What do I do if I have an episode of AF?

What should I do if I have an episode of atrial fibrillation?

Atrial fibrillation (AF) and atrial flutter affect people differently. Some people develop severe symptoms very suddenly, while others notice only a fast or irregular heartbeat, reduced energy or mild shortness of breath.

When should I call an ambulance?

Call 000 immediately if you experience:

Severe difficulty breathing
Chest pain, pressure or tightness
Fainting or feeling as though you may faint
Severe weakness, confusion, sweating or rapidly worsening symptoms
Symptoms of a stroke, including facial weakness, arm weakness or numbness, difficulty speaking, loss of vision or loss of balance

Sit or lie down while waiting for the ambulance. Do not drive yourself to hospital.

If this is your first suspected episode of AF, or the symptoms are different from your usual episodes, you should also seek prompt medical assessment.

What should I do if my symptoms are mild?

If this is a familiar episode and you are not experiencing any warning symptoms (as listed above):

Stop strenuous activity and rest.
Record approximately when the episode began.
Check your heart rate and blood pressure if you have a suitable monitor.
Record an ECG using your smartwatch or portable ECG device if available.
Continue your regular medications, including any prescribed anticoagulant, at their usual doses.
Avoid alcohol, dehydration and strenuous exercise while you remain in AF.
Follow your personalised AF action plan, if you have one.

Many AF episodes settle without treatment. However, contact Hunter Heart, your GP or an emergency department if:

The episode does not settle within the usual timeframe
Your heart rate remains much faster than usual
Your symptoms are becoming worse
You have missed any anticoagulant doses
You think you may require a cardioversion

Taking additional medication during an episode

Some patients are given an individual medication plan for when an AF episode occurs. This may include an additional dose of a prescribed medication.

If you are going to take an additional dose of medication to help stop an episode of AF you should know:

Which medication to take
The exact dose
When it should be taken
When to seek medical assistance if it does not work

Do not take an additional dose of sotalol, flecainide or any other heart medication unless this is specifically included in your personal treatment plan.

The pill-in-the-pocket approach

Some patients with infrequent episodes of AF may be prescribed a single dose of an antiarrhythmic medication to take when an episode begins. This is called a pill-in-the-pocket strategy.

This treatment is not suitable for everyone. Your cardiologist must first assess whether it is safe for you and advise you on how much of a specific medication such as flecainide to take. If a pill-in-the-pocket strategy doesn’t work then an electrical cardioversion might be needed to restore normal sinus rhythm.

Anticoagulants or blood thinners

If you regularly take an anticoagulant—such as apixaban, rivaroxaban, dabigatran or warfarin—continue taking it exactly as prescribed during an AF episode.

Electrical Cardioversion

A cardioversion uses a controlled electrical shock to restore the heart’s normal sinus rhythm (with a very short anaesthetic). This can be very useful for patients whose episodes of AF/flutter don’t tend to stop of their own accord.

Lake Macquarie Private Hospital Emergency Department can assess patients with AF and may perform a cardioversion when clinically appropriate. Private emergency-department fees apply. Its emergency department is currently open continuously and does not require an appointment.

For stable patients, Hunter Heart can arrange a cardioversion at a private hospital within one to two days for patients who are covered by their private health-insurance for cardiac procedures. Contact Hunter Heart if you think you need one arranged (02 4952 3900).

John Hunter Hospital Emergency Department can also assess and treat AF. As with all public emergency departments, patients are treated according to clinical urgency, and waiting times and access to non-urgent cardioversion will vary.