AFIB - Symptomatic VS. Asymptomatic

Is there specific reasons why some people are Symptomatic and others are not? In my case, the more I read
here the more I'm perplexed. I actually have AFIB 100% of the time, AND ON TOP of that Severe Mitral
Regurgitation. I would think that with those two things combined I would be VERY SYMPTOMATIC, but
it is actually the EXACT opposite.

I've read so many posts on AFIB here where people talk about how bad the symptoms are and how it's
difficult to cope and deal with those symptoms, yet, I am virtually 100% Asymptomatic. How can that be?
I will say that I had more "shortness of breath" episodes if I got worked up BEFORE I was prescribed
Diltiazem. It seems for me that Diltiazem really keeps my Heart Rate somewhere between 70-85bpm when
I am walking or standing. At rest I get down in the 40's usually, sometimes the 50's. With moderate to heavy
exertion, I get up over 150, but it's usually not for a prolonged period of time and I almost never have symptoms.

Is there anything that is a tell-tale sign as to why some people even with light exertion are exhausted, dizzy and
out of breath, and while others simply are not? Again, I did notice BEFORE I was prescribed Diltiazem, and BEFORE
I lost 45lbs, If I had moderate to heavy exertion my heart rate would get over 150, I could feel palpitations, and in some
cases be short of breath or dizzy. But again, SINCE Diltiazem, and the weight loss, no matter how much exertion I do
I don't seem to have any symptoms. Any ideas on why this is?

That's one of afib's mysteries. The only thing I've noticed that seem to correlate well are symptoms and persistence. Highly symptomatic people are almost always paroxysmal, and asymptomatic people are almost always persistent. Also, persistent afibbers usuallly don't have as high heart rates. My afib typically ran at about 180, and I can't imagine anyone not noticing that their HR was that fast even if they felt no symptoms.

Although it's easy to see why that's bound to be true to some degree simply because symptoms prompt people to seek treatment, it's not easy to see why people develop persistent afib and never even noticed when it started. I know of a number of people like that who were diagnosed only incidentally by ECGs for other reasons. Who knows how long they'd been in afib without knowing it.

Your lack of symptoms with the diltiazem is because it caps your heart rate. No matter how hard you push yourself, it won't let your HR go above some number. For me on 100 mg of metoprolol, that number was 105. No matter how hard I pushed, I could not get my HR over 105. Unfortunately, the outcome of that equation is it limits performance. For example, there's a local hill I use to measure my conditioning level on my bike. I ride up it at a modest pace of 12 mph and when well conditioned I get to the top with a HR of about 110. When deconditioned, it will be more like 130. While taking metoprolol, I simply could not get to the top of that hill at 12 mph without huffing and puffing like someone dying of heart failure because a HR of 105 just can't do the job for me.

It is often, the case, surprisingly often, that the typical AF or flutter patient doesn't know it's taking place. I know a retired university professor, very outdoorsy, very active, very handy, who didn't know he was in flutter until an annual physical. Same for my brother-in-law who went in about suspected skin cancer.

I didn't feel it come on when nearing the end of a 10 km daily run. Suddenly, my legs felt weak, but I felt nothing untoward above my belt, My wristwatch said my pulse was 130+ for the next hour, but I didn't really feel any thumping. Later in my evolution, though, I knew when I entered AF. I'd feel a weird swell in the chest near my heart, and then the first thump would come, and then others. I sometimes wonder if my history was more PACs with occasional AF because when it got bad enough for me to seek an EP's help, the thumping was what kept me anxious and alert. After my first ablation, it was PACs that told the tale by Week 10, and not AF. Later, about a month later, the AF returned with a vengeance.

So, my guess is that, when people are highly symptomatic, they'll probably in AF or flutter, but if they feel the alarming thumping in their chest wall, those are PACs. Either one is going to put people off, and in the case of AF or flutter, there must surely be a degradation of physical output when doing sports or garden work, vigorous walking up an incline, etc.

Then, there are the occasional PVCs, but that's a whole nuther ball of wax.



Edited 2 time(s). Last edit at 11/01/2023 01:10AM by gloaming.

I can't tell you why, but I think it is very individual. Also, you are more likely to read about those who are symptomatic as those who aren't have much less motivation to tell their story. Though I'm aware I have afib, I've always been able to function well during afib. 19 years ago, I had a 2.5 month episode and I continued to do all activity: rock & mountain climbing, skiing & so on. Subsequent to converting that episode with PIP flecainide and creating an remission program that I've continued to titrate, episodes are infrequent and tend to last a couple of hours. Since I generally use PIP flec, I usually am quiet during an episode as I don't take a beta blocker with it and being quiet lessens the risk of flutter with 1:1 conduction. I sometimes violate the quiet rule and have pushed my heart rate to 225 BPM, but when I quit the exertion, my rate will settle back to the mid to low 100's. If I'm very quiet during an episode, I can drop my rate into the 70's or 80's, which may precede conversion. During episodes, I have and will test many different things as my objective is to upset the afib homeostasis and initiate conversion to NSR.



Edited 1 time(s). Last edit at 10/31/2023 10:11PM by GeorgeN.

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That's one of afib's mysteries. The only thing I've noticed that seem to correlate well are symptoms and persistence. Highly symptomatic people are almost always paroxysmal, and asymptomatic people are almost always persistent. Also, persistent afibbers usuallly don't have as high heart rates.

Carey, I'm gonna end up signing over all my paychecks to you, man. lol I know for sure I am persistent, and think I can
track persistent AFIB to the last 2 years. My EKG from two years ago (after a more significant afib episode and when
heavier and with no Diltiazem) showed NSR. I believe I became persistent months after, and yes, my average heart rate
is low to average, and yes, anything over 150 I definitely feel. I am very THANKFUL (Thanksgiving right around the corner)
that I am NOT Symptomatic, and that I don't really have any triggers for a serious episode other than drinking a lot of alcohol.
I've cut Alcohol down substantially, but even moderate amounts do nothing to me. Either does Caffeine heavy exertion or
anything else. I feel I am VERY fortunate for this, but I am still dealing with the fact I have SEVERE REGURGITATION, but
from other posts, I should have a MUCH better understanding on how to handle that and the time frame by End of November.

Thank you Gloaming for that great info, I learned some things once again.

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I had a 2.5 month episode

2.5 MONTHS??? HOLY......wow, even before the weight loss and before Diltiazem, I never had more than 24 hours of a
more rapid heart rate and palpitations. The Shortness of breath and some dizziness never lasted more than a few
minutes, and even that WAS very rare and with heavy exertion. I can NOT imagine 2.5 months, but it seems like you
were perfectly fine, and that is what matters. Hopefully with medical advances and science we will know a lot more about
this condition in the years to come. I also agree more people are prone to post when they are helpless and have severe
symptoms. Again, even though I have to get to the bottom of the Severe Mitral Regurgitation and 100% AFIB burden, I am
THANKFUL have a nearly 0% PVC burden, and a 1% PAC burden. I almost never feel my heart flutter or any palpitations
and I am thankful for this. I just do not or will not let my Left Atria get much more enlarged or any other aspects of my heart
to be affected.

Thanks again for all the great info here, I very much appreciate it. I understand that while I have some issues that are
concerning, it could be much worse and having daily symptoms would be completely miserable so I better be thankful.

And one day I'll figure out where to end the Margins on this site so I don't keep chopping off my posts and have to edit
numerous times!



Edited 4 time(s). Last edit at 10/31/2023 09:22PM by cornerbax.

It’s definitely an individual thing. I am very symptomatic, experiencing chest, arm and jaw pain, shortness of breath, passing out and extreme dizziness. My heart rate like Carey’s around 180, but has slipped into the 200s plus. I have given up going to the ER an try to manage it at home.
I wish for a quieter heart on a daily basis.

Quote
It’s definitely an individual thing. I am very symptomatic, experiencing chest, arm and jaw pain, shortness of breath, passing out and extreme dizziness. My heart rate like Carey’s around 180, but has slipped into the 200s plus. I have given up going to the ER an try to manage it at home.
I wish for a quieter heart on a daily basis.

I'm very sorry to hear this. No medications or anything works for you?

When I got AF only a few times a year, I knew right away when I was in AF, I could feel the strong beats and had to rest until it stopped. Now that I went into permanent AF a few years ago, I don't feel it at all. So how about that.

Liz

I'm 65, with paroxysmal AFib, very active and very symptomatic, despite my AVG HR while in AFib is usually in the 125-135 bpm range without taking meds.
I may have various kinds of ectopics too, PACs or PVCs, some from time to time or in long runs (for PACs), as well as ectopics in "regular" form (bigeminal pattern). Everything is felt, but I'm able to stay quite active while my heart is not in NSR.
I was thinking very active patients (athletes) like me would likely be symptomatic, since they're more tuned to their HR than the average people, but it seems it's not even the case for some of them.

I’ve tried all the meds, and nothing helps. BB’s slow it down but turn me into a zombie.
Really I just ride them out, try and keep exercising, walking swimming, riding my bike, altho riding my bike has seen me have a few falls so that’s on hold.
Earlier in the year I spent a few sleepless nights on the PC and put together a song and a slide show about my AF. I enjoy watching it when I get an episode. it’s a bit like laughing at your own jokes ><

When I was in afib, I definitely felt it. It felt like a large fish flopping around in my chest and I got really light headed and short of breath. It was awful. And it sometimes went on for days.



Edited 2 time(s). Last edit at 11/03/2023 06:41PM by FibberMcGee.

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Carey

Your lack of symptoms with the diltiazem is because it caps your heart rate. No matter how hard you push yourself, it won't let your HR go above some number. For me on 100 mg of metoprolol, that number was 105. No matter how hard I pushed, I could not get my HR over 105. Unfortunately, the outcome of that equation is it limits performance. For example, there's a local hill I use to measure my conditioning level on my bike. I ride up it at a modest pace of 12 mph and when well conditioned I get to the top with a HR of about 110. When deconditioned, it will be more like 130. While taking metoprolol, I simply could not get to the top of that hill at 12 mph without huffing and puffing like someone dying of heart failure because a HR of 105 just can't do the job for me.

I've taken Diliazem for a while and was recently diagnosed with flutter. My heart rate seemed high in the 140's even when using it. They recently added 25 mg of metoprolol so we will see how that affects the cap of the high rate.

I didn't realise how many different types of Afib there is.
I have been trying to understand why a mate of mine who is in constant Afib and appears to have had it all his life is a runner and cyclist and was doing so at a moderately high level. He didn't know he had it until he was around 60 and was picked up during a routine doctors visit.
Also he was the guy I told about my weird heart beats after a run when I was a teenager. He said that is normal for some people. He said he has the same thing. Probably the wrong person to ask back then.
When I have Afib I can feel it with exertion so usually only walk or ride eMTB. I have a degree of control over my exertion. Don't surf as too many variables eg paddling though broken waves and holding breath repeatedly.
We are all different.