Lone af help

Hi can anyone give me advice on my af.
I believe I have had it since then start of October when I think it was on and off until November then been permanent.
I was diagnosed with it on January 20th. I have been given Bisoprolol 2.5ml Eliquis apixaban 10mg.
My history is I'm a very fit 37 year old I don't smoke or often drink to much I have no other heart problems or any history in either side of my family of heart problems.
I am how ever a lone distance runner training about 50-70km per week and think that it first went out while running.
I'm also taking Amitriptyline 10mg and have been for a year. I was drinking to much caffeine.
Now they are planning on shocking my heart to try and reset it. Where I'm confused is they have told me I would be able to go back running after yet I see it as a cause for my af also a side effect of Amitriptyline I have read is a fast and irregular heart beat yet not one doctor has said it could be connected.
I have cut the caffeine right down and also eating even better . I read about vitamins helping what should I take as the doctors have said nothing about it.
Any help or advice would be appreciated as I'm sure many of you have seen some great doctors and found much out yourself.
Thanks spencer

First, I'm so, so sorry that you have this now. Afib is rotten. There are better words to describe it, but in keeping with decorum, I choose not to use them!
Second, the moderators of this group are very knowledgeable about medications and supplements and can help you with that, but the big question is, have you seen a true electrophysiologist, i.e., a cardiologist who specializes in arrhythmia's, and lists Afib as part of that specialty? They are out there - don't waste a moment of time, find one now.
Third, no more caffeine, ever. Sorry, I know, it sucks. But it's better to avoid Afib. Decaf is not so bad, yet asking for it always made me feel old. Fortunately, I love tea and there are lots of caffeine free teas. (I was diagnosed with Afib in my mid 30's as well.)
Finally, having Afib is a trial. You will find that you have to take much better care of your body and mind. Our whole body is so interconnected, yet often times doctors just treat the one system. That is how they are trained. It will be your job to incorporate the entire mind, body connection. Yes, should be able to run again, but long distance, I don't know. At what distance does the running cause more damage than good? I recommend you research other runners who have been diagnosed with this.
I hope you can get things squared away. It will not be a simple "fix it", but if you take care of yourself, get a good electrophysiologist, and make a few lifestyle changes, you'll be fine. (Sounds simple enough right?! I'm being sarcastic with the simple comment)
Best of luck,
Linda

Same here.

I was a 41-year old running 30-35 miles/week. AF tends to fall into two categories: adrenerigic (activity brings it on) and vagal (rest brings it on). Runners tend to have high vagal tone due to the long-term conditioning that occurs with exercise. What's your resting heart rate? Mine, for example, will wander down into the mid-40's in the afternoons.

Echo the thought on the EP visit. Many folks could suggest one if you let us know your general geographic location. In the meantime, I'd suggest cutting the caffeine and beginning an electrolyte supplementation program that includes the essential trio of magnesium, potassium and taurine. Cheated magnesium glycinate is the preferred form. Magnesium oxide is the worst and least effective. Taurine is really cheap, just find a health store somewhere. Potassium is a bit trickier, be careful not to overdo that one.

Long term, being only 37 and otherwise fit, you are likely an excellent candidate for ablation if lifestyle methods can't contain the AF. In no case would you want to be medicated or anticoagulated for the rest of your life. Start with a good team of cardiologist and EP and work from there. It sounds like you're just on the start of your AF journey. It will, unfortunately, probably last months to a year, but rest assured there is an end and it will very likely be no less than the restoration of your normal life. That's the good news.

Unfortunately I live just outside London in the uk and we tend to get what we are given with the NHS so it's best for me to find out everything I can about it for myself then if I choose to pay a large amount of money to go privert I will know who to go to.
At the moment I have another echocardiogram in 3 weeks and then have a ecg fitted and more blood tests they have said they will try to reset it with electric shock soon.
I have wonder if the Amitriptyline could be connected as fast and irregular heart beat is a side effect although I was taking it for a year prior.
My resting heart rate was 43-52 before now it's 75-90 but the moment I walk around it's 140-160 and running over 215 where my max was about 197 before.

Shannon has a list of highly reputable EPs in the UK. Sorry, I have no experience with the NHS (being a Yank and all!). Also the tri-cyclic antidepressant isn't anything I know about. More than likely someone here does.

There is also Bordeaux, should you elect to go the private route.

For an ablating EP, suggest Sabine Ernst <[www.rbht.nhs.uk] at Royal Brompton
<[www.afibbers.org]

My ticket to afib was also chronic fitness at 49. I'm now 61. My ticket into afib remission was a) chemically (flecainide) converting my 2 1/2 month episode (which started 2 months after my first afib episode) to NSR, b) supplementing with magnesium to bowel tolerance, c) a prescription for flecainide on-demand if I go into afib, d) detraining and e) not overdoing calcium in my diet. This works pretty well. I've had 3 episodes in the last 3.75 years for a total of about 2.5 hours of afib. The flec usually converts me in about an hour. By detraining, I mean I no longer train using endurance activities nor do I compete in them. I remain very fit and active. I now train with body weight exercises (TRX Military Fitness) and relatively infrequent Tabatas on a Schwinn Airdyne fan bike or Concept 2 fan rower. By active, I mean I ski off-piste 50+ days a year and a couple of weeks ago skied more than my age in vertical feet in one day. I also rock climb, hike, kayak & etc. My opinion is that long duration high heart rate activities are not healthy for the electrical system of my heart. This took me two years to get through my endurance exercise addicted skull before I fully implemented it. Short duration, like the tabatas, are OK. This would not be OK for an afibber with adrenergic triggers <[www.afibbers.org] . Most endurance athlete afibbers are vagal.

I was talking with a doc, Mark Cucuzzella <[naturalrunningcenter.com] , last weekend at a conference. Mark also is a high end runner (won the US Air Force Marathon running barefoot). We were talking about the excessive inflammation that running can cause. Mark says he uses the Maffetone approach <[philmaffetone.com] as he feels it is low stress. Whether it is low enough stress for a vagal afibber, I don't know. I don't plan to go back to running, but it is an interesting thought. Mark thinks the only days he gets stressed are competition days, like running Boston.

Mark is also a type 1.5 (late adult onset) diabetic, who controls his diabetes with a low carb ketogenic diet and no meds. Though not diabetic, I also follow this approach as I started to gain weight once I detrained.

The prior moderator, Hans Larsen, wrote a piece on endurance exercise <[www.afibbers.org]

Good luck!

George

Thank you all for your input and advice.
I'm not sure what sort of laf I have or if they will find out since they don't seem to do enough tests or really ask many questions.the other problem with the NHS is I can't speak to anyone who might know as the GP won't know and I can't get to see a cardiologist until they do the tests they want and pass them on to him then he comes to see me.
.I hope I will gain enough knolage before I see him so I can ask the right questions and get things going in the right direction if not then find the right person private.
After reading the article from the link I'm not sure I have run enough or be old enough for it to effect me in the same way. It talks about training over 45 minutes and I used to run 10k in the mornings around 40 minutes and a sub 90 min half at the weekends also I was only running 2 years and took 5 months off with back problems.
Are the running supplements any good they contain calcium 27mg magnesium 5mg potassium 60 mg per serving??
I will look into the above Sabine Ernst thanks again all

Spencer - Here's an overview of important considerations for you to understand. Part of this was a response to another afibber a while ago... and I've elaborated a bit more. My intention is not to overwhelm you, so read in small doses, but each point is an important consideration as much of it relates to lifestyle 'habits' that can be altered and which are known to have significant positive effects.

With runners, the main consideration typically links back to fundamentals involving dehydration, electrolyte/mineral imbalances and dietary habits that help excite heart cells…ie, caffeine, alcohol, and additives in packaged/processed foods such as MSG, artificial flavorings and even the process of cooking meats that liberates free glutamates which are excitotoxic to heart cells and are known to promote arrhythmia.

Pay attention to your water source. Purification chemicals are often detrimental as is added fluoride so try to drink pure, filtered water if possible....and consider making the home made version of magnesium bicarbonate water which provides the beneficial alkalizing factor as well as a magnesium bicarbonate.
Alkalinity and pH post [www.afibbers.org]

Endurance exercise is known to produce free radicals and oxidative stress which causes inflammation, so another goal is to reduce the oxidative stress with antioxidants. An inflamed heart will not be a calm heart.
Inflammation also contributes to thick, sticky blood (hyperviscosity) and with that comes the risk of stroke or myocardial infarction, so it’s important to be mindful of reducing the inflammatory factors.

While an ablation may obliterate troublesome cardiac cells, other cardiac cells still need the required nutrients for proper function. Heart meds typically don’t restore the nutrients, either. Actually, drugs help deplete the all-important magnesium so your diligence in daily repletion becomes top priority.

Magnesium supplementation is the place to start. Food sources are typically low and many things deplete magnesium…so virtually all afibbers need magnesium. Note that many afibbers find they need to take 800 mg and often higher doses of just magnesium…preferably in the amino acid chelate form (magnesium glycinate or bisglycinate) because that’s the most likely to reach the target cells easily.

Assess also your calcium intake from dairy …milk and cheese. According to Cardiologist, Thomas E. Levy, MD, JD author of “Death by Calcium,” most people consume far too much calcium …typically from dairy sources and that is known to overpower magnesium. Arrhythmias are just one complication of the imbalance. Increased calcium-to-magnesium ratios cause increased absorption of calcium and decreased absorption of magnesium which results in an absorbed calcium-to-magnesium ratio that is greater than the actual ratio of Ca:Mg taken in. While basic dietary guidelines typically emphasize that this ratio should be 2:1… the healthy ratio is actually the reverse with much more magnesium then calcium. This is important for those with arrhythmias because calcium is excitatory to cells whereas magnesium is relaxing.

There are other supplements that help support heart cell function… and have been discussed here in many posts and also The Strategy… [www.afibbers.org]

Check out the other Resources links on the importance of potassium, taurine and other detailed and relevant findings – including this Conference Room Report #72 on Potassium and Sodium Ratios…[www.afibbers.org]

From The Strategy:
Magnesium’s regulatory role in energy production, in the biosynthesis of catecholamines and other neurotransmitters needed for neuromuscular activity, as well as neurological excitability, muscle relaxation after contraction, and bone metabolism, gives magnesium a key role in musculoskeletal function and health.

Then after establishing your daily magnesium intake, consider also that you need optimal potassium intake either from food or supplements. It’s far easier to get enough potassium than magnesium from food sources. Yet, many people are consistently low in daily potassium and often much too high in sodium. Here again, the higher the sodium, the lower the potassium and the more likely the heart activity of afib or flutter because the lack of potassium allows for a faster time between heart beats (refractory period). When that happens, you are at much higher risk for slipping in and out of some form of aberrant heartbeat.

Another relevant clip on this ratio from The Strategy:

THE SODIUM-POTASSIUM PUMP – as it relates to afibbers

Richard D. Moore, MD, PhD (8) goes into great detail about the function of the sodium/potassium pump (Na/K pump) and what he calls the K Factor. (K for potassium; Na for sodium). While he is specifically addressing hypertension in his book, The K Factor, the science fits for afib as well because “tissue compliance” is dependent upon a dietary intake of potassium that provides a favorable ratio of K to Na in the body and ultimately, cells… every cell in all tissue of your whole body.

Early man’s consumption of sodium and potassium worked out to about 11,000 mg daily of potassium and only 690 of sodium. A ratio of about 16:1. (Moore) Other sources say the potassium was around 6,000 mg with 600 mg sodium. Salt was not a big factor in early man’s diet.

Dr. Moore says: “The low ratio of potassium to sodium in the typical American diet is one of the biggest - perhaps even the biggest -cause of bad health in our country.” So, let’s examine what this might mean to afibbers.

Cellular biophysics tells us that one of several dozen energy-consuming mechanisms in living cells uses about 25% of the total energy of that cell and therefore is of vital importance to that cell. This mechanism is the Na-K pump and it’s the key to survival for every cell in our body. Not only does this specialized pump keep potassium levels in the cell high and sodium levels low, but it makes an electrical current which is carried by positive sodium ions that the cell uses for itself, but also serves to regulate acid and calcium levels inside the cell. Dr. Moore says: “When a living cell is exposed to a substance that specifically inhibits the Na-K pump and without affecting any other mechanism…that cells dies. So this pump is of vital importance to everyone – afibbers especially.

Must view: video simulation of How the Sodium-Potassium Pump Works.
[tinyurl.com]


Quote from Principles of Biochemistry, 1992:
The activity of this Na/K-ATPase in extruding Na+ and accumulating K+ is an essential cell function. About 25% of the energy-yielding metabolism of a human at rest goes to support the Na/K-ATPase.
25%!! Think about it! If we don’t have these pumps working, imagine how this affects heart tissue, especially.

Dr. Moore says the ideal ratio of dietary intake will be between 2 and 4 parts potassium to one part sodium. In his book, he emphasizes 4:1.

His message: “The sum of intracellular K+ Na is a constant… meaning you can’t raise IC potassium unless you lower IC sodium.”

(Moore) (8) Chapter 4, p. 78: The Key Problem: An Imbalance in the Ratio of Potassium to Sodium (The K-factor)
"For purely physical reasons (connected with the law of osmotic equilibrium), inside the cell the sum of sodium plus potassium must be constant. This means that sodium can go up only if potassium goes down. Likewise, if potassium goes up, sodium must go down. So potassium and sodium are unalterably linked together like two children on a teeter-totter. You can't change one without changing the other."

POTASSIUM AND THE REFRACTORY PERIOD.
Potassium prolongs the refractory period…or the time when the heart is resting between beats. At this time, heart cells can’t be stimulated to contract.

Supporting biochemistry:
In the resting state, cardiac muscle cells are polarized due to gradients established by the active inward transport of potassium ions and the outward transport of sodium ions. Various stimuli-including drug-induced effects-can cause shifts in these gradients, producing a decrease in the internal negative membrane potential. This process is known as depolarization.(9)

Adverse effects or clinical consequences of potassium depletion predominantly affect the cardiovascular and neuromuscular systems. Both respond to the associated hyperpolarization of electrical tissue.
The presence of hypokalemia (potassium depletion), decreased membrane permeability to potassium (which prolongs action potentials), shortens refractory periods and increases the incidence of spontaneous and early depolarizations.
For cardiac cells, the result of these alterations is a propensity for arrhythmias, particularly in persons who are taking digitalis (Rutecki & Whittier) (10)

Caution: "A note of caution about beta blockers. Beta blockers diminish the regulation of serum K during potassium loading. In the presence of beta blockers, plasma potassium can spike during a potassium load."
Dr. Moore (8) Chapter 19, Information for the Physician, p. 323,
Drugs That May Make the K Factor Dangerous

It's not simply the amount of potassium that's important, it's the dietary and IC potassium-to-sodium ratio, which needs to be at least 4:1

Here’s the link to The Strategy so you can start at the beginning and read more. Two topics that will be in the revised version, include the importance of maintaining alkaline tissue pH continually and also the importance of vitamin D on heart cell function. [www.afibbers.org] and the Alkalinity post is here: [www.afibbers.org]

Start with your daily dietary assessment of those electrolytes/minerals… ie, magnesium, potassium, sodium and calcium so you know if you are eating wisely and safely. That’s a start. There is a lot to ‘digest’ here read and ask more questions. We are all here to help.

Best to you,
Jackie

This post is extremely helpful to me too! Thank you Jackie!

Quote
Spencer
Unfortunately I live just outside London in the uk and we tend to get what we are given with the NHS so it's best for me to find out everything I can about it for myself then if I choose to pay a large amount of money to go privert I will know who to go to.
At the moment I have another echocardiogram in 3 weeks and then have a ecg fitted and more blood tests they have said they will try to reset it with electric shock soon.
I have wonder if the Amitriptyline could be connected as fast and irregular heart beat is a side effect although I was taking it for a year prior.
My resting heart rate was 43-52 before now it's 75-90 but the moment I walk around it's 140-160 and running over 215 where my max was about 197 before.

That's quite a jump of HR, 43-52 to 75-90. That's before and after the TAD (Amitriptilyline)?
Do you really need this Drug? These TAD's have all sorts of side effects. Can you Try to go without it?
Yes increasing HR that much increases odds of getting AF.
You probably get PAC's (Premature Atrial Contractions) when you exercise (common for endurance athletes), and by increasing your overall HR, these become closer together, and rapid sequential PAC's raise AF risk. There is multiple things that happen in order to sustain AF, but rapid PAC's can definetly help initiate an episode.

Do you realize how you feel with that much of an HR increase? Just walking around, and your HR goes to 150! That is not normal, and I would hate it if that was happening to me. Also that high of a HR all the time would have other negative effects like over-stressing the Adrenal glands, with could also contribute to AF.

My heart rate was 43-52 Before I went into AF now I'm in AF it's 75-90 with beta blockers before the beta blockers it was 90-110.
To be honest I don't really feel it apart from dizzy spells standing up to quick and a feeling like anxiety a bit had it not been for my running times dropping all of a sudden it would of been a long time before I found out.Im trying to come off the amitriptyline that I take to block nurve pain in my back and see what happens. I have started on the magnesium
And looking into the other supplements also cut all caffeine out and see what happens.



Edited 1 time(s). Last edit at 03/05/2017 04:59AM by Spencer.

It is possible to run in full-blown AF (I've done it), but it is remarkably different than running in NSR! And, if the ventricular rate is high, it would be just about impossible, I think, to do much more than walk. I wonder if you were just experiencing multiple PACs during your excercise versus full-on AF. Everyone is different, though, so I suppose anything is possible.

All I know is when I'm running my heart shoots up so quick to 220-230 Bpm yet I'm not that out of breath although I just can't go any faster.
I always used to wear a heart rate monitor when running until it started giving readings that I thought can't be true so I stopped wearing it.
I race a half marathon two x country's and the British ocr finals in AF but my times were disappointing.
That's when I first stated seeing doctors who said I had asthma wasn't until 4 doctors later and I had told each one my resting heart rate was double normal that someone listened to my heart and sent me strait to hospital.

Before I knew I had afib, episodes would send my heart rate to 180. Normal resting Heart Rate was low 50's. I was in very good condition, doing lots of things including jogging. Once diagnosed and on HR control meds, an episode of afib would send my HR to 90-100. I pretty much could do every I would normally do, except exercise or very active sports. But my episodes would only last a few hours and only a few times a month, so life didn't change that much. After 6 years on meds, I finally got a successful ablation. That was 10 years ago.

I exercised normally in AFIB. Fortunately for me I can easily control my rate with Diltiazem and Bystolic, so that my HR is only slightly higher both at rest and during exertion from NSR baseline.

What are the best drugs to help with this? Is there anything I should ask for?

Medical treatment of AF has 3 parts:

Rate control (beta blockers - metoprolol, bisoprolol, etc)
Rhythm control (anti-arrhythmics propafenone, flecainide, etc)
Anticoagulation (warfarin, xarelto, eliquis, pradaxa)

Your physician may want to use one or all three. It depends on the case.

Tell your Doc that you like to exercise and don't want to be sedated. Tell him you want to get your AF rate (both resting and exercise) down as close to your normal HR as possible. The Doc probably never had AF, so he/she won't realize how much of a difference this can make. Cardio-selective Beta-blockers like Bystolic or Atenelol are known to not cause drowsiness, or effect Muscle tone at lower doses. Bisopropol is also listed as Cardio-selective, but I've never used it or researched how that compares to the other drugs. Calcium Channels Blockers like Diltiazem help slow down the Heart (rate control) and also will lessen the force of the Plapitations in AFIB. CCB do not generally cause sluggishness unless you take so much that your BP gets too low.

This will take some experimentation. Monitor your BP to make sure it's not too low, if you are taking these drugs to really get your AF HR down.



Edited 1 time(s). Last edit at 03/06/2017 06:13PM by The Anti-Fib.

Thanks that's good to know.

Hi Spencer.

I am in London too, and had long term persistent AF many years ago. What they are going to do for you sounds like an electrocardioversion - they knock you out for a few seconds and give you electric shocks to try to get the heart back into normal rhythm. I had three of them but they only lasted about 48 hours each time then I was back into AF and had to wait three months for the next one. I finally went to Bordeaux for ablation in 2003 which was successful so far.

Navigating the NHS is very tricky these days. Sabine Ernst has a good reputation and would be my choice if I needed NHS treatment but you will have to be clever and careful to get to her. First step is to get a referral naming her. This will then go to a committee who will vet it, and then probably offer you an appointment with a different consultant who has a shorter waiting time. The letter should have a phone number so you ring up and tell them that you want to change the appointment to Dr Ernst. Be prepared to insist, but politely!

It is really important that you see an electrophysiologist and not a cardiologist - the former are electricians, the latter are plumbers, and AF is an electrical problem.

If you would like to chat about it then send me a private message and I'll let you have my phone number.

Gill

Gill:

Why did u have to wait 3 months for the next one?
Are you saying you had to wait 3 months to get another Cardioversion? If so why? Insurance?

Thanks gill that's helpful. I have been waiting 2 months to get more appointments and only now are they going to check my urea,electrolyse and creat as that's just how the NHS works. I have that on the 19th a cardioversion pre check on the 22nd a ecg monitor fitted for 24 hours on the 23rd and a echocardiogram on the 31st of march.
I guess soon after that I will have the cardioversion. If this fails then I will push to see someone else and try Sabine first or at least go to papworth hospital not stevange/Welwyn
.what is Bordeaux I hear a lot about it ?

Spencer,

Bordeaux is where the whole AF ablation procedure got it's start about 20 years ago. Dr. Michel Haussegerre (horribly misspelled, I'm sure) was/is the pioneer. It remains a renowned center.

I had to wait 3 months because I was being treated by our underfunded NHS. There is a huge shortage of resources because in UK we spend a lower proportion of GDP on medicine than most other countries in Europe, and a huge amount less than in the US.

This means that if you have a life threatening condition you get superb treatment immediately, free of all charges, but otherwise you have to wait in the queue. If you can afford to pay for a private clinic you can get fast treatment for everything, but most people can't afford that.

In my opinion the last few governments have deliberately starved the NHS of funds in order to privatise it - as Chomsky said, defund, denigrate, divest. Sorry Shannon if that is a bit political!

Gill

Spencer - you asked about Bordeaux.

When I first got the AF diagnosis I didn't want to be on medication, which was the only thing being suggested back in 2002. I started digging on the internet and found a Reuters report which said that a Professor at the University of Bordeaux in south west France could do a procedure called radio frequency ablation which could stop the AF.

I asked the electrophysiologist I was seeing at King's College Hospital if it was a good idea. He said definitely not, it was a sledgehammer to crack a nut! (I have found that doctors who have not experienced AF themselve have no idea how disabling it can be and tend to see it as a nuisance.). I did masses of research, reading original articles in medical journals, and decided that ablation was a good option for me. I couldn't afford to go to the US, no one in UK was doing ablations at that time, and I speak fluent French, so Bordeaux was an obvious choice.

Although he didn't think it was a good idea the consultant at King's was very helpful, did a referral to Bordeaux, faxed all my records to them, and did all the folllow-up.

I had the ablation in January 2003. I was in despair when AF recurred after three days, but I was taken straight back to the lab for another ablation, and that was successful. I have been in normal rhythm since then. The total cost at that time, including air fares and hotels for three trips to Bordeaux, was £8,000. Best money I ever spent.

It will be much more expensive by now, and waiting lists will be much longer, but the team there are among the best in the world. If I need further treatment I will be back there.

Gill

Sounds alot harder to get a ECV over there. When I was first diagnosed, they did several tests on me right at first: Echo, Angiogram, and also put me on Blood Thinners. 3 weeks from diagnosis, I had my first ECV. If your in AFIB persistently, they should get your ducks in row, and Cardiovert you as soon as possible. The longer your in AFIB, the less chances of the ECV being successfull. After my 1st one, I either got Cardioverted in the ER room, within 1-2 days of the AFIB onset, or I schedule as an outpatient, and that takes 3-5 days to complete. Sometimes the ER staff are difficult, if they think its not an emergency, and of course, sometimes they are busy.

Hi I have read everything I could find on here about LAF is there anywhere I could find information regarding recent statistics
As most of theses seem to end in 2008 and I guess things have got much better now.

As Shannon always reminds us, the statistics really argue for one to seek out the most highly-skilled practitioner at the most reputable facility one can find. The broad-based statistics will include the leading EPs with the more pedestrian ones who only do a dozen or so procedures a year. If you isolate your research to the top tier facilities and practitioners, you will find that not only are success rates higher but also complication rates are lower.

The field evolves very fast. Probably due to the profit potential that an aging baby boomer demographic presents, but if that works in our favor then so be it, I say.

Quote
wolfpack
As Shannon always reminds us, the statistics really argue for one to seek out the most highly-skilled practitioner at the most reputable facility one can find. The broad-based statistics will include the leading EPs with the more pedestrian ones who only do a dozen or so procedures a year. If you isolate your research to the top tier facilities and practitioners, you will find that not only are success rates higher but also complication rates are lower.

The field evolves very fast. Probably due to the profit potential that an aging baby boomer demographic presents, but if that works in our favor then so be it, I say.

Very well said Wolfpack!

That is the problem with 'most ablation stats' that folks like Dr Mandrola quote when discussing what they see as equivocal results from AFIB ablation, the majority of such stats are often derived from data consisting of a significant majority of basically mediocre operators with modest experience levels, often with a much smaller number of more highly experienced true expert AFIB ablation operators mixed into the data whose daily practice is focused almost entirely on doing AFIB ablation and AFIB related procedures and very little else!

The smaller number of studies that are from top level high volume centers like Dr. Natale's group at St Davids or the Univ. of Penn, Bordeaux etc, show far lower complication rates and significantly higher long-term success from an 'expert ablation process'.

Read the Desmukhs study from several years ago which was a meta-analysis carefully analysing every Medicare ablation done in the US over a 10 year period from 2000 to 2010 ( PVI ablation for AFIB started at the end of 1998, and since the 91,800 AFIB ablation done in the US over that time frame represents a significant majority of all AFIB ablations done during that time the stats are pretty much applicable to all AFIB ablations during that period.

The shocking finding that out of this large groups of 91,800 some odd AFIB ablations >/= 81% of all these cases were done by essentially greenhorn EPs doing <25ablations a year and at small to mid size centers doing total of less than 50 ablations a year at those hospitals!!! Yikes!

Not surprisingly the lions share of more significant complications were found in this group of under experienced operators and similarly inexperienced centers! Those who would have had the wisdom wand foresight to have sought out the top 10% of more elite operators ... or better yet ... the top 5% of operators in terms of individual total volume of AFIB ablations done by the EP ... the complication rate was vanishingly lower in the top tier groups of EPs/centers compared to the over 81% doing <25 ablations a year who largely had no business doing ablations with such a low volume of cases they could attract each year

For those considering an AFIB ablation, save yourself a lot of guess work via way too much trial ... often with too much error involved ... by simply deciding you are going to entrust your only heart's care to ONLY the most experienced AFIB ablationist with the highest volume of challenging cases in their track record history that you can possibly arrange for yourself.

This is the golden prescription for sleeping much easier, not only leading up that that index procedure, but from then on as well when following up with whatever amount of work might be required by a true maestro-level expert to render one's particular degree of AFIB progression and complexity to a state of durable silence again and for the long term. Such that the former afibber can barely tell any longer that they even have a heart beat ... just like in the good 'ole days before the beast ever made an appearance in one's life!

Cheers!
Shannon



Edited 1 time(s). Last edit at 03/12/2017 07:54PM by Shannon.

Thanks for the advice .
I think that even though I have only just been diagnosed with afib and 37 years old I think that I have had it since I was 23. I first had a attack watching a film when my heart started pounding and I found it hard to breath I did attend hospital a couple of days later and a ecg showed all was normal then and they told me I suffered from panic attacks.
I would find this would sometimes happen over the next 15 years when I had been drinking heavy two days in a row being young and out with my friends on the weekend .
I had been to see the doctors many times and always the same tests diabetes thyroid but always fine and they continue to tell me it's panic attacks. Theses days how ever I don't drink much and keep very fit but my diet has let me down. My afib seems to be long turm as 4 months now and I'm hoping that the cardioversion will switch it back and I can keep it at bay with lifestyle change. If not and long turm I will try to fine the best ep I can but if abulation is needed I might have to go to France and that's a shame seeing we pay for the NHS anyway

Today I had my cardioversion and was told it was successful but after leaving the hospital a hour after I could feel it was back in af and to my knowledge I never felt it any different so I guess it reverted before I woke up. Next step abulation I guess.