Afib episode changing body chemistry?

I have had paroxysmal afib for ~15 years and I've recently developed this curiosity and was wondering if anyone else experiences anything similar:

My afib varies from month-to-month / year-to-year, but I probably have on average 20 or 30 afib episodes a year, almost always lasting 3-4 hours. I always convert on my own. I take flecainide+metoprolol daily. Most of the episodes are usually during a "bad few weeks" during the year. The time of year varies, but I might have afib every day or every other day during this time.

One thing I've started to become aware of recently is that it "seems like" I'm am basically "immune" to afib / pvcs / pacs for nearly 24 hours after an afib attack. It's like the afib episode itself has changed something body-chemistry wise. Or maybe "something" has been flushed out during the afib attack. About a day later, I become susceptible to afib / pvcs again.

Has anyone noticed anything similar or have any information about his possibility?



Edited 1 time(s). Last edit at 10/14/2022 05:44PM by mtwomey.

Quote
mtwomey
I have had paroxysmal afib for ~15 years and I've recently developed this curiosity and was wondering if anyone else experiences anything similar:

My afib varies from month-to-month / year-to-year, but I probably have on average 20 or 30 afib episodes a year, almost always lasting 3-4 hours. I always convert on my own. I take flecainide+metoprolol daily. Most of the episodes are usually during a "bad few weeks" during the year. The time of year varies, but I might have afib every day or every other day during this time.

One thing I've started to become aware of recently is that it "seems like" I'm am basically "immune" to afib / pvcs / pacs for nearly 24 hours after an afib attack. It's like the afib episode itself has changed something body-chemistry wise. Or maybe "something" has been flushed out during the afib attack. About a day later, I become susceptible to afib / pvcs again.

Has anyone noticed anything similar or have any information about his possibility?

In our ancient Conference Room archives [www.afibbers.org] (kinda hidden here) the 2nd in the list talks about it a bit. It was a common topic in the threads here in the early to mid 2000's.



Edited 1 time(s). Last edit at 10/14/2022 09:29PM by GeorgeN.

It seems to me that something must change, or else you would have extended your episode indefinitely. Instead, your episodes, like mine, are apparently self-limiting, or are truncated by some inter/intra-cellular change(s). I don't know it's an acetylcholine exhaustion, an increase in bioavailability of one or more truncating, or NSR-sustaining, agents, or some other mechanism.

So, if we can agree that there is something that alters the propensity to sustain or to initiate the arrhythmia, whatever type it is, what makes the unwanted cardiac behaviour desist for a day, two days, a week, or several months at a time? I have no idea, but I do believe that it must be present, or if it's an over-abundance, absent.

We have a similar history and I definitely experienced the same thing. In fact, I could tell a day or two ahead of time when an episode was coming. Very hard to describe, but I could feel a sort of "tension" building. When the episode was over, that feeling was completely gone and I knew I wouldn't go back into afib for a least a while. It was like some sort of tension or pressure built up and then the afib burned it off. I described this to my EP once and he came up with a great analogy; he likened it to tectonic plates. The plates push against each other, building up pressure, and then eventually an earthquake happens and releases all that pressure.

I have no explanation for the phenomenon, and several EPs I've asked about it didn't either.

Thanks @GeorgeN - thanks, that's a great link and the "Play" laid out there mirrors my experience exactly.

@gloaming, @Carey, ...et al. Yeah I can also sense it days ahead of time. It's very strange how our brains work. Having something like afib for a decade plus, allows you to "tune in" to all sorts of heart related things. For the first couple of years I was generally oblivious to how things were going or when I would have an attack (although I'm highly symptomatic when I am in afib). However over time, I became more and more aware and sensitive to how I was feeling as it related to afib. Now-a-days, I never need to take a pulse, I can just feel my heart beating at any time. I feel any and all irregularities, ...etc.

I really hate afib - but I have to say in a strange way, I've learned a lot about myself because of it.

Someone here one day used the words "clean and reset", to qualify an AFib episode.
As Carey said, there's a sensation something is building up in my body. An increase in pressure.
Then, AFib comes and I've to pee every 15-20min. AFib stops by itself one hour or two later. I'm clean. During the next 24-48hrs, I'm quiet. No AFib, no ectopics. The system has been reset.

Before an episode, to me it feels like, although I am in NSR, I don’t feel confident in it – sort of like it isn’t reliable and could be thrown into an arrhythmia at any minute. Maybe when people sometimes say that they come out of an ablation and their chest feels totally different, they are experiencing a solid, reliable rhythm—in other words, a “reset.”

Hi Mtwomey

Just to pick up on your comment that you don't have to feel your pulse - you can feel it at any time - I too when sitting or standing quietly can "hear" my heartbeat - Pulsatile tinnitus.

Being able to hear my heartbeat is both comforting when I'm in normal rhythm but very disconcerting when I'm in AF. When lying in bed at night with normal rhythm, hearing my heart beat nice and steady relaxes me and I quickly go off to sleep.

I'm more of an adrenergic AFibber. Stress definitely sets me off. Acute stress and I can go into AF within 10 minutes. Lower level of stress and I may go into AF 4 to 6 hours later. I agree with the comments that you can feel an episode coming on. For me, once those stress hormones are released, I get a feeling of impending gloom, and the anxiety of it can worsen it (vicious circle). What I have become a lot better at is calming myself down, telling myself is it really worth getting upset about a situation which is more often than not beyond my control, and that can stop an AF episode developing.

I'm coming up 5 weeks post my first ablation (my procedure was done on the 14th September). I had the cryo ablation (done in New Zealand). Post op I've had no signs of AF, no PAC's, or other irregularities. So far so good, hopefully it stays this way. I'm still on daily Flecanide 100 and Diltiazem 120, which gets reviewed in a month's time.

I even had 2 glasses of my favourite wine with my wife on my 51st birthday last week!

Stress for me as well, and I think I just passed a huge test....for me. Briefly, I have been in the ER twice since my ablation, and went on Amiodarone for a total of nine week to get my heart under control. I have been off Amiodarone for two weeks now, and have had all but one good day (a cranky evening with HR near 80 at the computer...not fighting with anyone... ). On the earlier advice from a specialist nurse, I took 12.5mg of metoprolol and that got on top of it.

The real story is that I received an email from someone to whom I had not thought my original email was sent. And we were talking about her (our rector at church). She asked if I had intended for her to receive it. I immediately began to flush, dreading that I had posted something uncomplimentary or patronizing. I expected my heart to go crazy any time over the next three hours. It didn't!

Upon reviewing my email, and seeing her mischievous smiley when I looked closer (than on my phone), I was able to let myself off the hook.

WHEW!! Twice.

I can tell when my heart wants to quit playing nice. I feel a pressure, or a swelling, almost like I am breathing on one side of my chest, using those intercostal muscles, but not the opposites. I dread that sensation because it has a record nearing 70% of correctly predicting my episode. I can stave off the episode often if I just get up and move around slowly, go into the garden, take my mind off what I fear may be coming. It works quite well.

Yes and yes.

It's so good to see what I experienced before every AF episode for decades wasn't in my head, that same build-up of tension inside my body, and once the episode was over it was a very lovely relaxing feeling. Prior to an episode kicking in it almost felt like I couldn't breathe properly and my lungs were too full.

Not one medical person I saw over those years would entertain the thought that it might be related to an episode of AF about to occur, usually 2-3 days before.

But then, many wouldn't agree that I needed to pee every 5 minutes or so when in an episode, or that I was nauseous and unbalanced and had arm and chest pain, and could pass out.
It was all put down to ME being stressed. I almost began to believe them, especially when my cardiologist at the time told me to "relax, go home and have a wine or two and hop into bed"

I too can feel every move my heart makes, slow, fast, and AF, In fact, the bed shakes when I'm in AF or tachycardia. My recent episodes of flutter were very disconcerting over many days.

I'm still holding my breath after my touch-up ablation, very fatigued and uncomfortable in my chest, but in beautiful SR. Fingers crossed.
I'm looking forward to getting back on my bike and heading back to the gym, but not being too gung-ho this time..



Edited 2 time(s). Last edit at 10/17/2022 10:23PM by JoyWin.

Quote
JoyWin
It was all put down to ME being stressed. I almost began to believe them, especially when my cardiologist at the time told me to "relax, go home and have a wine or two and hop into bed"..

Amazing, a professional giving such an advice, considering alcohol is, beside well known comorbidities, one of the very few unmistakable afib triggers!

Obviously, we're all different in our tolerance to whatever our triggers truly, and reliably, are. I think, though, that there is a curve if one could somehow measure the inclination for AF to take place after any amount of exposure. A beer has less alcohol than a 5 oz glass of wine has. Do people find that a glass of wine will set them off, and not a beer? Or would even a single beer, or half a beer, set them off? Can I slouch at the computer for half an hour, four minutes, two minutes? How much stomach distension should I permit when I eat before I start to get palpitations?

All this to say that he/she may not have learned, or has learned, that varying amounts of these 'stressors' are tolerable across his patient load, and that until that threshold is crossed, maybe a single glass of wine, but only four ounces, sipped over half an hour, might be innocuous and actually beneficial.