Atrial Fibrillation: When to Seek Medication for Irregular Heartbeat

Questions about arrhythmias in electrocardiograms?

Hello Doctor, recently my symptoms of arrhythmia have intensified.
Initially, it occurred once or twice a week and lasted for one or two days before resolving, so the doctor did not prescribe medication and suggested monitoring.
However, the frequency of discomfort has increased lately, and sometimes my smartwatch alerts me to arrhythmia during the night.
My heart rate can fluctuate between 90 to 100 bpm while sleeping, and I have experienced several consecutive days of palpitations and a feeling of heaviness in my chest.
I underwent a 24-hour Holter ECG and would like to know if I can request medication from my doctor to manage this condition.
Is this level of arrhythmia considered severe? Thank you.

1.
Dominant rhythm: Sinus rhythm.
Maximal HR 145 bpm, occurred at 09:37.
Minimal HR 45 bpm, occurred at 04:02.
Hourly average HR 82 bpm.

2.
Ventricular ectopic beat count: There were occasional PVCs.
192 beats/24 hours (0.2%), with 4 events of couplet.

3.
Supraventricular ectopic beat count: There were frequent PACs.
6832 beats/24 hours (5.8%), with 1330 beats of bigeminy, 191 beats of trigeminy, and 23 events of atrial pair.

4.
Supraventricular tachyarrhythmia: There was 1 episode lasting a maximum of 6 beats at a rate of 140 bpm, which occurred at 22:50.

5.
Pause: The longest pause was 1.9 seconds, occurring at 02:15.

Huang, 40~49 year old female. Ask Date: 2023/09/05

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is recommended to adjust your lifestyle and engage in regular exercise.
However, if symptoms do not improve, medication treatment is advised.

Reply Date: 2023/09/05

More Info

Atrial fibrillation (AF) is a common type of arrhythmia characterized by an irregular and often rapid heart rate. It can lead to various complications, including stroke and heart failure, making it crucial for patients to understand when to seek medical attention and potentially initiate treatment. Based on your recent experiences and the findings from your 24-hour Holter monitor, it seems that your symptoms have escalated, and this warrants a closer look.

From your description, you initially experienced infrequent episodes of irregular heartbeat, which were self-resolving. However, the increase in frequency and the persistence of symptoms—such as heart palpitations and a sensation of tightness in the chest—indicate that your condition may be worsening. The data from your Holter monitor shows a significant number of premature atrial contractions (PACs) and some episodes of supraventricular tachycardia, which can contribute to symptoms of palpitations and discomfort.

In general, the decision to start medication for AF depends on several factors, including the frequency and severity of symptoms, the presence of underlying heart disease, and the overall risk of thromboembolic events. Given that your heart rate has reached up to 145 bpm and you have experienced episodes of irregularity during sleep, it is reasonable to consider pharmacological intervention. Medications such as beta-blockers, calcium channel blockers, or antiarrhythmic drugs can help control heart rate and rhythm, thereby alleviating symptoms and reducing the risk of complications.

It is essential to consult with your healthcare provider about your current symptoms and the findings from your Holter monitor. They may recommend starting medication to help manage your heart rate and rhythm more effectively. Additionally, they might consider further evaluation, such as echocardiography or even an electrophysiological study, to assess the underlying mechanisms of your arrhythmia and determine the best treatment strategy.

In summary, your increasing symptoms and the findings from your 24-hour monitoring suggest that your atrial fibrillation may be more significant than previously thought. It is advisable to seek medical attention promptly to discuss your symptoms and the possibility of starting medication. Early intervention can help manage your condition effectively and reduce the risk of serious complications associated with atrial fibrillation. Always remember that any new or worsening symptoms should be taken seriously, and timely communication with your healthcare provider is crucial for optimal management of your heart health.

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