fast heartbeat

I have gone about 5 weeks without AF, but Thursday early a.m. I went into AF, sometime during the day I went into NSR. I however now have a fast heartbeat, at least for me, it is in the 80s I usually am in the low 60s, the fast heartbeat is hanging on. This has happened to me in Jan., since It was a Sat. I went to the ER to get an ECG, I thought I might have some new arrhythmia, they checked me out and said everything was fine, they didn't have a problem with the heartrate. This is new for me, before when I went into NSR I was then ok, no fast heartbeat.

I don't have an alivecor but I do have a BP machine, so I walked around very fast and then took my bP , my heart was pounding and it showed t
he little icon shaking, when I calmed down and took it again it was fine. That icon shaking is supposed to indicate AF. but when I am sitting for a while and take my bP it is ok, checking my pulse the heartbeat is in normal rhythm. I am not sure if anything is going on, my fast heartbeat makes me feel uncomfortable and I am having some Pvcs, it goes back to normal in about 4 to 5 days. It always happens on a weekend, I would go into my doctors office to get checked but can't do that, so I am asking if anyone has had a similar experience.

Liz

My BP machine also has one of those Irregular HR indicators. It's not that accurate. Almost always when I have AFIB, the indicator comes on. But it also comes on sometimes when I am just having PAC's, and I am in NSR.

Liz, Atrial Flutter??

Anti ftib:

Thanks I wondered how accurate it was.

George

Doesn't flutter have a faster rate? This is puzzling to me, I also don't have the energy when this is going on and it makes me kind of nervous, I am not like that as a rule.

Liz

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Elizabeth
Doesn't flutter have a faster rate?

Usually but not always.

Carey:

This happened to me in Jan., I went to the ER, they took an ECG and said no AF and everything was OK, Flutter does show on an ECG doesn't it? If I still am in this fast heartbeat tomorrow I will go to the doctor, I know something is wrong. Also when I was at the ER in Jan. they ran my thyroid test and I was hypo, perhaps I am again, however, I always thought that hyper would produce a fast heartrate not hypo.

I have been taking Propafenone, 150 mg. everynight before bed for the last 14 years, when I go into AF I do take a little more to go into NSR, could the drug cause me to go into flutter or whatever it is?

Liz



Edited 1 time(s). Last edit at 04/22/2018 08:13PM by Elizabeth.

Liz,

Carey knows much more than me, but from what I know, it can be hard to diagnose even on an 12 lead ECG, especially if the interpreter is not a very skilled cardio or EP.

As to rate, the atria are typically beating at a fast rate, say 300 BPM. With flutter, you can have 1:1, 2:1, 3:1, 4:1 or variable conduction rates. 1:1 means the ventricles are beating same as the atria - not good news. 2:1 means 1 ventricular beat for every 2 atrial beats (with atria at 300, ventricles would be at 150), 3:1 - 100 BPM ventricular rate, 4:1 75 BPM ventricular rate. As Carey posted on my conversion thread, you can also have variable conduction which mimics afib.

If you feel poorly, but the rate seems regular, flutter would be a good guess, but not certain.

George.

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Elizabeth
Flutter does show on an ECG doesn't it? If I still am in this fast heartbeat tomorrow I will go to the doctor, I know something is wrong.

Yes, flutter definitely shows on an ECG but it's not always obvious and sometimes takes an experienced eye to spot. But trust your gut instincts. If you know something is wrong, then something is wrong. See your doc.

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I have been taking Propafenone, 150 mg. everynight before bed for the last 14 years, when I go into AF I do take a little more to go into NSR, could the drug cause me to go into flutter or whatever it is?

No, not likely. I've seen some comments here to the effect that flecainide can cause flutter, and propafenone is in the same class as flecainide, but that's not quite right. If you're in flutter then that's just your underlying atrial disease. It's not caused by the drugs you're taking.

As Class 1C AAR drugs, both Flecanide and Propafenone can trigger a pro-arrhythmia or ventricular tachycardia, especially when combined with certain other agents. And to a degree, both drugs can cause the dreaded 1-to-1 pro-arrhythmic Atrial Flutter, even though with propafenone the Aflutter tends to be a bit slower than with Flec, Preloading with a beta blocker, or in some cases a calcium channel blocking drug, can prevent pro-arrhythmia, but it is not certain to do so.

Both Carey and I have experienced the dreaded 1- to-1 Flutter, and take our words for it .,.. it is no fun at all!

Shannon

Saw the doctor today, ran an EKG, checked my heart-----doc told me that because I have a pacemaker AF or Flutter will not show on the EKG, otherwise it is OK. Heart rate in low 80s, doctor said not exactly regular, said could be some off and on AF or flutter or PVCs, said to contact my EP. The problem with my EP he is only in his office a couple of times a week, otherwise he is at the U. of M., I have left a message and will be able to talk to his nurse tomorrow.

Why take an EKG if it doesn't show AF or Flutter, what else doesn't it show, my EP has taken EKGs of me. The tracings from my pacer shows AF, at least that is what they tell me. Heart rate still 80, seems regular to me right now.

Liz

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Elizabeth
Saw the doctor today, ran an EKG, checked my heart-----doc told me that because I have a pacemaker AF or Flutter will not show on the EKG, otherwise it is OK.

As a non-medical professional, I'll go out on a limb and say your doc is wrong!!

The pacer only sets a floor on your heart rate. Otherwise won't make a difference. So if the pacer is set at 60, your heart won't go below that as the pacer will fire. Otherwise, pacer makes no difference to your ECG.

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Elizabeth
Saw the doctor today, ran an EKG, checked my heart-----doc told me that because I have a pacemaker AF or Flutter will not show on the EKG,

That's utter nonsense. A pacemaker doesn't conceal any arrhythmias other than bradycardia.

When I went to the ER in Jan. the doc. there told me the same thing, I didn't believe him, but now that this doctor said the same thing as well, I didn't know what to think, I knew you guys would know, thank you. So, If this doctor said she saw nothing wrong would that mean that there isn't any AF or flutter? My EP will be getting the EKG this week so hopefully I will get an answer.

Liz

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Elizabeth
So, If this doctor said she saw nothing wrong would that mean that there isn't any AF or flutter? My EP will be getting the EKG this week so hopefully I will get an answer.

If she saw no afib or flutter then there wasn't any, but then again she displayed a rather appalling ignorance of ECG interpretation with pacemakers, so I'm not so sure how credible her opinions on this are. I would ignore her and rely on the EP's opinion.

What Carey said.

Liz - I certainly hope you can find a competent EP who can actually interpret the readings correctly. You may recall that when I attempted to have ECV via the local hospital ER, I was first given the chemicals for conversion which put me in A-flutter and out of the AFib I had been in and was approaching the 48-hour deadline since I was not on anticoagulants.

Apparently, since the flutter rhythm looked more "even" on the monitor to the staff and even to the EP who signed me out of the facility, I was discharged in flutter... but not told that... was instructed to check in with the supervising EP for my final discharge final directions...which I did. I had to wait over an hour with all the other cardio patients. Now, I knew I was in flutter as I could see it on the monitor, but I was glad to leave if they weren't going to do ECV... and so went to the EP who never mentioned the rhythm was flutter.

The next day, I was able to see a main-campus CCF EP who confirmed by another ECG that, yes, I was in flutter. I expressed my 'dismay' at how my case was managed. (Now keep in mind, I could always tell afib from flutter just by monitoring my pulse...no gadgets or monitors - fortunate in that regard as it's not always as straight forward as mine were.)

After that, if I needed an ECV, I traveled to a nearby city about an hour's drive away where I knew they knew how to read/interpret and manage my care properly.

Imagine the money that my insurance and I had to pay for that fiasco. Two visits, several doctors.... and my frustration.

The good news is that I did convert on my own as the CCF doctor suggested I would. And it's also a "good news" testimonial that from Tuesday to the following Monday morning ... in AF and AFl .... using only my nattokinase and other fibrinolytics that I didn't have a clot problem with the ECV.

Jackie

Jackie:

It is good that you can read the ECG, I can't, makes you Carey, and George a lot smarter than a couple of doctors I know. A copy of the ECG has gone to my EP, he will be in his office tomorrow so I will contact him then. I am glad I had the EKG done as today I am OK, my heartrate in back in the low 60s and it feels calm. For 4 days the rate was in the 80s constantly, I was low energy and feeling nervous, is that how flutter feels, this is the second time It has happened to me, once in Jan. and now. I did have them run my thyroid test, she gave me the TSH which is 3.9, I am better with it lower than that, the rest, T4 and t3 they were going to send.

I did monitor my pulse, it was fast, mostly regular, but just didn't feel the same as when I know I am in NSR, when I was sitting, resting it was regular but when I got up and moving around it was wasn't that regular, it didn't feel like AF but it wasn't like it should be, is that what flutter feels like? The last two times this has happened I went into AF first then it felt like I converted and this beat happened and lasted for 4 days.

If this is flutter, does It always happen after an episode of AF or just sometimes? Well, I will see what my EP has to say and go from there.

Thanks to all.

Liz

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Elizabeth
If this is flutter, does It always happen after an episode of AF or just sometimes?

Not always, but everyone is different. I went two years with flutter being the only arrhythmia I had, then afib reappeared and they mingled together. Sometimes the afib would initiate the flutter and sometimes it was the other way around.

Liz,

Without looking at the ECG, if your rate feels regular, but is significantly higher than usual and you feel "off," you are likely in flutter (not that there couldn't be other causes, but it is the most likely). Hopefully the EP will confirm.

George

Liz - Just to clarify... I was not reading an ECG... but rather observing the monitoring screen on the equipment in the ER room. I watched it change from AF to Aflutter and remain there in flutter when I was discharged.

As Carey notes, everyone is different...and for my experiences, AF was definitely different. Sometimes I would go from AF to flutter... other times, I would just start out in flutter. Typically, flutter would be very high rate often over 150 bpm... debilitating... but "calming down" to around 120 bpm. When it was very high, I felt awful. When the flutter was just slightly above 100 bpm... then, I was almost fully functional... didn't feel weak or light-headed.... versus the Afib and that typically made me feel awful. On one hand, I dreaded the flutter because for me typically, it meant a trip for ECV... whereas with the Afib, I'd either be totally down or just mildly impaired and cautious not to do too much.

Jackie

The copy of my ECG finally got to my doctors office, he left before it got there, however his nurse can read them. I spoke with her and she said there wasn't any AF or flutter because I was pacing and when your are pacing it won't show AF. That is why those other two docs said there wasn't any AF because of my pacer. They didn't say I was pacing or go any further. My pacer is set at 50, my understanding is that when my heartrate drops below 50 the pacer kicks in. So, why was my pacer pacing, it stayed at 80 BPM for 4 days, the last two days my heartbeat is at the low 60s, that is my normal rate. I spoke with the nurse and she said to contact the pacemaker clinic if something has changed with my pacer. I sent a tracing of my pacemaker to them, since it got there rather late, they said they will call tomorrow after reading it.

Something is wrong, why am I pacing at 80, I felt nervous and no energy when at 80 BPM. I feel like myself today when my heartbeat is in the 60s. These doctors that saw my ECG and saw that I was pacing said nothing.

Perplexed
Liz

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Elizabeth
The copy of my ECG finally got to my doctors office, he left before it got there, however his nurse can read them.

I think there's a communication problem here. There's no reason that afib wouldn't be apparent even if you were pacing, but she was probably trying to keep it simple for you. I think she must have assumed that if you're pacing then you're not in afib, and there may be some truth to that. It's really unlikely that you were in afib with a rate less than 50. I think you're just going to have to either accept her explanation or get an opinion directly from the EP.

And you weren't pacing with a rate of 80. Your rate was 80 because you were pacing. Look for other reasons for the nervousness and lack of energy.

Carey:

After 4 days in a Heartrate of 80 what made me stop pacing and go into my normal heartrate of 60? Hopefully the pacer lab will have some answers for me tomorrow, The pacer was put in originally because when I would go from AF to NSR my heartrate would almost flatline, the pacer is set at 50 so if I go below that the pacer kicks in, I have never had a problem before until this past Jan.,

{. A good cardiologist or electrophysiologist can tell which peak on the EKG strip is made by the heart and which is made by the pacemaker. I would guess that because of the difficulty in distinguishing which is which is the reason for the warning on the devices you looked at.)

I googled and found the above sentence, my EPs nurse did admit to me after my questions that she wasn't too well versed with pacers.
thank you Carey and George, if not for you guys I would have accepted those 2 doctors wrong statements and not checked further.

Liz



Edited 2 time(s). Last edit at 04/25/2018 10:40PM by Elizabeth.

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Elizabeth
After 4 days in a Heartrate of 80 what made me stop pacing and go into my normal heartrate of 60? Hopefully the pacer lab will have some answers for me tomorrow,

I don't know what the explanation would be, but hopefully your EP will have an explanation after he reviews the pacer report. I think you're really going to have to insist on hearing it from him because what you've been told so far is confusing, at best.

I don't have pacer experience, but to say your pacer is pacing you at 80 when it is set for 50 seems very suspicious. Makes no sense to me. When people use to send me heart rate vs. time graphs years ago, those with a pacer (including Shannon), showed a "floor" at whatever the pacer was set for. Above that, the pacer had no influence on the rate.

I'm also no flutter expert, but I understand that flutter can be hard to identify on an ECG. Hopefully the EP will clarify for you. My vote is still that the pacer was not pacing at 80 and you were likely in flutter at 80 BPM. Then you converted after 4 days.



Edited 1 time(s). Last edit at 04/26/2018 08:58AM by GeorgeN.

Liz:

When I was 1st reading through this Scenario, I thought it may be just Tachycardia of unknown cause. I myself have had had TachyCardia lasting days of about 10-20 BPM higher than normal, sometimes this occurred right after spontaneous Conversion. As far as I know it wasn't Flutter.

Later however, when I re-read through this, these periods of fast HR of around 80BPM, are definitely caused by your AFIB episodes. Whether its Flutter or not, it is just happening after the AFIB episodes. Flutter makes sense, because people do convert from AFIB to Flutter, and then on to NSR. This is common, especially if people are taking Propafenone, which is known to cause Flutter. It sounds like you could rule out AFIB, because you would be able to tell the Irregularity of it from just hand-checking your Pulse, as well as it should seen by the Doctors and Nurses who looked at it.

Flutter at 80BPM, could be easily mistaken for NSR. Multiple Doctors/Nurses could be making the same Error.

-- 80BPM is normal for most Patients in NSR
-- Superficial thinking can happen because the Doctors/Nurses are Busy
-- Doctors/Nurses would probably underestimate your Intelligence and that you knew what you were talking about.

Then this Bizarre Pacer issue confuses the situation.

I don't know much about Pacers, but what they are telling you would make sense if you had an AV/Node ablation, and your Rate was fully controlled by a Pacemaker. Obviously in your case, the Pacer just acts as a Floor to kick in when your rate drops below 50. This is more evidence that your Doc's/Nurses are just speaking superficially, and not slowing down to properly analyze the situation correctly.



Edited 3 time(s). Last edit at 04/26/2018 06:37AM by The Anti-Fib.

Well I spoke to someone in the pacer clinic and, really hard to get more info. Finally, said that yes it could be flutter and also some AF going on during those 4 days, periods of it not constant. Said the pacer senses between beats, (something like that) that's why heartrate was in the 80s the high is set at 110 BPM, according to this guy I was having a few episodes off and on during those 4 days, he finally said it was probably flutter, started with AF. My EP is only in his office in Northville one day a week now, he is at U of M, I will probably look around for a new doctor. All that can be done is to try different drugs. I have probably had flutter twice, is that now something I will now be having? Every time one has an episode of AF will flutter follow or doesn't that always follow. I had to pull it out of this dude that it might be flutter, he just wanted to say it was AF and no more talking, I was not understanding why my heartrate was a constant 80s, during those 4 days still don't. Also, flutter is a fast heartbeat so why am I pacing, I don't understand what this guy was talking about.

Liz



Edited 1 time(s). Last edit at 04/26/2018 03:04PM by Elizabeth.

Nobody can tell you whether flutter is always going to accompany your afib. You'll just have to wait and see. Also not sure why you were being paced since I don't know how it's programmed. That's definitely a question for the pacer clinic or your EP. It's possible it was programmed to pace in response to afib, which is known as overdrive pacing. The idea is to give your heart a regular rhythm to follow in the hopes it would take over from the afib. It didn't work well so it has fallen out of favor, but if you've had that PM for a while it's possible that's how it was programmed.

I've also found that many medical providers don't like to talk about flutter. They just lump it under afib, as a simplification for patients, I suppose, since the treatment is largely the same. My PCP used to do that. For two years I had a flutter problem but not afib. Nevertheless, he would always mention my afib. I would correct him and say I had flutter not afib, but the next time it came up he'd say the same thing.

Spoke with a nurse at the pacer clinic, I have an appointment this Tuesday to reprogram my device. Evidently it is set at 80 to pace when it senses AF or Flutter, that's the way it works, don't exactly understand why. They will drop the rate to 60 or 70 so that I hopefully won't be feeling it as much if this happens again. This nurse believes it was flutter.

Spoke to my EP, he called me, not in the office, wants me on Equilis, wants some blood work to determine dosage if I go on it. With my history it is worrisome, if I don't he will still work with me, I am on aspirin. I understand that aspirin isn't as good, but, hopefully better than nothing

Liz

Ah, so it is doing overdrive pacing. That would definitely explain what you experienced.

Why should I have that "overdrive" on my pacer, my understanding has been that the pacer was put in because of a 1st degree heart block, which was probably caused by taking beta blockers when first diagnosed with AF by my regular doctor. The pacer was only put in to kick in when my heartrate dropped below 50. It was put in 1998 and I have had no problems until now, the last interrogation of the pacer was Sept. 29th, 2017, I did not have any AF in Aug. and Sept., then got 3 or 4 in Oct. right after the pacer check. I was not aware of this "overdrive", could the tech have installed this when I was last there? It is strange because I have never had any symptoms like I have had these last few months. I will demand some answers, this last tech was new to me.

Liz

Extremely unlikely a tech would have programmed it other than how it was prescribed by your doctor. The question is probably when, which doctor, and why. By all means you need to demand answers.

Went to the pacemaker clinic yesterday, talked with one of the pacer nurses, tried to explain pacing to me, lots to learn in how to read the ECG. My pacer was pacing me at a heartrate of 80, she was very agreeable to change that to 60 or even to 50, since my heartrate is usually in the 60s I said set it at 60. I don't know why it was set at 80 in the first place, she said something about It was pacing the ventricle, I have a dual pacer, a lead in the right atria and right ventricle. I have a ventricular safety standby. They looked up my past tracings and went back to 2012, said pacing was set at 80, perhaps it was set at that time when I had a new battery inserted. When my AF episodes were over that was it, so if I felt a fast heartrate that was during the episode and when it was over I was back in my NSR. The last two times it didn't happen that way, it appeared to me that I was back in NSR but when moving around and doing things my heartrate felt fast and kind of a flutter, I then kept taking my pulse and it was usually 80, once in a while a little higher. The nurse said I was either going in and out of AF or in flutter. I am not sure what rhythms the pacer is programed to capture. Well I will see what will happen.

I also spoke with my doctor and asked him about the Watchman, he said that it can come loose and float in your body, didn't sound too encouraging about it.

Liz

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Elizabeth
I also spoke with my doctor and asked him about the Watchman, he said that it can come loose and float in your body, didn't sound too encouraging about it.

Not when placed by someone with adequate training and experience. He's doing you no favors telling you stuff like that. I doubt he has much actual knowledge of the Watchman.

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Carey
Not when placed by someone with adequate training and experience. He's doing you no favors telling you stuff like that. I doubt he has much actual knowledge of the Watchman.

One of the most useful skills in AF (or any) disease management is to know what “I don’t know” sounds like.

My EP is very intelligent, he also teaches at U of M in Ann Arbor, he has been an EP for about 30 years. There are quite a few lawsuits against the Watchman device at Boston Scientific. I will agree with you that one needs a very competent doctor to install the Watchman, but there have been problems with it.

Liz