Atrial fibrillation on holiday: Tips for Travel and Prevention
The Summer holidays can be a time for vacation and relaxation. However, patients living with a medical condition like Atrial Fibrillation may experience anxiety traveling abroad and away from the safety net of their healthcare team.
However, a good understanding of the condition coupled with preparation can mitigate a lot of the challenges when experiencing an AF event on holiday.
The first half will look at "Holiday Heart Syndrome" - the phenomenon of increased AF events during holidays and the second half will look to give practical tips and advice to remember alongside your Passport!
Holiday Heart Syndrome and Atrial Fibrillation:
What is Holiday Heart Syndrome?
In the late 1970s, an American physician coined the term 'Holiday Heart Syndrome' for the unusual phenomenon he was noticing of increased prevalence of hospital presentations with arrhythmias during holidays and the weekends, even in people who do not have previous heart disease. The pattern was clear- the irregular heart rhythms were associated with the intake of alcohol, especially binge drinking but the name 'Holiday Heart' stuck for the group of patients who have no other illnesses but fall into AF after drinking. Subsequently, several systematic reviews and meta-analyses have investigated the association between alcohol consumption and atrial fibrillation.
Why Does Holiday Heart Syndrome Happen?
The onset of AF may occur during a binge or up to 36 hours after it. The alcohol molecule can make heart cells hyper-excitable and thus more likely to go into AF. Furthermore, during a 'hangover', adrenaline levels can spike and when combined with the resulting electrolyte depletion and dehydration, it sets a perfect environment for AF to start. Palpitations, dizziness, and sweats are not uncommon in the hangover state and so it can be challenging to know where the hangover ends and AF begins.
How to Manage Holiday Heart Syndrome
Prevention is better than cure. Moderated (or no) alcohol intake, stay hydrated, and a balanced diet eliminates the trigger.
However, we know that in Holiday Heart, AF usually ends spontaneously with rehydration, replenishment of electrolytes, and as the adrenaline dissipates. But waiting it out is often easier said than done for the person going through it.
If medications are needed it usually responds well to tablets that neutralise adrenaline like beta-blockers. For a person experiencing AF in this setting for the first-time, it may herald future episodes in the setting of alcohol or even without. So it is important to try to make the diagnosis if you experience such symptoms because the risk of stroke can still be there and may need addressing with blood thinners.
Managing your AF when Abroad
Having a pre-existing diagnosis of AF doesn't eliminate the anxiety when going away. Leaving the safety net of your local GP, arrhythmia nurse or Cardiologist may make patients feel vulnerable to the possibility of developing an AF episode in a foreign environment and not know what to do.
Note: this does not constitute medical advice, simply general comments that may not apply to a specific patient or situation. So be sure to do your own research and speak to a healthcare professional for personalised advice. Here are some topics to think about...
1.Know Your Condition
AF on its own is not life-threatening. It can cause terrible symptoms though and that's why you can feel unwell and need medical attention. If you're having a typical AF episode and you know how long it usually takes to settle, sometimes just rest and recovery can do the trick. If you've been exposed to one of your known triggers e.g. Holiday Heart- addressing this directly with lifestyle fixes may be of value.
Plan Ahead with Your Medications
Carry an adequate supply of your anti-arrhythmia medication. If you're flying, keep a supply in your carry-on in case the airline loses your luggage. This might seem like a no-brainer, but if you haven't had an AF event in a long time or if you've had your AF treated with ablation, you might be on a pill-in-the-pocket regimen (meaning you don't take your tablet every day, only if you get symptoms). If that's the case, make sure you have a full (in-date) supply from your pharmacist to take away with you.
Prepare Essential Medical documentation
Have a copy of your ECGs and take any documentation from your hospital check-ups detailing your medical history and current treatment plan. Today, that could be just a few pictures or PDFs on your smartphone. This information will be valuable if you need to seek treatment abroad as it will help them understand what your heart function is like, what medications you take, and how long you've had AF.
Anticoagulation and Emergency Care
You may have a medic-alert bracelet but I would suggest going one step further if you're travelling to a foreign country. Go to Google Translate and have a local interpretation for how to say "I am taking a blood thinner tablet for my atrial fibrillation. I have not missed any doses in the last 4 weeks" (if that's true).
From an AF perspective, if you need a cardioversion to restore normal rhythm, it may save you a trans-oesophageal echo (a camera down the food pipe). This can be needed to check for blood clots in the heart in case they don't know your anticoagulation regimen. Additionally, if you need any other medical treatment or surgery whilst abroad, it can be very helpful then too.
Always take ALL the documentation
Speaking from experience, it can be so hard to piece together what happened in a foreign A&E without all the paperwork. If the episode leads to hospital admission, it's important to:
a) guide your further treatment escalation (if needed)
b) to know what the rhythm problems were when abroad (remember, just because you have AF doesn't mean other heart rhythm problems can't appear, which is why your Cardiologist is always asking for ECGs!
After any medical intervention abroad, request
- an ECG from when you arrived (and any after treatments too)
- a detailed discharge letter
- blood test results
- the reports from any scans or procedures
Getting hold of these once you've left the foreign hospital is close to impossible
Conclusion: Remember, though living with AF can bring challenges, it shouldn't prevent you from traveling. Let me know what you think of these travel tips and please share this post with anyone you know with AF making plans for the Summer!