To go to the ER or not to go, that is the question

I am trying to figure out if I should go to the ER tomorrow, so I am looking for advice here.

I started AF in late Jan 2012. I controlled it with 400 mg Mg per day for about a month, then it gradually came back so I went to 700 mg/day Mg, and it went away for 2 weeks. Then it came back gradually so I went to 1000 mg/da Mg and it reduced the duration, but I have progressed to daily AF, even while taking 1100 mg/da Mg, which I am on now.

I have no chest pain or anything with my AF, and in fact lately I cannot really even feel it without checking my pulse. My pulse during AF is typically 80-90 and 45-55 during NSR.

I have had daily AF for the past 3-4 weeks, roughly 1-2 hrs per day for the first couple weeks progressing to 4-5 hrs per day for this past last week. Starting today I had AF most of the day, with about 4 hrs NSR this afternoon. Also, when I am in NSR, I still have occasional ectopics, and the last couple days there have been brief periods where I might have a skipped beat every other beat, so my effective pulse would be half my normal, where normal is around 50. Sometimes during these I feel a bit faint, but they never last more than a few seconds where skipped beats are that close together. I am probably a candidate for a pacemaker, but I am not sure how that and AF would be handled in the ER.

I have never been to the ER for AF so I only know a little about what to expect. My concern about going to the ER in next few days is that I have an appointment with Dr Tchou at Cleveland Clinic (9 hrs away from here) in 9 days to be evaluated for an ablation, and I don’t want any local medical situation to interfere with that appointment for sure. We are even thinking about heading up to Cleveland a few days early, so if I did need an ER we could go to the CC ER.

Thoughts or advice?

Gary
Knoxville

Looking at your symptoms, I would go to the ER. My experience with two ablations and 13 trips to the ER over a 4 yr. period in 3 different cities. Their protocols are almost identical I have found... they will attempt bring you into NSR in a matter of a few hours... your EP is going to want you in NSR or he even may send you to ER right from his office . I have had this happen to me.

Most posters here will have different times one should go to the ER... but it sounds like you should be there after this many hours of AF. Its early in this journey but be there before too late... Most likely EKG... Drip Cardezem ... Blood draw for Potassium and Magnesium (a must) . This is the basic start and many times will bring you into NSR.

Just a word of caution on the Push Cardezem (have them do this very very slowly) some patients will do a complete drop to O (flat line) too quickly.. believe me they do forget this procedure sometimes they have to be reminded. (don't they just hate that)

I really think you do not have to worry they will do anything to mess up your EP's appt. If all goes well for you about 4 to 5 hrs. Most times they take AF patients immediately, I have found,

Good Luck head that way.

Gary,

If you are persistent, you should be on a blood thinner. That is the protocol.

Do you work with a local EP? I would be more inclined to go there rather than ER.

Dr. Tchou is top notch; good luck.

EB

Gary,

What EB said. Are you on any medications, anything to control your heart rate? When I had afib (ablated 5.5 yrs ago), without medication my heart rate went from the 50's to 180 bpm. With medication (Toprol XL) it went from 40's to 80's. Are you sure you have afib?

I had afib for 10 yrs (6 yrs on meds) and never went to the emergency room. It's different for each of us, so there can be a lot of variables.

EP#1 diagnosed me with atrial flutter based on my Feb 2012 Holter monitor results, and EP#2 said it was atrial fibrillation not atrial flutter, based on same Holter results. I believe I have a-fib due to the irregular heartbeat during episodes. My heart is strong, valves good, no underlying structural cause for AF, based on echo reviewed by both EPs.

In AF episode, my heartbeat is irregular, and goes from my resting normal of 50 to the 80-90 range. I have occasional bursts to 150 bpm pulse that is regular, but that has only lasted 5-15 minutes at most. The irregular 80-90 pulse episodes can last for hours, but usually starts and stops all day long.

I am on no meds to control heart rate at present. I tried Multaq under EP#1 which failed to control the AF. EP#2 won't give me any meds due to my upcoming CC appointment on Aug 9 -- he says Dr Tchou will put me on his favorite one at that appt anyway.

I am taking triamterene/hctz and evoxac for autoimmune conditions (the first for Meniere's disease and the latter for dry mouth, respectively). I suspect both have played a role in my AF development, just dunno how much.