Dr. John Day, Cardiologist

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The 7 Best Ways to Stop an AFib Attack

If you find yourself experiencing a very occasional incident of AFib, you need not panic provided you aren’t about to pass out, you’re experiencing chest discomfort, or you’re short of breath. Of course, if AFib is happening repeatedly then you need to see your cardiac electrophysiologist or “EP” as soon as possible. An EP is a cardiologist who has had two additional years of training in arrhythmias following their cardiology board certification.

And the off chance that such an attack might happen in a very inconvenient time—like when you’re on a long international flight, taking a cruise, or in a very remote area of the world—absolutely shouldn’t stop you from living your life.

Lots of people travel with a first aid kit. That doesn’t mean they intend to use it—it simply means they are ready in case something happens. No matter how long your AFib has been in remission from massive lifestyle changes or an ablation, I suggest having a plan of response ready to go, especially when you know you’re going to be away from a hospital or doctor for a while. As the Boy Scout motto goes: “Be prepared.”

1. “Pill-in-the-Pocket”

First, keep an antiarrhythmic medication, like flecainide, on hand for an emergency. Sometimes, my patients may also have a medication to also slow down their heart and a blood thinner in addition to the flecainide on hand for an emergency.

Even though many of our patients haven’t had an AFib episode in years following an ablation, many still keep an antiarrhythmic in their wallet, purse, or car just in case their heart ever starts fibrillating again. If nothing else, it gives them peace of mind and a sense of control should anything ever change.

2. Rehydrate

Next, always be ready to rehydrate. As dehydration is a big AFib trigger, many of our patients report that they are able to quickly get back to sinus rhythm simply by rehydrating. Always travel with clean water at arm’s reach.

3. Optimize Your Electrolytes

Third, keep your electrolytes up. Low levels of magnesium and potassium are another common AFib trigger. A quick boost through electrolyte-heavy foods, or drinks like tomato juice or low-sodium vegetable juices, is always a good bet. But if you’re going to be away from a place where you can access these foods and drinks, supplements are a good idea, especially in the case of magnesium.

4. Exercise Away Your AFib Attack

Fourth, exercise. While it may seem very counterintuitive, many of my patients report that all they need to do is to overtake their AFib heart rate with an elevated exercise heart rate to get back in normal sinus rhythm. When their heart slows after the exercise, their normal sinus rhythm is restored.

Of course, if your heart rate runs especially fast with an AFib attack then driving the heart rate up even higher with exercise wouldn’t be a good idea. For those whose hearts break speed records with AFib, option number 5 below may be a much better choice.

5. Lie Down

Fifth, lie down. If an exercise-induced increased heart rate doesn’t work for you, the opposite might do the trick. Many of my patients report that taking a nap or going to bed early when they are in AFib is the trick to getting back in rhythm.

6. Stimulate Your Vagus Nerve

Sixth, stimulate your vagus nerve. Sometimes autonomic nervous system imbalances can trigger AFib. One way to quickly correct this is through vagal maneuvers, like slow deep breathing, bearing down like you are trying to have a bowel movement, tightening your abdominal muscles, inverting your body by raising your legs or standing on your head, coughing, or taking a cold shower.

7. Get a Quick Cardioversion

Finally, if all else fails, it’s time to visit an ER during off-hours or your cardiologist/EP’s office for a quick cardioversion to restore normal sinus rhythm. For example, our practice provides same-day cardioversions during normal business hours provided you are fasting. While a cardioversion doesn’t fix the underlying AFib problem, it can provide temporary relief until your AFib is fixed either through lifestyle changes, including weight loss, or an ablation.

Concluding Thoughts

Having a plan in place to stop an AFib attack isn’t admitting defeat. Sometimes life just throws us a curveball. Let bad experiences become good data that can help you prevent another such experience. After all, for some this can be a lifetime fight.

Even people who have been “cured” from their AFib with an ablation may have that rare one-off AFib attack and then go decades without another AFib attack. Sometimes this once-in-a-blue-moon AFib attack can come from a major life stressor like a death in the family, divorce, etc., or even a massive infection.

As long as AFib is a very rare event, the symptoms aren’t worrisome, and the proper stroke prevention measures are in place then it shouldn’t cause too much concern. If, however, AFib attacks are repeatedly happening then you need a new treatment plan with your EP.

Also, if you liked the photo attached to this article, it is a picture I took this week running out of Neff’s Canyon just after sunset in the mountains overlooking Salt Lake City.