My cardiologist thinks I go to the ER too much.

I have paroxysmal afib. My cardiologist thinks I go to the ER too much. In early Feb I had an episode (I was dx'd 4 years ago) and so took Cardizem 30 mg, waited 4 hours and did that over and over again for 12 hours and I still had it, so I went to the ER. They kept me overnight. Then I had another attack last Sat. morning, so not wanting a repeat of Feb, I went to ER but converted soon after I got there. I was scolded for this, and it's not the fist time he has done this.

So he thinks I shouldn't go to the ER, but wants to do an ablation on me. This does not make sense. If I'm not bad, then why do the procedure?

Where or when do I draw the line and go the the ER for an IV of cardizem? When I have an episode it scares my wife and it's really uncomfortable, makes me feel lousy, and I'm still fatigued form last Sat morning. I cannot imagine letting it go on for a week or something like that while I wait for a spontaneous return to NSR.

I'm new at this a-fib thing, but I just wanted to add my (unasked for) two cents worth -- if your doctor or cardiologist is scolding you, as if you were a child, it might be time to take a fresh look at this doctor-patient relationship.

Perhaps your cardiologist doesn't realize this is how his input sounds to you.

Could you possibly -- if you're comfortable doing so -- say something like this: "It sounds like you're scoring me as if I was a child. What's that about?"

Do you have the option to seek a second opinion and/or to see another cardiologist?

Has your current cardiologist clarified why he now wants to do an ablation on you?

I'm sure others with lots more experience and info than I will ring in here.

Sue

I’m new here too. I have had two bouts of A Fib....my first time I went to the ER.....converted while I was there...right before they were going to cardiovert me.

The second time, I knew what was happening and decided to TRY to relax and wait it out at home. I took a beta blocker....and in a few hours I converted on my own.

My Cardiologist said I can stay at home but not for more than about 8 hours.....then head to the E.R.

But, I will tell you this, If I was feeling really poorly and felt the need, I would go to the ER.....and if my doctor scolded me....I would find a new doctor.

I sounds like it would be nice for you to have a loose plan in place....one you and your doctor are comfortable with.

Good Luck to you...its all so hard to figure out. Linda

Shiny sleeves,
Early on like first five years the jump into tachy or afib would scare me and went for the ER....always. Over time I got to the point that I realized just wait, chill. I always feel crappy in afib, but I would wait and it would break. Sometimes it would take 24 hours but eventually it breaks. There are pills you can use when you have a spell to assist, like flecainide. You should inquire. I think your doc is just trying to make you realize you won't die.....give it a minute. I recall quite a few times I was at the ER and it would break and it's like...ok let me go now. This sucks, I know but I really think the pill in pocket may be a good option. As far as ablation it may benefit to have that done early on. I would only go to a top notch doc tho!
Tim

It sounds like your cardio could use better bedside manner, but his advice isn’t necessarily wrong. ERs are a terrible place to treat AF. The only thing they will do is rate control via IV and then a cardioversion - both “sledgehammer” approaches to AF management. In their defense, AF is rarely a life threatening condition, and ERs exist to treat and stabilize life threatening conditions. I’m guilty of too many ER visits myself in the early days of AF. I quickly figured out you’ll get neither good treatment nor really any sympathy at ER departments. Nurses tend to be compassionate, but ER docs will treat you like a speed bump once they diagnose AF.

Hokay thanks everyone for replying.

To recap, on Feb 2 I had the really bad (IMO) attack 12 hrs popping pills and then staying overnight in the hosp. I asked if I could go home and the ER doc said "If we take you off the IV, your heart rate will go back up again."
So if I'm in afib and I'm overreacting to it, then why would it matter if my HR went up if afib is relatively harmless? We're talking an HR of 144 and I'm 61.

I saw my cardiologist a few days later. I said my heart raced so hard for so long that I wasn't sure if I hadn't hurt myself. He said, and I quote, "I don't know either." Then the next time I go to the ER he says I don't have to do that every time I'm in afib. One of my problems is, when I'm in afib, I'm confused and don't really know how bad it is or if it'll resolve soon enough.

The mixed messages are hard to translate.

I think I'm going to have to get rid of him.

Do you have a cardiologist or EP? If not maybe see an EP. The earlier you have an ablation the greater your chances of success. I never went to the ER with flutter or Afib. I just trusted they would stop on their own. And I was on eliquis of course for stroke prevention. Good luck

I wish I had the time to post about this more because I think it's important, but suffice it to say I agree 100% with your cardiologist. He or she is absolutely right, and so is wolfpack when he said, "ERs are a terrible place to treat AF."

Hint: Cardizem doesn't stop your afib. It stops on its own. It would have stopped at the same time if you had stayed home, relaxed, and taken a few simple measures that cost almost nothing.

I never converted at home; I would have a cardio version every time. This happened around 6 times but have had 2 Ablations since; 2014 then 2016 with LAA isolation. I was a unlucky Afibber. Lol

Quote
Shiny Sleeves
ER doc said "If we take you off the IV, your heart rate will go back up again."
So if I'm in afib and I'm overreacting to it, then why would it matter if my HR went up if afib is relatively harmless? We're talking an HR of 144 and I'm 61.

It matters because the higher the heart rate, the worse the symptoms. It's for your comfort, not your safety. A rate of 144 actually isn't all that high and isn't the least bit dangerous as long as it's not allowed to continue for long periods (meaning days or weeks, not hours).

Has your cardiologist given you a rate control drug like cardizem or a beta blocker? If not, ask him why not. When an episode occurs you could be taking cardizem to slow the rate and make you more comfortable and just waiting it out at home. As I said in my previous post, that cardizem drip the ER gives you does not stop the afib. It just slows it down to make you more comfortable, so there's no reason you need an ER to do that. You can do it yourself in the comfort of your own home.

It's just different for everyone and there seems to be a lack of consistency regarding advice from the Doctors as well.

As I stated in an earlier post today, during my 6 years of diagnosed afib, I had 192 episodes. The average length of each episode was about 8-10 hrs, but they ran in lengths from 1 hour to 72 hours. Early on, I did go for one cardioversion, but after that, with my control meds, my Doctor said that since I was in excellent health and very fit, there was no reason for a CV, plus I always converted on my own. Eventually, I decided to go for an ablation, which so far has been 100% successful for the last 11 years.

It's OK to go to the ER, if you feel bad enough, and you haven't been able to lower your HR on your own at home.
It would help to have a tentative game-plan in place. Discuss this with your Dr. Also I would rather go into the ER, after have notified and talked to either my own Cardio Dr.. or the on-call Dr. for his Practice Group. That way they can provide instruction to the ER Doc if necessary. It is hit-and-miss at the ER Room. Sometimes very Busy, Sometimes rude Staff, or even Young Inexperienced Dr's. Also most of us do better with a "EP" Specialist as opposed to a regular Cardiologist.