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Tell me about drugs....

Posted by bolimasa 
Tell me about drugs....
July 06, 2018 06:20PM
So the cardiologist office called.
I had an heart MRI on Tuesday... and everything looked normal. Now it's getting sent to the research, to assess fibrosis issuesn in anticipation of a possible ablation. I guess I should be glad all my tests keep coming back normal (other than sometimes crappy BP), I've always been in such good health... I just don't understand why my heart has gone wacky.

Meanwhile, they took a glance at the 30 day monitor I'm currently wearing... apparently I'm out of rhythm frequently and sometimes my heart rate is fast. They seem to be concerned about the heart rate issue, though it's unclear if the high rate is only when I'm in afib, or at other times too... Sadly it doesn't track what I'm doing at the time, and I routinely do things like walk up all the stairs to my 5th floor lab (yeah that gets my heart rate up), and go on up hill hikes. I know the my peak rate during my 48 hour monitor (180- yikes) was when I was hiking up a steep trail, so I don't know how they really assess the relationship between heart rate and activity (though I did have at least one high rate while I was probably sleeping,so there you go, it must be somewhat of a problem)

The gal I spoke to (nurse? PA?) seems concerned, wanted to know what I wanted to do. I barely spoke with the doc on my first visit, and assumed we'd discuss the options on August 14 when I go back. She wants to get me in sooner if she can, and seemed to think I need drugs, or an ablation.

So my question of the day... what do people think of arrythmia control drugs? I guess I thought that people with on and off afib were often fine with out any drugs, so I've not looked into drugs much.

While I'm waiting to see if I'm a good ablation candidate, should I be considering drugs?

I really hate this, I've avoided drugs of any sort my entire life.
Re: Tell me about drugs....
July 06, 2018 07:13PM
First off, Welcome! You've come to the right place.

I'm not sure what your AF history is, but the one thing about AF is that your risk of stroke does definitely increase so anti-coagulation drugs (such as Eliquis, etc.) may be wise. I had a stroke in January which the doctor believed was due to my AF. Long story but I finally was diagnosed with AF while in the hospital being treated for my stroke.

The side effects of anti-arr drugs can be gnarly so definitely do your research. I had an ablation this past April and it was the best thing I could have done and have no regrets!
Re: Tell me about drugs....
July 06, 2018 09:01PM
If you are on the road to an ablation and do want to seek temporary relief from AF, then I would consider “first-line” AAR drugs such as Propafenone or flecainide. You can safely start and stop these at low doses outside of the hospital. If they work, great. If not, not much lost. The next step up from those two are drugs that may lengthen the QT interval, and those earn you the 3 day hospital “staycation”. I’d skip that if I could. And, lastly, never take amiodarone. That should never be prescribed to a younger person in my opinion.
Re: Tell me about drugs....
July 06, 2018 09:13PM
It doesn't sound like you have awareness of when you are in afib much of the time. Hence an on-demand med to convert probably doesn't make much sense. Also sounds like your episodes are too frequent to make that appropriate.

For the monitor, You could keep a diary of times you are significantly exerting yourself on days. Then you could correlate that with the monitor results.

Concur with Wolfpack about Propafenone or Flecainide.

If you are staying at high rates for long periods, that would suggest a rate control med is in order. If you are doing significant activity, then not a big deal. If you are in afib, then 180 makes sense climbing up the stairs. If you are in NSR, then unless you were sprinting up the stairs, that is a high rate for a decently conditioned younger person (assuming that describes you).
Re: Tell me about drugs....
July 07, 2018 07:50AM
Yes, I should've mentioned that. The AARs would be used in conjunction with the beta blockers. That is especially true in the case of flecainide, as it has an increased risk of flutter. Propafenone has its own mild beta-blockade effect (about 1/20 that of metoprolol) and can sometimes be used alone in cases of vagally mediated AF. In adrenerigic cases I think a beta blocker should always be prescribed.
Re: Tell me about drugs....
July 07, 2018 01:29PM
My suggestion to you as i check a lot of boxes you do.....get an ablation....you will prob. need 1 anyway why wait....i am yet to hear anyone say dam why did i get that ablation so fast and not go on drugs instead......there are plenty of suggestions on a narrowed down list of incred. Ablationist out there on this great forum so if you decide to move on my sugg. you are in good hands in the EP room and that's an understatement. As Nancy would say........ just say no to drugs.......with the exception of Propafenone used as needed to kill an episode or as they say Pill In Pocket until you get you ablation.....like i am in the process of doing and should have done at least 3 years ago.
Also it sounds like your not always aware when you get an ARRHYTHMIA...if you use PIP therapy you have to be very aware at all times with much pulse taking or paying more attention to just the way you feel minute to minute...your pulse does not lie...keep your thumb ready.
Its hard to believe anyone cannot feel that monster in your chest EVERY SECOND the ARR starts up...i am the opposite....awake or sleeping the alarm bells go off and its PIP time about 5 min. later as i wait a few minutes as i convert 50% of the time inside the 1st 3 minutes by taking a big drink of cold water, urinating or #2 otherwise i am off to the races until my temporary best friend (until my procedure) Propafenone KO's it in less than 1 hour.



Edited 1 time(s). Last edit at 07/07/2018 01:47PM by vanlith.
Re: Tell me about drugs....
July 07, 2018 09:57PM
Quote
GeorgeN
It doesn't sound like you have awareness of when you are in afib much of the time. Hence an on-demand med to convert probably doesn't make much sense. Also sounds like your episodes are too frequent to make that appropriate.

For the monitor, You could keep a diary of times you are significantly exerting yourself on days. Then you could correlate that with the monitor results.

Concur with Wolfpack about Propafenone or Flecainide.

If you are staying at high rates for long periods, that would suggest a rate control med is in order. If you are doing significant activity, then not a big deal. If you are in afib, then 180 makes sense climbing up the stairs. If you are in NSR, then unless you were sprinting up the stairs, that is a high rate for a decently conditioned younger person (assuming that describes you).
For the most part I don't seem to be aware I'm in afib....but it the 48 hour holter is representative, during that period I was in Afib 0.03% of the time, longest for 4 min. 16% pacs, 1% pvcs 2.4k runs of atrial tachycardia(longest 17 beats)... I almost feel like Afib is the least of my problem, but maybe all this other crap comes with the Afib? The cardiologist did not discuss these results with me.

I'm in the middle of the 30 day monitor now... I'm supposed to hit the button when I feel weird, I've only hit it a couple of times. I had one night when it felt really crappy, and my BP monitor did say my pulse was irregular and my heart rate high. I assumed I was in Afib at that time. I check my pulse a lot, it's often good for 30 or so beats, skips a beat or gets a little wacky than goes back to normal for while. Sometimes the wacky lasts a while. I have no idea what to think.
Not sure about the heart rate biz... I'm for me in lousy shape, but my lousy shape is not so bad for a 57 yo gal. I'm sure my heart rate is sometimes elevated because I routinely take the stairs at work. 104 stairsteps up to my lab... That absolutely gets my heart rate up. Of course the monitor doesn't have a button to track activity. That seems kind of dumb to me.... As I expect to be different while hiking or doing the stairs than sitting at my desk.
Re: Tell me about drugs....
July 07, 2018 10:11PM
Quote
vanlith
My suggestion to you as i check a lot of boxes you do.....get an ablation....you will prob. need 1 anyway why wait....i am yet to hear anyone say dam why did i get that ablation so fast and not go on drugs instead......there are plenty of suggestions on a narrowed down list of incred. Ablationist out there on this great forum so if you decide to move on my sugg. you are in good hands in the EP room and that's an understatement. As Nancy would say........ just say no to drugs.......with the exception of Propafenone used as needed to kill an episode or as they say Pill In Pocket until you get you ablation.....like i am in the process of doing and should have done at least 3 years ago.
Also it sounds like your not always aware when you get an ARRHYTHMIA...if you use PIP therapy you have to be very aware at all times with much pulse taking or paying more attention to just the way you feel minute to minute...your pulse does not lie...keep your thumb ready.
Its hard to believe anyone cannot feel that monster in your chest EVERY SECOND the ARR starts up...i am the opposite....awake or sleeping the alarm bells go off and its PIP time about 5 min. later as i wait a few minutes as i convert 50% of the time inside the 1st 3 minutes by taking a big drink of cold water, urinating or #2 otherwise i am off to the races until my temporary best friend (until my procedure) Propafenone KO's it in less than 1 hour.

Of course I don't really want to do a procedure, but everything I've read seems to indicate that Afib only gets worse, not better. I also get the impression that an ablation might work better early on, while your heart is less damaged? So far other than arryhmia my heart appears normal, though I'm still waiting for the research team to look for fibrosis. (I had a lot of fun 'analysing' my own MRI, but could not even begin to guess about fibrosis).

I guess I'm thinking that you are probably right in that I'd be better off ablating sooner than later, and I do have good insurance now, and from what I can tell my doc is a top level EP. Still not happy about the thought of it, but drugs sound shirty too, and I'm not 'that' old and want to continue life as an active person... My goal is always to hike and ski more, not less. (darn the workinggig for getting in the way of that)
Re: Tell me about drugs....
July 08, 2018 12:46AM
Quote
bolimasa
I know the my peak rate during my 48 hour monitor (180- yikes) was when I was hiking up a steep trail, so I don't know how they really assess the relationship between heart rate and activity (though I did have at least one high rate while I was probably sleeping,so there you go, it must be somewhat of a problem)

Sorry, but my bet would be welcome to afib. There might be some atrial flutter or SVT mixed in there, but the underlying cause is likely to be afib.

As you've already figured out, your choice now is medical management (drugs) or ablation. But from what you've told us so far, I don't think you know enough to make a decision. If I were you I would not pursue an ablation nor would I take antiarrhythmic drugs, at least not yet. I would recommend mindful watching for now. Find out what your heart is doing, take your time, and get all the facts before acting.
Re: Tell me about drugs....
July 08, 2018 11:53AM
Quote
Carey

I know the my peak rate during my 48 hour monitor (180- yikes) was when I was hiking up a steep trail, so I don't know how they really assess the relationship between heart rate and activity (though I did have at least one high rate while I was probably sleeping,so there you go, it must be somewhat of a problem)

Sorry, but my bet would be welcome to afib. There might be some atrial flutter or SVT mixed in there, but the underlying cause is likely to be afib.

As you've already figured out, your choice now is medical management (drugs) or ablation. But from what you've told us so far, I don't think you know enough to make a decision. If I were you I would not pursue an ablation nor would I take antiarrhythmic drugs, at least not yet. I would recommend mindful watching for now. Find out what your heart is doing, take your time, and get all the facts before acting.

I certainly don't want to rush into anything. That's why I refused blood thinners at the ER.... Wanted to do my homework.

Heck, part of me wonders if the stupid BP med I've been taking set this off. I kinda want to quit that, quit the calcium channel blocker, see what my body does by itself.

I thought it was weird when the gal who called me the other day wanted to know what I wanted to do. How can I decide that without complete assessment of the problem, causes, efficacy of treatment. Five minutes with the doc prior to my MRI and 30 day monitor didn't exactly prepare me to answer that question, and despite lots of reading, a month of research hardly gets me to expert level lol.

Of course if ablation is the answer, sooner is better for me, as I want to be healed fir winter. This all depressing enough... I don't want it to ruin happy season too!
Re: Tell me about drugs....
July 08, 2018 12:04PM
Quote
bolimasa
Heck, part of me wonders if the stupid BP med I've been taking set this off. I kinda want to quit that, quit the calcium channel blocker, see what my body does by itself.

Everyone does this at first -- they search for a cause. It's rare that anybody finds a cause, and when they do it's usually sleep apnea, hyperthyroidism, or a major bodily insult such as surgery or a serious illness. I very much doubt that your BP meds are to blame. Calcium channel blockers are commonly prescribed for afib as rate control drugs.


Quote

Of course if ablation is the answer, sooner is better for me, as I want to be healed fir winter.

You would need to be scheduling your ablation now to have this over and dealt with by winter, and that's just not possible with any top notch EP because they are always booked months in advance. Don't let anyone who can do an ablation on short notice touch you.
Re: Tell me about drugs....
July 08, 2018 06:57PM
Quote
Carey

Everyone does this at first -- they search for a cause. It's rare that anybody finds a cause, and when they do it's usually sleep apnea, hyperthyroidism, or a major bodily insult such as surgery or a serious illness. I very much doubt that your BP meds are to blame. Calcium channel blockers are commonly prescribed for afib as rate control drugs.

Yeah, now I'm wondering if I should get checked for sleep apnea, as I do snore sometimes.

First thing I did was was have my GP, lower my thyroid dose, as my TSH was at an all time low for me at the ER.... And I even keep wondering if this could relate to my ski accident in December. The guy who hit me hit me super hard... Though I would have thought that would given me problems sooner.

So yeah, it's crazy making trying to figure out why my heart is failing. I truly feel betrayed by my body.
Re: Tell me about drugs....
July 08, 2018 09:28PM
Sleep apnea study is an excellent idea.

Your heart’s not failing. AF is a pain in the ass, but it’s peanuts compared to real heart failure. There’s a way through this with careful and deliberate choices. You can be free of atrial arrhythmia.
Re: Tell me about drugs....
July 09, 2018 11:54AM
Quote
wolfpack
Sleep apnea study is an excellent idea.

Your heart’s not failing. AF is a pain in the ass, but it’s peanuts compared to real heart failure. There’s a way through this with careful and deliberate choices. You can be free of atrial arrhythmia.

Well, maybe it's not technically failing, but I sure feel like it is failing me. (***whine***)
I keep eyeing mountains I've climbed before and ones I've hoped to climb and wonder if I will be able to.
I'm definitely feeling the uphill worse than normal.

Which really gets me wondering... how much do arrythmia problems effect athletic performance?
I have never been a great up hill person. Not even when I was younger, thinner, running regularily. I always found it frustrating that I seemed to get more winded on the uphill then friends I'd be out hiking with. Always felt like I had to woerk twice as hard to get into the same shape as my peers. Decades ago I was told I had an extrasystole and 2 inconsequential murmers. Nothing to worry about. So I did not.... Now I kind of wonder if that the extrasysole was always happening more than I realized. I had times when I would notice it. but most periods in my life I did not of simply didn't pay attention. Rarely did the doctors find it, but when I saw my GP the other day I payed attention to how long he listened to my heart... and the answer was not very long... I imagine at most it was 10-15 beats. He thought I sounded fine. Of course I'mconstantly checking my pulse now, and even as wacky as my heart is acting I'll go 10, 20 or occasionally more beats before I detect an irregularity (unfortunatelt now often a series rather than a single 'skipped beat' (actually premature right?)), so I can easily see how the average doc would miss it. I was shocked that at the cardiolgists office they only do a 10 second ECG... that would miss a lot too.

I guess they don't worry much about PACs and PVC's? Do PACs and PVCs effect things like hiking/running up hill? Was having them precursurs to the problems I am having now?

Just a few more neurotic ruminations and over-analysis on my part.
Feel free to ignore if it's the same old same old... as from what others have said I'm not the first to over think all this.
Re: Tell me about drugs....
July 09, 2018 05:21PM
And the good news... or is it really bad news?... they moved my appointment up a month to next week.

(and now I can confirm that those crappy waiting times are because they double book... cuz that's what the scheduler said he was doing.)

If anyone has good ideas regarding questions I should be asking I would be appreciative.

I would like to go in prepared.
Re: Tell me about drugs....
July 09, 2018 06:47PM
Yes the PACs (or PVCs) can certainly affect performance if they happen while you’re exerting yourself. Happens to me all the time. A “double shot” of PACs while I’m jogging uphill feels like someone stuck a ShopVac down my throat and sucked all the air out!
Re: Tell me about drugs....
July 09, 2018 07:15PM
"how much do arrythmia problems effect athletic performance? "

This varies widely from person to person. I had everything: frequent PAC's, AFIB and Heart Failure. The Doctors were amazed at how active I was able to remain. Increased breathing can help compensate for loss of blood flow. Unless it's severe PAC's like every other beat, the AFIB should effect you the most, which is why it is important to be able to tell right away when your in AFIB. Rate-Control Drugs can help Athletic Performance while in AFIB, by slowing down the HR enough to allow the Ventricles to fill with Blood. This is important, as when in AFIB, we lose "Atrial Kick" as the Atria no longer pumps Blood down into the Ventricles.
Re: Tell me about drugs....
July 09, 2018 08:38PM
Does exerting be yourself bring on more PACs?
Re: Tell me about drugs....
July 09, 2018 08:47PM
With me it's actually quite weird. What will happen is about 2 miles into a run, they'll start. Then after 10 minutes or so they'll vanish completely. I can only figure it has something to do with the fluid shifts that happen as one begins to sweat and then sweats profusely. Probably potassium leaving the cells but then later being overwhelmed by sodium outflux in the perspiration. There's no way to prove any of that and also no way to test for it, but it remains my personal pet theory!

That being said, it all speaks to proper hydration and electrolyte management. Which is a giant pain in the ass during the swampy summers here in North Carolina. Curse that meteor that created the Gulf of Mexico, but without it I suppose we'd all still be dinosaurs... smiling smiley
Re: Tell me about drugs....
July 09, 2018 08:53PM
Quote
The Anti-Fib
"how much do arrythmia problems effect athletic performance? "

This varies widely from person to person. I had everything: frequent PAC's, AFIB and Heart Failure. The Doctors were amazed at how active I was able to remain. Increased breathing can help compensate for loss of blood flow. Unless it's severe PAC's like every other beat, the AFIB should effect you the most, which is why it is important to be able to tell right away when your in AFIB. Rate-Control Drugs can help Athletic Performance while in AFIB, by slowing down the HR enough to allow the Ventricles to fill with Blood. This is important, as when in AFIB, we lose "Atrial Kick" as the Atria no longer pumps Blood down into the Ventricles.
I'm still not really sure when I'm in AFib. I'm ***guessing*** that when my heart feels really weird I'm in AFib. I've hardly had that happen during 3 weeks of monitoring. I had one night when I felt weird and my heart rate was high.
During my 48 hour holter I was only in AFib 0.03% of the time but PACs and PVCs and AT nearly 20% of the time.
I just ordered a monitor, maybe that will help me figure it out.
Re: Tell me about drugs....
July 09, 2018 09:05PM
Quote
bolimasa
Does exerting be yourself bring on more PACs?

Slow steady exertion caused mine to go away. Short term high exertion like weight Training or Boxing usually increased them. Just walking and breathing deep helped me the most with reducing Etopics (PAC's).
Re: Tell me about drugs....
July 09, 2018 09:15PM
Quote
bolimasa

"how much do arrythmia problems effect athletic performance? "
_______________________________________________________________________________________________

This varies widely from person to person. I had everything: frequent PAC's, AFIB and Heart Failure. The Doctors were amazed at how active I was able to remain. Increased breathing can help compensate for loss of blood flow. Unless it's severe PAC's like every other beat, the AFIB should effect you the most, which is why it is important to be able to tell right away when your in AFIB. Rate-Control Drugs can help Athletic Performance while in AFIB, by slowing down the HR enough to allow the Ventricles to fill with Blood. This is important, as when in AFIB, we lose "Atrial Kick" as the Atria no longer pumps Blood down into the Ventricles.
_______________________________________________________________________________________________

I'm still not really sure when I'm in AFib. I'm ***guessing*** that when my heart feels really weird I'm in AFib. I've hardly had that happen during 3 weeks of monitoring. I had one night when I felt weird and my heart rate was high.
During my 48 hour holter I was only in AFib 0.03% of the time but PACs and PVCs and AT nearly 20% of the time.
I just ordered a monitor, maybe that will help me figure it out.

I can tell when I go into AFIB, as very mild palpitations and a subtle increase in Anxiety. To verify whether I was actually in AFIB I just checked my Pulse with my Finger. AFIB is more irregular than PAC's. Also the strength of the Pulse fluctuates while in AFIB. I also use a Pulse Oxymeter. When in AFIB, the HR will fluctuate wildly. Mine would jump around from 80-120. This shows up on the Oxymeter, as they rate will constantly change. If it's just Ectopics, then HR remains steady, only going up or down gradually, depending upon exertion. Heart Monitors have helped many people, but after awhile you shouldn't need one.



Edited 2 time(s). Last edit at 07/09/2018 09:24PM by The Anti-Fib.
Re: Tell me about drugs....
July 09, 2018 09:19PM
Quote
The Anti-Fib

Does exerting be yourself bring on more PACs?

Slow steady exertion caused mine to go away.
What do you mean? Caused them to go away permanently or momentarily?
Like if you noticed to yourself having PACs a walk would make them mostly go away? And are they really gone or do you just not notice them? (Since I rarely notice mine if I'm not looking for them)
Re: Tell me about drugs....
July 09, 2018 09:42PM
Quote
bolimasa


Does exerting be yourself bring on more PACs?

Slow steady exertion caused mine to go away.
What do you mean? Caused them to go away permanently or momentarily?
Like if you noticed to yourself having PACs a walk would make them mostly go away? And are they really gone or do you just not notice them? (Since I rarely notice mine if I'm not looking for them)

They would go away for awhile, it depends how bad they were. They might subside for several hours or several days, or even Weeks. I was checking my Pulse, so I know they would go away. PAC's come and go. I've has PAC's every 3rd or 4th beat for weeks at a time, and then they can mostly go away for a month. If you get a report back from your 30-day monitor that will give you a much better idea of how much Ectopy you are having versus the 48-hours monitor. You should just finger check your Pulse every 5 minutes or so when you are Hiking. NSR is smooth and Rythmic, whereas the PAC's will be felt as a brief pause or gap in the Heart Rythm. Many times the PAC's occur at regular intervals like every 2nd, 3rd, 4th or 5th beat. If I was in your situation, I would go on a Hike, and constantly check my Pulse for PAC's, to see what intensity would make them better or worse. I would also experiment with trying to take relaxed deep breathes to see if that helps.
Re: Tell me about drugs....
July 09, 2018 10:35PM
bolimasa, if you really want to know when you are in Afib, I recommend getting a Kardia device: Amazon.com Kardia.

Just $99 and in 30 seconds it shows you if you're in Afib or not. (They push a monthly subscription, but its not required.)

Very helpful device!

(I researched the available at-home afib detectors and this is the one to go with if simplicity and cost are key factors.)

It also creates a PDF report of the EKG trace that you can save or email to your cardio if you want.



Edited 2 time(s). Last edit at 07/09/2018 10:37PM by DavidK.
Re: Tell me about drugs....
July 10, 2018 12:58AM
Quote
wolfpack
With me it's actually quite weird. What will happen is about 2 miles into a run, they'll start. Then after 10 minutes or so they'll vanish completely. I can only figure it has something to do with the fluid shifts that happen as one begins to sweat and then sweats profusely. Probably potassium leaving the cells but then later being overwhelmed by sodium outflux in the perspiration.

You become hyperkalemic during exercise. I know this not only from my own experimentation with a potassium meter and a bicycle, but also from the literature. The longer and more intense the exercise, the higher you go. A study using a British professional soccer team found that some of them reached serum potassium levels as high as 8.0 during practice sessions. That's a level that would land you or me in an ICU that we might not leave alive, but apparently during exercise it's harmless. Fascinating paper. Anyway, the point being that you're basically right about the potassium leaking from cells. But the key to why it stops the ectopics is because hyperkalemia does that. It slows conduction between cells, and that's enough to often break the reentrant cycle that keeps such things going.
Ken
Re: Tell me about drugs....
July 10, 2018 10:12AM
I know that knowing when one is in afib or not varies a lot between individuals. For me, prior to diagnosis and meds to control the rate, my resting heart rate was 50. In afib, it was rapid, weak, irregular and up to 180 bpm. Easy to feel on my carotid or radial pulse. No doubt what was going on. However, until it was caught on an ECG, I didn't know what was happening, and my Dr. suggested it was "an irregular pulse due to mitral valve prolapse". Which it wasn't.
Re: Tell me about drugs....
July 10, 2018 02:01PM
Quote
Carey
You become hyperkalemic during exercise.

That may also explain the frequent need to "find a tree" at about the same time.

But when they vanish, man, they're gone for good. Except the one time two months ago when they turned into AF. Which is more evidence that we can influence AF but at some point it's just going to do what it's going to do.

Won't stop me from running, though. Myopic brain, meet myopic atrium! smiling smiley
Re: Tell me about drugs....
July 10, 2018 02:39PM
It's interesting to see how this is for everyone else... as I'm certainly at the stage where it is confusing to me.
Thanks for sharing.
Re: Tell me about drugs....
July 10, 2018 02:46PM
Well I'm hoping the monitor proves useful... The bad thing is that I'll only get data when I choose to use it.
What I'd really like is full time monitor like the one I'm wearing now, but one were I can see the data and one where I can flag the times I'm doing exertive sort of of exercise.

I didn't order the Kardia monitor... I decided to try the Emay monitor since it it supposed to show a variety of cardiac event, not just afib. If the the 48 hr monitor I did is representative, it seems I'm doing everything else much more than Afib... My %time in afib was miniscule compared to PACs and AT, so I'm curious about those as well... especially the AT since I *think* this is the thing the PA was worried about.
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