Asymptomatic Atrial Fibrillation: How do you monitor?

Posted by Myak @janet23, Mar 17, 2022

I have a three year history of short episodes of paroxysmal asymptomatic atrial fibrillation, PACs, PVCs, tachycardia and bradycardia. The abnormal heart rhythms were diagnosed on Holter and Event Monitor tests from 7-30 days long.

I started seeing an Cardiac Electrophysiologist instead of general Cardiology and I follow the lifestyle changes in the AFib Cure book; I was hoping to stay off medications until I had a seven hour AFib episode after my VO2 Max exercise test at Mayo this year. My only symptom was a little fluttering feeling in my chest, which alerted me to check my Apple Watch ECG multiple times, and it kept flashing the yellow banner “atrial fibrillation”. I took the patient shuttle from the Gonda building to the St Mary’s Cardiology and an ECG confirmed that I was in AFib. I did not have any symptoms while my heart was racing at 120-154. After I met with my Mayo Cardiologist, I took my “pill in the pocket” meds Flecainide and Metoprolol prescribed by my EP doc at home to use as needed, and walked back to my hotel. The meds started working a few hours later and I was back in sinus rhythm. I am now taking Flecainide and Eliquis twice a day. I feel better overall and no AFib.

I was surprised to learn from my EP Cardiologist that many patients do not have symptoms with AFib, like chest pain and palpitations, but the abnormal rhythm damages the heart. I was advised to check my Apple Watch ECG a couple of times a day and take my meds. I also keep an eye on my Apple Watch heart rate.

Does anyone else have this problem? What do you do?

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

@janet23

I have also been told that some people choose, against the official guidelines, to cut the Eliquis in half and take 1/2 pill twice a day so they have some anticoagulant in their system if they form a clot. Then, increase the dose when they go into AFib. Once the clot forms, it can quickly move. I decided to play it safe, take the Eliquis, and check my Apple Watch ECG 3 times a day. I also like to exercise daily and exercise can trigger arrhythmias, including AFib, in me. I trust my EP with over 20 years experience who has been following me for three years. He worked with me to try and keep me off medications until now. It is a personal decision to make with your doctor.

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I didn't think about exercise putting one in AFib..

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I just had my first episode of AFib that sent me to the ER. During the 4hrs there I realized that I didn’t have symptoms once my hr got down to the 130’s-140’s. It makes me realize that the fleeting flutters I’ve had in the past were probably more than I realized at the time.
I converted to sinus rhythm after a bag of lactated ringers so I didn’t get any meds. Today I have a slight headache and some brain fog and fatigue.

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@blanche123

I just had my first episode of AFib that sent me to the ER. During the 4hrs there I realized that I didn’t have symptoms once my hr got down to the 130’s-140’s. It makes me realize that the fleeting flutters I’ve had in the past were probably more than I realized at the time.
I converted to sinus rhythm after a bag of lactated ringers so I didn’t get any meds. Today I have a slight headache and some brain fog and fatigue.

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@blanche123 it might be the other way around: when your afib stops, your heart rate might go down!

Have you worn a monitor or do you have a Kardia or Smart Watch? It will be good for you to find out if the "flutters" are related to afib.

You said they did not give you any meds, so I assume they did not suggest a blood thinner after the one episode, right?

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@janetg -- Good morning, J.

Very surprised you don't detect an HR of 120 to 154. I'd guess nearly everyone would sense that fast a rhythm... whether in AFib or in sinus. Many might at least describe it as a jitteriness, an "anxious-ness," a "nervous feeling," or even feel their chest pulsing -- some folks feel their heart beat in their ear when they lay on the left side.

Anyway, if you don't feel it, then you might wanna check several times during the day, and then take the beta blocker, or whatever your doc has suggested for you.

Sustained rates over 100 bpm (and certainly around 154 bpm) when you're not exercising, physically working, "happily excited," etc. may eventually lead to heart failure. If these rates start to occur on a routine or daily basis, which your EP can periodically check via a Holter monitor, he / she may wish to script a regular, daily dose for you.

All the best!

/LarryG

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@bettysamny

I didn't think about exercise putting one in AFib..

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Mine happens an hour or more after exercise when I’m back home in the recliner. It’s like my heart gets confused when I’m not exercising or something

I’ve also noticed that my max heart rate is about the same going for a walk as it is during moderate cardio exercise.

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I never feel that I am in A-fib, but the tests confirm it. I am on a Blood thinner and Dofetilide, 2 a day of each.

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@bettysamny

I didn't think about exercise putting one in AFib..

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I love to swing dance and have found it to be a good all around exercise besides lots of fun. I do know enough to stop and take breaks when my heart tells me to..I recently met with my cardiologist who had planned to do a stress test. When he asked what I had been doing, I told him about the swing dancing. He said, “That’s your stress test.”

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@bettysamny

I didn't think about exercise putting one in AFib..

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I have read advice saying (among other things) that exercise
can be a good way to handle Afib. Seems to help!

(Other ways are drinking a glass of ice water fast and learning to take deep abdominal breaths to trigger a "vagal response".)

Supposedly, the vagus nerve is key in the functioning of the autonomic nervous system which is operative in triggering and turning off an Afib response.

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New to the group.. when you speak of 4 or 5 hour-episode of Afib, does that mean a continuous fast heart rate? I joined this group to understand the difference between Afib and PVCs/PACs. I've read that the treatment is not the same.
I appreciate your thoughts.

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@mb28

New to the group.. when you speak of 4 or 5 hour-episode of Afib, does that mean a continuous fast heart rate? I joined this group to understand the difference between Afib and PVCs/PACs. I've read that the treatment is not the same.
I appreciate your thoughts.

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Hi mb28,
Here is a link explaining the different types of arrhythmias.
https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia
I have experienced most of them over the past three years - some with symptoms and some without. My AFib episodes are typically fast and can be a short burst during an exercise session or longer (heart rate 100- 170) The Apple Watch flags them as Afib. A Cardiologist or Cardiac Electrophysiologist (EP) interprets the rhythm abnormality on an ECG, Holter or Event Monitor. I see an EP doc. Uncontrolled rhythm disturbances over time can cause heart failure. My heart failure is mild and I continue to work on lifestyle changes by following the guidelines in the book “AFib Cure”. I am getting better and I recently decreased my Flecainide dose. I hope to go back to “pill in the pocket” med dosing.

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