11 months on from 1st ablation

Hi guys,

I've been somewhat absent in the past 6 months, as things more or less leveled out after my first cryo-ablation last June 22nd and I had a 6 month period where I was able to mostly live like a normal human being. I had the occasional run of PAC/PVCs but nothing I couldn't handle or that didn't just go on its own after a day or so.

Not had any episodes of afib and I've gradually worked myself into a position where I'm walking around 80-90k steps a week (which was normal for me prior to ablation) and am mostly feeling myself again, heart-wise.

The past 2 weeks have seen a large increase in PACs/PVCs though, and it's really brought me back down in a big way. I can't actually pinpoint an exact cause, but food/eating seems to be the jumping off point since they started up.

At the moment, I'm getting them daily, quite persistently and - of course - the worry/stress that it'll convert to full afib is probably only making them worse. At the moment I'm sat in work and the heart was fairly quiet until I had my first meal of the day: a cereal bar and an Actimel. From there on, it's come on gone, with about 30-40 per hour. Yesterday, it was quieter and Saturday even more so and both days I had a 30 minute run and a 1-2 hour brusque walk following.

Now, since diagnosis last year I have really changed my diet. Much healthier and rarely have anything resembling 'junk food'. Also, since January (when I was told I may suffer silent migraines) I have cut out 90% of chocolate, cheese, etc. and haven't touched caffeine in 14 months. The only thing I still indulge in now and again, which you'll probably all tell me off for, is a few lagers or beers. Now, in all of my experiences with afib, alcohol was never a trigger. On 3 occasions I've had major episodes, it's been the after-effects of alcohol (i.e. vomiting and dehydration). So even when I have a single lager I am still drinking 2-3 litres of water per day. I'm also taking around 300mg potassium, 400mg magnesium, 500mg taurine and fish oils each days. Although, having read a recent post here I've started to up those doses somewhat.

I haven't actually even looked at a drink in around a month anyway, so the only thing I have changed prior to the ectopics starting again is running. My wife and I began couch to 5k, as I've always been a runner but she was keen to join me so we've started off pretty light. We did our first run about 2 weeks ago, on a Sunday morning. I believe the ectopics began the following day. I'm not necessarily saying the running is the cause because on the days I have run since then I've not noticed a major difference in heart rhythm. And my heart rate rarely hits 105 during/after a short run. I'm mentioning the fact I have started running again, as it's the only thing I've changed.

A couple of other noticeable differences are: 1. my gut. I'm not sure whether this is just a natural change with age, but my stomach/bowels have been much more irritable over the past 7-8 months and increasingly in the past few months. I'm wondering whether my body just can't tolerate that much magnesium, so I've considered cutting down a little.
2. As I mentioned earlier in the post, I was told I may suffer silent migraines after another long-standing issue with brain-fog, neck pain, and I was advised to use a hot water bottle on the back of my neck for 20 minutes each night, and given exercises to carry out each day that will help strengthen muscles in that area, so I'm wondering whether I've somehow managed to badly irritate my vagus nerve which has set off this recent spate of increase ectopics.

I'm not actually sure what I'm looking for really, other than input from any of you guys. Is this fairly normal for somebody 10-12 months post ablation? It's getting me really down, and I'm worried I've done something to cause this or there's a more serious underlying cause that's seen the PCVs/PACs start up again 6 months later.

Any thoughts would be very welcome.

DT

There isn't really a "normal" for somebody post ablation. Everyone is different and experiences vary widely. I've had multiple ablations, the most recent and most successful being 9 months ago with Dr. Natale. I have experienced zero ectopics since then, but that sure wasn't the case with previous ablations. I spent years on a roller coaster of ectopics and abnormal rhythms before that. I think the thing you need to keep in perspective is that ectopics aren't afib. They're annoying and they can stress you out, and yes they can trigger afib, but the important thing is they're not triggering it. And that means your ablation is doing what it was meant to do. It's preventing afib from initiating and sustaining itself. Take comfort in that and don't let the ectopics stress you out. They don't signal anything more serious.

I think your desire to nail down causes is natural, but it's unlikely to bear fruit. More useful is finding ways to quiet the ectopy. Since you're a runner I have to say that the one trigger I found to be extremely powerful is dehydration. I'm a cyclist, and I used to think I hydrated adequately, but nonetheless I would often experience an episode within the 24 hours following a long ride, especially in hot weather. So on the advice of my EP's nurse practitioner, I literally doubled the amount of water I consumed before, during and after a ride, and I added more potassium and salt (coconut water in particular). I found this quieted much of the ectopy and prevented most of the episodes I had been experiencing after long rides.

I will definitely try that, as I obviously am assuming I'm hydrating properly but just drink the same 2-3 litres per day.

I'll definitely look into raising my salt and potassium levels too.

Thanks for your response )

Davros - Definitely look to increasing your water intake and try to use a source that is free from purification chemicals if that's possible and practical.

Also... what form of magnesium are you taking? ... since some forms are far more likely to cause the bowel tolerance issue than other forms. If you don't have an adequate amount of intracellular magnesium, then using other supplements may not be nearly as beneficial or effective since the cells first need optimal magnesium for proper function. You may find that soaking in Epsom Salts baths or even foot soaks help add magnesium to your system....
or the topical magnesium oil or 'gel' without increasing the bowel tolerance risks.
[www.ancient-minerals.com]

Since alcohol depletes magnesium, you may need to stop that until your heart stabilizes. There are many afibbers who can manage moderate alcohol intake and keep a calm heart... and there are also many that have found their heart stays more calm without it.

On the fish oil... do you take one of the molecularly distilled, pure and free of contaminants? Some have found that if the fish oil is not the pure, molecularly distilled... the impurities can stimulate heart activity... especially if it has become oxidized or rancid. One tip for that is if it has a 'fishy' taste or smell. If so, then don't use that as it's oxidized. All fish oils by nature contain impurities typically because of the environmental water, but several companies are much more conscientious than others for eliminating that risk. Two of the top brands are Carlson's and Nordic Naturals. Always refrigerate.

On the migraines, here's a link to an article by Mark Hyman, MD, on magnesium and migraines.
[migraineagain.com]
Dr. Hyman is director of Cleveland Clinic’s Center for Functional Medicine and Founder of The UltraWellness Center in Lennon, Mass.

I certainly wish you success with managing to lower or eliminate the frequency of the PACs/PVCs..... just remember that stress, itself, can be working behind the scenes and contributing.... so hard as it may be, try to think good, positive thoughts and don't dwell on the negatives.

Kind regards,
Jackie

Currently, all of the supplements I'm taking are in tablet form. Usually, from Holland and Barrett (a health foods/remedies chain in the UK, for those that aren't familiar). I admit, there are probably better sources but these are the most readily accessible to me at the moment.

With regards the fish oils, the claim on the packaging is 'pure' but that' probably not a 100% guarantee.

At the moment, I believe stress may be a major contributing factor. I'd managed to convince myself - very comfortably - for a long time that every minor run of ectopic beats was just a hiccup and didn't overly stress about it. But this recently spate for a couple of weeks has really made it quite difficult to reason with myself!

Thanks for your input though, Jackie.

Davros

Since my ablation over 15 years ago I have been in nsr but had many ectopics, nearly 8000 on a 24 hour Holter. The docs in Bordeaux said they were a nuisance but not a problem. They did however feel very uncomfortable, like being kicked in the chest every few minutes.

Following advice on this site I started taking magnesium, made no difference. I then added potassium, slight improvement. Then I added Taurine and there was a huge difference - I thought they had stopped, but another Holter showed they were still happening, I just don’t feel them any more.

I have continued taking these three supplements for many years and the ectopics no longer bother me. In fact I see them as a sign that I am in sinus rhythm because when I had Afib I didn’t get ectopics.

Gill



Edited 1 time(s). Last edit at 05/22/2018 09:39AM by Gill.

I am 7 months or so post ablation #4, 1st with Natale. I am afib free and cleared to be off all drugs including blood thinner. To your question, I too have PVC's quite a bit. They have gotten better but hardly gone and sometimes quite often, other times quiet. Eating is definitly a trigger but really no pattern. My 7 day holter showed them less than 1% of total but when you string a bunch in a row they can feel like afib and take your breath away.

I have accepted they are not afib and hope they get better over time but if they don't I can deal. I too take all the supplements here and no real difference. I think some of us just get stuck with them and others do not. You could chase them forever and it may just be the way you are.

I also suffered from Migraines with Aura kicking in heavily after my 1st ablation 3 years ago. The auras were the worst part and continued to be the worst part. I was having them as often as twice a week After a couple of months now off Elequis they are almost non existent. My new neuro suggested this link right before I went off elequis and fingers crossed it appears her theory may have been right on.

My heartrate is still fairly elevated in the 90's a lot and spiking baove 100 in day to day but for most part settles down into 80's at night. Hopefully that trend continues as well.

I have a very occassional alcoholic beverage, I don't notice an increase in PVC's but a general increase in my heart rate for sure even after one. Sometimes by 15-20BPM's. And when you are already at 90-95 it is noticable. A whole lot better though than 160BPM in AFIB.

Calcium is not well thought of on this board yet according to the URL Jackie gave to Mark Hyman, he says this:
5 – Boost Effectiveness with Calcium: To be absorbed effectively, magnesium should preferably be taken along with calcium. The ratio of calcium to magnesium for women, is 2:1 whereas for the ideal ratio for men is 1:1 as men require less calcium.

Hyman is saying that Magnesium doesn't work as well without calcium.

Also Davros T. says that his doctor said that he might suffer from "silent Migraines", what the heck is that, I never heard of it?

LIz
:

Quote
Gill

Following advice on this site I started taking magnesium, made no difference. I then added magnesium, slight improvement. Then I added Taurine and there was a huge difference - I thought they had stopped, but another Holter showed they were still happening, I just don’t feel them any more.


Gill

I'm guessing Gill meant potassium for the second magnesium.

Hi Gill - when I read about people who've had 1000s of ectopics a day, I feel like a slight fraud. Here I am getting stressed out and moaning about having a few hundred a day!

I definitely feel that the point you make about the ectopics being a sign that you are in nsr as making sense though.

Fibrillator - I struggled with PACs and elevated HR for a long time after ablation, and doing normal things like sitting and leaning forward, lying back and burping all used to initiate these little runs. They've since stopped occurring in those circumstances but still get these runs, and seemingly more frequently of late.

Elizabeth - I was a bit dubious about silent migraines too, but apparently it's a thing! They're are, from my understanding, migraines that come with all the usual symptoms but without the crippling headaches.

Liz - the majority of doctors - 'holistic' or otherwise - unless specifically treating arrhythmia patients are not aware of the interference from calcium supplements. Typically, they go by the standard guidelines and that's unfortunate since supplemental calcium for afibbers is definitely contraindicated. Assessing dietary intake of calcium is necessary as well.
Although he's on the right path with functional medicine, unfortunately, Dr. Hyman hasn't yet made the leap into the reality about what we know about calcium intake relative to arrhythmia... but his overall approach to wellness is definitely a step in the right direction. He speaks with personal experience having had a horrific toxic exposure from which he recovered using a holistic approach, as I recall.

Jackie

Thanks George, you are quite right! I have edited the post.

Gill

Jackie:

The point is, is he correct about calcium is needed with magnesium in order for it to be absorbed effectively, maybe that is why some of us are still low on magnesium even with taking it everyday.

Liz

Quote
DavrosT
(...) when I read about people who've had 1000s of ectopics a day, I feel like a slight fraud. Here I am getting stressed out and moaning about having a few hundred a day!(...)

Davros, I'm among those having had thousands of ectopics a day and, happily, those days are now gone, but I must admit it wasn't that much worse than having a few hundreds a day or even a couple dozens a day. I experienced all those situations, and I think ectopics are worse when you're worrying about them. And from my experience, when you have just a few, they always surprise you and you may get some stress. On the opposite, when they're always with you, you end not thinking about them, even if they are unpleasant.

Liz - Liz - Ultimately, what’s important to understand (for afibbers especially ) is that calcium is excitatory to heart cells….and magnesium helps relax those cells-- facilitated, of course, by the actions of potassium when it keeps sodium out of heart cells. As mentioned previously, many of these doctors don't have expertise in treating arrhythmia patients.
High calcium content of cells blocks the entry of magnesium.
Jackie

The dangers of magnesium deficiency
April 6, 2014 by Cardiologist, Thomas Levy, MD JD

Probably the single-most important property of magnesium in the body is its ability to act as a natural biological antagonist to calcium. As most adults have excess calcium throughout their bodies, it is this reciprocal relationship between magnesium and calcium that makes most people in need of regular magnesium supplementation.
In fact, the more you have of one, the less you have of the other. When calcium levels are high in the cells and the extracellular fluids, as they are in most adults, magnesium levels are corresponding low. And, because of this unique relationship, taking regular sizeable doses of supplemental magnesium works to mobilize and excrete calcium – which is one of the healthiest effects that can result to the typical body overloaded with calcium.

The medical myth surrounding calcium
Deficiency of calcium is common in aged bone, but, in contrast to what is believed by many docs and supplement takers, there really is no such thing as a body-wide deficiency of calcium, only normalcy, which is rare, and excess, which is very common. Continue: [www.peakenergy.com]

Association between intakes of magnesium, potassium, and calcium and risk of stroke: 2 cohorts of US women and updated meta-analyses.
CONCLUSIONS: A combined mineral diet score was inversely associated with risk of stroke. High intakes of magnesium and potassium but not calcium were also significantly associated with reduced risk of stroke in women.
Am J Clin Nutr. 2015 May 6. Epub 2015 May 6. PMID: 25948665


Minerals are generally known to have an antagonistic or competitive effect when it comes to absorption. Thus high intake of any of the following minerals could potentially reduce magnesium bioavailability:
• Calcium
• Phosphorous
• Iron
• Copper
• Manganese

Calcium Magnesium Balance
A healthy cell has the right calcium magnesium balance – high magnesium and low calcium levels. Calcium can lodge anywhere in your body and cause serious harm if not balanced with magnesium, which regulates the action of calcium. For instance, excess calcium buildup around your bones and joints mimics arthritis. Too much calcium lodged in your heart imitates arterial lesions. Calcification or calcium poisoning can manifest as heart disease, cancer, wrinkled skin, kidney stones, osteoporosis, dental problems, bone spurs, cataracts and many other health problems.
Calcium and magnesium are opposites in their effects on our body structure. As a general rule, the more rigid and inflexible our body structure is, the less calcium and the more magnesium we need.

Dr. Garry Gordon wrote, “If you have compromised cell membranes or low ATP production for any reason, then the cell has trouble maintaining the normal gradient. This is because the usual gradient is 10,000 times more calcium outside of cells than inside; when this is compromised you will have increased intracellular calcium, which seems to always happen at the time of death. Whenever intracellular calcium is elevated, you have a relative deficiency of magnesium, so whenever anyone is seriously ill, acute or chronic, part of your plan must be to restore magnesium, which is poorly absorbed through oral means.” Continue: [drsircus.com]

Association between intakes of magnesium, potassium, and calcium and risk of stroke: 2 cohorts of US women and updated meta-analyses.

CONCLUSIONS: A combined mineral diet score was inversely associated with risk of stroke. High intakes of magnesium and potassium but not calcium were also significantly associated with reduced risk of stroke in women.
Am J Clin Nutr. 2015 May 6. Epub 2015 May 6. PMID: 25948665

And then, just when I have a relatively.. shall we say 'quiet' day with regards the ectopics, I get home from a busy day at work to a strange 'quivering' sensation in my chest. Almost feels like a vibration. Same thing occurred on Saturday night, very strange and a little uncomfortable.

Every day has something new to stress yourself out about, eh!

I love water and have no problems downing 64 oz. plus throughout the day. However my palpitations increase drinking too much water as I have more bathroom visits. I think I eliminate a huge portion of my minerals resulting in palpitations.

And the more you drink, the thirstier you get if you drink more than your body needs. I have a sister in law that got caught up in continual thirst because she always has a bottle of water with her and was always drinking.

64 oz. of water a day for an inactive adult is probably way too much to drink. Too many buy into one answer for everyone (64 oz.) when there are huge variations in size, body weight, and activity.