Back again after 6 yrs, should I do anything differently?

Hi,

Was a regular on this forum about 12yrs ago when my af started. Had about 4 episodes over a 5yr period then nothing for the last 6 yrs. Each episode lasted around 24hrs and reverted by itself. My main triggers seemed to be lying down ( esp after eating). From memory seemed like over active parasympathetic system. I have had bigeminy and occasional pac's but nothing lasting.

Anyway, I woke up yesterday in af again. Have taken Verapamil to contol rate and thats about it.

Now I'm getting on for 36hrs in. Has anything changed in the last few years for people with lone af like myself? Guessing i should ride it out for another day or two and then go to hospital for attempted cardioversion (haven't needed that before).

Any advice?

I take magnesium each day with multi which i have for years. Also take krill oil which should help keep blood thin I guess.

Thanks again,
Dave

Dave,

Most won't cardiovert after 48 hours without anti-coagulation been in place for 3 weeks as I recall. I think a TEE can be used in place of the anti-coag.

George

Thanks George.

What's the popular option for 'pill in the pocket'. Any chance that could work after 36hrs?

Hospital ER almost certainly will not cardiovert after 48 hours since Episode started. The 3 weeks Goerge talked about would be if you weren't sure or if your Dr. wasn't convinced that you were in NSR continuously up until the onset of the episode. As an Out-Patient, the Hospital can still do the CV after 48 hours, a TEE would need to be done, and the ER room would probably not do a TEE, so you would have to do it as a Out-Patient Procedure. Also they will want you on Blood Thinners even with the TEE, from the onset of the Episode.

Having said all that, it doesn't sound like you should go for the CV right away, especially if your already past the 48 hour mark, If you have converted on your own always in the past. Without knowing all the details of your case, it looks like you could wait several days up to a week, before getting a CV.
It's doesn't appear wise to go get a CV if you would have self-converted on your own within several days anyhow.

Other advice:

Load up on your Mg, and have your electrolyte levels checked right away.
Don't worry about the AFIB, and don't try to hard to get back into NSR, relax, and let the body correct itself.

Dave,

Pill in the pocket is a loading dose of either flecainide (which I use) or propafenone. Here is the article <[www.nejm.org] The first time I ever used flec, I took 300 mg and converted a 2 1/2 month episode. EP said statistically it wouldn't work, but it did for me. I had been anti-coagulated for a couple of months.

Most people (but not me) are now prescribed a beta blocker or calcium channel blocker to precede the flec dose by 30 minutes to mitigate the chance of flutter. Jackie has listed out Natale's prescription for her several times here. <[www.afibbers.org]

I take 300 mg at once and chew it so as to get the full effect as quick as possible.

George

If you go past the 48 hr mark without converting, you should probably be on blood thinners. I know from experience you can throw a clot by that time - it's not worth the crap-shoot imo.

Hi all,

Thanks for the help. I went to ER and they weren't keen to cardiovert given it was about 36 hrs. They put me on Rivaroxaban and verapamil and if it doesnt revert itself would plan for cardiovert in a couple weeks.

Thankfully when i had a shower on Tuesday morning i reverted to nsr. A big relief.

Given the total episode was 48hrs i'm thinking it probably isnt a good idea to stay on rivaroxaban given my chad score is 0 ( 45 yrs old with no related issues).

Certainly a wake up call...as I have read on other threads, you know you have stopped being as careful with food etc when you have a good run. But this snaps me out of my apathy.

Thanks,
Dave.

Glad to hear I was right about you Converting on your own. The old standard to get CV was 24 hours, and some ER Doctors still tend towards that. Helps if you have your Cardiologist nudging them on to do the CV.