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?

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When I first had AFIB, I did not feel any symptoms. I was hospitalized for AFIB when a doctor discovered it during a office visit for a dislocated finger. I also use and apple watch to check for AFIB and it works very well. I love the exported data from the watch, which I take to cardiology appointments.

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My husband has no to little symptoms and is in it 24/7! Sure wish I did too. When I go into Afib (with rvr) it knocks me off my feet. My EP just gave me some metoprolo to take when I'm having an episode. Last episode lasted 30 hours. 30 hours wasted.

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I always feel my afib, maybe because heart rate goes up to 180+. I had a seven hour episode last summer and am still not on meds. I have diltiazem at home but have only used it twice, when I had an episode. I have episodes about once a year. I always end up in ER (and last time ICU) because diltiazem lowers my already low blood pressure so they are careful. Still not on blood thinners. The last one was my longest and they did an echocardiogram to check for clots. My monitors did not show afib over 7-30 days.

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@vwjoday

My husband has no to little symptoms and is in it 24/7! Sure wish I did too. When I go into Afib (with rvr) it knocks me off my feet. My EP just gave me some metoprolo to take when I'm having an episode. Last episode lasted 30 hours. 30 hours wasted.

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I was diagnosed w mild? Afib after I contracted covid….
My heart rate stays between 59-63 & b/p (on meds) stays within normal range. I bought the kardiamobile device & it hooks up w your phone & gives you a EKG which my Dr will accept. I cannot tell when I am in Afib so I depend on Kardiamobile to monitor it. I take a low dose of Eliquis 2xs a day After I saw a Cardiologist. The ER doc who confirmed my Afib said he didn't think I needed blood thinner bcuz my Afib is mild But Do what the Cardio recommended. My husband did have Afib but does strength training, short runs & has Not had a episode in years.

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@windyshores

I always feel my afib, maybe because heart rate goes up to 180+. I had a seven hour episode last summer and am still not on meds. I have diltiazem at home but have only used it twice, when I had an episode. I have episodes about once a year. I always end up in ER (and last time ICU) because diltiazem lowers my already low blood pressure so they are careful. Still not on blood thinners. The last one was my longest and they did an echocardiogram to check for clots. My monitors did not show afib over 7-30 days.

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Oh my gosh – I am relatively new to this A Fib thing, and still finding out about it. I am on my third cardiologist since October. While under the care of the first two I was admitted to hospital twice and had to go to ER in middle of night one time. This last doctor has made a difference – I am now on the correct range and dosages of medications and although I still have some issues I am a lot better. I would recommend that you seek out a new doctor, if only for a second opinion.

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@mtnmarge

Oh my gosh – I am relatively new to this A Fib thing, and still finding out about it. I am on my third cardiologist since October. While under the care of the first two I was admitted to hospital twice and had to go to ER in middle of night one time. This last doctor has made a difference – I am now on the correct range and dosages of medications and although I still have some issues I am a lot better. I would recommend that you seek out a new doctor, if only for a second opinion.

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@mtnmarge No I have seen three cardiologist actually. I chose the one who supports me staying off meds. I am absolutely fine 12-18 months at a time with no afib at all. Docs initially told me to go on blood thinners and I declined. Then the criteria changed and those same docs told me I had been right to decline! In my view, most docs will tell us to go on blood thinners even for infrequent afib, because there is liability if they don't tell us to do that. Unfortunately liability only applies in that direction. I am comfortable with an echocardiogram to check for clots after an episode, but I also feel that the studies on short term anticoagulation (1 week-1 month) should be put in practice for someone like me.

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I was never told about a pill from regular cardiologist.i take eliquis and toprul .EP against most potent meds. Originally no symptoms until last two years..palpitations…pauses.5 to 6 sec. Weakness..tell me about flenacide.

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Flecainide is an antiarrhythmic medication. I am on the lowest dose, 50 mg, and Eliquis twice a day, and I don’t have any side effects with either medication. I can’t take many medications for my heart because my heart rate also drops in the 30’s at times, I get bradycardia, and feel like I am going to pass out. My blood pressure also runs low at times. Eliquis is expensive, but I don’t want to have a stroke when I can’t feel the AFib when it occurs. Hopefully, no more episodes!

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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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@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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It sounds like you have a great doctor @janet23. The creative and flexible approach is something I would consider if I have another episode over 5 hours. I like that your doc tried to keep you off meds and has come up with this customized regimen. I am sending you a private message.

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