how fast to seek help when AF episode hits

I've had AF episodes on and off since 2004. I'm not a lone afibber though, since my condition is related more to an enlarged atrium due to mitral stenosis/reflux. My last cardioversion took place on July 30. All was well until Sept 1 when I started having irregular heart beat. My wrist monitor says my heart is beating at a normal rate but it's definitely irregular, which has zapped my energy. I'm OK when sitting and not exerting myself, but am trying to carry on my normal routine otherwise. I have an appointment with my cardiologist on Sept. 21 and thought I would just wait till then to seek further treatment. I'm taking Tikosyn but think it's run its course, so I was planning to ask to be put back on Rythmol, which worked for me for three years, although at near-maximum dose. Does anyone know if being in AF for three weeks is harmful?

Being in AF for three weeks is, as you hopefully know, creates a very high stroke risk. If you're not anti-coagulating, that's a problem. Also, the longer you're out of rhythm, more atrial enlargement is likely and more electrical remodeling will occur. Generally, not universally, the old saying, "AF begets AF and NSR beget NSR is true." That means that longer episodes are likely to produce more and longer episodes, barring some intervention.

You should call your doc and get a quick-acting anticoagulant prescribed now...seriously, if you've been in afib for 3 weeks you have a high probability of having clots formed that can cause strokes. The danger is when going back into NSR...that's when the clot/clots move out of the heart and jam things up.

Three weeks of afib otherwise isn't a big deal - according to both my cardiologist and EP the dimensional changes will eventually reverse once back in NSR. Studies have shown that the electrical remodeling reverts very quickly also. I've been in persistent afib for 2 months now and actually cancelled a cardioversion as the EP said the extra month until I get ablated won't make any significant difference. He's a very well respected EP with good success, so I tend to go with his advice.

Thanks Tom and Steve. I do take coumadin and had it tested a couple of weeks ago. INR at that time was 2.7. I've had trouble sleeping due to chest discomfort, so I probably should seek treatment sooner rather than waiting around till the 21st. I'll call doctor's office and talk to his nurse tomorrow.

Tom B., my EP did the same thing, instead of getting another cardioversion prior to my scheduled ablation, he just put me on Coumadin for eight weeks while a was waiting for the procedure.

I am on TIKOSYN and Warfarin with a little Metoprolol thrown in for good measure as nobody knows who put me on it and nobody wants to take me off of it. Go figure.

My instructions on discharge from hospital in NSR were that if I believed that I was in aFib at ANY time I should present myself at the hospital for ECV and monitoring within 12 hours of it starting.

I have had a few episodes of skipped beats (PACS/PVCS?) resolved through Potassium infusion, but have always appeared to be in NSR.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.