Horizontal Afib

[terk]

Recently, I have experienced afib when I lay down such as first going to sleep or when I wake up in the middle of the night to go to the bathroom and upon laying down again. It starts with palpitations and then transitions into afib.

Someone suggested taking my metoprolol closer to bedtime but I have a low pulse rate (probably due to the medication) so wouldn't taking this slow down my heart rate even more and thereby triggering afib later at night?

I have read about so called triggers but I haven't changed anything in terms of diet or lifestyle that coincided with this change.

Any suggestions?

And how is "chronic" afib defined in terms of frequency and duration? Thank you!

terrance k.

[arthur]

The fluttering sensation...there is anecdotal evidence that some folks who have or had a PAC or PAF condition, sometimes feel a fluttering sensation which does not show up on a ECG and can occur while having a perfectly normal pulse.  I am one such person. In my case, prior to having an ablation performed to get rid of PAF, the fluttering occurred at about 200-300 beats per minute, and would occur occassionally, and would be difficult to "feel" externally, ie, not quite palpable.  After the ablation, it became quite constant and a bit faster.  Three years later, it has become less noticable.  My discussions with those in the know (EPs and Cardios), along with eliminating everything else internally (like esophageal spasms, arterial blockages, and diaphragmatic flutter), suggests that what you might be picking up is the actual movement of a focus (ie, a small island of electrically discharging cardiac tissue) by means of the surrounding nervous system, which may act as an amplifier.  Typically, this fluttering sensation kicks in with a sudden increase of adrenaline (like when you exercise or get up at night to urinate or are awaken by a vivid dream).

No one has suggested a cure.  My take on this is that the cure is not worth the risk, as it would require an ablation routine designed to locate the offending focus.

-Arthur

[usar13b]

Lately when I'm about to fall asleep, I do the same thing with my breathing.  Sometimes my breathing is fine and I just get the startled part of it though.  But like you, it is always right before I'm completely asleep.  I also have been having what I think may be a-fib.  I will get this really fast fluttering  sensation in my chest that will last about 10 or 15 seconds.  When I check my pulse in my wrist, it is not beating nearly as fast as the flutter sensation.  I'm actually wearing an event monitor right now and have sent in recordings of this three different times but they always say everything looks fine.  Any ideas???
PS I've suffered from PVC's for several months now.  I had an extensive workup that showed no abnormalities.  I took toprol xl for a few months but have since weaned off because the side effects were much worse than the pvc's.  They are not that big of a deal anymore and I've pretty much learned to ignore them.  Hopefully this new thing will be the same.  Anyway thanks and I'll look forward to a response from someone:)

[Cudadown]

Exactly the problem I'm going through. I'm at the point where I dread bed time. I dont know if my meds are causing it or not. I have started hitting the stationary bike each evening getting my heart rate to about 105 (hard to do with meds). Maybe its anxiety. I'm not sure. Today I'm going to try and not take this Amiodorane and see if that is making it worse. I'll still take the Metropolol in morning and one in evening. I take Lipotor in the morning as well. If I cant seem to blame it on the meds I'll have to ask the Doctor for some sleeping or anti-anxiety pills to help. I have to do something. I'm getting less sleep each week now.


P.S. Sometimes when just about to fall completely asleep, It seems like I forget how to breath or something like that. Causes me to jump out of bed.

[dquenzer]

Most people who have paroxymal or lone afib have the same problem.  I typically get my afib in the evening and most often during the night when I wake up.  My solution (which may not be yours) is to make sure that I have plenty of relaxed time before I go to bed.  The more I am revved up in the evening the higher the probability I will have afib when I sleep.

Also your heart rate can be too slow.  If you have vagally caused afib, slowing your heart rate may actually cause the problem.  I found that was my problem.   For example I have found that when I run on a consistent basis I have fewer PAC's since my heart rate stays higher during the day.  Running also helps me get adrenaline out of my system.  My theory on this is that when you have vagally caused Afib the combination of adrenalin and some beta-blockers percipitate the problem.

If you are taking your beta-blocker in the evening, then try taking it in the morning, or maybe even reducing your dosage in the evening.

Also you might also ask for a mild anti-anxiety med to take an hour before you go to bed.  It could very well be that you have set yourself up for getting irregular heart beats by getting a bit anxious before you go to bed.  

This afib can be a vexing problem.  As my cardiolgist says controlling it is really trying lots of different strategies until one works.  What works for one person won't work for another.

I'm going in for an ablation for mine, and my EP specialist said Afib won't kill you.  In fact he knows of some pro basketball players who have it.  You sure wouldn't know it.

[terk]

Hank,

thanks for the response. i'm checking the web now and the info under vagally mediated is a little confusing/technical. can you explain in simple terms what this is and what can i, and others probably, do about it (i realize no guarantees but i got to try something.) again, mucho thanks.

t.k.

[Cleveland Clinic]

terrance,

alot of people experience atrial fibrillation at night and some can attribute their symptoms to certain triggers.  You can try to change the dosing of your metoprolol and see if it helps your symptoms.

chronic really means that you are atrial fibrillation all of the time and really cant be converted successfully with medicine or electrically. Other terms associated with atrial fibrillation are paroxysmal (meaning atrial fibrialltion that self terminates), persistant (fibrillation that needs to be converted back into sinus with medicine or electrically, and lone (paroxysmal without structural heart disease).  

You should also talk to your physician about the risk and benefits of coumadin.

good luck