Long story.. advice would be greatly appreciated

Hi, my name is Billy. I'm 54 yo and have been dealing with afib since 01. It started out in 01 when I was going through a horrible divorce and my heart went afib for over 24 hours. I went to the hospital and was converted using a cardizem drip within a half hour. Had all the tests etc. and was told it was lone afib. Didn't have many episodes but maybe once or twice a year and they would self terminate.
Within a few years the episodes were becoming more and more frequent but they would only last a couple of hours or so.

I remember one day very clearly. I was sitting on the couch and eating on a bag of Funyuns when I noticed my heart rate escalating and then I went into afib. I put the puzzle together and realized it was the msg in the funyuns that caused it. It turned out I must have had an addiction to msg as most of the food I had in the cupboard contained it. I threw it all out and stopped consuming msg and I had zero afib for many years unless I accidentally ingested it. In 2010 I began to have afib episodes again with no apparent cause. Usually after exersize or after waking or basically when just doing nothing. I studied a bit and figured out I had the vagal type of afib.

As the years went on, it just has gotten worse and worse and I've tried many things to try and tame it. I've tried all the usual a fib supplements and I've had many tests done on my heart. In the past 3 years, I've had 2 ablations and neither has improved my condition. If anything, its gotten worse. I've read alot about afib and mine seems to be somewhat unique in the fact that it is completely debillitating for me. When I am in afib, I have trouble walking 20 feet at a time. If I get out of a car for instance I have to hold onto the car for a minute or so to get my bearings because I'm blacking out. I've passed out many times and once while driving. My afib is very distinct and I no it immediately when it starts. It starts with just a couple of skipped beats and then goes full on afib withing 5 seconds or so. It feels like someone gave a 4 year old a pair of drum sticks and let him play drums for the first time. I am in afib 50% of the time. Its almost like clockwork now. I'll go two and a half days in afib and then two days without afib. Right now I've been in afib for a little over two days so I expect to go nsr hopefully soon.
This is killing me because I cant do anything anymore. I cant plan anything or work. Its completely ruined my life. However, the days I am in nsr, I'm in pretty good shape. It takes a bit for me to get energy back because of the long duration of the afib but I'm usually pretty good when in nsr and have decent energy..

My Dr, (Dr Malay Gandhi,) who performed the two ablations, has given me a few options now going forward. Another ablation, a pacemaker, an av node ablation w/pacemaker or drugs. I've been on cardizem and metropolol, metropolol for high bp as well, we've tried propafenone with no change as well. None of that has changed anything except keeping my heart rate in check. My pulse usually doesn't go over 110 in afib and bp drops some but stays relatively normal. ( I should say systolic drops, not diastolic)

Doing some research, I've read that beta blockers are not helpful with vagal afib and can possibly make it worse. I've been taking 50 mg of metoprolol 3 x's a day for many years so I asked the Dr if I could get off them and try something else. So now the plan is to take cardizem and flecanaide to try and control rate and rythym. I was just at the Drs today so I haven't tried it yet. Does this sound like a reasonable plan?
Without any BP medication my BP was running 165 over 115. (of course that was years ago as I haven't went without BP medication in 7 or 8 years.)
I just dont know what to do any more. My quality of life has gone down the toilet. At this point I'm starting to get very depressed. Before all of this afib, I was a very happy upbeat person.
I have other issues as well. I have crohns disease and have been battling that for awhile too. I have also been taking ppi's for 25 years or so because of a hiatal hernia and a valve in my esophagus that doesn't close. I feel that the vagus nerve is playing a role in my afib but can't put a finger on it and determine the exact cause.
ANY suggestions or reccomendations would be appreciated. I have no health insurance and I've been getting all of my help through the florida dept of health. Feel free to ask any questions as well.

Thanks in advance, Billy

Hi Billy, sorry to heart your struggle. So you got your first afib at age 37...I got mine at 36 when having multiple stressful events and anxiety. Through your post I can kind of seeing my not so bright future. I’m sure someone is going to advise you to get an ablation with Dr Natale. But well, you’ll need to get proper insurance first...

I jut wanted to know how was your quality of life in the past 17 years. I know you had put in some history in above.

Good luck!

Quote
kong2018
Hi Billy, sorry to heart your struggle. So you got your first afib at age 37...I got mine at 36 when having multiple stressful events and anxiety. Through your post I can kind of seeing my not so bright future. I’m sure someone is going to advise you to get an ablation with Dr Natale. But well, you’ll need to get proper insurance first...

I jut wanted to know how was your quality of life in the past 17 years. I know you had put in some history in above.

Good luck!

Hi, my quality of life was pretty good up until about 2011. Thats when the afib really started to escalate. Its like a run away train now. I'ld be happy just to get some reduction in the amount of events. Good luck to you as well.

I don't know how your complicating Health issues relates to your AFIB, but in general, Yes trying a Calcium Channel Blocker would make sense. It should help lower your BP. Also makes sense to try Flecainide, although I would recommend that you start out slow with a low dose, and titrate up. Still good options like this to explore. Many of us have used Cardizem and Flecainide successfully.

Commiserations Billy!
I'd try to establish what causes your high BP. Is is ischemia, reaction to food or environmental or perhaps a combination. Also crohn's disease needs to be dealt with at the same time.
Seems to me that both would/should respond to some, perhaps radical, changes to diet?

20 or so years ago i had high BP (about 170/180 over ???) and it turned out that my habit of using thymol as a mouth wash was the cause. Stopped using it and BP went down to normal range.

First off, you need a new EP. You do not want, repeat do NOT want, an AV node ablation and pacemaker. That is an irreversible process and every second of your life will depend on a machine in your chest.

It certainly sounds like you could benefit from a more experienced EP such as Dr Natale. Health insurance will be an issue. You can always go “fee for service” but it won’t be cheap. Others can perhaps give a ballpark number.

My number one advice for now is don’t do something that is permanent. That eliminates options in the future.

Billy:

Would the Florida dept. of Health pay for another ablation? There is a Hospital in Florida that is part of the Cleveland Clinic, a few people have gone there for their ablations and did well. Dr. Natale, who is in Texas now and a famous doctor once was with the Cleveland Clinic in Ohio.


Cleveland Clinic Florida | Highest Ranked Hospital in ...
[my.clevelandclinic.org]

Find out more about Cleveland Clinic Florida's medical center. Home to over 240 of the world’s top physicians and specialists representing 40 specialties.

Your doctor mentioned you might need a pacemaker, just a pacemaker without a node ablation (you don't want that, I have a pacemaker I got it because when I was in AF and going back into NSR I would almost black out, my heartrate would almost flatline. The pacer stops that from happening, but for gosh sakes don't let them ablate your AV node. You could have a heart block and beta blockers make it worse unless you have a pacer.

Liz



Edited 2 time(s). Last edit at 04/11/2018 11:15PM by Elizabeth.

AV node is the atrio-ventricular node. It is the “gate” between the heart’s atria (upper chambers) and ventricles (lower chambers). It is responsible for passing the electrical activity in the atria down to the ventricles. In Afib, it will often reject every other pulse from the atria (something called 2:1 conduction), which is why our atria may fibrillate at something like 300 beats per minute, but our ventricles only respond at 150 bpm. It’s not fun, but it does keep us alive.

If the AV node is ablated, that permanently breaks the connection between the sinus (SA) node in the right atrium and the ventricles. At that point, your heart would only have the ability to beat autonomously at the rate of ventricular repolarization, which is something like 20 to 30 beats per minute. That is insufficient to pump enough oxygenated blood through the body and would be fatal in just a few minutes. Hence the need for a pacemaker to replace the “broken wire” between the SA node and the ventricles. Your atria will fibrillate uncontrollably, but the pulses will have no way to get to the ventricles, which will only respond to the pacemaker. The beat may feel more regular, but some cardiac insufficiency will remain due to the lack of atrial “kick” priming the ventricles and you will be on anticoagulation therapy for life to prevent clots from forming in the atria since at that point all attempts at atrial rhythm control have been forever abandoned.

Sinus (SA) node ablation is something I’ve never heard of. While it may be performed in some exceedingly rare cases of something called “sick sinus syndrome” it certainly has no bearing on AF management.

wolf:

I didn't mean to call it a snus node ablation, it is a AV node ablation, but I said and I strongly said DO NOT ABLATE THE NODE. His doctor mentioned a pacer and the node ablation/pacer, two options, Bill said he almost passed out a few times, he may have a heart block, that may be why his doctor mentioned a pacer, that is set at anywhere from 50 to 60 (heartrate) so if his heartrate falls below 50 the pacer kicks in.

Liz

Billy, I hope you find a solution. As you no doubt can tell, Natale is highly regarded on this forum and one of the best, if not truly the best, EPs on the planet.

If you are looking into an ablation with him, here are the details on the three locations where he works in the US and the fees for the preliminary consultation with him if paying cash: Natale insurance, location and availability

FYI, the receptionist at Natale's San Diego office recommended getting a PPO-type plan if shopping for insurance for an ablation procedure there.



Edited 1 time(s). Last edit at 04/12/2018 06:43PM by DavidK.

I agree with WolfPack and Liz. An AV Node Ablation/Pacemaker would like an absolute last resort.

Sorry to hear of your problems.
Your research would have revealed that the three key triggers associated with AF are weight, high BP and sleep apneoa.
A question is whether you have all three of those under control?

I am 63 and have had AF for over 20 years. I have had four Catheter Ablations, the most recent only two months ago was unsuccessful. Now I am scheduled for a Cox IV Maze next week.

Cox IV Maze may not be appropriate for your condition, but it is something you should look into...there are a number of variants such as the Wolf Minimaze: minimally invasive or fully endoscopic. All involve Bipolar radio-frequency devices and cryo are used to burn through the entire thickness of both atrium walls, in a pattern which blocks off the Pulmonary Veins and completely fences of atrial walls that are the source of electrical activity. Surgical access to the heart: and some variants create the lesions using Atricure RF clamp only from outside the atrium.

Cox IV involves surgical access to the heart, then incisions in the atrium through which the RF and Cryo ablation tools are inserted to create lesions...this scar tissue is electrical inert. Cox IV lesions are continuous, go through the entire atrium wall and completely enclose and isolate the main electrically active problem areas, it is expected that the electrical isolation will be complete and that AF will be fully controlled.

The procedure also involves removal or clamping of the Left Atrial Appendage, which is a small sac on the left atrium which is the source of 95% of clots in AF sufferers, and the source of our main risk of stroke...so it is the main reason we take anti-coagulants. My LAA will be removed, which will mean that in the course of my recovery I will go off anti-coagulants for good.

Cox IV is the gold standard for ablation, with a success rate of over 90% across its population, around 10% of whom continue to require some Anti Arrhythmic Drugs. That population includes patients whose procedure combines valve replacement or coronary artery bypass, for whom the success rate is reduced. After 5 years, studies show over 80% remain AF free.

Wolfpack,

I would respectfully point out that to the best of my knowledge (for whatever that's worth!) 2:1 conduction applies to A Flutter, not A Fib. In A Fib the ventricles respond in a totally random ad hoc manner - hence the term irregularly irregular. Some folks will have a AF ventricular rate of 170BPM (very unpleasant) or anything down to 70 BPM (often totally asymptomatic).

I see lots of folks on forums here in the UK who've had an AV node ablation and pacemaker and they feel way better than they ever did in AF. Yes one is reliant on a pacemaker, but then again so are millions of other folks out there in addition to which the vanishingly small risk of a properly serviced/checked PM failing is usually outweighed by the risks associated with symptomatic AF particularly where the ventricular response rate is not adequately controlled (which it can't readily be for some folks who just don't get on with the necessary drugs).

So far as I'm aware in the absence of anything from the atria the junctional rhythm from the AV node to the ventricles is around 40-60 BPM which just about keeps things going, so when you refer to 20-30 BPM do you mean that once the AV node has been ablated there is no more junctional rhythm with it just being the ventricles that kind of just chug along on their own without anything from the now-ablated AV node? This is one aspect of it all I remain a little unsure about.

Regards,

Mike F

Quote
wolfpack
AV node is the atrio-ventricular node. It is the “gate” between the heart’s atria (upper chambers) and ventricles (lower chambers). It is responsible for passing the electrical activity in the atria down to the ventricles. In Afib, it will often reject every other pulse from the atria (something called 2:1 conduction), which is why our atria may fibrillate at something like 300 beats per minute, but our ventricles only respond at 150 bpm. It’s not fun, but it does keep us alive.

If the AV node is ablated, that permanently breaks the connection between the sinus (SA) node in the right atrium and the ventricles. At that point, your heart would only have the ability to beat autonomously at the rate of ventricular repolarization, which is something like 20 to 30 beats per minute. That is insufficient to pump enough oxygenated blood through the body and would be fatal in just a few minutes. Hence the need for a pacemaker to replace the “broken wire” between the SA node and the ventricles. Your atria will fibrillate uncontrollably, but the pulses will have no way to get to the ventricles, which will only respond to the pacemaker. The beat may feel more regular, but some cardiac insufficiency will remain due to the lack of atrial “kick” priming the ventricles and you will be on anticoagulation therapy for life to prevent clots from forming in the atria since at that point all attempts at atrial rhythm control have been forever abandoned.

Sinus (SA) node ablation is something I’ve never heard of. While it may be performed in some exceedingly rare cases of something called “sick sinus syndrome” it certainly has no bearing on AF management.

Quote
mwcf
So far as I'm aware in the absence of anything from the atria the junctional rhythm from the AV node to the ventricles is around 40-60 BPM which just about keeps things going, so when you refer to 20-30 BPM do you mean that once the AV node has been ablated there is no more junctional rhythm with it just being the ventricles that kind of just chug along on their own without anything from the now-ablated AV node? This is one aspect of it all I remain a little unsure about.

There are three natural pacemakers in the heart: the SA node, the AV node, and below that the Bundle of His. When the AV node is ablated all that's left functioning is the Bundle of His, and it produces a heart rate in the 20-40 bpm range (usually closer to 20 than 40). So that's what wolfpack was referring to. Many people think that following an AV node ablation failure of your pacemaker will result in instant death, but that's not true. You won't fall over dead, but you will be very ill with a heart rate barely adequate to keep you alive until EMS can get to you and begin pacing you externally.

Many thanks for the response Carey - most informative and much appreciated. Good to know those folks who've had an AV node ablation still have a fighting chance even in the highly unlikely event that their PM goes wrong - providing, of course, they're not too far away from emergency care.....
Cheers,
Mike F

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The Anti-Fib
I don't know how your complicating Health issues relates to your AFIB, but in general, Yes trying a Calcium Channel Blocker would make sense. It should help lower your BP. Also makes sense to try Flecainide, although I would recommend that you start out slow with a low dose, and titrate up. Still good options like this to explore. Many of us have used Cardizem and Flecainide successfully.

Thanks for the advice. I hope to get some relief anyway. Do you know how long it would take for that combo to take effect or not?

Quote
Joe
Commiserations Billy!
I'd try to establish what causes your high BP. Is is ischemia, reaction to food or environmental or perhaps a combination. Also crohn's disease needs to be dealt with at the same time.
Seems to me that both would/should respond to some, perhaps radical, changes to diet?

20 or so years ago i had high BP (about 170/180 over ???) and it turned out that my habit of using thymol as a mouth wash was the cause. Stopped using it and BP went down to normal range.

You make good points. EVERYTHING is connected. I've tried many different diets both for my afib and crohns. I have many different triggers that I'm aware of. But in my experience its like a time bomb. Its gonna go off, its just a matter of when. I can accelerate that by consuming a trigger. As example, drinking an ice cold drink. can set it off if I'm somewhat due for it. Otherwise, the cold drink may not bother me at all if I just came out of afib. Thank you

Quote
wolfpack
First off, you need a new EP. You do not want, repeat do NOT want, an AV node ablation and pacemaker. That is an irreversible process and every second of your life will depend on a machine in your chest.

It certainly sounds like you could benefit from a more experienced EP such as Dr Natale. Health insurance will be an issue. You can always go “fee for service” but it won’t be cheap. Others can perhaps give a ballpark number.

My number one advice for now is don’t do something that is permanent. That eliminates options in the future.

I'm not happy with the guy. He is very short with words and he doesn't like to listen. Just a bad communicator. Others have said the same thing about him. To his credit, he really wasn't advocating for an AV node ablation. he basically was sayings its a last resort and I agree. He called it "end stage". I interpret that as last stop for a cure.lol.
I would love to go to a better EP. Hopefully that happens some day.
Thanks

Quote
Elizabeth
Billy:

Would the Florida dept. of Health pay for another ablation? There is a Hospital in Florida that is part of the Cleveland Clinic, a few people have gone there for their ablations and did well. Dr. Natale, who is in Texas now and a famous doctor once was with the Cleveland Clinic in Ohio.


Cleveland Clinic Florida | Highest Ranked Hospital in ...
[my.clevelandclinic.org]

Find out more about Cleveland Clinic Florida's medical center. Home to over 240 of the world’s top physicians and specialists representing 40 specialties.

Your doctor mentioned you might need a pacemaker, just a pacemaker without a node ablation (you don't want that, I have a pacemaker I got it because when I was in AF and going back into NSR I would almost black out, my heartrate would almost flatline. The pacer stops that from happening, but for gosh sakes don't let them ablate your AV node. You could have a heart block and beta blockers make it worse unless you have a pacer.

Liz

The dept of health would pay for another ablation as I was offered on by my current Dr. It is still offered but I don't want him to do it because hes already done 2 and I've had no improvement at all. I would have no confidence with him doing another.
Thanks so much for the links for the Cleveland clinic in Florida. I looked it up and it may be promising. They dont mention ablations specifically but they may do them.
As to the pacemaker. He offered me a pacemaker with the last ablation and I said no and he agreed that it wasn't really neccessary. The reason he suggested it was because when I wore a holter for 2 weeks they reported that I had several times where my heart wasn't beating for a few seconds. I dont know. I may end up with one if I cant get this straightened out.
Oh and I had one time where I blacked out coming back into NSR. It was really strange. I've blacked out many times in afib though.
Thank you

Quote
Elizabeth
wolf:

I didn't mean to call it a snus node ablation, it is a AV node ablation, but I said and I strongly said DO NOT ABLATE THE NODE. His doctor mentioned a pacer and the node ablation/pacer, two options, Bill said he almost passed out a few times, he may have a heart block, that may be why his doctor mentioned a pacer, that is set at anywhere from 50 to 60 (heartrate) so if his heartrate falls below 50 the pacer kicks in.

Liz

What is a "heart block"? I just had an echo a few weeks ago and I was in NSR and they said everything was fine.

Quote
DavidK
Billy, I hope you find a solution. As you no doubt can tell, Natale is highly regarded on this forum and of the best, if not truly the best, EPs on the planet.

If you are looking into an ablation with him, here are the details on the three locations where he works in the US and the fees for the preliminary consultation with him if paying cash: Natale insurance, location and availability

FYI, the receptionist at Natale's San Diego office recommended getting a PPO-type plan if shopping for insurance for an ablation procedure there.

Thanks alot for the info. It sounds like this Dr is the best. It would be nice just to meet him.

Quote
tiggwigg
Sorry to hear of your problems.
Your research would have revealed that the three key triggers associated with AF are weight, high BP and sleep apneoa.
A question is whether you have all three of those under control?

I am 63 and have had AF for over 20 years. I have had four Catheter Ablations, the most recent only two months ago was unsuccessful. Now I am scheduled for a Cox IV Maze next week.

Cox IV Maze may not be appropriate for your condition, but it is something you should look into...there are a number of variants such as the Wolf Minimaze: minimally invasive or fully endoscopic. All involve Bipolar radio-frequency devices and cryo are used to burn through the entire thickness of both atrium walls, in a pattern which blocks off the Pulmonary Veins and completely fences of atrial walls that are the source of electrical activity. Surgical access to the heart: and some variants create the lesions using Atricure RF clamp only from outside the atrium.

Cox IV involves surgical access to the heart, then incisions in the atrium through which the RF and Cryo ablation tools are inserted to create lesions...this scar tissue is electrical inert. Cox IV lesions are continuous, go through the entire atrium wall and completely enclose and isolate the main electrically active problem areas, it is expected that the electrical isolation will be complete and that AF will be fully controlled.

The procedure also involves removal or clamping of the Left Atrial Appendage, which is a small sac on the left atrium which is the source of 95% of clots in AF sufferers, and the source of our main risk of stroke...so it is the main reason we take anti-coagulants. My LAA will be removed, which will mean that in the course of my recovery I will go off anti-coagulants for good.

Cox IV is the gold standard for ablation, with a success rate of over 90% across its population, around 10% of whom continue to require some Anti Arrhythmic Drugs. That population includes patients whose procedure combines valve replacement or coronary artery bypass, for whom the success rate is reduced. After 5 years, studies show over 80% remain AF free.

Your research would have revealed that the three key triggers associated with AF are weight, high BP and sleep apneoa.
A question is whether you have all three of those under control<<

I have heriditary high BP, (although its not that high). I'm taking metoprelol for it and I think it may be making afib worse because its a beta blocker and I am a vagal afibber. I'll be trying a CCB soon instead. The Cox IV sounds really good. My Dr said a maze/any maze is very ineffective. I dont think he is correct on that. I hope you have success with it.

Quote
Elizabeth
Billy:

Would the Florida dept. of Health pay for another ablation? There is a Hospital in Florida that is part of the Cleveland Clinic, a few people have gone there for their ablations and did well. Dr. Natale, who is in Texas now and a famous doctor once was with the Cleveland Clinic in Ohio.


Cleveland Clinic Florida | Highest Ranked Hospital in ...
[my.clevelandclinic.org]

Find out more about Cleveland Clinic Florida's medical center. Home to over 240 of the world’s top physicians and specialists representing 40 specialties.

Your doctor mentioned you might need a pacemaker, just a pacemaker without a node ablation (you don't want that, I have a pacemaker I got it because when I was in AF and going back into NSR I would almost black out, my heartrate would almost flatline. The pacer stops that from happening, but for gosh sakes don't let them ablate your AV node. You could have a heart block and beta blockers make it worse unless you have a pacer.

Liz

Liz, this is a good suggestion. Sergio Pinski is a Natale protege'. Ten years ago, I referred my cousin to Dr. Pinski after I thought he was getting bad advice from his EP. Pinski did a successful ablation that has lasted since.

<[my.clevelandclinic.org]

George



Edited 1 time(s). Last edit at 04/12/2018 08:48PM by GeorgeN.

Quote

What is a "heart block"? I just had an echo a few weeks ago and I was in NSR and they said everything was fine.

It is the abnormal delay or outright failure of the AV node to transmit the pulse from the atria to the ventricles. It comes in degrees. 1st degree is just an abnormal delay and isn’t really serious as long as the patient is symptom free and the delay shortens under exertion. 2nd degree is when a beat actually gets “dropped”. That and higher requires treatment.

It is a separate condition from AF, and not related.

Quote
Billyjeans
Your research would have revealed that the three key triggers associated with AF are weight, high BP and sleep apneoa.

Not so sure the science fully agrees with you. Some cardiologists might agree based on their clinical experience, but I'm unaware of any compelling evidence that weight and hypertension are causative factors. The world is full of obese, hypertensive people who don't have afib and non-obese, normotensive people who do. The evidence for sleep apnea is a bit better (but why are Brits so fond of adding unnecessary vowels? ;-))

Wolfpack: and bill

Thanks for the explanation of a heart block.. When I first got AF, my doc. put me on a beta blocker, my EP believes that is what led to my first degree heart block. For me, when having an episode of AF and going back into NSR my heart rate almost flatlined for a few seconds and I would almost black out, it happened a couple of times, the last time it was caught in my doctors office. My EP immediately had me go to the hospital for a pace maker, which I did. I am glad I have It, I have never had that blacking out again, my pacer is set at 50, I very seldom have to depend on it.

Bill if you had a heart block it would show on your echo or EKG, so if everything was ok then you don' have it.

Liz



Edited 2 time(s). Last edit at 04/12/2018 10:07PM by Elizabeth.

There are doctors, and then there are doctors. Some are good and some must be avoided. I just had an echo, and the technician said one of her friends recently got AFib which was totally debilitating...she was unable to walk as fare as her letterbox. The community hospital said take this drug and lets see how you feel in a month. Her local doctor said keep taking this drug and lets see how you feel in a month, but she got a referral to a cardiologist. The cardiologist said keep taking this drug and see how you feel in a month. After a few months of this she was no better and felt life as she knew it was escaping her, so she went to a major emergency centre, who after their tests said they could not let her leave...and soon after gave her a cardioversion she restored sinus rhythm.

In the course of my early AF treatment if changed cardiologist three times before finding one I was satisfied with...who also happened to be Professor of Cardiology at the major in-state teaching hospital. So I would recommend you shop around.

I am unfamiliar with crohns, so cannot comment on possible interaction between crohns and AF teatrments, particular the maze procedure. However, to my mind, a cardiologist who's opinion is that the maze if ineffective would immediately signal to me that I should hurry up and find a different cardiologist. The results of studies of Maze procedure success can be found through Google.

Catheter Ablation success is usually indicated as around 90%, but there is success and then there is success. In this context, success is a reasonable improvement with or without anti-arrhythmic drugs. Persistent, drug-free resolution of AF through Catheter Ablation is only around 70%.

Cox IV Maze success is usually indicated as around 80% persistent, drug-free resolution, increasing to 92% when those continuing to require anti arrhythmic drugs are required, across all categories of eligible patients regardless of weight or other underlying illnesses. After 5 years, the figure does decrease to around 70% and 80%...

Of course, as I am only a few days away from having Cox IV Maze surgery, i am taking the most positive of views...it a a confronting prospect even in its least-invasive form and so not acceptable option for everyone.

I medicate for mild BP, and understand there are five classes of BP medications. Betablockers are one class, which are also used in the treatment of AFib, so I agree it is worth trying others. Betablockers make my heart rate crash...the lowest I have had is 29 bpm on betablockers...although my normal heart rate is low, coming in around 50 bpm

I was on Flecanide for 18 months after Catheter Ablation #3 in 2016. I did have several episodes while on it, the most recent of which went for two months leading up to Catheter Ablation #4 in Feb 2018. So, at least for me, Flecanide benefit was limited at best.

As for being on Warfarin, if you tolerate it and you have a stable INR, then these are good reasons to persist with it. Otherwise, there is a range of new generation anti-coagulant drugs available, which only involve a tablet a day and no blood testing...

My wife controls her BP by absolutely minimising dietary sodium...our western processed diet contains an excess of sodium versus potassium, whereas the reverse occurs in a fresh food diet high in vegetables...in combination with beetroot juice...beetroot naturally suppresses blood pressure, and studies have shown two or three a day reduces blood pressure in the majority of those with high bp.

tiggwigg,

Your story resonates re salt intake.

MSG in excess WILL put me into AF (well, an ectopic set against a backdrop of MSG will). Last 3 years I've had 6 AF episodes: last 3 years I've had 3 Chinese take-aways (no more again!) and each time 2 hours later (8pm) AF (AF for me normally 1am to 6am). Flecainide has worked well for me as daily preventative for 10 years. It's a sodium channel blocker. Last AF episode 16th March at 5am I'd 100g bag of no-MSG pork scratchings (love 'em!!) around 10pm - checked packet following day and 3.9g of salt in those... . Today shopping I looked for the first time really looked at salt content. I like poppadoms as snacks. 0.7g salt in each one! Salsa dip for crisps. Around 3g in one jar (hat I'd always eat in its entireity - I'm not one for moderation, never have been... although I'm having to learn to be...)! With a PhD and AF for 19 years it's only finally NOW that I'm starting to really look at salt intake..... I know many here will advocate 'the body's many cries for salt' and suchlike, but for me I'm gearing up towards really cutting it down, although not eliminating it. Just some late evening musings. Everyone of us is a unique experiment of one - never a truer word written.

Best to all!

Mike F.

Hi Mike - The MSG is not only the sodium issue, but also has the excitotoxic effect from the glutamate component. Together, they undoubtedly spell double-trouble for afibbers.... especially those who may be low in potassium, magnesium or both.

Glutamate can certainly stimulate arrhythmia. Remember Fran Ross and her story about the glutamate content as a result of long cooking times of meat and how she eliminated her AF by significantly reducing the cooking time and thus, the free glutamate content. So, makes sense if one consumes packaged, processed foods that have taste enhancers added such as MSG.. and of course, a lot of extra salt for taste appeal, those prone to AF are easy prey. Today, the increasing popularity of bone broth should be a concern for those who tend to be sensitive to free glutamate as well.

Soon I'll be posting a reminder about the role of taurine that's especially helpful for irritation to heart nerves from exposure to the excitotoxic damage of glutamate. Hope to finalize it this weekend.

Jackie

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Jackie
Hi Mike - The MSG is not only the sodium issue, but also has the excitotoxic effect from the glutamate component. Together, they undoubtedly spell double-trouble for afibbers.... especially those who may be low in potassium, magnesium or both.

Glutamate can certainly stimulate arrhythmia. Remember Fran Ross and her story about the glutamate content as a result of long cooking times of meat and how she eliminated her AF by significantly reducing the cooking time and thus, the free glutamate content. So, makes sense if one consumes packaged, processed foods that have taste enhancers added such as MSG.. and of course, a lot of extra salt for taste appeal, those prone to AF are easy prey. Today, the increasing popularity of bone broth should be a concern for those who tend to be sensitive to free glutamate as well.

Soon I'll be posting a reminder about the role of taurine that's especially helpful for irritation to heart nerves from exposure to the excitotoxic damage of glutamate. Hope to finalize it this weekend.

Jackie

Have you ever heard of anyone trying the supplement GABA? I just recently found this and thought it was curious.

[examine.com]

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Billyjeans
Have you ever heard of anyone trying the supplement GABA? I just recently found this and thought it was curious.

[examine.com]

Yes.

It makes you sleepy. I doubt it has any first order effect on AF, but it may help to calm a person. I use it nightly, as I have terrible problems getting to sleep. It works.

Hi Jackie,

I have often wondered what happened to Fran/how she’s doing these days - have you ever heard from her in recent years?

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Jackie
Hi Mike - The MSG is not only the sodium issue, but also has the excitotoxic effect from the glutamate component. Together, they undoubtedly spell double-trouble for afibbers.... especially those who may be low in potassium, magnesium or both.

Glutamate can certainly stimulate arrhythmia. Remember Fran Ross and her story about the glutamate content as a result of long cooking times of meat and how she eliminated her AF by significantly reducing the cooking time and thus, the free glutamate content. So, makes sense if one consumes packaged, processed foods that have taste enhancers added such as MSG.. and of course, a lot of extra salt for taste appeal, those prone to AF are easy prey. Today, the increasing popularity of bone broth should be a concern for those who tend to be sensitive to free glutamate as well.

Soon I'll be posting a reminder about the role of taurine that's especially helpful for irritation to heart nerves from exposure to the excitotoxic damage of glutamate. Hope to finalize it this weekend.

Jackie