Worst episode ever-Anyone have this?

I am fairly new to a-fib, but thought I had gotten past the point where it could scare the life out of me. This incident was very unusual and I am just wondering if someone else has experienced this.

Yesterday I had an episode of a-fib while we were away from home. It started out as fluttery and was going in and out of NSR every ten minutes or so. We were touring a college and had a walking tour which I didn't complete because it felt like my rate was getting too high. I had taken about 80 mg. of fast acting verapamil. Perhaps I had pushed myself too hard, but on the drive home I had a sensation that my heart stopped and felt like someone had their hands around my neck restricting the blood flow. All of a sudden I felt a rush of blood to my head and my vision momentarily went out of kilter. It happened two more times on the drive home, but without the visual effect.

When I arrived home I called my EP and the dr (his partner). on call was not overly concerned (no er trip necessary) because I am young and have a healthy heart. Said my heart probably paused when converting and to call the office in the morning. It sounds like they may do another 30 day monitor.

I might add that I do not travel well and have anxiety, so how much is a function of normal a-fib and how much is anxiety driven (higher rate) I am not sure.

Has anyone had this happen during their a-fib career?

Lynn:

I had a couple of episodes where I started blacking out, but didn't blackout completely. The one incident was caught on a ECG---when converting back into normal sinus rhythm, my heartrate dropped to almost a flatline for a few seconds.

I had a pacemaker implanted, the low end is set at 50, so if my rate drops below 50 my pacemaker kicks in. I have never had any near-blacking out episodes since.

Now that may not be your problem, you need to get checked and a 30 day monitor should be helpful.

A lot of people blame everything on stress, anxiety, that can contribute somewhat, but don't blow it off on that, get checked, it is better to be safe than sorry.

Liz

I had similar episodes when I was on Flec and Dialzp. One episode was caught on an ECG and they wanted to implant a pacemaker immediately. I disagreed as I'd never had the symptoms pre drugs and as soon as I stopped taking the drugs the symptoms vanished. I then began serious planning for my ablation. Some people can't tolerate various stages of the drugs very well and you may be one of them.

Thanks for your responses. The only thing I am on is verapamil which I only take as needed. I was just thinking about the possibility of it being a reaction to the medication.

About two years ago before the a-fib really started I had a couple of episodes which when I think about it seem similar. I was laying in bed and had the sensation that I could not breathe, had head pressure then a racing heart and blood pressure spikes.

My cardio had sent a note to the neurology dept. regarding evaluating me for dysautonomia (when I was having my MS eval), but my cardio recently found out this was never done.

I had a return call from my EPs nurse yesterday basically asking what I want done. More drugs, monitoring etc. Seems like they are not taking this very seriously.

Lynn,
I had a similar event during my first occurence of AFib 8 years ago. I am a very active person with a really slow resting heart rate. When I converted (spontaneously) from AFib back to sinus brady the pause was long enough that I had a syncopal episode. I had been loaded on Digoxin the night before in the ER but discharged while still in AFib. Neither my primary doctor or my cardiologist were very concerned about the event.

I haved been doing Verapamil PIP. In fact my two prior episodes I took nothing because the rate did not seem too high.

My EP thinks if I did a daily dose I would not get these conversion pauses. I'm inclined to not take a calcium channel blocker again ever because he admitted that with the Verap.caused my hearts own pacemaker to be slow to react.

I also have 10 mg propranolol to use as a PIP and am thinking of taking it more often as a preventative at the times I expect to experience stress. Or perhaps actually take it on a daily basis.

Interestingly, I had actually given up my L-Taurine the week before this episode. Guess that was a big mistake.

Just wondering how common post conversion pauses are and whether they would happen with a daily beta blocker or calcium channel blocker or with nothing at all.

Any input would be appreciated.

Lynn:

I got my pacemaker in 1999, at that time I had afib once in a great while, the doctor gave me atenolol (a beta blocker), 25 mg. every day, I also was taking synthroid at the time, the beta blocker interfered with the uptake of my thyroid hormone and I became hypo. So being hypo and taking that beta blocker everyday, I became very tried, I then began to experience the almost-blacking out when going from afib to NSR.

I was in my doctors office and looked at my chart, there was a notation saying that the beta-blocker probably contributed to my sick sinus problem. So, I avoid beta-blockers like the plague, take another drug if you can.

Liz

Lynn

Verapamil is contraindicated in those with sick sinus syndrome. I think if you googled around enough you might find it can also produce it. Anyway - there is a relationship. It can also in rare cases produce asystole

[www.mentalhealth.com]

"Verapamil slows conduction across the AV node and rarely may produce second or third degree AV block, bradycardia and in extreme cases, asystole.

Verapamil causes dose-related suppression of the SA node. In some patients, sinus bradycardia may occur, especially in patients with a sick sinus syndrome (SA nodal disease), which is more common in older patients

The total incidence of bradycardia (ventricular rate less than 50 beats/min) was 1.4% in controlled studies. Asystole in patients other than those with sick sinus syndrome is usually of short duration (few seconds or less), with spontaneous return to AV nodal or normal sinus rhythm. If this does not occur promptly, appropriate treatment should be initiated immediately (see Overdose: Symptoms and Treatment)".

I found another site that said something about betablockers and sick sinus, but lost the url.

I am NOT an expert in heart rhythm disturbances, and I offer this up with considerable humility, because I just don't know enough.

But the above site provides clues that Ca-channel blockers (and / or beta blockers) might produce the kind of event you experienced.

I think your instinct to take this seriously is a good one, and doing more online research and getting more tests makes sense.

all the best
Lynn

Well that is both interesting and distressing. What is an afibber to do. First line meds are beta-blockers and calcium channel blockers. Next step seems even more risky.

Does anyone just not take anything when they have an episode?

What is more confusing is the fact that my cardio. told me not to be afraid to take two or three of the 40 mg. fast acting verapamil if I have an episode. My EP thinks that maybe two fast acting verapamil was too much and may have caused the episode (but not to worry, it is not "life threatening").

Both are pushing me to take either the verap. or propranolol everyday. EP says that if I took it every day it would keep the rhythm steady and I would not have these conversion issues.

Last year was my first episode, I've had one each month this year (two this month). I've resisted the daily meds so far and am hoping I can turn this around, but maybe I am being too hopeful.

I am only 49 and just can't believe this is happening.

Any input is appreciated.

Hi Lynn

I do apologize if I have added to your distress by that post. I feel badly about that,

I can't remember if you have Hans' first book or not - but reading or rereading his chapter on drugs might make you feel a bit better.

My notes say that he feels treatment with antiarrhythmics is not required for patients with infrequent and well-tolerated AF episodes (that is, for LAFers with healthy hearts). Lone AF is not life-threatening.

I'm not trying here to make any recommendation about what you personally should or should not do about drugs, because I am in way over my head there.

But, according to Hans' very careful reasoning, it looks as if you won't be at risk if you take your time about making a decision about daily drugs, while you get your feet under you and maybe get some more tests.

I would also encourage you to keep posting with your questions. Sometimes a post just dies for no apparent reason, and I would like to see more knowledgeable people responding to you. Maybe a second post could get their attention

all the best, and keep hopeful
Lynn

Lynn, I saw you mentioned Taurine in your post. Are you taking any other supplements, if so, what are they?

Lynn-Not to worry. Hans advice definitely makes sense. From what my EP has said it is not life threatening, very little likelihood of clotting, and if I let my rhythms get too high it can cause thickening of the heart, but that is reversable. Which is why my mindset has been to avoid drugs which seem to have a bigger downside than the condition itself. Logical I think.

My EP rationalizes taking daily meds as a quality of life issue. For example yesterday I was on the phone with him and he said that if I took my daily meds. I would not have to spend time calling his office, therefore my quality of life would be better. (I think he means his quality of life)

My cardio. is another story. He has outright lied. I went to his office with my second a-fib episode on a day he was not in. I saw his partner who did an ekg and confirmed it was afib, said 150bpm was a bit too fast and to take another verapamil. He then sent me on my way.

Well, here is where it gets interesting. When I saw my own cardio, he looked at the stip and said that by letting my heart go that fast I was risking going into VF which is fatal. (I do not have that syndrome) On the spot I told him that I didn't believe him and asked why his partner would let me walk out the door if I could potentially drop dead. His answer: "It was Friday afternoon and he didn't want to be bothered."

What is it with these guys? Must get free trips from the pharma reps.

Sharon, here is my list of supplements:

Life Extension mix
Primal Defense-probiotic 610 mg 3X day
Super Omega-3 2000 mg 1X day

Co Q 10 100 mg 1X day

Ashwaganda 250 mg. 2X day
Magnesium Glycinate 400 mg 2X day
D3 4000 IU 1X day
Liothyronne extended release 10 mcg 4X day
L-Carnitine 500 mg 1X day
Pantothenic acid 500 mg 1X day
Methyl-cobalamin 1 mg. 1X day
Folic acid 1 mg. 1X day
Asprin 81 mg 1X day
L-Taurine 500 mg 1X day
Super Booster/Vit K & Vit E & ginko - I take sporadically

Vitamin C 500 mg 6X day
Blood builders (iron) 26 mg 1X day

Alpha lipoic acid 100 mg 2X day

I do have Han's first book, but just skimmed the drugs part because I was not planning on using anything on a daily basis. Perhaps will re-read.

If anyone has comments or suggestions on the supplements, they are certainly welcome.

Lynn

Lynn:

Why don't you take a PIP approach to ending an afib episode---I take propafenone at the onset. plus magnesium and an aspirin, usually within 3 hours I will convert back into NSR.

I was getting afib every two weeks and sometimes more, I am vagal and I always got my episodes during the night, waking me or sometimes just resting at night. My EP suggested that I take one propafenone beofre bedtime and this has worked quite well for me, I can go months at a time without an afib episode. There are some beta-blocking properties in the drug, no need to take a beta blocker with it, I believe you do with Flec.

I also take biotin and evening primrose oil which has stopped all of my pacs, now it seems like I am the only one these two supplements has worked for, but believe me they did stop my pacs, I just don't have any, I havn't for the last couple of years that I have been taking these two supplements.

In your list you don't include fish oil, now I can't take fish oil but I can and am taking flax seed oil, a tablespoon everyday, the claim is that fish oil is better but we do what we are able to do.

Liz

Thanks Liz, it is nice to hear from someone who has had success.

I must have forgot to list the fish oil 1000 mg. Plus a combo oil from Barleans with omega 3 and 6 1000 mg.

i haf to look up asystole, and it neans flatline, no heartbeat. this is what finally occurs when we die. Not a good thing to have happen.
PeggyM

Peggy - asystole (of short duration) doesn't always mean death. There can be a pause in the heartbeat pattern where a beat is absent and is identified as asystole... as in what was quoted in Lynn Robinson's post..

Asystole in patients other than those with sick sinus syndrome is usually of short duration (few seconds or less), with spontaneous return to AV nodal or normal sinus rhythm. If this does not occur promptly, appropriate treatment should be initiated immediately (see Overdose: Symptoms and Treatment)".

When I stupidly agreed to that emergency room treatment for aflutter, they stopped my heart...which was definitely flatline or asystole but then restarted it (thankfully) and the beat resumed again.... alas, still in aflutter....so not everyone dies when they have asystole...

BUT just like my friend who recently passed out, flat-lined/ code blue... the doctors said if he hadn't been in the hospital and hooked up to the telemetry so they knew it immediately, he would have died. You can't sustain asystole for very long without dire consequences.


Jackie

apologies for careless typos in above post. i HAD to look up asystole, not haf. And it MEANS flatline, not neans.
PeggyM

Jackie:

Just curious, what was the cause of your friend's asystole. Did he have an underlaying condition?

Lynn, don't mean to frighten you, but I did a quick search on side effects of two things you are taking, below are the results. I think I would challenge the doctor, especially on the one that clearly says side effects could be severe dizziness and also irregular heartbeat. That is what you are trying to avoid and you are on a medication that could cause it, that does not make sense to me. Lynn, I know this is overwhelming to you, it was to me also, but I learned real quick that I had to take my health back into my own hands because sometimes doctors just write a prescription without really knowing what the side effects are. They should study that but they don't.
Here is what I found about two you are taking especially the Verapamil which you took and had the reaction to. Both of these can disturb the heart beat. Sharon


Verapamil Immediate-Release
Side Effects
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Verapamil Immediate-Release: Constipation; dizziness; fatigue; headache; lightheadedness; nausea.
Seek medical attention right away if any of these SEVERE side effects occur when using Verapamil Immediate-Release:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; fainting; lightheadedness, especially when standing; severe dizziness; shortness of breath; swelling of the feet or hands; symptoms of liver problems (eg, yellowing of the skin or eyes, dark urine, pale stools, severe or persistent stomach pain, fever, general feeling of being unwell); unusually fast, slow, or irregular heartbeat.

Liothyronine
ADVERSE REACTIONS
The most frequently reported adverse events were arrhythmia (6% of patients) and tachycardia (3%). Cardiopulmonary arrest, hypotension and myocardial infarction occurred in approximately 2% of patients. The following events occurred in approximately 1% or fewer of patients: angina, congestive heart failure, fever, hypertension, phlebitis and twitching.
Thyroid hormones appear to increase catabolism of vitamin K-dependent clotting factors. If oral anticoagulants are also being given, compensatory increases in clotting factor synthesis are impaired. Patients stabilized on oral anticoagulants who are found to require thyroid replacement therapy should be watched very closely when thyroid is started. If a patient is truly hypothyroid, it is likely that a reduction in anticoagulant dosage will be required. No special precautions appear to be necessary when oral anticoagulant therapy is begun in a patient already stabilized on maintenance thyroid replacement therapy.