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Heart Remodeling

Posted by katesshadow 
Heart Remodeling
March 04, 2019 07:12PM
I have read that an episode of Afib can "remodel" the heart. I don't know if it has to be a certain length of time or not.

But, does having long periods of time between episodes remodel the heart in a good way?

I know I'm not wording my question very well, but hopefully you can all figure out what I mean lol.
Re: Heart Remodeling
March 04, 2019 07:54PM
One episode doesn't cause remodeling. It's prolonged and/or frequent afib that causes remodeling. Yes, stopping afib does cause some remodeling in the opposite direction, but it's probably never complete. There's not really an easy way to precisely measure remodeling, so there aren't going to be exact numbers for this.



Edited 1 time(s). Last edit at 03/05/2019 09:37AM by Carey.
Re: Heart Remodeling
March 04, 2019 10:28PM
Quote
katesshadow
But, does having long periods of time between episodes remodel the heart in a good way?

I started my afib "career" in July 2004. At the end of August 2004 i started what turned out to be a 2.5 month episode. I terminated it with 300 mg flecainide on Nov 5. Not an auspicious beginning with that long an episode. That termination took 20 hours as did the next, a month later (~Dec 10) with flec. I later figured the atria was still "stunned" from the 2.5 month episode. I was working out my remission protocol of magnesium, potassium & taurine plus detraining from endurance exercise. I had episodes in March & April. The March one terminated in less than an hour as did April, both with flec. I then got my routine fairly well dialed in and went two years without an episode. In June, 2006, I thought I was healed with reverse remodeling. So I stopped all supplements. Afib returned within 24 (or 48 at the most) hours after the 2 year hiatus. Thus disabusing me of my "healed" notion. Even though my control has been very good since, I know the line between afib and no afib is thin for me. I can do most things with impunity, as long as I keep to my plan of the supps, avoiding consuming too much calcium and avoiding excessive endurance activity. I also know that if I deviate afib will surely follow and very quickly. So some reverse remodeling, but as Carey notes - it only goes so far.
Re: Heart Remodeling
March 05, 2019 03:12AM
Very hard to pin down what remodelling further to a <24hr episode of AF actually is. To my mind remodelling - whatever it actually precisely comprises - is more likely to be what happens many years of PAF and/or a few months of persistent AF.

Yes I appreciate what all the literature out there says, but the reality is nobody really knows exactly what remodelling really is (and to what extent it contributes to the reoccurrence of AF) and how reversible it is and after how long. Lots of talk about cardiomyopathy, but assuming this is essentially fibrosis, is that really what causes AF? I doubt it since my guess is lots of middle-age folks who never get AF will have significant degrees of fibrosis. Prof Jais told me last year that he found no low voltage areas (fibrosis) at all in my heart when he did my ablation. That's why I think I've remained paroxysmal this last 20 years (my mother remained paroxysmal for 35 years and never had an ablation).

My take is that the AF backdrop will be mainly genetically predisposed autonomic imbalance and/or electrolyte handling abnormalities which can both obviously be exacerbated by the usual AF triggers such as chronic stomach issues, alcohol, stress and MSG.

I see my own situation like this. Most middle aged folks are running on 70 out of a 100 on what I'll half-jokingly call the AF precipitation point-scale. Most everyone will be creeping up the scale as they age - hence why 1 in 4 over 80-yr old men have AF. It's all about where you are on that scale when you're middle-aged. Folks like GeorgeN and myself are likely already running at 97 to 99 and, as such, it doesn't take much to put us in AF. Hence the trick is to try and claw your way - in so far as you reasonably can - back to 95 rather than letting it hit 100.

Take 'holiday heart syndrome' for example where a young guy gets AF after a helluva binge on booze. He might never get AF again, but my take is that since lots of folks drink really hard and never get AF, the the holiday heart guy is likely already on a 80 on the scale and might well get AF later in life. I seriously doubt that his 1 episode of binge-drinking-precipitated AF will have caused remodelling that increases his predisposition towards AF going forward - it's that he was already at 80 on the scale whereas most men of his age are on 50.

But then again, what do I know! Just how I see it is all.

Best regards to all here, Mike



Edited 2 time(s). Last edit at 03/05/2019 03:24AM by mwcf.
Re: Heart Remodeling
March 05, 2019 08:40AM
I guess I misunderstood remodeling. I thought it was simiar to Afib begets Afib.

You probably guessed my hope was the longer I stayed out of Afib (my episode was late November 2018), the better my heart would heal. I guess that's not the case. I think my biggest trigger is stress/worry and there are some days (like yesterday) that I was depressed a good part of the day about Afib and how it has changed my life. It seems to affect a lot if people this way. The doctor told me last week it was like PTSD

I know everyone is different. Just look at this forum.

George, did you try the entire 2.5 month to get out of A Fib and then go to e Flec? It's encouraging that you have been able to control yours with lifestyle and supplements, but 24-48 hours without supplements is a relatively short time. I am taking 400mg magnesium (divided 200mg AM and PM), 1000mg Taurine, B12, Vit D3 and MK7. Trying to up Potassium with diet. As a side note, I had my Vit D tested and discovered it was 11!

Mike, I agree with you. I have been a worry wart my whole life. I think it all just hit the fan on Nov 27. I know stress is very harmful and causes a lot of health issues. I'm not saying it caused my Afib, but I feel like it was the trigger.
Re: Heart Remodeling
March 05, 2019 10:52AM
Remodeling is kind of a years-long thing. If you've had paroxysmal episodes for just a few months, I wouldn't worry too much about it. Your heart is basically the same as it was before AF. You just really need to concentrate on your plan for dealing with the AF, be that medical (AARs, betas, NOACs) or surgical (ablation). Lifestyle and risk-factor management apply equally to both courses of action.

Stress depletes electrolytes, especially magnesium. It plays a huge role in AF. You're not imagining that. Ignore the whitecoats who say it doesn't matter. We all know better.
Re: Heart Remodeling
March 05, 2019 11:01AM
Kate - I hear you. You are hoping the longer you are in NSR, that your heart would prefer to stay there! There may be some that have one Afib episode and then never again. However, as Mike, Carey and George have said, once you have had it, you are more prone to it. However, don’t dispair. Many, many people live long productive and happy lives with Afib. They may control it with meds and supplements, decide to have an ablation or if those fail, live in permanent Afib. I know that it is hard to have a positive outlook when one first starts dealing with arrhythmia. But, today you are in NSR and be grateful for that. Hopefully you are for years to come. However, if the day comes and your heart goes off the rails again, you will not have wasted time worrying about it. My first episode was in 2003 then the next in 2009. Starting in 2013, I was having an episode every 6 to 8 months - all resolving themselves. In November 2017, while hiking in New Zealand, I went into Afib and was there for 3 days. Come home and then January 2018, I went into Afib for a week and had to be shocked back into rhythm. I decided then that my heart was going to keep having longer and more persistent episodes. I had my first ablation in February 2018 and my touch up in June at TCAI in Austin. Other than a 20 minutes episode just a few days outside of my 3 month blanking period from my second ablation, I have been in NSR. I am off of Sotalol and hoping to get off Xarelto soon. But, the psychological part of all of this has been the worst. So, my advice to you as to not worry is advice that I have also had to learn and work on everyday. Working out and living my life to the fullest is the best for the anxiety that goes with this condition. All the best and rock on!
Re: Heart Remodeling
March 05, 2019 11:56AM
Quote
katesshadow
I guess I misunderstood remodeling. I thought it was similar to Afib begets Afib.

There is both electrical and physical remodeling.


Quote
katesshadow
George, did you try the entire 2.5 month to get out of A Fib and then go to e Flec?

In the two months prior to the 2.5 month episode, I learned I could convert many episodes with exercise. However that did not work for this episode. Initially I had a cardio who told me his favorite afib med was digoxin. I knew I was vagal and that digoxin was contraindicated for vagal afibbers, so we'd have hour long discussions where I refused digoxin and he'd tell me why he didn't believe in vagal/adrenergic triggers. He put me on warfarin, where I needed to be on it for 4? weeks before he'd try to cardiovert me. Ultimately he transferred me to the EP (likely because he got tired of our discussions). The EP suggested I remain out of rhythm as my afib heart rate was low. I proposed a "Plan B" which was him cardioverting me followed by my trying to stay in rhythm with electrolytes with PIP flecainide as a fallback. He agreed to this. I scheduled a cardioversion, but then tried the flec, which worked.


Quote
katesshadow
It's encouraging that you have been able to control yours with lifestyle and supplements, but 24-48 hours without supplements is a relatively short time.

Yes it is and I have inadvertently tested this over the years. The biggest cause of my afib episodes is forgetting to take magnesium. It is rare that I do this, but stress can cause me to forget. I have a son with glioblastoma brain cancer and dealing with that has caused me to forget a number of times. I do focus on making it a priority.

Other than doing the things I do to stay on my remission protocol, I focus on optimizing my overall health. In a number of posts in this thread <[www.afibbers.org] I detailed some of this. I'm also very aware of when I'm pushing my limits. For example, I skied Aspen and Aspen Highlands four days last week, lapping the steeps without issue, but by myself. On Saturday I skied with my adult children and their spouses. and some other friends. My daughter is 35 years my junior and an excellent skier. We started lapping the steeps with a couple of my young and excellent skier friends. In this environment, I pushed myself to work harder (i.e. go faster on every turn) than I do by myself. I don't take breaks, so I continue while others eat. About 3:30PM I noticed my heart rate was still a bit elevated while I was on the lift and the beats felt hard. This could be a signal that I was turning the activity into an endurance like activity. So I told everyone I was going to take an easy run down and be done for the day. I went to the car where I had a liter water bottle where the water has 4 g's of potassium as citrate in it. I slowly drank some. When I got home, I took a loading dose of magnesium as hydroxide mixed in organic apple cider vinegar to make magnesium acetate. When I checked my rate in the evening, it was slightly elevated (70) but still fine. My instinct is that had I ignored my warning and continued to push hard, I could have had an episode.

George



Edited 1 time(s). Last edit at 03/05/2019 01:34PM by GeorgeN.
Re: Heart Remodeling
March 05, 2019 12:57PM
Great post Miss Sunshine. YOU rock!
Re: Heart Remodeling
March 05, 2019 01:06PM
Hi George,

Now you mention it, I to get elevated heart rate after pushing myself too hard, which is slow to recover and have to take it easy, and rest.
I haven't up till now taken anything but water, I will try taking magnesium in the future.
I hadn't noticed this in the past before my fitbit,...... I could have saved me some episodes.
Re: Heart Remodeling
March 05, 2019 03:57PM
Quote
wolfpack
Remodeling is kind of a years-long thing. If you've had paroxysmal episodes for just a few months, I wouldn't worry too much about it. Your heart is basically the same as it was before AF. You just really need to concentrate on your plan for dealing with the AF, be that medical (AARs, betas, NOACs) or surgical (ablation). Lifestyle and risk-factor management apply equally to both courses of action.

Stress depletes electrolytes, especially magnesium. It plays a huge role in AF. You're not imagining that. Ignore the whitecoats who say it doesn't matter. We all know better.

Yes, when i told the first cardiologist that I wanted to take Magnesium, she said "it won't help, but it won't hurt."
Re: Heart Remodeling
March 05, 2019 03:59PM
Quote
MissSunshine
Kate - I hear you. You are hoping the longer you are in NSR, that your heart would prefer to stay there! There may be some that have one Afib episode and then never again. However, as Mike, Carey and George have said, once you have had it, you are more prone to it. However, don’t dispair. Many, many people live long productive and happy lives with Afib. They may control it with meds and supplements, decide to have an ablation or if those fail, live in permanent Afib. I know that it is hard to have a positive outlook when one first starts dealing with arrhythmia. But, today you are in NSR and be grateful for that. Hopefully you are for years to come. However, if the day comes and your heart goes off the rails again, you will not have wasted time worrying about it. My first episode was in 2003 then the next in 2009. Starting in 2013, I was having an episode every 6 to 8 months - all resolving themselves. In November 2017, while hiking in New Zealand, I went into Afib and was there for 3 days. Come home and then January 2018, I went into Afib for a week and had to be shocked back into rhythm. I decided then that my heart was going to keep having longer and more persistent episodes. I had my first ablation in February 2018 and my touch up in June at TCAI in Austin. Other than a 20 minutes episode just a few days outside of my 3 month blanking period from my second ablation, I have been in NSR. I am off of Sotalol and hoping to get off Xarelto soon. But, the psychological part of all of this has been the worst. So, my advice to you as to not worry is advice that I have also had to learn and work on everyday. Working out and living my life to the fullest is the best for the anxiety that goes with this condition. All the best and rock on!

Great advice! You've been through alot.

One of my big stresses is worrying about the next episode and how I'm afraid I won't handle it right. That I'll be scared that it's not *just* Afib and something different.
Re: Heart Remodeling
March 05, 2019 04:00PM
Quote
GeorgeN

I guess I misunderstood remodeling. I thought it was similar to Afib begets Afib.

There is both electrical and physical remodeling.


George, did you try the entire 2.5 month to get out of A Fib and then go to e Flec?

In the two months prior to the 2.5 month episode, I learned I could convert many episodes with exercise. However that did not work for this episode. Initially I had a cardio who told me his favorite afib med was digoxin. I knew I was vagal and that digoxin was contraindicated for vagal afibbers, so we'd have hour long discussions where I refused digoxin and he'd tell me why he didn't believe in vagal/adrenergic triggers. He put me on warfarin, where I needed to be on it for 4? weeks before he'd try to cardiovert me. Ultimately he transferred me to the EP (likely because he got tired of our discussions). The EP suggested I remain out of rhythm as my afib heart rate was low. I proposed a "Plan B" which was him cardioverting me followed by my trying to stay in rhythm with electrolytes with PIP flecainide as a fallback. He agreed to this. I scheduled a cardioversion, but then tried the flec, which worked.


It's encouraging that you have been able to control yours with lifestyle and supplements, but 24-48 hours without supplements is a relatively short time.

Yes it is and I have inadvertently tested this over the years. The biggest cause of my afib episodes is forgetting to take magnesium. It is rare that I do this, but stress can cause me to forget. I have a son with glioblastoma brain cancer and dealing with that has caused me to forget a number of times. I do focus on making it a priority.

Other than doing the things I do to stay on my remission protocol, I focus on optimizing my overall health. In a number of posts in this thread <[www.afibbers.org] I detailed some of this. I'm also very aware of when I'm pushing my limits. For example, I skied Aspen and Aspen Highlands four days last week, lapping the steeps without issue, but by myself. On Saturday I skied with my adult children and their spouses. and some other friends. My daughter is 35 years my junior and an excellent skier. We started lapping the steeps with a couple of my young and excellent skier friends. In this environment, I pushed myself to work harder (i.e. go faster on every turn) than I do by myself. I don't take breaks, so I continue while others eat. About 3:30PM I noticed my heart rate was still a bit elevated while I was on the lift and the beats felt hard. This could be a signal that I was turning the activity into an endurance like activity. So I told everyone I was going to take an easy run down and be done for the day. I went to the car where I had a liter water bottle where the water has 4 g's of potassium as citrate in it. I slowly drank some. When I got home, I took a loading dose of magnesium as hydroxide mixed in organic apple cider vinegar to make magnesium acetate. When I checked my rate in the evening, it was slightly elevated (70) but still fine. My instinct is that had I ignored my warning and continued to push hard, I could have had an episode.

George

I'm impressed by your knowledge winking smiley and confidence to handle yourself!
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