203 afib episodes (and still counting)

Hi everybody.
I'm new to this forum and relatively new to afib, since I got my first attack in Nov 2015, and I hope finding some help and good advices here, where many people are experiencing for years things I'm only living for months.

Since Nov 2015, I've known hundreds of afib attacks, had lots of exams, tried several kinds of meds and diets, and had three ablation procedures.

In the beginning, I had about two afib attacks a month, each lasting 12-24h, with horrible symptoms. Docs gave me propafenone, then sotalol, then flecainide. In vain. With Sotalol my BP and HR were too low (even with less than 80mg/day), I was feeling bad and still experiencing afib. Class 1c rhythm drugs (flecainide, propafenone) were just a little more effective, because I can only tolerate low doses (to avoid dangerous QRS enlargement), and afib was still frequent.

Since my first ablation procedure (PVI), in Sept 2016, my afib attacks were shorter (1-2h) with lighter symptoms, but I got them about two times a week instead of two times a month. I was globally feeling better, but I had lots of premature beats (up to ten thousands a day).

I had another EP procedure in Feb 2017 (a total failure – they did not even manage getting me in afib) and a last one three weeks ago. Of course, it's too soon to say this very recent procedure is a success or not, but I've still unsustained afib about 2 times a week, for 1 hour or two. During those events, there are PACs and PVCs, the former probably kicking some unsustained afib.
I'm still taking flecainide (2x50mg) and bisoprolol (1x2.5mg), plus 400mg magnesium citrate. Because of my recent ablation, I must also carry on taking dabigatran for a couple of months.

I'm a 60 y.o. physically active male, BMI 20, biker (not for performance) with a healthy heart. Everything is normal, except for some GERD (I've a bad lower esophageal sphincter). Because of this, I've been prescribed a PPI drug, but I don't take it any more. Too bad for digestion and bowels, and as I don't feel any heartburn, I think it's better avoiding PPIs.
Nevertheless, my HR problems are nearly always combined with stomach bloating. I'm more likely having PVCs after meal, but afib attacks usually come during the second part of the night (from 1 or 2 AM), sometimes just before standing up.
I've tried some diets (gluten free, FODMAP free...), but without success.

I've lived more than 200 afib episodes, and I still don't know what triggers them ! Of course, some movements (leaning forward, standing up or laying down quickly) may induce premature contractions ; and I've to start exercise gradually. Outside of this, it's a mystery. I'm just sure afib is always announced by premature beats. Each time I believe having found a culprit, the next weeks make me realize it was probably just a coincidence.
At the moment, I think I'm just prone to afib and, as soon as I'm receptive, a lot of different things may trigger it. When I'm not, even two monk beers wouldn't kick anything.
Being receptive is a vague notion, but I'd say it's when I'm weak (sick, very tired), dehydrated or excessively anxious; and, above all, when my last afib attack is older than two days. So, I've found a stupid rule : « the further my last afib attack, the nearer my next ».

I've read here lots of comments from people having mainly long afib episodes. Did some of you already experienced many short afib attacks, like those I've to bear? How did they evolve?
Do you think the short unsustained afib attacks I'm getting since my recent ablation procedure are a good or bad sign? What should I do? What should I expect?

Thanks for reading and for your advices to a « young » afibber.

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Pompon
Do you think the short unsustained afib attacks I'm getting since my recent ablation procedure are a good or bad sign? What should I do? What should I expect?

Well, they're not a good sign but being only three weeks out from the procedure they're not a sign of failure. It's possible the episodes will end in the coming weeks as the lesions form scar tissue. It's not really possible to predict how it will go at this point.

What country are you in? And has the same doctor done all three of your ablations?

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Carey

Well, they're not a good sign but being only three weeks out from the procedure they're not a sign of failure. It's possible the episodes will end in the coming weeks as the lesions form scar tissue. It's not really possible to predict how it will go at this point.

Thanks for your answer, Carey.
After my PVI ablation, I've had nearly the same consequences: lots of premature beats often leading to afib; but back then, symptoms were stronger and afib sustained. Now, I'm always feeling everything, but it's bearable. It seems better, but not about to cure.

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Carey
What country are you in? And has the same doctor done all three of your ablations?

I'm from Belgium. Here, we have an obligatory health insurance system, so healthcare is "nearly free".
I've seen three EPs. The PV ablationI and the second attempt have been done by one of them. I've been referred to a third EP (connected with the team at Bordeaux) for the recent attempt.

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Pompon
I've read here lots of comments from people having mainly long afib episodes. Did some of you already experienced many short afib attacks, like those I've to bear? How did they evolve?

I've had afib for 16 years. In the beginning my episodes were few and far between and didn't last very long. Maybe a few hours. I could go months at a time with no afib. As the years went on I had more episodes and they started lasting longer. In the year before I finally had an ablation (just two weeks ago) my afib would come a few times a month and last for days, the longest being 5 days.

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Victoria

I've read here lots of comments from people having mainly long afib episodes. Did some of you already experienced many short afib attacks, like those I've to bear? How did they evolve?


I've had afib for 16 years. In the beginning my episodes were few and far between and didn't last very long. Maybe a few hours. I could go months at a time with no afib. As the years went on I had more episodes and they started lasting longer. In the year before I finally had an ablation (just two weeks ago) my afib would come a few times a month and last for days, the longest being 5 days.

I'm worried about this. I don't want getting more and more afib. As my episodes are very frequent, I hope they carry on being short. If they went longer, I'd be close to permanent afib.

Thanks for your answer.

After having been afib free for a full week, I got my 204^th episode this monday from 5:00 to 5:55 AM.
The event followed the classic scheme for me :

1.- Last meal between 6 and 7 PM
2.- In bed at 10 PM and quickly asleep.
3.- Three to four hours of good sleep, then waking up with a bloated stomach and some premature contractions.
4.- If I can relieve the pressure (burping), I may sleep again (to wake up about one hour later with the same problem). If not, premature beats get worse and may trigger afib.
5.- Sometimes, standing up may help, but it's not a rule.

It seems the problem comes only at rest. Just sitting for a while is enough. No need to sleep. I guess it's because being active helps burping, while resting or sleeping allows the gas being trapped in the upper part of the stomach and creating bad pressure on the diaphragm, heart, lungs and descending aorta.
I've tried some diets (gluten free, FODMAP free...), but without success.

It seems to be a digestive problem (from the bowels?), the bloated stomach disturbing the heart. But why not the opposite: heart rhythm disorders disturbing the stomach and the bowels?

I don't know what to do. I'm afraid having more and more afib.
Do you have any suggestion? Some good advices?

Pompon - The gas/bloating during sleep can be from numerous sources... one might be that you have a sensitivity to lactose ... consumed during your last meal. That's a fairly easy fix...cut back or eliminate dairy and if you do consume, then use the enzyme, Lactase, when you do eat any dairy. An OTC product is Lactaid. This is not a dairy allergy - that's another issue.

Another related issue can be inadequate stomach acid which means that mainly proteins and fat aren't broken down adequately in the stomach because you lack the nutrients to produce enough stomach acid (hydrochloric acid or HCl) to break down foods adequately. Therefore, it doesn't pass through the stomach in a timely manner and sits in the stomach and causes gas and bloating. Two angles of attack there... have a Digestive Analysis test to determine what's missing... and supplement accordingly.... and while you're waiting for results, you can begin with a digestive enzyme supplement with meals ... a 'multi' for digestion. One that I have personal experience with is by Source Naturals... Read more at this link... [www.iherb.com]

Sometimes, if the problem is protein digestion and if the Source Natural's product doesn't do it, you may have to add more pancreatin enzymes separately and also Betaine Hydrochloride.

Ideally, you correct the foundational issue which is is not enough of the proper nutrients to make enough of your own natural stomach acid... and that involves the testing to determine your levels of the various B vitamins, zinc, iodine, and such. ... but often, the digestive aids help in the interim until you can determine the deficiencies and a plan to build up the natural stomach acid. Vegetarians are most often found to have vitamin B deficiencies which leads to the inadequate stomach acid and digestive issues.

Allergies can result also from not enough natural stomach acid.... thus the allergic response can be inflammation, gas and bloating.

Last can be gut dysbiosis. Again, specific GI testing is the best way to determine what's causing the problem. It can be parasites or other microbes, Candida (yeast) overgrowth, H. pylori or total lack of the beneficial microflora that are required in the entire GI tract to keep your body functional. The importance of a healthy microbiome is now connected to brain health as well. Again... testing targets the culprits and then you follow the appropriate protocol remedy.

You'll need to consult with a physician who has advanced training in Functional Medicine because they are the only ones who know which tests to order and how to interpret them so you can find relief. I can elaborate more if you like... send me a PM.

Jackie

Hi, Jackie. Thank you so much for your kind informative answer.
I've already had numerous tests, but I'm not sure to use the correct words to name them (here we are french speaking)...

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Jackie
Pompon - The gas/bloating during sleep can be from numerous sources... one might be that you have a sensitivity to lactose ... consumed during your last meal. That's a fairly easy fix...cut back or eliminate dairy and if you do consume, then use the enzyme, Lactase, when you do eat any dairy. An OTC product is Lactaid. This is not a dairy allergy - that's another issue.

I've been tested for lactose sensitivity: nothing wrong. I've then tried myself eliminating dairy for some weeks, but nothing changed.
I've tried eliminating other usual suspects, like gluten, but the bloating was still there. So, I cut back FODMAP for more than two months. It was just slightly better with stomach bloating, and I was suffering from constipation. This "fodmap" diet eliminates lots of healthy fruits and vegetables. Too bad for my bowels!

Quote
Jackie
Another related issue can be inadequate stomach acid which means that mainly proteins and fat aren't broken down adequately in the stomach because you lack the nutrients to produce enough stomach acid (hydrochloric acid or HCl) to break down foods adequately. Therefore, it doesn't pass through the stomach in a timely manner and sits in the stomach and causes gas and bloating. Two angles of attack there... have a Digestive Analysis test to determine what's missing... and supplement accordingly.... and while you're waiting for results, you can begin with a digestive enzyme supplement with meals ... a 'multi' for digestion. One that I have personal experience with is by Source Naturals... Read more at this link... [www.iherb.com]

I've been checked for this too... Forgive me If I can't name things the way I should, but here's what I underwent:

- Gastric emptying scan
- Abdominal ultrasound exam
- GI endoscopy
- Colonoscopy

Everything was normal, but they found I'd some GERD because of a weak lower esophageal sphincter, and some gastritis. I was prescribed a PPI drug (pantoprazole) I only took for some months. I stopped it progressively: it was too bad for my bowels (constipation) and I had dyspepsia.
I then took (and I'm still taking) some bitter plants, and it's better. I avoid late meals and very acid food, and I sleep with my head and torso slightly raised. I don't feel any heartburn.

Quote
Jackie
Sometimes, if the problem is protein digestion and if the Source Natural's product doesn't do it, you may have to add more pancreatin enzymes separately and also Betaine Hydrochloride.
Ideally, you correct the foundational issue which is is not enough of the proper nutrients to make enough of your own natural stomach acid... and that involves the testing to determine your levels of the various B vitamins, zinc, iodine, and such. ... but often, the digestive aids help in the interim until you can determine the deficiencies and a plan to build up the natural stomach acid. Vegetarians are most often found to have vitamin B deficiencies which leads to the inadequate stomach acid and digestive issues.

Allergies can result also from not enough natural stomach acid.... thus the allergic response can be inflammation, gas and bloating.

You're probably right about this: not enough stomach acid.

Quote
Jackie
Last can be gut dysbiosis. Again, specific GI testing is the best way to determine what's causing the problem. It can be parasites or other microbes, Candida (yeast) overgrowth, H. pylori or total lack of the beneficial microflora that are required in the entire GI tract to keep your body functional. The importance of a healthy microbiome is now connected to brain health as well. Again... testing targets the culprits and then you follow the appropriate protocol remedy.

You're probably right about this too. I've been checked for helicobacter pylori, and it was OK, but I may have too few or too much of something else. It's really hard finding answers. It seems doctors don't know. They reckon heart rhythm and digestive disorders can be related, but they all care about their own field...

There are things I really want to know. The first one is: is my HR disturbed because of digestive problems or is my digestion disturbed because of my HR problems?
The fact is those two issues are linked. Surprisingly, after a bad night with afib and a bloated stomach, the next night is always fine. That's what I've just noticed one more time.
Yesterday at 5:00AM I was in afib, my stomach was pushing upwards and I was trying to relax the whole thing with some burping. It took me nearly one hour to relieve the pressure (or tension) and get back to SR. After that, the whole day was fine. Now I've just had a good night of sleep from 10PM to 4AM. There have been some stomach bloating, but my heart didn't missed a beat.
It's as if some sort of battery inside my body had a charge/discharge cycle; afib episodes doing the "discharge" work and unknown things doing the "recharge" job.

Quote
Jackie
You'll need to consult with a physician who has advanced training in Functional Medicine because they are the only ones who know which tests to order and how to interpret them so you can find relief. I can elaborate more if you like... send me a PM.

Jackie

Thank you very much for your help, Jackie.

This is the kind of chaos I caught yesterday around 5:30AM (Lead2 tracing):






Afib is not sustained, there are some p waves here and there and the avg HR isn't very high (mostly below 100BPM).
I'm not qualified to analyse those tracings, but I'm sure some people here should be able to see other particularities.

I've tracings captured a couple minutes later, after having moved the + electrode to the V2 place.
Of course, I firmly intend to show those recordings next month to the EP who performed my recent RF touch up.

I don't think there's a lot to be analyzed there. The positive news you can take from it is, as you said, that the afib isn't really sustained. Your heart keeps trying to do the right thing so as the ablation lesions heal, hopefully it will gradually settle down into a normal rhythm.

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Carey
I don't think there's a lot to be analyzed there. The positive news you can take from it is, as you said, that the afib isn't really sustained. Your heart keeps trying to do the right thing so as the ablation lesions heal, hopefully it will gradually settle down into a normal rhythm.

I hope so...
Afib is now less disabling for me than the absorbtion of the drugs. Afib acts only at rest, but the drugs lower my physical power the whole day.

Here are two ECG tracings recorded near the end of a recent afib episode.
I was feeling unusual sensations in the chest, so I grabbed my portable monitor and caught them. What do you think about the cluster, on the second image?
I'm pretty sure there were a couple of such clusters in the previous minutes, and this is the last one. Soon after, my heart went back to SR.

You need to show that to your EP. That's v-tach.

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Carey
You need to show that to your EP. That's v-tach.

Can it be caused by the flecainide? I'm only taking 50mg two times a day...

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Pompon
Can it be caused by the flecainide? I'm only taking 50mg two times a day...

It's not impossible but I doubt it. However, if you are having v-tach episodes then flecainide is something you probably shouldn't be taking. Like I said, your EP needs to see that recording.

This happened some weeks ago, before my last ablation touch up. Back then, I was taking flec alone because the associated BB was disabling. My HR would hardly reach 100bpm even when climbing stairs very quickly.
Since then, I got back to bisoprolol. 1.25mg at first, and now 2.5mg because my average HR is higher since my recent procedure. I'm not able to exercise the way I'd like to, but I've no other option for now.
I'll show those tracings to the EP in may. I've an appointment.
Thanks for your answer.

Saw my EP this week.
He wasn't any bothered by the tracings I showed him. Even the 12 successive complexes here above didn't seem to be something to worry about. He said it was just PACs conducted aberrantly with QRS enlargement, the kind of thing appearing otherwise while exercising and having my HR above 120bpm (a class 1c rhythm drug side effect, for me).

I showed him other home ECG tracings, some with lots of PACs and PVCs, some with afib. As afib wasn't sustained, he said it was likely not afib in most of the cases, but just numerous consecutive PACs. The resulting irregularly irregular rhythm might resemble afib...
I had to admit that, the rhythm itself aside, my symptoms are now considerably lighter than before my PV ablation, and still lighter than before my recent touch-up ablation.

EP explained (as we all know) that two or three procedures are often required to stop afib. And he did add he only recently made what's to be considered my second ablation procedure, not my third, since nothing could be done last year (see first post).

So, I shouldn't worry about such trifles...

The problem is, as he's no afibber himself, he does not know how we are living with our trifles...