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What are the first line treatments?
Backstory: I'm 28 years old. Normal blood test, normal echo. No other health problems and i weight 160. I had a bout of my first afib occurrence after I fell and broke my arm. I have no idea what sent me into afib. I went back into normal sinus rhythm on my own after about two hours. I take propranolol three times a day for anxiety reasons. My question is if i experience this again should i go to the ER? Or see my cardiologist right away? I'm afraid this will happen again and want to know what i can do. Will I need an ablation, cardioversion or need heart rythm meds to help next time I have this?
Thumper2, July 16, 2020 6:58am EST
bcrouse13, I hope that you never go back into AFib again, but if you do, I'd recommend that you not go to the ER (because it's not likely that you'll get a heart specialist there). Instead, by way of preparation, find yourself an electrophysiologist (EP), a cardiologist whose specialty is atrial fibrillation. An EP will be able to evaluate your situation and recommend what paths you might take-- ablation, cardioversion, heart meds, or other. Keep us posted!
BethClark, July 16, 2020 12:12pm EST
Was there a doctor who did some testing and made the aFib diagnosis for you? (When you say that you went back into sinus rhythm on your own I wasn't sure whether you had gone into the ER or to a doctor when the aFib occurred or if you were relying on a device like a watch for the diagnosis.) If you haven't had a formal evaluation, I would think that it would be prudent to have an assessment done, especially because AFib tends to occurr mostly in older folks and you certainly are not that. Electrophysiologists are the specialists in heart rhythm problems so are the best to go to for heart rhythm issues. The doctor would be able to evaluate whether any treatment would be helpful to keep another episode from occurring. I was started on one medication and then a second one added after the second episode. Plus I was prescribed a blood thinner when I was diagnosed because my Chads score was a 2 due to age and gender. Because of your young age I'd guess that wouldn't be needed--lucky if that is the case. The doctor can also answer the question of whether you should go to the ER if an episode occurs. (Mine said yes but said not necessary to rush in.) Some of the forum participants wait it out to see if the aFib will resolve on its own. Some go to the ER. I was so symptomatic when I had my two episodes that I went to the ER. Therefore, I don't agree with Judy's recommendation to not go to the ER. The ERs are well equipped to do stop aFib episodes. But ERs do not do follow up care, of course, so you would need to go to a doctor outside of the ER for ongoing care.
MariLee, July 22, 2020 5:55pm EST
I'm sorry you experienced a-fib at such a young age, it can be very frightening. I had my first episode 20 years ago; I had just turned 38 and my first child was 8 months old. I went to the ER because I was highly symptomatic, and it was many hours before I finally converted to SR (I don't remember if it was due to medication or just time). They sent me home after an overnight stay, telling me it's not life-threatening (as if that made everything OK) and I was pretty much on my own after that. I went through extensive testing, both through cardiology and my ***, and nothing was out of whack. I had tons of palpitations for a long time after that, and stopped being able to sleep more than a couple hours/night so finally went on an antidepressant (Paxil) to control my anxiety. Thankfully, it wasn't until 6 years later that I had a second episode (when my mom died) and again 2 years after that (following a long period of work and personal stress). After switching to Zoloft from Paxil ~6 months after that third episode, it had been 12 years until everything went crazy in May 2020 (3 episodes in a week). I tell you all this because once you've had afib, it likely will eventually return - even if you're young and healthy. Mine seems to be triggered by hormonal fluctuations, high stress, and lack of sleep. My personal theory is that the Zoloft contributed to lower anxiety that helped keep my a-fib at bay.
While going to the ER is a personal decision based on your symptoms and experience of self-converting, the triage nurse told me a heart rate over 140 indicates the ER is warranted; my *** told me there is no reason to suffer at home (especially when you are alone) when your heart is racing at such a high rate and you're having irregular beats and rapid ventricular response. Of my recent episodes, the first one required an electric cardioversion, but the second two (a week later) converted within 10 minutes or so with Procainimide (IV drip). Because of the sudden frequency of episodes, I am now taking Flecainide (50mg twice/day) and Propranolol ER (60mg once/day). These medications are doing a great job controlling the a-fib so far, but make me feel awful, which I'm sure is why they did not start me on meds when I was younger. Ultimately, your choice of treatment will depend on your clinical status (if you haven't had a full cardiac/physical work-up, you should get that done) and whether a-fib is significantly disrupting your quality of life.
Wishing you all the best,