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In this Q&A session Linda had a two part question. Her questions were:
First, do afib episodes keep getting closer together or are they truly random?
Second, I’m nervous about going to sleep as both my recent afib episodes happened at night. I am pretty sure there is absolutely nothing I can do about that, am I right?
In answering Linda’s questions I discuss:
- The randomness and unpredictability of atrial fibrillation
- Two things you can do to get control over your afib
- The two different types of afib
- What types of drugs you might want to avoid if you have vagal afib
- The best type of drug to consider if you have vagal afib
- The strong connection between atrial fibrillation and sleep apnea
The Randomness and Unpredictability of Atrial Fibrillation
The randomness and unpredictability of afib is its hallmark. Now, most people that have afib are going to eventually progress to persist afib but not everyone will. The obvious follow up question then is, if that progression happens, when is it going to happen?
Unfortunately, nobody knows. Again, it’s random. It’s unpredictable. That is the most frustrating thing about atrial fibrillation. It leaves a person without any control over the condition.
I remember when I had my many follow-up appointments with my EP and he said in all his years of working with afib patients, that was the one thing that was the biggest challenge for people with afib – not having any control over it because it’s so unpredictable.
You can have sporadic episodes all your life. You could have sporadic episodes for a two-month period and then be afib free for a couple years and then it comes back again. You could have your first afib episode one day and two weeks later you’re in persistent afib. Everybody is unique so all of our experiences with afib is going to be unique.
There’s no cut and dry one-size fits all answer in terms of what your future holds. When you ask are your episodes going to be more frequent or not, nobody knows. I’m sure it’s not the answer you want to hear but that is the nature of the beast as they say.
How To Get Control Over Your Atrial Fibrillation
There is actually a way to get control over your afib. The way to do that is to arm yourself with knowledge and seek the best medical care you can find.
When my afib started spinning out of control, but even before it got to that point, I was working with some very good EPs. These EPs gave me some very sound advice in terms of how I should manage my afib. For instance, my first EP recommended taking flecainide as a pill in the pocket instead of just putting me on drugs right away and have me taking drugs everyday and for the rest of my life. He had a very sensible approach to managing my atrial fibrillation.
When my afib started getting out of control, I opted to get an ablation. I went to the best EP I could put my trust in to operate on my heart. And as a result, I’ve been afib free now for almost three years.
I got control over my afib by learning more about the condition. I did a lot of research, and by talking to other people with afib I learned even more. Ultimately, I put my care in the best hands possible.
Vagal vs. Adrenergic Atrial Fibrillation
Having afib episodes at night, especially in the middle of the night during sleep, is not only uncommon but it’s actually quite the norm for a lot of afibbers. The reason for this is, a lot of people that have afib have what’s called, vagal afib.
There are two different types of afib. There’s vagal atrial fibrillation and there’s adrenergic atrial fibrillation. Vagal afib is afib that occurs mostly at night during sleep, after a meal, or when you’re resting after exercise. Adrenergic afib is afib that’s mostly triggered by exercise, stress, stimulants, and exertion. Most people fall in the former category, the vagal afib category.
How Do I Prevent Afib Episodes at Night?
There’s two things that you can do to help prevent afib episodes at night. The first thing you should do is talk to your doctor about getting off beta-blockers if you are taking them because these aren’t ideal for people with vagal afib.
In an article on afibbers.org, it references a Euro Heart Study from 2008. The study involved over 5,000 afib patients treated in 182 hospitals in 25 different countries. The majority of the vagal afibbers, 72% to be exact, received non-recommended drugs, specifically beta blockers.
The vagal afibbers who were prescribed non-recommended drugs were more likely to progress to persistent or permanent afib than were vagal afibbers prescribed recommended drugs, primarily flecainide. After one year of followup, 19% of vagal afibbers prescribed non-recommended drugs, again the beta blockers, had developed persistent or permanent afib as compared to 0% in the group prescribed correct drugs, again flecainide.
Hans, the editor of afibbers.org at the time that article was written, was had conducted an annual survey called the Lone Atrial Fibrillation survey, or the LAF survey. In the article, he commented on the study by saying, “It’s interesting that our first LAF survey that was conducted in February 2001 revealed that 50% of vagal afibbers had been prescribed non-recommended drugs. This resulted in an average afib burden more than twice as high than the burden among vagal afibbers taking flecainide.”
I’ll also reference another article from Steve Ryan’s website, a-fib.com. The article briefly discusses the difference between vagal and edrenergic atrial fibrillation. The article also states that beta blockers usually aren’t ideal for most vagal afibbers.
If you are fairly certain you have vagal afib and are taking beta blockers you might want to have a conversation with your doctor. You might find that switching to a different type of drug does a better job managing your afib. You should talk about specifically changing to flecainide.
Again, these are general suggestions. Each person’s case and personal health situation varies so beta blockers might indeed be your best option. It never hurts, however, to discuss other possible options with your doctor to find better ways to control your nightly afib episodes.
All People with Atrial Fibrillation Should Rule Out Sleep Apnea
The other thing that you can do is rule out sleep apnea because there is a very strong connection between afib and sleep apnea. I wrote an article on this topic for NewLifeOutlook. When I worked on that article I discovered during my research that it’s estimated that between 40% to 50% of patients with atrial fibrillation have obstructive sleep apnea, and patients with sleep apnea have four times the risk of developing afib. If you talk to any good EP, they will tell you there’s definitely a strong connection between afib and sleep apnea.
In fact, a lot of the afib centers across the country screen for potential sleep apnea. They have a questionnaire where they ask questions to determine if you could potentially have sleep apnea. I predict in the near future it’s going to be common practice for doctors to put their afib patients through a sleep study to rule out sleep apnea.
A lot of people think they are only at risk of having sleep apnea if they’re overweight or “fat,” or if they snore a lot. Another common risk factor is having a “thick” neck. Certainly these are all very common risk factors of sleep apnea, but you can be perfectly normal weight and have a perfectly skinny neck and still have sleep apnea! If you have afib, it makes sense to be tested for sleep apnea just to rule it out.
My Sleep Study to Rule out Sleep Apnea
I had a sleep study done a couple years ago. Fortunately, my sleep study revealed I do not have sleep apnea. Finding that out gave me peace of mind. I didn’t have to worry if sleep apnea was playing a role in my afib. Having a sleep study isn’t exactly fun but it’s definitely worth doing if you have afib – especially if you have the common risk factors of sleep apnea!
The added benefit of having a sleep study done is if it’s discovered you do have sleep apnea you can be treated. And treating your sleep apnea can significantly reduce your afib burden – not only in terms of the number of episodes you have but also in terms of the severity of those episodes.
I don’t want to say treating sleep apnea cures afib, but treating it can certainly reduce your afib burden especially if you’re having episodes primarily at night during sleep.
Atrial fibrillation is usually random and unpredictable. It’s impossible to know what your future holds when you’re diagnosed with it. You may go many years with sporadic episodes or you may quickly progress to frequent episodes and eventually persistent afib.
The best way to get control over your afib is to arm yourself with knowledge and put your care in the best possible hands. Don’t rely solely on what your doctor tells you and don’t just settle with any doctor you can get an appointment with!
If you have afib episodes mostly at rest or at night, you likely have vagal afib. If you have vagal afib and are taking a beta blocker, that might not be the best solution. You might be better off taking Flecainide as beta blockers can sometimes make afib worse if you have vagal afib.
Finally, if you have atrial fibrillation you should rule out sleep apnea by having a sleep study done! If a sleep study reveals you have sleep apnea, you may be able to greatly reduce your afib burden by getting your sleep apnea treated!
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I’ve had about six afib attacks in 3 yrs, and I was ok with that, but since Xmas 2019,I have been waking every night will my heart racing and along with that I have an enlarged prostate, so each time I wake with an urge to pee it coincides with the pounding in my chest,I believe the two are somewhat related.to be perfectly honest the doctors I have seen here in the west of Ireland are pretty clueless and that is being fair to them, my treatment for the last 3 yrs has been 150 twice daily, 20mg of lecalpin for BP and an aspirin,, that has not changed in the time I had the first attack .I’ve been to the Aand E dept a few times and they basically say you are in sinus rythem give you a leaflet and out the door .Ive never been told or recommended a apnea test and feel like I’m going backwards when I here about how other people get the help needed .its 8 months wait to see a heart guy here .in the meantime I sit up downstairs in the chair trying to still my beating heart haha,,,but joking aside I dread the night and the crap that it brings
I was diagnosed with AFIB just 6 months ago and I am so confused, I have seen four different consultants, one put me on Flecainide which helped me but another said continue with the BBs another not wanting to offend the first one prescribed propafenone …..I really do not know what to do and am very apprehensive about going to sleep as have an episode most nights, although all day I am fine .
How are you today? And how how much flecainide are you taking every day? And are you taking beta blockers too by chance? You don’t mention your age or afib details (i.e. how many episodes you’ve had, how long they last, etc.). Depending on your age and overall health, I’d strongly encourage you to consider having an ablation.
I am a female 79 years of age and have had AF for 15 years 4 times a month, episodes last 4-15 hours HR up to 180 BPM.
I believe I should have opted for an ablation years ago but my Cardio constantly brushed it off.
Now I know better and regret not doing it.
I’ve tried all of the medications and am currently on Metoprolol (which makes me feel terrible) and a Eliquis. I am pretty sure I am a Vagal AF er, and really shouldn’t be on a BB. I have tried other drugs and Flecainide was the best but now have CAD so cant take it.
What do you think about an ablation at my age?
I am currently seeing a new Cardio at RMH Melbourne who is very proactive and have had a Reveal Link Recorder implanted.
I had Afib a few years ago and now I think I have it again. At night I get very light headed and dizzy and when I get up my morning blood pressure is 160/96. A few hours later my blood pressure goes down. Is this a sign of afib?
Your symptoms aren’t necessarily a sign that your afib has returned. The only way you’ll be able to confirm what’s going on is if you use a heart monitor. I’d talk to your doctor about getting one. If this is happening nightly a 24 or 48 hour Holter monitor will work. Otherwise if it’s only happening occasionally then you’ll probably need an event monitor that you can wear for 14+ days.
Short of having a professional heart monitor, you could also try capturing the events with a consumer grade heart monitor like the Alive Cor device.
I am so thankful that I ran across your article on the 2 different types of A-fib. I was just recently diagnosed with a-fib, and I am not a very happy camper right now. I have had palpitations over the years but they always went away so I didn’t really worry about them.
I have been an exerciser for over 30 years. I go to the gym 5 days a week, lifting weights and doing cardio. All together I spend about an hour at the gym plus take a power walk weather permitting.
I weigh between 115-120 lbs and have never taken any type of meds. Now I have to take a blood thinner, digoxin, and a beta blocker.
My cardiologist is not very receptive to any type of conversation that I would like to have with him. Changing Dr’s is not all that easy, so I am trying to educate myself with articles like yours. I learned something that I haven’t seen before that there are two types of A-fib because mine almost always happen at night when I want to go to sleep.
Thank you. I will keep researching and learning as much as possible about this condition. Kitty.
Thanks for your comments. I applaud your efforts to take your health into your own hands by educating and empowering yourself. That’s terrific!
I would talk to your doctor about digoxin. I’m going to be writing about this drug soon. Sufficed it to say, it’s a very old drug that has very little utility today and in fact might not be good at all for people with afib. If your doctor insists on keeping you on it, be sure you’re getting monitored regularly for potential digoxin toxicity.
I so appreciate that you answered my email. Matter of fact I had an appt. today, received my results relating to a bloods test and wearing a Halter monitor, all were okay, he told me I had to stay on the Digoxin and the other meds. I will most certainly do more research about the Digoxin. I went a whole week without palpations at nights, then they started again, it is so very frustrating to figure out what the trigger may be, but I will keep at, and hope I might be able to wean myself off the meds. soon!!! I am back at the gym, even so he told me NO GYM. Thank you for doing such a wonderful job with your all the advice you give. Again thank you. Kitty
What about rate control? I take 100 flecainide bid and 120 ER diltiazem plus ativan and melatonin and eliquis. You can’t take flecainide without rate control. When I go into afib – generally after exercise or after a meal, or at night, I take metropolol and more flecainide.
I usually get out of it in 7 hours but today it has been 9 hours and I am still not out of it. I am very symptomatic and in pain. I had one ablation and it didn’t work. I’ve seen top doctors in the USA and they say it isn’t a cure and they can’t say if it will even work or how long it will last. It is still a progressive disease and always gets worse.
Not everyone has to take a rate control drug when they take flecainide. I never did and I know many people who take flecainide only.
I don’t know what “top doctors” you have talked to but they are only partially right. While there may not be an official cure, you can eliminate afib with the right procedure done by an experienced EP. Also, it’s not always an automatic that afib gets progressively worse. There are many people who live for years with paroxysmal afib (i.e. it never progresses to persistent or permanent afib).
I just wanted to correct some of your assumptions so they don’t freak out my readers:)
I hope by now you are out of afib. Take care and God Bless!
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