Questions on Lone AFib Situation

Hello all, this is my first post. I am 43, decent health (with the caveat I’m about 15 lbs overweight at 6’2” and 215 lbs) and fairly active. On in August of 2016 I woke up with AFib with RVR. I headed to the Duke Medicine ER in NC in the early morning thinking I my time was up. After sitting in the bed for 15 mins ready to meet my Maker, I asked the nurse who was nonchalantly walking around that this must not be serious. She said “We see this daily. Relax, you are fine.” Needless to say, that was difficult to do. My HR was bouncing from 110 to 160 depending on what was going on. They gave me some Cardizem to slow my heart down, but it seemed to work only a little bit. The one ER doc would freak out if my rate went above 120, making me more stressed.

About an hour later, my blood tests came back. My potassium was at 2.9. So, in went the potassium… a lot of it. I converted naturally to SNR around 5 hours later. The staff thought I was on some kind of illegal drugs, given my situation. They wanted to test me. I confessed that I did drink 1-2 energy drinks and ate 1-2 pieces of 50mg caffeine gum a day. I also found out that I had undiagnosed sleep apnea when the EKG monitor kept screaming at me that I was in apnea. The nurse thought it was an error, but then I thought about the same thing happening 12 years ago… another incident of low potassium I had during a 6 mile run sending me to the ER (no afib at the time, just tachycardia with a HR over 200 and severe cramping) and the monitor barking “apnea”. So, my PCP sent me for a sleep study and I have it… badly. So now I am on CPAP and compliant with that (AHI < 0.4 over 30 days).

I’ve been free of afib runs, I think, since then. I am back on a 30-day monitor because I had two episodes over the last 2 weeks of my HR going to 80-100 bpm for 2 hours and the beats feeling VERY strong. I mean I could feel these over my whole body and the bed was shaking that I was laying on. They were regular, though, so I don’t know if I was in afib and my ventricles were trying to deal with the mess, or it was something else. One seemed to start after a week binging on high sodium snacks and sugar free drinks (non-caffeinated) and the other was when I was on travel and woke at 3am with my heart racing at 110 BPM, but went down to the 80-90 region for a few hours, though it did peak again around 3pm to 80-105 for an hour or so while sitting down.

My question is, what is the prognosis for holding off afib? I know it will come back at some point in my life, but what are the chances? I have taken better control of my diet. Cut out caffeine, sans a single cup of coffee once or twice a week if I am not feeling antsy in my chest like I do before my rare PVCs. I haven’t really drank much alcohol over the last 10 years. I make sure I follow the vitamin/mineral regiment on this website and get my potassium checked regularly.

Also, final question. If it comes back, would it be wise to tackle the beast now and get an ablation at my age with only a few attacks?

Thanks!

6'2" and 215lb isn't terribly overweight. A PCP may pay it lip service, but you'll be hard pressed to find an EP who will care too terribly much about that body mass index (they probably routinely see MUCH, MUCH worse).

Your potassium is key here. Get on a supplement if not actual prescription potassium chloride. Magnesium supplementation is recommended to help your body absorb the potassium. If you can, nix the caffeine as it just makes you shed K and Mg. Sodium is also bad.

Given your history, an EP consult is certainly a fine thing to do, but I wouldn't rush head long into the ablation process until you've given supplementation and electrolyte management a try. Of course, if things worsen in spite of that, you can always get on the list. Duke is a decent center. I had my ablation done there just a year and a half ago.

Good work on getting the apnea addressed, that will help in the long run.

And, love the comment on ER docs and wanting to test you for illegal drugs! LOL! I know it's unavoidable, but ERs are horrible places for bedside manner. I was 41 when I first presented in the Raleigh, NC, Rex hospital with AF. They thought I was binge drinking for an entire weekend! Sheesh. Don't take it personally is all I can say.



Edited 1 time(s). Last edit at 02/09/2017 08:08AM by wolfpack.

Welcome Fibbin –Sorry you have to visit this website, but you’ve certainly come to the right place. At least the ER caught your low potassium and restoring your levels put you back in NSR. It’s not always the case as ER treatments vary a lot.

It’s often said that developing Afib is the canary in the coal mine… signaling that something is out of balance in the body.

Good that you’ve identified many of your triggers… the low potassium, sleep apnea, stimulants such as caffeine and energy drinks, artificial sweeteners (chemicals) in diet drinks and the need to replenish electrolytes continually since you are a runner and make sure your sodium intake doesn’t overpower your potassium intake. Hidden sodium can be a huge culprit. You should plan to make lifestyle changes immediately and eliminate those negative factors permanently.

Magnesium is the core nutrient for stabilization; potassium can’t work without optimal intracellular magnesium. Having the ExaTest is a good place to start so you know the true intracellular levels of electrolytes.

If you are dedicated to optimizing and balancing your electrolytes plus managing the sleep apnea, you have a good chance not to need an ablation. And, certainly, ablation doesn’t correct nutritional deficiencies so you’ll need to be mindful of those for a lifetime so you can continually support healthy heart cell function. Work on these first and give it some time - 3 - 6 months.

Spend some time reading the reports at this link [www.afibbers.org]

We’re all here to help.

Jackie

Get thee to a cardiologist, with perhaps a referral to an electrophysiologist too. Tons of information on this web site but your individual condition warrants real ticker specialists, not just ER docs despit the fact that they may be excellent physicians. You have take a huge step getting the sleep apnea treated, something I stupidly ignored for years -- to my ultimate detriment.

Wolfpack and Jackie,

Thanks for the info and kind words. It makes me feel better that I can keep in NSR for quite some time (hopefully).

JayBros,

I have been to the cardiologist quite a few times. In fact wearing a 30 day monitor for a second time to catch this weird heart thumping I got twice per my message above in the last month.

I have a stress test next week just to make sure there are no blockages. I had an echo that I passed, also. After that, I am switching over to an EP at Duke proper. It is rated #5 in cardiology in the country, so I am feeling a little good about it.

Thanks