Walt61
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Walt61, December 3,  2020  8:55am EST

Newly Diagnosed w/afib

To start I'm male, 62 years old and no symptoms when I am in afib.  My initial afib experience lasted 6-7 months. 

How I was initially diagnosed

I wear a Fitbit and the band broke in November 2019.  In January 2020 I bought a new band and started wearing it again.  I noticed that my resting heart rate was 20+ bpm above normal and swung wildly during the day from the mid eighties to above 140.  I brought this up at my March exam with my (first time visit) ***, and she seemed to think that a resting heart rate in the mid 80s was fine. She checked my rate manually, my Fitbit said 110 she got 84 and concluded my device may be in error.  My blood pressure was normal (96/69), blood tests were normal and since I had no symptoms except a Fitbit giving me anxiety we dismissed the Fitbit.

After 6 months with a high wildly fluctuating heart rate, on July 9th, a switch changed and my heart rate dropped 20 beats in a second and stayed normal for 2 days. Then on July 25th my heart rate returned to normal again, this time for 4 days. On 13 August it went to normal again this time for a full week. Since then, it has flipped flopped every 2-5 days from being in atrial fibrillation to being normal.

In the beginning of August Fitbit asked for folks who wanted to participate in a Heart Study to see if they could detect abnormal heart rhythms with their device. I said yes, I would like to join. If Fitbit's algorithm detected an abnormal heart rate I would be accepted and screened by a doctor, if after being asked a million questions I was still appropriate for the study they would send me a heart monitor to wear for a week. Afterward the data would be analyzed by a Cardiologist and explained by another doctor. I was accepted. My results (received toward the end of October) said I was in atrial fibrillation for 48.5% of the time. I scheduled an appointment with a local cardiologist and started researching atrial fibrillation.

Root Cause: Heredity, Virus, or Life Change?

Who knows. My Mother and older Sister had/have atrial fibrillation.  At the end of December 2019 I had a virus that kicked my *** for 2-3 weeks. I honestly thought I might die. Looking back I had all the symptoms of Covid-19 but not Covid-19, nor the flu. I also transitioned from 16 years on night shift to working days in the same time period.

My Quick Education on Afib

It turned out there was a 3-day virtual conference for patients on atrial fibrillation organized by Stopafib.org  (I attached the program) from 30 Oct to 1 November. I attended the 3-day conference. It was in-depth, covering most all aspects of treatment. One of the presenters was an Electrophysiologist from Duke Medical Center. He was in charge of the department that specializes in atrial fibrillation. After his presentation, in the 30-minute side session where folks could ask questions I was able to see how he interacted with patients. The conference definitely let me see how complicated this field of study might be, so I switched from the local Cardiologist to the Electrophysiology group at Duke Health.

First visit with my Electrophysiologist

Mid-November I went into Duke Health to be evaluated. After an ECG and a bunch of questions it was determined that the Fitbit Heart Study was accurate. My Doctor told me that most folks are put on blood thinners to help prevent a stroke. But he ran my numbers through his stroke risk calculator and said, given my age, blood pressure and overall good health that even with atrial fibrillation my risk of having a stroke was lower than most guys my age. Due to this, placing me on blood thinners would be riskier than not taking them. He further stated that even after I hit 65 if my health is the same, blood thinners still won't be required. The medication he wants to put me on (flecainide and metoprolol succinate) to help keep my heart in a regular rhythm requires a test prior to use.

My Echocardiogram and Stress Test

While prepping for the stress test they hooked me up with about 1000 leads and a blood pressure cuff. Just standing there relaxed my heart rate was 154 bpm. Their automated blood pressure cuff had problems with my atrial fibrillation heart rate and interpreting my BP. It read 56/35, and they asked me if I was ok, expecting me to faint at any moment. I told them I was fine. They tried a few more times and finally gave up and rolled in a manual automated BP cuff. The new device checked my BP, and they still seemed confused from this reading. I glanced down at the device and it read 95/60. I let them know this was in the ballpark for me, and I was fine. My BP has been in the 90s/60s for many years ever since I switched to a plant based whole food way of eating. Obviously having a BP in this range is unusual for most of the patients they see that are my age.

After 6-7 minutes on an inclined treadmill my heart rate was 181 and my blood pressure was about what most folks think as normal during rest at about 128/78. After resting for 13 minutes my heart rate was 112 bpm and my BP was back down to normal of 99/69.

All the pictures of the heart chambers, valves etc... showed no issues whatsoever. This means I have no major signs of heart disease and I can safely use the medication he prescribed. Of course there is a slight ***** up in the mail delivery and the prescription is in postal service holiday hell.   Three - four days after starting the drug combo prescribed I have to get a new ECG to verify that the new drug isn't having the opposite effect.

What does the future hold?

Hopefully at some point the medication will surface from postal service holiday limbo.
If the medication is a success, great.
If the medication has minimal side effects, great.
If the side effects are bothersome, or the drug doesn't work, in the future I might opt for a surgical procedure. Before any potential surgery I hope to lose 30-40 lbs and get down from 220 lbs (just shy of being obese) to 180-190 lbs.
 

I appreciate this group, if you got this far “Thank You” for reading my version of War and Peace.

Sitting here writing this I have been in normal rhythm for 2 days and my heart is at 64 bpm. 

I wish you all a great holiday season and a long and active life.

4 Replies
  • BethClark
    BethClark, December 4,  2020  7:50am EST

    As you read posts from this group you will see that different people have different experiences with medications. I've been on the metoprolol and flecanide combination for 5 years now without any side effects--and without any aFib episodes that I am aware of. (I was very symptomatic during the two episodes I have had so I'm assuming I would have known if I have had any others.) As you know from the conference there are other treatment options should the medications not work, have too many side effects for you, or you don't want to be on meds. 

    Some people in my breakout rooms at the conference mentioned they knew people whose first clue that they had aFib was a stroke. So I think that those of us who have gotten our diagnosis before such a catastropic event are quite lucky. Congratulations to you for pursuing getting enrolled in the Fitbit study. You've been quite proactive about getting your diagnosis and working with your doctors to come up with a treatment plan. It will all serve you well.

    Beth

  • Thumper2
    Thumper2, December 4,  2020  8:24am EST

    Walt61, yours was a very interesting summary of your AFib journey.  I'm glad that you are now seeing an EP at Duke Health and are pursuing a healthy way of life and educating yourself on AFib and your future with it.  Please keep us posted!  

    Thumper2 (Judy)

  • Walt61
    Walt61, December 8,  2020  11:41am EST

    Beth, thank you for your reply.  I managed to work around the prescription being lost in the mail.  I started metoprolol and flecainide last evening.  So, I have only had 2 doses of flecainide so far.  Hopefully, the levels in my blood will rise to the level of having an effect on my heart (currently in afib) in the coming days.  The availability of the Fitbit heart study was fortuitous.  I am lucky to have had a diagnosis before a major event.

    Judy,  thank you, as things progress I will keep this group updated.

  • DkinAA
    DkinAA, December 9,  2020  4:48pm EST

    Sounds like you had quite an adventure. Mine was much more mundane - routine checkup (age 68 - five years ago), tech noticed my HR was high, took ECG, then doc sent me to ER for full diagnosis and first step of treatment. It had probably been going on for awhile, but I thought it was just a caffeine overdose or panic-attack anxiety. Got full workup at our clinic here, including Holter monitor and sleep study, started anticoagulants. I lost some weight at first, fixed the diet, treated sleep apnea, and all of these helped. But I'm now on an antiarrhythmic drug (propafenone, similar to flecainide) which has helped a lot but I still have occasional "breakthrough" episodes. Maybe time for an ablation. My relative had one episode, and that's it! This is a very individual condition.

    For what it's worth, I've discovered that the optical pulse sensors in both my Apple Watch and my oximeter usually can tell me pretty reliably that I am having an episode, even if the rate is below 100.   While sitting and resting, I watch the heart rate for a minute or so, and the rate will bounce up and down a lot - like 60, then 90, then 70, etc. These devices read the rate over a period of a few seconds and then take another sample, so if my rhythym is irregular, it shows up as unstable and inconsistent readings.  Your Fitbit will probably do the same thing. Sometimes this is more convenient than using my Watch ECG, but it averages the HR over 30 seconds, giving a more stable number.  Of course, feeling my pulse often works well if the rhythym is really wacky, but the numbers are good to have.

    My old Omron BP monitor was happy to do a BP measure during an episode, even signalling the irregular rate, but my newest Omron, while very nice, just throws in the towel if the rate is irregular. What's with that? 

    You've already made an excellent move in taking advantage of the information on this site!  Keep us posted!

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