Fast Heart Rate

Hi All,
With Flecainide working for many years (2009), I have been lucky with few and far and between short episodes (and no need for ablation???), but this weekend
I was in a heart beat run averaging about 125BPM or 36 hours or so. When I went to EP Monday, he said a cardio conversion needed to be done (this was going to be a first for me), but that night HR went back to my normal 60 naturally. In times past, my BP machine which shows irregular beat, but this weekend it was not showing a broken beat pattern just a fast one. But maybe machine getting old??? Or maybe I was in Atrial Flutter...Is that less detectable ? And is AFlutter likely to be a little less symptomatic to someone than Afib (to which in times past I have been extremely symptomatic).
At any rate, whatever I was in...or in and out of ...caused fast heart rate and caused my BP
to go low and then a little high--- weird.
Now, getting my strength and wind back gradually. Today 4 flights of stairs does not make me winded and today I was less headachy. Not sure what it does to your heart to run fast like mine did.
Not sure what set me off around late Saturday night. I had had one mixed drink earlier in the evening....which I usually dont do.....but holiday time( I Usually stick to light beer if I drink at all.
Sorry to bore on. Hope the Flec keeps working.
Does the board believe in preemptive strikes ie ablation or best to not disturb a snake?
Happy Holidays to Shannon and to all. THANKS

Tibbar



Edited 3 time(s). Last edit at 12/21/2018 08:02AM by tibbar.

Quote
tibbar
I was in a heart beat run averaging about 125BPM or 36 hours or so. When I went to EP Monday, he said there was need to cardio convert (would have been a first for me),
but that night HR went back to my normal 60 naturally. In times past, my BP machine which shows irregular beat, was not showing a broken beat pattern just a fast one.
But maybe machine getting old??? Or maybe I was in Atrial Flutter...Is that less detectable to machine? And is AFlutter likely to be a little less symtomatic than Afib....to which in times past I have been extremely symptomatc.

I would bet heavily that was flutter, probably with a 3:1 conduction rate (meaning your AV node is transmitting every 3rd beat from your atria to your ventricles). I very much doubt there's anything wrong with your machine. Flutter is detectable with a 12-lead ECG, but with single lead devices like the Kardia you can only guess that it's flutter based on the rapid, regular rate, and a prior history of afib. If you can see P waves at all, flutter would show multiple P waves between each QRS, but you probably won't be able to see them at all so if you don't then it means nothing.

Flutter is usually less symptomatic than afib because it's a regular, coordinated rhythm, so it moves blood more effectively.

I'm curious why your EP didn't want to cardiovert it. Did he give a reason?



Edited 1 time(s). Last edit at 12/20/2018 01:11PM by Carey.

Carey,
Wow. Thanks for taking time to give such a detailed reply.
EP said that cardi-conversion was needed and he scheduled it. Thankfully I converted naturally before the next days scheduled trip back to hospital.
My BP machine has, I believe in times past been accurate, and in times past me taking my pulse would show irregular. This time not.
The person who read my pacemaker and the PA who I saw before EP did not make it clear if I was at that point in afib and I asked about flutter. I was not sure of my state other than fast heart beat for sure. A 12 point EKG was done just before DR saw me.
EP saw me and said need to convert. He did not get into particulars of afib vs aflutter, and as far as i was concerned at that point (the Dr had stayed late to see me and had to reschedule the next days bookings for conversion.) I felt time no need for me to be adding to the discussion.
I wanted to get the rate down as it was wearing on me causing fatigue and headache and messing with my BP numbers.

tibbar



Edited 1 time(s). Last edit at 12/20/2018 12:42PM by tibbar.

Yeah, flutter may be less symptomatic than afib, but it's still no walk in the park and it has all the same risks (stroke, heart failure if left uncontrolled, etc).

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Carey
Yeah, flutter may be less symptomatic than afib, but it's still no walk in the park and it has all the same risks (stroke, heart failure if left uncontrolled, etc).[/quote

Not that I know, but surely the atria just quivering with AF implies a much higher thrombus formation risk than AFlutter?

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mwcf
Not that I know, but surely the atria just quivering with AF implies a much higher thrombus formation risk than AFlutter?

That's what I've always thought too, and the EP I asked said he also that it's likely true, but I'm unaware of any data that specifically compares the two. They always get lumped together in the literature and the existing consensus is they should be assumed to carry the same risk.

AF or flutter, the atria are contracting around 300 bpm. One may be more organized than the other, but either way it’s too fast to be a good pump primer.

Agreed, but I think it's bound to come in degrees, and if so then flutter is bound to pump at least a little better than afib since it is a normal, coordinated sinus beat with a P wave.

My own flutter seems to suggest this is true. Even with flutter at 250 bpm, I could go on for hours. I remained conscious, in no visible distress, with otherwise normal vital signs, no shortness of breath, and capable of driving myself to an ER and walking in on my own power. However, I'm quite sure none of that would have been true if I'd been in afib at 250. On a subjective scale, I found flutter at 250 to feel about as bad as afib at 170-180.

Just to add/embellish, luckily, in times past the afib episodes I have had were usually under 2 hours ( I have not had many of that duration or longer in the last 7 years (except one I had when I got Lymes in 2015),......but when in afib, I am very symptomatic and distressed — sea sick, anxious, BP bouncing, tired, headache, etc.. I think in afib my heart rate may vary more in its speed during irregular beats.
This time I did not feel as sick..HR I think was steadish at 130 and not converting as I usually did with afib., lightheaded, tired, and headache, and low BP 85/65 and high BP in same day 150/100. But I was functioning ok...sort of ..just dragging. I assume if anyone has high heart rate going on, the longer it goes on the more tired they get and winded doing steps, etc. I don’t know that to be true though.
In my case, The PA did not want to overstep her bounds, but when I asked her if maybe aflutter, she did not say no. When the EP made time to see me despite being very busy, he kept in simple: basically you need a conversion your heart is not beating right.

Enough about me, you all be well!,,,,,,,

Again, thanks forum for your insights!

🌲🌲Happy Holidays🌲🌲
Tibbar (J.H.)



Edited 3 time(s). Last edit at 12/21/2018 08:00AM by tibbar.

Oh, for sure the longer you're in the arrhythmia the more tired you're going to be.

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Carey
Agreed, but I think it's bound to come in degrees, and if so then flutter is bound to pump at least a little better than afib since it is a normal, coordinated sinus beat with a P wave.

Yes, there’s always the “it” factor that comes along with all of us.

I’ve never experienced flutter myself, but did diagnose it in my Dad using nothing but the Kardia and being 50% of what he is I can imagine what it would be like in me.

I recently experienced a dozen hours of fast HR (AVG 115-130 bpm), regular but obviously not resembling sinus tachycardia. The sensation was that of a regular rhythm, but with beats weaker than normal. All beats appeared equal in (low) strength.
I showed the tracings to my EP, who confirmed it was flutter.
Atrial flutter is hard to stop. I likely had it because of the flecainide I was taking twice a day (50mg) after my recent touch-up ablation procedure. I increased my dose of BB to try lowering my HR, but it took me a dozen hours to get back to NSR.
In flutter, my BP was around 95/75. The EF was likely lower than normal.