2nd episode in 3 years, treated in ER

Hello,

This is a great forum and I have read for a couple of years, never posted (that I remember!).

I just had my second episode of afib.

First one, I had just flown across country to aid a very sick daughter, had had Sudafed, and was dehydrated. I lay down to sleep and bam, it hit. I was rescued on the street by a fire truck whose crew I asked for directions to the hospital while they were at a red light! They jumped out and treated me on a roadside bench, then sent me to ER. Heart rate 180, bp 70, not feeling too good. Only lasted 45 minutes I think and converted itself. Discharged quickl.

Second one, two nights ago, hot weather, probably dehydrated (GFR 50 so...), a little stress after just moving and finding some problems in the new place. Same thing, lay down to sleep. I have alarms on my phone from my daughter's type 1 diabetes device, which definitely can be, well, alarming an that seemed to be the immediate trigger. (I would guess my AF is adrenal-based-?)


Drove to police station, very close, to the chagrin of paramedic who showed up quickly. Heart rate over 180, chest pain radiating up, breathless and woozy, big fishes jumping around in chest. Familiar to all of you. Lasted 4 hours, treated with diltiazem drip due to low blood pressure. They kept me in the hospital overnight. One 12 hour dose Lovenox.


My own cardiologist will now probably insist on blood thinner but hospital cardiologist said no, since my episodes are 3 years apart. My CHADS score I 2 due to being female, 67. No structural problem with heart.


I know that 4 hour is not a long time, but I have read clots can form even after 2 hours. Should I be on something even temporarily, for a week or so? I read here about the PIP approach of taking something for a week after an episode.


I want to be safe now and I also want to have something to suggest to my cardiologist to keep him happy versus long term blood thinner.


I have done a couple of 30 day monitors. First one I was on Advair ( a prescription given to me in error since I avoid bronchodilators) but even then, only 22 heartbeats of AF in 30 day and a few flutters and also PVC's. Off Advair did 14 days out of 30 and nothing at all in terms of AF.


I consider myself lucky so far compared to more frequent or constant Afib and know it may get worse. I take magnesium (pills) and potassium (V8 low sodium).

Main question:should I be taking something now after a 4 hour episode, to prevent a clot and stroke?

Might be a future concern if your afib progresses (more frequent and longer), particularly if the arrhythmia begins before you notice the symptoms. The stroke risk would happen when you get back into rhythm if a clot was present.

Quote
windyshores
Main question:should I be taking something now after a 4 hour episode, to prevent a clot and stroke?

No. Your CHADS score is low, and your episodes are infrequent and short. So the risk of an anticoagulant would probably outweigh the risk of stroke. Also, many EPs don't consider the point for being female to be valid. They would say you are in reality a CHADS 1.

As for clots forming in 2 hours, the studies that have shown that clots can form in short periods of time were all conducted with older, sicker patient populations. If you were 80 and had heart disease, it would be a different matter.

Many people with afib use a PIP approach, but not usually with anticoagulants. With anticoagulants you either take them daily or not at all. However, if you ever need to be cardioverted to stop an episode, that will become a different matter since, as jpeters noted, the stroke risk occurs when you convert back to normal rhythm. So if you need to be cardioverted, it's likely they'll either do a transesophageal echocardiogram (TEE) first to make sure there are no clots in your left atrium, or they'll put you on an anticoagulant for three weeks before doing the cardioversion.

And do yourself a favor. If you think you need to be in the ER, quit trying to get there on your own. Just call 911.

Ditto the ER comment. If you think there’s a problem with heartbeat or breathing, take the bus ride (ambulance)! I realize you can get a big bill for it and insurance can be a pain, but best not to chance risking yourself or others. Interestingly, many local governments have some sort of EMS fund which, if you contribute to annually, will waive any ambulance fees for your address. My county does exactly that for $60/year. Now that’s cheap insurance!