"Anyone else have atrial tachycardia episodes that don't cause an increase their resting pulse rate ?"

For 2 years, I have been having occasional "early morning involuntary stretching" episodes of atrial flutter (see post by erich from Dec. 26th 2015) [www.afibbers.org]

This is how it happens: upon my first semi-cognitive moment, I arch up my back, yawning and stretching for 3-4 seconds. When I do this, I feel something happening in my chest/throat area. I put my hand across my heart with fingertips draping from the lower neck down toward the heart, and feel a fast pulsing sensation. If I count, "one one-thousand, two one-thousand", etc, it seems like 3-5 pulses per second. (= maybe 240 bpm), but none of these episodes have caused my overall heart rate to increase (my radial pulse is between 55-65 when this is going on).

Eventually, the pulses seems to get faster, then fade away, and I can't feel it any longer. Maybe it is going back to NSR... or possibly fibrillation ?
(I am in the process of obtaining a Kardia or similar home ECG device)

(Edit) Some have doubted that a flutter pulsation can be felt, but I did find one old PDF article referring to a jugular pulse waves that were reflecting an atrial flutter rate via an old "phonogram" recording (made via a stethoscope). The article mentioned that that this study result was possible because of the subjects slow resting pulse, and the AV node blocking/modifying all the excess atrial impulses... resulting in ample time between ventricular sounds to record "atrial pulsations" at the base of heart and jugular veins. [www.ahajournals.org]

Hello, this is my first post here, but I have been 'lurking' for months
I am a 62 yr old Chiropractic Physician, and veteran runner of 40 yrs (I've also been doing ultras over the last 15 yrs)
I studied Cardiology in the 70s training to be a cardiac catheterization asst., so I enjoy the technical discussions here.
I'm an ex-pat living in Ecuador, so I have limited access to US services except for a couple months per year.

While scrambling up a mountain in 2017, I had my first attack. It was a non-painful but unsettled feeling in my chest. I was suddenly so tired, I had to sit down. My pulse rate was nothing more than I expected for the super-aerobic activity (about 140-150bpm), but it was also quite weak and 'thready'. At the time, I had been recovering from a recent virus/cold and was still having chills and mild headaches just the day before, so I later thought, "Maybe the virus lodged in the heart?"

I had an echo + stress test done, but they found nothing, and dismissed the event entirely.

Over the last two years, I have stopped aerobic activity above a 65-70% HR, and doubled down on my mostly raw-vegan diet (+ occasional eggs/chicken), but a few months ago I started having afternoon PVCs while sitting at the computer for prolonged times, and these evolved into a Bigeminy rhythm that left me short of breath at times.

That got me serious, and I discovered this group and a plethora of new information on the internet. I began adding more/better Mg, and started: Nattokinase, Bromelain, Taurine, NAC, and CoQ10 w/ Flax Oil (I will soon add Vit. K-2)

The PVCs and bigeminy stopped after the changes, but the morning flutter and weak pulse continues.
Now I must now determine if I am in fibrillation at times without knowing it, and also find out my cellular Mg levels (and other minerals)

I have spent hours reading here, and am looking forward to learning more from all your knowledge and experiences.

Thanks for listening!



Edited 3 time(s). Last edit at 04/07/2019 01:22PM by jwb74.

Quote
jwb74
This is how it happens: upon my first semi-cognitive moment, I arch up my back, yawning and stretching for 3-4 seconds. When I do this, a brief (less than 1 minute) atrial flutter episode occurs at a rate of about 240 bpm, but NONE of the atrial beats translate to ventricular beats.....

You sure about what you're feeling? I've never heard of someone being able to feel atrial beats well enough to actually count them, and counting a rate of 240 is nearly impossible even with ventricular beats.

Hi Carey, I have enjoyed reading your posts and comments here... and thanks for being an admin!

So given your extensive time here on the forum, I can see why you might doubt me. Indeed, I am one of a very few I could find (via search engine) who reports ZERO history of transference of atrial tach into ventricular tach during their attacks, as well.

Perhaps I threw you off with the number 240? The "4 per second" estimate I make is based on the age-old 'one-one-thousand, two-one-thousand' method of estimating the length of a second. There are 4 syllables to the phrase, and the beats I feel match the syllables as I count... so in reality, it could be anywhere from 3 to 5 per second, or 180-300 per minute.

This has been a repeating phenomenon that always manifests in the same way. I simply put my fingertips over the left superior thoracic quadrant (like saying the pledge) just below the clavicle, and I feel them. At the same time, or stopping intermittently, I feel the radial (wrist) pulse going at the normal rate I have always had, so there is no doubt what is happening. Additionally, my radial pulse, though normal in rate, is always 'thready' (less bounding), during these episodes. This can be connected with decreased ventricular stroke volume. The ventricular stroke volume is determined in part by the effectiveness of the atrial contraction. The atria are like turbo boosters in an engine.... forcing extra blood into the ventricles before they contract, thereby increasing the volume of blood in each beat or pulse. So if the atrial contractions dont match the opening and closing of the Mitral and Tricuspid valves, the turbo effect is severely diminished, and the ventricles pump less blood each contraction. Does that make sense?

As I stated, I studied cardiology, and also went to medical school... not that has anything to do with one's ability to sense something with their fingers, but when you put the pieces together, it helps to have that understanding.

Very interesting story JWB74,

However, having experienced documented in the 240bpm range of atypical left
flutter, I come from the same planet as Carey in that I find it beyond impossible to even latch onto any discreet atrial beats at anything close to an actually detected 240 range flutter. I’m not suggesting you might be counting something else, but if you are really rocking away in high speed flutter and can directly sense those separate discrete flutter quiver, you have a much more refined sensory network than myself or anyone else I know.

The flutter beats I could sense during any fast atypical flutter episode back in the now distant days when I was still arrhythmia prone, were always a faint fraction of the actual ‘fluttery’ waves captured electronically at full lightening speed. I could have easily fooled myself trying to sense various pulse points along my neck, jugular, left of sternum between 3rd and 4th rib etc etc, and thought I was measuring accurately, but I never came anywhere close to actually counting the captured flutter circuit at full tilt measured boogie.

If you can ever confirm via 12 lead EKG testing that you can accurately count such discrete points of high speed flutter, that would indeed be very interesting and perhaps Guinness book of world record worthy!

Keep us posted, as I’ve not heard of a discrete atrial sensing in the absence of any ventricular response component as yet either, but who knows ... there’s always a first eh!

And welcome to the forum!

Cheers!
Shannon



Edited 1 time(s). Last edit at 04/07/2019 10:31PM by Shannon.

Well, I guess your tactile senses must be a lot better than mine. Being an EMT for many years I've felt thousands of pulses, and it's not uncommon to be unable to palpate a pulse at the wrist even when there is a normal heartbeat. And that's a ventricular beat, so being able to feel an atrial beat is a pretty astonishing ability.

I'm going to go with your 3-5 beats/sec estimate. I lived with atrial flutter for two years that hit rates as high as 250, and no way could I accurately count my pulse during those episodes. I relied on a Kardia or 12-lead instead. In EMS, when I encountered a super fast rate I would immediately slap a monitor on them because counting rates that fast just isn't possible, or at least not for any EMT, nurse or doctor I ever met. If an EMT looked up at me after palpating a pulse and gave me a number higher than 180 or so I would take that number with a big dose of skepticism. What I'd rather hear from them is "too rapid to count," which wasn't an uncommon statement.

Sorry guys, didn't mean to argue. I feel like I'm starting off on the wrong foot here

The reason I posted was to introduce myself and describe my event history to the best of my ability... in hopes of finding others with similar subset experiences.

Folks, all I'm say'n is I feel two different things happening simultaneously every morning... felt at two different places and running at way different speeds. Although flutter beats usually cause a faster ventricular pulse, that is not always the case. Here we have an ECG with a 360bpm flutter and 60 bpm ventricular rate. [www.healio.com]

A better title to my post might have been: "Anyone else have atrial tachycardia episodes that don't affect their resting pulse rate ?" or "Anyone ever feel anything weird going on in your heart/chest with your first yawn and stretch while laying in bed in the morning?"

So far, I have found only one other person who felt the same wake-up stretch episodes that I do, but he did not mention what it did to his resting pulse, other than to say it caused instant Afib, but later, it only caused 'palpitations'.

Anyone else out there?

We're not arguing and you didn't get off on the wrong foot. We're discussing, not arguing! You're good, we're all good.

The thing I can't understand is how you could have an atrial rate of 240 (or whatever) that doesn't transmit to a rapid ventricular rate but at the same time have a normally functioning AV node. Either your AV node transmits atrial beats or it doesn't, and if it doesn't, you're in heart block and need a pacemaker. I can't imagine what mechanism would lead to atrial flutter not being transmitted to the ventricles when normal sinus beats are. That just doesn't make sense.

Thanks Carey... maybe we have a problem with terminology, so I added a link to my last response that may help: [www.healio.com]

This link helps also: [www.healio.com]

Atrial Flutter (defined as ~240-500 atrial p-waves per minute, depending on whose site you read) has a wide range of ventricular responses to atrial impulses: from filtering all atrial beats except those consistent the usual ventricular 'NSR' (as seen in several of the tracings in the above links), to a response of full V-fib! (as can happen with WPW syndrome)

The main site for the links above has clickable sub-links in the left margin showing many ECG tracings ranging from 3:1, 4:1, 5:1, and even 6:1 flutter beats to ventricular beats. The ventricular rate on several of these sub-link tracings shows ventricular response rates of 60-75 bpm, while others are higher at 120-150. Notice also the absence of PVCs and irregular R-R intervals... also something common to flutter, but not Afib.



FYI (you probably already know this) : How to determine HR from an ECG or rhythm strip:

Go by RR or PP interval. If it is 1 big box (0.2 secs) then the rate is 60/0.2 = 300 bpm. The rest of the sequence would be as follows.

1 big box = 300 beats/min (duration = 0.2 sec)
2 big boxes = 150 beats/min (duration = 0.4 sec)
3 big boxes = 100 beats/min (duration = 0.6 sec)
4 big boxes = 75 beats/min (duration = 0.8 sec)
5 big boxes = 60 beats/min (duration = 1.0 sec)

I know what flutter is and I know how to read an ECG.

Like the guy is kinda trying to say, maybe he is having short episodes of fast (300bpm) AFlutter with 5:1 conduction thus giving a palpable radial pulse (ventricular) of 60 BPM? Is that so far-fetched? Or am I missing something.... probably!
(A bit of a LoL at the FYI to Carey )



Edited 1 time(s). Last edit at 04/06/2019 02:48PM by mwcf.

Sure, that's possible. I'm still astonished at being able to feel atrial beats, but a 5:1 conduction rate is a bit unusual but certainly possible.

Last night for the first time, i had a PVC event that started as bigeminy (PVC every other beat) for half a minute, then flipped to a pace that felt like my moderate to brisk running pace, then slowly returned to normal over a few more mintutes.

Since my events are occuring more frequently, I am going to get a Holter scan this week.

If I find I am in constant Afib, I am thinking of having a cardio version. I read that they can be done at much lower voltage (20-50 Joules) with Afib

Anyone had this done successfully... and how long did you stay Afib-free?

They don't usually go any lower than 100J. There's no benefit to going lower since all that would do is increase the odds of needing additional shocks at higher power, and there's no harm to using a higher setting. The risk of creating a skin burn goes up, but that's caused by a poorly applied pad, not higher power settings.

I've had many, many cardioversions. They always work, but the question is for how long. It can last from seconds to years, but without an antiarrhythmic drug on board, it's unlikely to last long. Afib will return as soon as it would have otherwise.

Thanks Carey

They probably would want to start out at 150J or so, it depends on the Dr. You could ask them to start out at 100 or 125J for the 1st try, then go higher if need be.

Thank You.

Joules are units of energy, not voltage. To get voltage from joules you need a capacitance.

20J would be about the energy delivered by a precordial thump. That’s where a physician hits the sternum as hard as he or she can with the side of a clenched fist at full arm’s length. So, not much. The defibrillator does a lot more. It can go up to 300J which will make your whole body convulse and raise up off the bed. Hence the sedation!



Edited 1 time(s). Last edit at 04/07/2019 08:43PM by wolfpack.

Hi Carey, just wanted to share a couple things in regard to the ability to sense atrial pulse waves...

Turns out that what I was feeling is probably the same thing Shannon mentioned he used to feel (but less succinctly), ie reflexive jugular waves. In Afib, the jugular vein reflects atrial contractions reverberating upstream after being blocked by the closed Tricuspid Valve during ventricular systole. According to this article, they used to measure and record all sorts of waveforms and pulses, including the "V" waves of the jugular vein.

[scontent.fuio4-1.fna.fbcdn.net]

Notice the V waves match the P waves



Edited 2 time(s). Last edit at 04/08/2019 02:38PM by jwb74.

Welcome jwb.

A few thoughts. Detraining from endurance activity, as you have done, is a good thing IMO. So is adding taurine, as you said you are doing, to a mostly vegan diet.

How is your glucose-insulin system? I ask because of people like South African Dr. Tim Noakes (author of the Lore of Running), who has run man marathons and ended up with T2. So did a friend of mine, Dr. Mark Cucuzzella, who has run 30 marathons under 3 hours, as well as running Boston 30 times, though Mark's issue may be more pancreatic insufficiency.

Cheers,

George

Hi George, thx for your interest in my case

...been yrs since I had a 5 hr GTT, but I think I'm pretty healthy in that regard. I eat very little, and practice intermittent fasting often. I eat no processed foods and eat a lot of salad from my garden.

I want to get a Calcium accumulation CT and make an effort to reduce any fibrotic build up with enzyme therapy and K2

Forgot to add that my son got Afib at 22 yrs old... he was a 2:45 marathoner and was so symptomatic he had both ablation and a defibrillator implanted. His work was done at Johns Hopkins and he and I both tested negative for genetic markers



Edited 1 time(s). Last edit at 04/08/2019 03:03PM by jwb74.

An ICD for a-fib? That doesn’t make a whole lot of sense to me. ICDs are for ventricular arrhythmias. I’ve heard of pacemakers for a-fib in the context of patients who experience long pauses when converting from AF to NSR, but that’s it.

Thanks for the correction in terminology, Wolfpack (are you an alumnus of NC State Univ. in North Carolina?)

I'm still learning, but my EP and also my internet research tells me that cardioversion for afib can be an option, and 20-50 Joules is used routinely by my doc and some other EPs for resetting afib to NSR.

Although the benefit is almost always temporary, the two reason given are:

1 - the patient's afib is causing a ventricular episode that is not terminating very quickly

2 - the patient is newly diagnosed in persistent afib, and hopes to literally buy a little more time in NSR while pursuing longer term solutions.

Ya, I think Johns Hopkins may have gone a little too far in offering the permanent defibrillator to my son. He was in so much fear from his episodes and everything was covered 100% by his employer, so he went for what appeared to offer the most security at the time. I tried to reason with him, but to no avail. Last year, he had another ablation (9 yrs after the first!), and I believe they turned off the ICD after that.



Edited 1 time(s). Last edit at 04/08/2019 11:02PM by jwb74.

Yes. I graduated North Carolina State University with a master’s degree in electrical engineering back in 1998. Hence the username.

Cardioversion is the standard treatment for AF in an emergent situation. Just about every cardiologist or ER will do that. If the episode is less than 48 hours old they will anticoagulate you and do it pretty much right away. If it has been longer then you’ll get the TEE (trans-esophageal echogram) to look for clots and proceed from there. I never “rode the lightning” myself but the energy levels you mention seem low. I’ll defer to others here who have been “electrocuted”.

I've ridden the Lightning on many occasions. A low 50J Shock sounds like for Atrial Flutter, not Atrial Fibrillation. The lowest I have ever seen referenced for Conversion of Flutter is 50J. Cardioversion of Ventricular Tachycardia is also done starting at 50J.

I am interested in where are you reading 20-50J, or anything lower than 50J? Unless you are talking about the less common "Internal Cardioversions". These are done via Catheter, at the end of an Ablation procedure or by way of the Esophagus, called a Esophageal Cardioversion.