Afib triggers and dealing with afib when traveling

Hello everyone. I am a 66 old female, 110 pounds, always in fairly good health, except for anxiety. I had my first afib episode on Labor Day, September 2, 2019 at 8:30 am. After being woken up by the neighbor’s landscapers and their extremely loud leaf blowers at 7:30 on a holiday I became very upset and suddenly my heart beat at a high rate and in a very erratic way. I had no idea what hit me. My husband called the ambulance and they took me to the hospital. After two hours it resolved itself. I was horrified when they told me that I had afib - I had never heard about it. I learned everything I could, cut out triggers, like chocolate and alcohol, and after one year without another afib attack I thought it must have been a fluke. I started to drink a glass of wine once in a while and went back to eating some dark chocolate.
My next afib episode occured on almost the same day, two years later, September 5, 2021 at 9:50 am. I think it might have been caused by a contentious phone call with my daughter the day before, which left me very agitated. This time I stayed at home and it resolved after 5 hours.
This second episode made me really depressed, because obviously the first one was not a fluke and I thought I had done everything right (supplements, like magnesium and potassium), but maybe the chocolate and a drink once in while had an effect? I decided to walk at least 3 miles a day, but it did not help. My next afib episode was two months later on November 30, 2021, from midnight to seven am with no apparent reason, maybe a bad dream? After that I my life changed even more: no more traveling, because I was afraid I would get into afib at the airport, absolutely no chocolate or even a drop of alcohol. Everything I do is with the question: could it cause an afib attack. I have oral surgery coming up and I am scared of the anesthesia. My electrophysiologist tells me to live a normal life, but when I ask her what to do when I decide to accompanying my husband on a flight to Europe, and get afib at the airport, for example should I board the plane or let my husband fly alone or hope it goes away on the flight, she shrugs her shoulders and says she doesn’t know, but not to board the plane. She gave me flacanide, but what if I take it and have an averse reaction?
I am also wondering whether alcohol and chocolate are accumulative triggers, like if you eat it you could get afib eventually, or if it’s okay to eat chocolate and have a drink if there is no immediate trigger. It’s so sad not to even have some chocolate cake, or a glass of wine, apart from not traveling. But maybe going back to normal after my first episode eventually triggered my second one? I would be thankful for detailed descriptions for triggers, for example: how long does it take for a reaction to a specific food to kick in? Also suggestions for dealing with long distance traveling. Thanks!

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Edda
She gave me flecainide, but what if I take it and have an adverse reaction

First, don't know how she told you to dose, but the max dose for those under 154#'s is 200 mg. At your weight, I'd probably start with a max of 150. Hopefully she prescribed a rate control med, like a beta blocker, to be taken either coincidentally with the flec or perhaps 20-30 minutes before. This will reduce the risk of flec converting you to high rate atrial flutter, a small risk, but a risk nevertheless. Unless you have some prior experience with flec, I would not take it on a long fight. Since afib typically converts for you, if you do a long flight and get afib, I would not take the med till you got off.

I've had afib for over 18 years, and for most of that time, I've used flec to convert. It has worked very well for me with no material negatives. It typically converts me in 1 to 3 or 4 hours, though it took 20 hours to convert a 2 1/2 month episode near the beginning of my afib career. The EP didn't think it would work, but it did, just took a while. For me, afib isn't fun, but I can function fine in aifb. For some folks, afib is debilitating.

As to whether to travel, is afib debilitating for you? If not, then go ahead. I'm 67 and have traveled many places, including a 2 week paddle raft trip on the Colorado River through the Grand Canyon. I do take flec with me. Early on, I had aftb after snowshoeing in with a 70# pack and breaking trail, then constructing a 3-person snow cave. The other two did little to help me. A consistent afib trigger for me is pushing myself hard with a high heart rate for many hours. I have vagal triggers, so the afib comes from a delayed, vagal (parasympathetic) trigger. My afib came on at around 11:30 PM in my snow cave. I took my flec, washed it down with water from a partially frozen water bottle. I converted in under an hour and went to sleep.

Triggers are very individual, and can be maddeningly random & hard to figure out. It turns out the chocolate and alcohol (in moderation) are not triggers for me. I commonly have chocolate on a daily basis, but quit even a glass of wine as it negatively impacted my sleep quality.



Edited 1 time(s). Last edit at 09/27/2022 04:40AM by GeorgeN.

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Edda
I have oral surgery coming up and I am scared of the anesthesia.

If you want to be extra careful you can request a local anesthetic that doesn't have epinephrine. I always request this and have never encountered a dentist or oral surgeon who didn't have it available.

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Edda
She gave me flacanide, but what if I take it and have an averse reaction?

Did she give you Flecainide as a "pill in the pocket" or to take daily? Pill in pocket is a larger dose that you take only when you have an episode. If this is what she gave you, you will probably have the opportunity to give it a try in a "safe" environment at home, before you do something like board a plane. It has a good record for terminating episodes and is tolerated by most.

As far as the food triggers you mentioned, most of us have discovered that they don't make much difference (except for excess alcohol) and that Afib comes when it wants to, though things like stress, dehydration, thyroid problems and sleep apnea do seem to be triggers for many. I have never heard of food triggers being cumulative though.

We're all different, and it behooves each of us to use a methodical approach, or as close to one as possible and practicable, to learn what our individual triggers are. A distended stomach, from aerophagia to too much mass in the stomach, will almost invariably set me off. I have to remember to belch after eating for some time to ensure I don't go into AF. Slouching at the computer or at a table reading something will also set me off. It seems, to my great chagrin, that caffeine might be a problem for me, so I try not to have more than about 40mg, and then just sipping it over an hour or more so that I don't get a whack of it right away. I'm on Amiodarone for the time being, and that means avoiding alcohol.

As for traveling, prior to my ablation, I asked my EP if it would be okay to fly. He asked what I would do if I went into AF during the flight. I replied that deep breaths, trying to relax, often distracting myself with electronics, those work reasonably well. He seemed content with that and said, sure, go ahead and fly. I think he answered that way because of my history of self-conversion after a few hours.

As for fearing an adverse reaction to Flecainide, I would urge you to take one and see if it does cause you to react. Best to know before you are forced to use one. I wouldn't do it just cuz, but I would not miss the obvious opportunity if I went into AF some time before the flight.

Then again, traveling is not without its stresses, and if you have a history of 'getting wound up' over things beyond your control, I would counsel you to avoid placing yourself at risk for the unpleasantness of having to remain seated for another three hours until the plane lands, or worse, having the captain down the aircraft at the closest city to get you help.

Edda,

While no two of us are exactly alike, RELAX. I had afib for 11 years (first five undiagnosed), then went on a blood thinner and a rate control drug. During those last 6 years, I recorded every episode of afib, and had over 200 lasting as long as 72 hours, always converting on my own. The afib did not impact my daily living. The only thing I avoided when in afib was moderate and high-level exercise. Finally, an ablation which lasted for 13 years, and then a second ablation now on year 3 of success.

Why would flying or traveling be an issue with afib? What concerns you? I also drink wine or beer daily and always have some dark chocolate in the evening. I do take daily Mg, potassium and Taurine.

Depending upon the dental procedure you're going to have, your dentist may not perform it if you're taking blood thinning medication as there's potentially too much blood in the tooth for him to see what he's doing. Epinephrine helps dry up blood and he may consider it necessary for the surgery. If so, ask your EP for a bridging schedule of heprin to get you through the procedure. He and the Endodontist may need to conferenve on amounts and timing but keep them in contact and they'll find a way to get you through it safely.

Hi Edda,

I am sorry you are having difficulties. I can hear this is very upsetting to you...

I have had afib for 20 years, and would suggest you read the book, 'The Afib Cure', lots of good current information on triggers, etc. I would also suggest a beta blocker consult with your physician for anxiety and rate control, a very low dose. I take 5mg of propranolol. This has helped me greatly to shelter me from my chronic, low grade anxiety. (paramedic for 2 decades .

As for myself, I have fully changed my lifestyle to a 'whole foods only' diet. So many processed foods and supplements are certain triggers for me and I suspect most adrenergic afibbers (adrenaline/stress triggered).

I have accepted, that at 70 y.o. I am now more delicate and I don't want an ablation with its low risks / radiation, unless totally necessary. So I have chosen a total lifestyle change,
and I am so much better for it! Now I only have an occasional short episode controlled by 200mg of flecainide.

My lifestyle is so much healthier now with respect to my afib and against the development of most age related disease processes. So I actually look at my afib as a blessing in disguise; a guide, and a teacher for a more balanced life; with all of its significant benefits both physically and emotionally. Peace and surrender are now now my touchstones.

If I can help you further Edda, feel free to personally message me. Good luck, Jeff

Thank you everyone for all the information and support! This forum is so unique - it helped me so much, especially with my first afib episode, three years ago.I was always lurking in the shadows :-), and I am glad I finally signed up.

I am going to see my EP tomorrow and will address the flecainide issue: what dose and whether to try it out somehow to see how I react. And yes, she also prescribed metoprolol, but did not mention to take it 20-30 minutes before the flec to avoid atrial flutter - great advise! It really would be nice if flecainide could be my security blanket.

I don't take an anticoagulant. She said with my low CHADS score (1 for female, and 1 for being over 65, but just so), anticoagulants do more harm than good. And I kind of appreciate that she is not a pill pusher. So I guess that's not a problem for the oral surgery. The dentist also has to do some fillings and crowns and wants me to have what they call conscious sedation, and I am wondering whether that could trigger afib.

Is afib debilitating for me? I would say yes, because of my high heart rate (about 180-200). Even under normal circumstances I can feel it when my heart rate goes over 100. During my last afib episode, which started at midnight and lasted until 7 am I felt completely paralyzed. I was even afraid to go to the bathroom. I think I am traumatized by the hospital stay during my first afib, when they didn't let me go to the bathroom. They said, they wouldn't "let me go to the bathroom with a HR of 200". It sounded very scary and now I am afraid to even move when in afib. When my EP suggested that I live my life normally I asked her how can I live my live normally during afib when they didn't even let me get up in the hospital to go to the bathroom. Her answer was that it was all protocol.

And yes, I am eating a pretty clean, mostly organic whole foods diet, and I always did, or at least during the last thirty years or so. I think I might try to have a drink once in a while and eat some chocolate for get some fun back into my life, since most of you seem to think that a bit of alcohol or chocolate is okay.

Thanks again for your caring response

With a rate control drug, your BPM of 200 will drop considerably. I am/was highly symptomatic with afib, but with a lower HR while in afib, I just moved on with a normal life. The only irritating issue while in afib was if I tried to sleep on my left side, it felt like I was on a vibrating bed, so I slept on my right side. I am 6' tall and weigh 165, so no excess weight.

While in afib, even with a high HR, blood circulation is reduced (I heard about 20%), so less oxygen if getting to your brain with a HR of 200, thus the hospital is concerned about fainting. That was never an issue for me when I was in afib, but standing up slowly while in afib is always a good idea.



Edited 1 time(s). Last edit at 09/28/2022 09:19AM by Ken.

AF can be triggered by Vagus tonality, and when we encounter physical stressors, the response can be triggered AF. It's a Catch-22 situation when you are in dangerous BP and HR territory, but you are going to stay in AF as long as the full bladder is competing for your energy and attention. To me, physical comfort is very important when hoping to self-convert. Added stresses such as noise, especially busy hospital noises, physical stimulation like pain or bowel distension, needing to burp, these types of things begin to weigh on the patient needing quiet and rest.

I didn't know about oxygen reduction during afib even without a high heart rate, that explains why some people faint during afib.

And yes, I am extremely noise sensitive (after all, my afib was triggered by leaf blowers in the first place) so the hospital noise (tvs left and right) did not help

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Edda
Is afib debilitating for me? I would say yes, because of my high heart rate (about 180-200). Even under normal circumstances I can feel it when my heart rate goes over 100. During my last afib episode, which started at midnight and lasted until 7 am I felt completely paralyzed. I was even afraid to go to the bathroom.

Before I started taking flecainide and a beta blocker daily, I also had heart rates similar to yours as well as very high blood pressure during episodes. After I started taking medications my heart rate stayed way down during episodes, rarely going over 120. This made a huge difference in how I felt. However, if your episodes are quite rare, your EP may prescribe flecainide as a pill in a pocket. I don’t know if this protocol would result in the same reduction in heart rate, but when given with the beta blocker a half hour first, it might well.

Yes, I saw my EP last week and she gave me the Flacainide as PIP: If I get afib I am supposed to take 100 mg twice daily , and metoprolol 25 mg every 6 hours. If I don't convert by myself after 24 hours, I am to take Eliquis and go to the hospital for a cardioversion. She was still evasive about long distance travel - I guess there is no perfect answer. She just keeps insisting to live my life...

Far be it above me to issue cautions about dosages of various medications, but one thing to monitor very closely taking 25mg every six hours (the half-life of metoprolol is roughly 5 hours) is if that level of drug reduces your HR to dangerous levels. It happened to me after about four months of 100mg daily. I was getting light-headed with a prickly sensation around my scalp, and I had one fainting episode. The next ECG showed 33 BPM and low blood pressure. I was instructed to discontinue metoprolol immediately, and they put me on another anti-arrhythmic.

I hasten to assure the reader that I am not questioning the dosage, or even the choice of drug. I'm just urging close self-monitoring to ensure you aren't getting low heart rate, well into the troublesome level.

Hi Edda,

My personal experience seems to be that I can almost trigger Afib in myself by being so anxious and worried about it that perhaps my anxiety causes it?

For me, valium helps. (Diazepam). For example I have a dental appointment tomorrow (just cleaning), but that makes me anxious. So I always take half a pill before going to the dentist and that gets me through it with no issues.

I have tried to research if taking diazepam is harmful or not when having an Afib episode, and from what I’ve learned it seems there is no clear answer, but I have noticed that I’m not the only one who uses it. It is clear that diazepam doesn’t do anything to help the Afib, but it does help me get through it.

My triggers are alcohol, dehydration, and lack of sleep. I have almost 100% quit drinking, but do have one “NA” beer almost every night. I have learned to drink many glasses of water daily, and to watch the color of my urine.

Traveling is a problem for me because if I change many time zones, I tend to lose sleep and that can trigger my Afib. All these steps seem to be helping (but I’ve learned never to be too optimistic with Afib). My “current plan” for my next Afib episode is to immediately take diazepam (In the past I’ve taken half (5mg), but next time I will likely take 10mg). Then take an extra metoprolol and sit-up and watch a youtube “relaxing music” episode while controlling my breathing and drinking ice water.

Good Luck!