With a ‘Silent’ A-Fib episode, when is it time to call your doctor or visit the emergency room? That’s the topic of this email we received from Ross Johnston. He wrote he was recently diagnosed with ‘Silent A-Fib’ (discovered during a routine ECG). He asked me:
“During a ‘silent’ episode with few symptoms, when is it time to visit the ER? When my heart rate hits 150, 175, or 200? Or when my A-Fib lasts more than 24 hours? Or 48 hours?”
Ross is very fortunate that his Silent A-Fib was discovered. About 30%–50% of people with Atrial Fibrillation are walking around not knowing they have it. All too often they have a stroke and only then find out they have Silent A-Fib (and the probable cause of their stroke).
A-Fib is easily identified from an electrocardiogram (ECG or EKG), which should be part of your annual physical exam.
Silent A-Fib Is Seldom Totally Silent
Anyone with Silent A-Fib should learn to take their pulse and take it often. Besides the number of beats-per-minute, also note is it uneven? Too fast (or too slow)?
To learn how, see the Arrhythmia Alliance video: “Know Your Pulse wth Sir Roger Moore”. You can also use a device like a pulse oximeter (such as the Contec Pulse Oximeter for about $20 from Amazon.com or from your local drug store).
A Conservative Approach
Silent A-Fib is seldom totally silent. If you feel something is “off” or different about your body, check your pulse. Don’t hesitate about going to the emergency room.
A conservative, safe approach is to go to the ER if your heart rate is over 100 bpm and/or lasts for 24-48 hours.
My Best Advice: Create an ‘A-Fib Episode Action Plan’
Anyone with Silent A-Fib (or any type of A-Fib) should develop an action plan. During an A-Fib attack, an A-Fib Action Plan reassures you you’re taking the right actions and helps you stay calm.
• When to contact your doctor’s office
• Your doctor’s cell number and email address for emergencies
• What symptoms or criteria should send you to the emergency room
• When at the ER, if you should call your doctor
• When at the ER, if your doctor will call and talk with the ER staff
• When you should “just ride out” the episode
• How to recognize the signs of stroke
Write up the answers and add other helpful information, i.e., your local emergency room, directions, phone numbers, etc. Post a copy in a prominent place and discuss your A-Fib Action Plan with your loved ones.
The Bottom Line
If you feel something is “off” or different about your body, check your pulse. Then refer to your A-Fib Episode Action Plan and check for your next actions. If not sure, don’t hesitate to go to the emergency room.
For more, see my article: Why & How to Create Your ‘A-Fib Episode Action Plan’.
Dr. John Camm of St. George’s Hospital in London, England discussed how silent (asymptomatic) A-Fib can have similar long-term effects as A-Fib with symptoms. Silent A-Fib may progress and get worse just like symptomatic A-Fib. But all too often people with silent A-Fib have a stroke and only then find out they have A-Fib.
Doctors today have a wealth of new A-Fib monitoring devices to detect A-Fib, such as the Medtronic Reveal DX which is inserted just under the skin and can monitor the heart for over a year, or the Zio Patch which you wear like a Band Aid for 1-2 weeks, or phone apps like the
AliveCor Heart monitor for SmartPhones.
BUT—how can we get heart monitors to the people who need them the most—people with silent A-Fib? Read more of Steve’s summary of Dr. Camm’s presentation->
At the recent AF Symposium in Orlando, Dr. Jeremy Ruskin of Massachusetts General asked, can anyone in A-Fib really be asymptomatic; that is, if you dig deep enough, will you find that A-Fib does affect their life-style or how they feel? In the case being discussed, read why Dr. Ruskin recommended an Electrocardioversion for his patient. Read more.
AF Symposium 2015
Can Anyone in A-Fib Really Be Asymptomatic?
Dr. Jeremy Ruskin of Massachusetts General made a statement during the ‘Challenging Cases’ discussions which changed my thinking about the true nature of asymptomatic or ‘silent’ A-Fib.
Not everyone may “feel” their A-Fib symptoms…but losing that amount of blood flow must affect your body and brain in some way
In the case being discussed, Dr. Ruskin recommended an Electrocardioversion to get the asymptomatic patient back in Normal Sinus Rhythm (NSR). Many times patients who are used to living with their A-Fib will indeed notice a difference when returned to NSR—they often feel much better.
In A-Fib, you lose 15%-30% of your normal pumping blood volume because the atria fibrillate instead of pumping blood down into the ventricles. Not everyone may “feel” A-Fib symptoms like chest pains, palpitation or shortness of breath. But losing that amount of blood flow must affect your body and brain in some way. Patients with persistent A-Fib may adjust their life-style to this loss of blood flow or just get used to it. Or they may compensate with strenuous exercise (making the ventricles suck blood down from the non-functioning atria like a turkey baster). But A-Fib is affecting them, consciously or not.
I have a friend who is in persistent A-Fib and is “asymptomatic.” He is a swimmer and exercises a lot. He does take a blood thinner to prevent an A-Fib stroke (which he doesn’t like. He wants to get a Watchman device installed to close off his Left Atrial Appendage [LAA] so that he doesn’t have to take anticoagulants).
I will now recommend to my friend that he get an cardioversion to see if he notices a difference when he is in Normal Sinus Rhythm (NSR) compared to being in persistent A-Fib. A cardioversion is non-invasive and pretty safe. The only problem is that the result often doesn’t last. But even if it lasts for just a few days, my friend would still be able to compare being in NSR versus living in persistent A-Fib. (I’ll also remind him that the best way to get off of anticoagulants is to cure your A-Fib.)
And returning to NSR after a cardioversion even for a few days is generally a good sign that a successful catheter ablation may fix his A-Fib, that his A-Fib hasn’t progressed so far that he can’t be shocked out of it.
Last updated: Friday, February 27, 2015
Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)
11. “I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?” UPDATED
12. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?“
16. “I have to be on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (81 mg) or a high dose (325 mg)? Should I take the immediate-release (uncoated) or the enteric-coated aspirin?”
17. “I don’t want to be on blood thinners for the rest of my life. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of. Is there anything I can do to get off of blood thinners?“
21. “I”ve read about a new anticoagulant, edoxaban, as an alternative to warfarin (Coumadin) for reducing risk of stroke. For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?”
Last updated: Wednesday, May 25, 2016