from eating and eating less because the afib feeling displeasures me more than not eating. I'm amazed by the PVCs I'm getting with this afib that are followed in seconds by stomach or intestinal turbulence, and this plays out over and over.

I'm not woken up by it, in fact I woke a few days ago and thought I was in sinus rhythm, but soon the jumping around started. I did wake (not due to my heart though) a few nights ago, heart rate was near 100, almost went to the hospital, this is still new to me, but I took a small amount of Metoprolol more, my family doctor is aware and OK with it and it settled down.

Anyway, I'll see the cardiologist early this week, I'll have questions for him too.

Thanks much.

Hello @soliloquized
I would like to join Lisa, @lisalucier, in welcoming you to Mayo Connect. I appreciate your concerns regarding A-Fib. I can certainly understand how difficult this must be to have continued A-Fib and to be trying different treatments.

While I have had some rapid heart beat problems it is not as complicated as your situation. In addition to the others that Lisa invited to this discussion, I would also like to invite Martin, @predictable, as he has also had some heart difficulties and he might be able to add something to this conversation.

Please remember that it is always your right to seek a second opinion on a complicated situation like yours. Have you considered getting a second opinion on this matter before going forward with the suggested treatment?

I haven't considered a 2nd opinion since I rely on my family doctor (an Internist) and a 2nd doctor, a Cardiologist that I've used before and that is in close contact with my family doctor. Apparently there's a study based on Rhythm vs Rate Control that's predicated on patients 65 or older. I heard the cardiologist point out to the family doctor that I still have a few years to go until I'm that age, that he considers my heart healthy, ejection fraction is 65% now and 65% a year ago, and both echo cardiograms were identical. But that's why I'm here, to learn more.

I saw two Electro Physiologists for a PVC issue in the past. The first said the source was likely X (can't remember the name) and easy to get to. The second had the nurse continue to take my EKG until she captured a PVC on every lead. Then the doctor took the EKG and went to his office. He came back and emphatically said the first doctor was wrong, rather sternly, saying it was in the Purkinje Fibres near the bottom of the heart, so it was complicated to get there for the ablation, but was possible. I decided to wait it out, he prescribed an anti-arrhythmic medication that I declined (it wasn't considered serious, I didn't want to tamper with stability) and he prescribed Acebutolol, which stopped the chronic PVCs in short order.

5 years ago, I'd never imagined living with the symptoms I have now, that the top of the heart can do it's own thing independent of the bottom. Sometimes it feels like a squirrel running around in there. But I'm asymptotic except that I can feel it.

Hi @soliloquized. I'm weighing in at the suggestion of Teresa @hopeful33250. I'm awestruck by the complexity of your symptoms and by how firm and calm you are in your relations with the medical professionals you have encountered. My own experience bears little resemblance to yours. I'm hypertensive from a genetic kidney defect that steals my potassium, so when I was diagnosed with A-fib four years ago, nobody seemed surprised (except me). My symptoms showed up almost exclusively on an EKG. I have no sense of irregular heartbeat except from watching a blood pressure meter or seeing an EKG report. My heart rate (about 58 bpm for years) rose modestly to about 70-75 bpm after I started medicating the A-fib with Carvedilol. We assume my A-fib changed my heart rate initially by +30-35 bpm and the Carvedilol pushed it down by half of that, winding up at 70-75 bpm. I'm also taking Coumadin as an anticoagulant, although it let me down one time last summer, and I suffered a "small stroke" that keeps me a little off-balance even now.

I hope you will be able to get your doctors to meld their analyses and further studies so that you have a stable vision of what's troubling your heart, and I hope you and your doctors reach a unanimous conclusion on steps to take. Compromises are not very satisfying, I know, but neither is treatment that seems like a set of trials. Do you have access to a university-based medical system or a noted clinic like Mayo where research- and patient-driven diagnosis and treatment are available? Martin

Thanks for the reply. The physician is part of the UPMC (University of Pittsburgh Medical Center) cardiology group (Heart & Vascular Institute), though it seems to involve a constellation of physicians rather than a practice per se.

The doctors at the hospital where I was admitted have a history of over testing, according to my wife's former employer. I'm not going to weigh in on that much, but without consulting me on the need, I was scheduled for an adenosine stress test, and I'm sure that'd been followed by a heart catheter, as that is the tests my wife's former employer (a cardiologist) complained about. After telling me that restoration of normal sinus rhythm is best done within 72 hours of the occurrence of afib, the fact is they were making no attempt to address the afib directly.

Prior to afib, I was on 600 mg of Acebutolol, (200 mg three times a day). Upon being admitted to the hospital, they discontinued the Acebutolol and had me on less than 100 mg Metoprolol. Online equivalency charts list 200 mg Acebutolol as equivalent to 100 mg Metoprolol. And guess what, I'm now on 300 mg (in divided doses) of Metoprolol, which conforms exactly to the equivalency chart for the dosage of replacing 600 mg (in divided doses) Acebutolol with 300 mg Metoprolol. Hospitals scare me, they drastically reduced the beta blocker, I can't imagine the reason why, it's almost like they dosed me like a new patient that wasn't on beta blockers at all. I even spoke with the Electro Physiologist (EP) in the hospital, he told me he doesn't know who put me on Acebutolol, but I told him it was another EP and my cardiologist (at the time) was also aware and wrote the prescriptions for it. (Acebutolol is an older drug with a few unique properties, ISA - intrinsic sympathomimetic activity - It slows the heart an average of 4 beats per minute less than an equivalent non-ISA Beta Blocker).

Ironically, my previous cardiologist told me, only a few years ago, that unless I lose weight, I'd end up in afib. I wish I'd be proactive on his prognostication.

Thanks for the comments and suggestions. Wish you very well in your health.

Ok, since I have been asked to join the conversation, I will chime in here. In August of 2009 I was diagnosed with Paroxysmal Afib. I awoke at one AM in the morning with my heart beating rapidly and erratically. I had no idea what was happening. I tried to calm down, but nothing happened. I called 911 and was taken to emergency. There they tested my blood, and said both my potassium and magnesium levels were very low. So first they gave me potassium in a drink, and put me on an IV drip with Magnesium. This evidently got my levels up to where they wanted. The afib did not stop, and they gave me a blood thinner. In the morning, they sent me for an echo. They said my heart was healthy, but I was in afib. Scheduled me for cardio conversion, but first said they would like to try a med as it it was preferable if it worked. I agreed and had to sign a waiver. ( I knew nothing about these medications at the time) They gave me a 50mg tab of Flecainide Acetate. Within twenty minutes my afib stopped! They kept me in the hospital for a few days, and then released me. I was taking the Flecainide twice daily along with Digoxin. After about a week, I was feeling very dizzy and weak. My cardiologist ( who originally saw me in the hospital ) took me of the Digoxin and gave me Metoprolol 25 mg instead. I took these along with one 325 mg of Asprin daily. I felt better, but my heart rate went down to around 45BPM and I said that scared me. He then told me to take the Metoprolol in halves twice a day. I gradually started feeling normal again. I took both those meds all that time. Then last year, I started having brief episodes of afib, they were happening almost weekly, so the doctor upped my flecainide to 100mg twice daily. Both my afib and pvc's ( which I have had as long as I can remember ) stopped! Then I moved to North Carolina and had to find a new Cardiologist. He said he saw no signs of afib at all. He continued to keep me on the same meds, although he told me the Asprin did nothing to prevent a stroke. Suggested down the line that I take something else. However, he didn't really seem to believe me that I even felt occaisonal PAC's. He had me wear a monitor for a month. The results he said, showed not one single PAC! I did have some PVC's though which he said were nothing to worry about. He did not like the fact that my heart rate was too low. He took me off the Metoprolol. That was a roller coaster ride. I was having constant PVC's and it was very scary. But within a week they subsided. For what it matters they stopped entirely! I have only had a few since then. He recently had me do another echo. and said it did show a leaky Mitral Valve, but said it was not a big concern as yet. Scheduled me for another in six months. I am currently still taking Flecainide and Asprirn. That is my story.

I forgot to mention some important information on my response. Besides the first echo, I was given an Adenosine Stress test after I was discharged from the hospital. It showed a possible minor blockage, so they wanted me to also have a Catheterization. I declined, but a year after experienced a day long episode of constant PVC's. I went to emergency, and once again they admitted me. This time when I was asked about the Cath. I said Ok. I was really afraid of the procedured, turned out it wasn't all that bad and I was semi conscious the whole time. The result surprised my Doc. My arteries were totally clear! He then dismissed the "spot" as an artifact. I still don't know what they mean by that. I had another Stress Test last year and It was OK. He said the reason for the Adenosine Test was because a treadmill test, simply would not get my heart rate to the pointed he needed it.

Thanks much, read it all, including your addendum. Bad day for me, erratic a few times when nervous, of course just before visiting the cardiologist. Early January they'll do the electro conversion attempt. Had slight pain, not really pain, but an odd feeling, with my spasming heart, but I told the cardiologist, he just did an ekg when my heart was fluttering again (atrium) and didn't seem concerned.

@soliloquized
It could be that your cardiologist's not seeming concerned about your last EKG might be a good thing. Cardiologists have read a lot of EKGs and they know when to be concerned and when something is less than serious.

I know what I'm going to say is easier said than done but: try to relax. Find some way to occupy yourself and keep your mind and hands busy. Do you have any activities that you enjoy, like music, knitting, crafts, art, etc.? If so, try to focus on that. January will be here soon enough and the conversion attempt will happen and perhaps you will begin to find relief.

What can you do today to give yourself a break from your worry?