Ectopic beats 3 months after cryoablation

I had a cryoablation for Atrial Fibrillation with an excellent EP in London on December 5th, aimed at PV isolation. After a few 'interesting' arrhythmias things have settled down nicely, and I have had no episodes of AF (Atrial Fibrillation) in the last 5 weeks although I still get plenty of ectopics.

One area that has interested me is the question of ectopics. Reading on the subject has revealed the following:

Ablation aimed at electrical isolation of PVs is designed to prevent impulses within the PVs from penetrating into the left atrium and initiating reentrant wavelet propagation, which in turn leads to AF.

As my AF is absent (at least for now) presumably the impulses within the PVs are not penetrating into the left atrium. In which case why do I still get so many ectopics?

It appears possible that non-PV AF trigger sites may be present, but if that is the case why are they not causing AF for me?

I would be very interested in comments from people who have a better understanding of the ablation rationale and process than I do.

Hello Herbert and welcome.

It's not uncommon for some ectopic activity to continue after the ablation blanking period for some individuals for a while longer than is typical as everyone is slightly different as the heart settles down. Many here have found that getting back on the dietary regimen of the regular supplementation of the core electrolytes needed to help maintain stable, normal sinus rhythm. This would include mainly magnesium but also with an assessment of dietary sources of potassium and limiting calcium and sodium.

Be aware that in "The Grand Scheme of Things"... with Afib, it's almost always necessary to make lifestyle risk management adjustments on a permanent basis. As an example, this would be an awareness of too much sodium from processed and prepared foods, sometimes too much calcium from a diet high in dairy, not enough fresh, fruits and veggies that have a significant potassium content. Adequate, continual hydration habits with pure water free of chemicals is important and also avoidance of alcoholic beverages on a regular basis. ,,,,Just to name a few.

If you were aware of 'triggers' prior to your ablation, you may need to continue to avoid those as well since. For example, if they triggered an inflammatory response in your body that set off the Afib, then you need to continue to eliminate because the ablation doesn't correct the inflammatory reaction.

Check at this link for various reports that may be helpful. [www.afibbers.org]

We are all happy to try to help.

Jackie

Herbert

After my ablation in Bordeaux in 2003 I experienced huge numbers of ectopic beats, almost 8,000 on one 24 hour Holter. They were very uncomfortable, like being kicked in the chest every few minutes, even though the EP said they were a nuisance not a problem.

Following advice on this forum I started supplementing with magnesium, no difference. I then added taurine, slight improvement. Finally I added potassium and there was an amazing difference, I couldn’t feel them at all, thought they had stopped. But a subsequent 24 hour Holter showed just as many.

I have continued these supplements for many years and accept that the ectopics still happen, but they seem to be dampened down, I don’t feel them unless I check my pulse, and I now just forget about them. In some ways they are a good thing because as far as I know you don’t get them when you are in AF, so each one is a reminder that I am in dinus rhythm!

Gill (Pronounced Jill, and female)

Hi Jackie and Ms Gill,

Many thanks for your ideas.

Although there does appear to be an excess of wishful thinking over hard evidence for magnesium supplements I will follow your suggestion and give magnesium a go. Incidentally Gill did you know your blood potassium level prior to taking the supplement?

Herbert

Herbert - It's more than just wishful thinking. It’s been known for a very long time that magnesium deficiency is common and is related to a variety of heart problems not the least of which is arrhythmia. Several books, papers and websites are devoted to examining the impact of magnesium deficiency on not only heart health but many other health issues as well.

Here’s a sample.

Start with the reports here and here in the Afibbers Forum Archives
[www.afibbers.org]

[www.afibbers.org] - just scroll down through the titles


[www.ncbi.nlm.nih.gov]

[www.ncbi.nlm.nih.gov]

[www.ncbi.nlm.nih.gov]

[www.ncbi.nlm.nih.gov]


Doctors writing on Magnesium benefits

(This contains the relevant facts)
The Magnesium Factor
Mildred R. Seelig, MD, MPH and Andrea Rosanoff, PhD.
[www.amazon.com]


Carolyn Dean, MD, ND… on Magnesium Deficiency
[drcarolyndean.com]

Magnesium by Alan R. Gaby, MD
[www.amazon.com]

Mark Sircus, OMD on Magnesium deficiency symptoms and diagnosis
[drsircus.com]

Paul Mason - Magnesium-Deficiency Catastrophe: The Magnesium Web Site
[www.lifeextension.com]
Magnesium water website…. [www.mgwater.com]

Jackie

Thanks for all these Jackie.

There is a huge amount of very interesting information, opinion, circumstantial evidence, and fervour there, however I may have missed it but I didn't find any Hard Evidence of the efficacy of Magnesium supplementation in Atrial Fibrillation. By this I mean a double blind, randomised clinical trial, properly designed, properly monitored, and analysed by a statistician.

I must point out that I am a medical statistician and have spent my life working with clinical data. It is possible to assemble massive quantities of early stage scientific research, there can be vast numbers of medics who passionately believe in the treatment, and there can be lots of anecdotal evidence, but all of this means little until conclusive results from a good quality clinical trial (ideally more than 1) are available.

Having said this I have ordered some of the supplements on a "nothing to lose" basis.

Herbert - yes - well, as you probably know, research $$ aren't often spent on confirming these natural remedies because they aren't funded by Big Pharma.. ie, no large profit picture for patent revenue..... but you can find a variety of benefit confirmations in the References Section of the Magnesium Factor book by Mildred Seelig or the Research section at the Magnesium Water website... you'd just have to have the time, patience and interest to slog through all the entries.....such as this one: [www.mgwater.com]

I wish you well with your supplementation... sometimes the form of the magnesium and the dosage needs to be varied due to individual needs and tolerances. Let us know your progress.

Jackie

Herbert

>>Gill did you know your blood potassium level prior to taking the supplement?<<

I knew that it was within normal range. I have blood tests every 6 months to check kidney function is ok because any excess magnesium and potassium are excreted by the kidneys. The results are always the higher end of normal for both of them.

I understand your quest for solid evidence, feel the same way myself, but, as Jackie said, no one is prepared to pay for double blind clinical trials unless there is the possibility of making money out of them. But I feel a lot more comfortable since I started taking the supplements, and they don’t do me any harm. In this game we are all experiments of one.

>>presumably the impulses within the PVs are not penetrating into the left atrium. In which case why do I still get so many ectopics?<<

My understanding is that parts of the heart muscle (inside the coronary sinus in my case) produce electrical signals when they shouldn’t, so you feel the ectopics. They don’t cause AF because the rogue signals hit a scar and go no further.

Gill



Edited 2 time(s). Last edit at 02/23/2018 06:49PM by Gill.

Thanks very much for your comments Gill.

I agree with your 'experiments of one' for the ectopics . My plan is to give the supplements a month or so to see if they have any effect on the ectopics. If the ectopics do seem to have improved then I will stop the supplements for a week and see if the ectopics return. This should test whether any improvement was due to the supplements, or just to continued improvement since the ablation.

I think the position regarding supplements for episodes on paroxysmal AF (Afib in USA) is impossible to assess on an individual basis, due to wildly varying patterns on episodes and the long time periods involved. This definitely needs a clinical trial.

Another very good reason for me to try potassium, magnesium and taurine is that recently I have been hit with major muscle cramps which is playing havoc with my attempts to swim. It appears that all three can be helpful in relieving the cramps
- another test to carry out at the same time. It is also possible that apixaban may be causing the cramps.

Herb

Herb - muscle cramps are classic signs of magnesium deficiency... (and also dehydration).

On your plan to start and stop the electrolytes/minerals to see if they are effective.... as an example...magnesium may take several months to become optimized intracellularly and stopping for a week may not show up in symptoms, but very well could give you a setback if you hadn't yet reached optimum IC levels. Having enough IC magnesium continually is a lifetime commitment for health.... that and the other required essential electrolytes in the proper ratios.

Incidentally, there is study confirmation that magnesium IVs do prevent arrhythmias from occurring after cardiac surgery procedures.

Jackie

Jackie,

Yes, I know about the IV studies after cardiac surgery, Good circumstantial evidence but ,sadly, different treatment and different indication.

I would think a month would be a reasonable time for treatment to show some effectiveness. If no effect then maybe I will give it a little longer. These products are absorbed and excreted within hours. Not too worried about a setback - more important to me is to establish what does and does not work.

Herb

Gill,

"My understanding is that parts of the heart muscle (inside the coronary sinus in my case) produce electrical signals when they shouldn’t, so you feel the ectopics. They don’t cause AF because the rogue signals hit a scar and go no further."

This was my thinking originally but I don't think it works for PV ablation, because rogue signals hit the scars before they hit the atrium. If they stop there then they won't produce an ectopic. And the electrical signals on their own cannot be felt apparently. Hence the mystery.

Herb

I'm new to this page and I'm reading about the supplements you should be taking. How many milligrams should I be taking of the magnesium, omega 3, taurine, and potassium gluconate is the potassium safe to take I once heard of my can drop your heart

Kathy,
I am only just starting on these supplements, but from a little reading these are the doses I am going for:

Potassium gluconate
Dose: 500 mg/day of elemental potassium (from potassium gluconate)
Tablets contain: 595 mg of potassium gluconate =100g potassium
My dose: 1 tablet 3 times daily with food + water + 2 tablets at night

Magnesium taurate
Dose: 375 mg/day of elemental magnesium (from magnesium taurate)
Tablets contain: 2 capsules = 250mg magnesium
My dose: 1 tablet 3 times daily with food + water

Taurine
Dose: 3-4g / day
Tablets contain: 1g
My dose: 1 tablet 3 times daily with food + water

Hope this helps.

Herb

Kathy - There are general guidelines and; most importantly, guidelines for you, specifically, based on your overall health status, if you take medications, your current afib status, your lifestyle risk factors and dietary nutritional intake overall that influence nutrient selection and dosing recommendations.

Everyone is different in their nutritional status and especially with the core electrolytes so dosing is typically offered in generalities and what works for some may not be tolerated in others. For this reason, we often say "we are experiments of one."

We can certainly help guide you if you provide more details. As a start, I'd suggest you read through The Strategy posted a number of years ago which offers the basic, core nutrients that are found to be helpful and why.

Go to this link and then scroll down to The Strategy. [www.afibbers.org]

Jackie