AFIB Reappeared....

Just looking for some experienced, knowledgeable perspective as it has been a long time since I have posted...

Nov, 2006 - first AFIB. Hungover, no sleep, big bowl of chili and a Bud for lunch. Converted on my own in ER ~2 hours
March, 2007 - 2nd AFIB. No sleep, big chocolate malt. Chemically converted in a Trauma ER ~10 hours
Nov, 2007 - 3rd AFIB. No sleep, much stress, ate a large meal. Cardioverted ~3 hours

EP presrcibes various drugs, we start talking potential for ablation. I find this website plus much more research. Start to get more sleep, drink less, and eat a banana and 3-5 glasses of OJ per day plus Prilosec and 50mg Atenelol. BP goes from 125/85 to 115/60. HR goes from 90bpm to 65 bpm...for the next 12 years, no AFIB.

March, 2018 - Normal physical and I decided to get a Cardiac CT calcium scan...no symptoms, just precautionary. My score comes back in the 180's for a 50 year old...94%. So I get a cardiologist and they add 80 mg Atorovastatin and 1 baby Aspirin...plus DRAMATIC Diet Change. I remove all red meats plus pork, dairy, and processed foods. Dropped 25 pounds...already BMI was 24...now 20. No longer need Prilosec...as heartburn disappeared with the new diet. Cholesterol drops like a rock...Tri - 65, HDL - 40 (good for me) and LDL - 51...ratio 2.6. Good shape...

Jan, 2019 - First AFIB in 11.5 years...lots of wine, no sleep. Lackadaisical with my hydration...cardioverted after 20 hours.
August, 2019 - AFIP again...lack of sleep, and a bit dehyrdated...cardioverted after 4 hours.

Have my obvioius triggers...but I have done this off and on for 10+ years...the only real change I have made is replacing the 4-5 glasses of OJ with a daily fruit smoothie(trying to lower my sugar intake due to my Cardio Calcium score).

I had truly forgotten how to deal with AFIB...and now it is back 2x in the last 6 months. So I am scheduling a follow up today with my EP to discuss strategies...I think I know them...any thoughts on getting the K from another source?

And another comment...the cardiovert hurt...the following combo made my chest feel like it was going to explode until the shock...first time for that....following was given in ER:
enoxaparin (LOVENOX) 80 MG/0.8ML injection 80 mg Last given at 5:34 PM
etomidate (AMIDATE) injection 7.9-11.9 mg Last given at 5:47 PM
FENTanyl PF 100 MCG/2ML soln cartridge 50 mcg Last given at 5:50 PM
lorazepam (ATIVAN) injection 0.5 mg Last given at 5:50 PM
metoprolol (LOPRESSOR) 5 MG/5ML soln cartridge 5 mg Last given at 4:33 PM

Thanks in advance for your comments...

Three thoughts:

1) Dehydration is your #1 enemy because it causes electrolyte imbalances, particularly potassium loss. Avoid it at all cost. And excess alcohol leads to dehydration so careful with that.

2) Two episodes in 8 months, both preceded by dehydration, doesn't necessarily mean you need to be doing anything other than avoiding the dehydration and toning down the alcohol.

3) Regarding the following... WTF? Find another ER. That's a ridiculous concoction of drugs for a cardioversion.

Quote
shca67
And another comment...the cardiovert hurt...the following combo made my chest feel like it was going to explode until the shock...first time for that....following was given in ER:
enoxaparin (LOVENOX) 80 MG/0.8ML injection 80 mg Last given at 5:34 PM
etomidate (AMIDATE) injection 7.9-11.9 mg Last given at 5:47 PM
FENTanyl PF 100 MCG/2ML soln cartridge 50 mcg Last given at 5:50 PM
lorazepam (ATIVAN) injection 0.5 mg Last given at 5:50 PM
metoprolol (LOPRESSOR) 5 MG/5ML soln cartridge 5 mg Last given at 4:33 PM

Thanks for the note Carey...seems my triggers are dehydration/overdoing the cocktail hour, and lack of sleep. With the success I was having, I suppose I became a little careless.

What in particular is the concern with the combo of drugs administered? I will say I had major pressure in my chest after they administered the drugs and right before the cardiovert...also, I felt the cardiovert this time...a bit of a jolt to say the least.

Finally, I was in AFIB for ~4 hours prior to conversion...what is the protocol for the anticoagulants now? Used to be <24 hours, good to go. Seems this direction has changed as the ER wanted to send me home with blood thinners...I have yet to hear back from my EP or cardiologist.

The concern with the combination of drugs is the sheer number of them. The combination of etomidate, fentanyl, lorazepam, and metoprolol would knock out an elephant and likely drop his BP into the basement. That's probably why you felt chest discomfort. If they're not willing to use propofol, some versed or ketamine is all they needed. And the Lovenox was just plain weird. I don't know what they were thinking with that.

My cardio is recommending Xarelto for 4 weeks...is this the new normal? In 06/07, I was told less than 24 hours, no need for thinners...now they saying after cardovert, 4 weeks on small dose...

Quote
shca67
My cardio is recommending Xarelto for 4 weeks...is this the new normal? In 06/07, I was told less than 24 hours, no need for thinners...now they saying after cardovert, 4 weeks on small dose...

Anticoagulants for 4 weeks following cardioversions is the current recommendation. That's because cardioversions have a stunning effect on the atria that lasts quite a while. There some danger that this stunning will lead to stagnation within the left atrial appendage and clots forming after the CV. That's why you're being told Xarelto for 4 weeks.

Got it...thank you.