Frequent short episodes

Hi all,

Still a pretty infrequent poster but I read regularly. Started my journey in June. With one 6 hour episode of afib that resolved spontaneously in the ER. Since then I had an episode in September that lasted 3-4 minutes. The EKG I got on my Apple Watch was interpreted by my EP as looking more like SVT (rate in the 120s to 130s). Since that episode I’ve now had an episode every 5-10 days (feels more frequent) all short (3-5 minutes) and all self resolving. I’m now wearing a 14 day event monitor to try to get a better tracing to define what this is. Just wondering if anyone else has had a similar experience and how they managed. I should say I’ve also developed some pretty intense anxiety over this whole issue despite my cardiologist, EP, and ED doctor friends all telling me not to worry too much about it. Any advice/experience would be greatly appreciated.

Patrick G

Count yourself very lucky. Episodes so short are rather unusual. At least for now I wouldn't even bother treating episodes that short and I wouldn't take an anticoagulant unless I had a high CHADS-Vasc score. Basically, i would do nothing.

Unfortunately, afib tends to be a progressive disease. It's very likely that eventually those episodes will become longer and/or more frequent. That might not be for years, but it will likely eventually happen. I started out in 2002 with 1-2 episodes per year that lasted almost exactly 6 hours every time. That lasted over six years, but then in 2008 the 1-2 episodes per year became 3-4, and then monthly, and eventually every 3-4 days by 2010. The episodes became longer too. They went from 6 hours to 12+. But the important thing to keep in mind was that it took six years for it to begin progressing. During those six years I took no drugs for it, and never even bothered seeing a cardiologist since I knew what it was. So who knows, maybe you'll get six years too.

So, knowing this, what you can do is consider what you're going to do when and if the episodes become longer and more frequent. What's going to be your threshold for when you actually do something? If you've been reading here much, you know your options: drugs, ablation, Maze procedure.

Hi Carey,

Thanks for the quick response and for the hope. I think I’m mostly freaked about by the frequency. I had one of these episodes in early 2016. Didn’t think about it because it passed so quickly. Then had another one 3 years later and now I’m having them like every 5-6 days. Seems like it’s already progressing if it’s happening that frequently. But what do I know. Part of me just wants to ignore it like you say but the increase in frequency in such a short period of time has me...nervous. This is despite starting the magnesium and taurine and potassium protocol listed here back in September. At 34 years old with a 0 CHADS2VASC I know my stroke risk is pretty low but I’m already wondering if I should be considering my treatment options. More than once per week just feels like too much. Even if it’s only a couple of minutes the mental/psychological burden seems to last much longer than just those 3-4 minutes. Thoughts?

I didn't know you were only 34 and that changes my thinking significantly. You need to get ahead of this because you've potentially got 50-60 years of life ahead of you and spending 50 years battling afib with drugs and supplements isn't a reasonable option.

Where do you live? What sort of medical insurance do you have?

Carey,

I live in Charlotte, NC and even though I work in a hospital my insurance is garbage. I pretty much have to go to a physician in my hospital system or pay out of pocket up to a maximum of 16k. I’ve already had follow up with cardiology and EP here and the EP has said he would take me for EP study and possible ablation. To be honest I’m a little hesitant. It’s only been like 3 months and the risks of the procedure, although rare, are not insignificant. With 4 kids under 5 I’d like to be around and useful to them for a while longer. I’d obviously prefer to have the ablation while it’s still paroxysmal but the confusing thing to me is was the afib just the episode in August? Are these other episodes afib or SVT or some other atrial tachycardia? I obviously have heard all about Dr. Natale on here but I’m not sure that’s going to be financially doable for us given my insurance. Really hope this event monitor gives me some answers.

Patrick

Patrick,

Don't recall your story.

At 34, you may have a strong genetic predisposition.

A few thoughts. In many cases, young people with afib tend to be chronically fit. However most of these "young" people are 6-10 years older than you. If you are chronically fit, you may want to rethink that. I had my first episode at age 49 from chronic fitness and detraining while remaining fit is part of my remission plan (I'm now 64).

If you have any metabolic dysregulation, fixing that through lifestyle is another target.

Some of us have found that electrolytes can make a difference. In my case, magnesium to bowel tolerance, potassium citrate powder (2 tsp which is about 4 g K+) in a liter of water consumed over the day (my version of "timed release"), 2-4 g of taurine powder and avoiding excess calcium (primarily no supplements or dairy) work to keep me in NSR with a very low AF burden. I also take flecainide whenever I'm out of rhythm to revert to NSR as I had a 2.5 month episode in at the beginning of my "career" and I don't wish to repeat. The flec is not appropriate for you now.

George

Hey George,

That’s the thing about my history. I have no genetic predisposition on either side of my family and although I am fit (played soccer for years and years) I was never a distance runner or cyclist. Not really sure how I ended up here. All My lab work has come back normal so thyroid and other common causes are ruled out. The only test I haven’t done yet is sleep apnea which I’m scheduled for in December. Like I said to Carey, I’m not even sure if these short episodes are afib or another type of atrial tachycardia.

The only family history I have is really HTN and anxiety and thankfully at least for the time being I haven’t been diagnosed with HTN yet. The anxiety is new for me since the ER visit in June for afib. Part of me wants to believe these short episodes are panic attacks instead of a heart pathology but I’m inclined to think that’s wishful thinking. I know it sounds weird but yes I would prefer to have panic attacks.

Patrick

Hi Patrick,

I'd be seriously reflecting on your sense of "safety" or "threat", and how to keep yourself in ''safe zone" mentally / emotionally.
My first AF episodes were at age 30. I'm now 49. I'm fit and healthy. I eat well, I take Magnesium and Taurine, I breathe only thru my nose... etc. All of those lifestyle changes have reduced my AF burden.
The first 5 years, I had no idea that my AF episodes were related to anything emotional. Then I had an inkling... but it was weird, cuz often there was a delay of 2-4 days from the stressful event, till AF onset.
My AF 'journey' has been convoluted and full of exploring my chemistry and my self: I've gone thru months where I was ready for the ablation, my episodes were not self-reverting...i've had numerous electrocardioversions as a result.
In the last year, I've arrived at the conclusion that my AF is a result of 'nervous system overload': I've gotten consistently better at recognizing my stress triggers and stepping away or eliminating them in my life. And the 3 episodes I've had this year have all been self reverting, just by taking myself away from a threatening situation, to safety (whatever that is for me in the context of the triggers). This is now more reliable way of reverting than a cardioversion!
I've found Stephen Porges' polyvagal theory super helpful as a way of understanding AF. This theory is 20 years old now.. and Peter Levine and others do interesting, related work.
Your AF episodes are so short. Unless you have some genetic propensity towards AF, I'd be asking what your heart is trying to teach you. in real terms.
Wishing you regular rhythm, and no reason to be on this forum, other than to tell your story of 'no more AF'.
RR

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pgrove1
I live in Charlotte, NC and even though I work in a hospital my insurance is garbage. I pretty much have to go to a physician in my hospital system or pay out of pocket up to a maximum of 16k. I’ve already had follow up with cardiology and EP here and the EP has said he would take me for EP study and possible ablation. To be honest I’m a little hesitant. It’s only been like 3 months and the risks of the procedure, although rare, are not insignificant. With 4 kids under 5 I’d like to be around and useful to them for a while longer.

Sounds like your insurance is an HMO-type policy. If so, yeah, that means you're limited to the doctors in their network. So what you need to find out is who the EPs are in that network and how much afib ablation experience they each have. There is absolutely nothing that matters more with ablations than experience actually doing the procedure. Don't be swayed by academic credentials, titles, or general reputation. EPs don't generally publish their "numbers" so the only way to find out is to ask. How many afib ablations (not other kinds of ablations!) has Dr. X done in his career? How many does he do per year? Those are the questions you need answered.

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I’d obviously prefer to have the ablation while it’s still paroxysmal but the confusing thing to me is was the afib just the episode in August? Are these other episodes afib or SVT or some other atrial tachycardia?

Without seeing ECGs there's no way to know, but if you've had a documented episode of afib then odds are they're all afib. Yes, you could have a mix of another type of SVT such as flutter because flutter and afib often go hand in hand, but that's almost beside the point. If afib is present then that's the hard thing to ablate. The others are comparatively easy and would be dealt with in the same procedure.

RR,

Thanks for the encouraging message. Does this mean you've lived with A fib for 19 years without an ablation and are still only having 3-4 episodes per year? If so that is amazing and definitely what I would be hoping for (although given my current circumstances it kind of sounds like a pipe dream). I am going to see a counselor for anxiety now to try to help me with some of that but so far that hasn't slowed down my episodes.

Carey,

So just so I'm understanding you, it sounds like you are advocating for an ablation sooner rather than later (i.e. ASAP). I'm happy to go ask those questions and my current EP (performing ablations for 12 years) has not been asked those questions yet so I will start there. He seems busy (it took me 7 weeks to get on his schedule for an appointment) which seems like that's a positive thing. But I will make sure I ask the questions.

Patrick

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pgrove1
So just so I'm understanding you, it sounds like you are advocating for an ablation sooner rather than later (i.e. ASAP). I'm happy to go ask those questions and my current EP (performing ablations for 12 years) has not been asked those questions yet so I will start there. He seems busy (it took me 7 weeks to get on his schedule for an appointment) which seems like that's a positive thing. But I will make sure I ask the questions.

I'm not going to use words like ASAP because you've got plenty of time to do your homework and make informed decisions, but afib doesn't get better on its own and the drugs that control it all pretty much suck. You can limit it with lifestyle changes and supplements, but ultimately you'll never eliminate it from your life and, as the saying goes, afib begets afib. You've got a lot of years ahead of you for remodeling to happen and your afib burden to increase. An ablation at this point would likely be successful with little more than a standard PVI. Although cryo isn't usually my first choice, it could very well be sufficient for you. As for risks of the procedure, you probably face higher risks every day when you drive to work. The fact that it took you 7 weeks to see this EP is a good sign. Beware the EP who can see you this week and who wants to schedule an ablation next week.

Carey,

The EP answered back via email to say he completes between 75-100 afib ablations per year and he does the highest rate in the group at this time. Their success rates are around 75% and their complication rate is around 1%. I know that's not the volume most would advocate for on here. Although the financial burden would be extremely high, if I really should go to Austin for an ablation, I can try to get in touch and get on the schedule once I get the results from this event monitor. Let me know what you think.

Patrick

75-100 is a respectable number. It's not in Natale's realm but few EPs are. The success rate of 75% is the average for most EPs with paroxysmal afib (much lower for persistent). I give the EP points for answering with actual numbers. It sounds to me like this guy would probably do a good job. With your age and history I doubt that you're a complex case and as I said before it's entirely possible a standard PVI would be all you need.

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pgrove1
RR,

Thanks for the encouraging message. Does this mean you've lived with A fib for 19 years without an ablation and are still only having 3-4 episodes per year? If so that is amazing and definitely what I would be hoping for (although given my current circumstances it kind of sounds like a pipe dream). I am going to see a counselor for anxiety now to try to help me with some of that but so far that hasn't slowed down my episodes.

Patrick,

I've had afib for over 15 years. As I mentioned, had a 2.5 month episode in the first 4 months. I've been on my afib remission program that I designed from Nov 2004. In short it is a) detraining from high intensity, long duration endurance activity (can to long duration low intensity or short duration high intensity), b) magnesium to bowel tolerance, c) 2 tsp potassium citrate powder dissolved in a liter of water and consumed over the day, d) 2-4 g taurine powder, e) avoiding consuming sources of high calcium (like dairy), f) flecainide on demand to convert any breakthrough episodes. I've had a good track record with no progression. In the last 17n months, I've had 2 episodes, each lasting about an hour (and converted with 300 mg flec. This is typical for me. I think the longest I've gone without an episode is 2 years. The 2.5 month episode at the beginning was not auspicious, but after that it has been good.

I'm not saying what I do will work for everyone, but just wanted you to know it is possible.

My 34 year old son-in-law started having episodes a few years ago. He's military, so also fit. He would also drink hard on occasion. I bought him a Kardio device and coached him to mitigate the exercise a bit as well as the alcohol. Also to supplement with magnesium. So far, he's not seen progression and the last time I asked my daughter about it, she said it had been a long time since he'd had an episode.

George

Patrick,

sorry, not sure how to do the little square quote box thingo, but:
yes, that means I've had AF for 19 years. no ablation.
Good on you, getting yourself to a counsellor. However, deep behavioural change doesn't always happen instantly (sometimes it does!), and it can take the nervous system a while to catch up with your positive change, so the fact that you've yet to see impact on your episodes of AF doesn't indicate that your inner work isn't effective!
I'm on the public health list to have an ablation - this can be a 12 - 18 month wait in oz - so I've pretty much dedicated this last year to accelerated nervous system retraining. Cuz ultimately, I'd be comfortable with having 2 self-reverting AF episodes a year (or no episodes!) going forward, and bypassing the surgery option.
Are your episodes "high rate" AF? cuz that is cause for more concern; i have so-called 'low-rate' AF (altho my heart rate is higher than when in NSR, it doesn't bump up into the extreme range, say 120 to 200 bpm that is unsustainable).
Obviously, your body, your choices. If an ablation is going to give you peace of mind, then absolutely go for it. I may yet get one. I'm fortunate to have a v good ablationist here who is on 'the list' recommended by Natale. I'm a woman, so CHADS score suffers.
I follow a similar regime to George.

RR

Hello Patrick.

There isn't much I can add to the great advice you have received here this far. I was a young afibber as well. Mine would go dormant for long periods of time. And other times cause me much consternation.

I lived with it this way for years until it finally got to the point it was unmanageable. So as mentioned your first step now is to find the best EP available to you. Also you should try some of the suggestions given such as magnesium and potassium.

So far as genetics goes my mother developed Afib many years after I did. So the genetics could be there and haven't showed up in those that gifted it to you yet.

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strongHeart
sorry, not sure how to do the little square quote box thingo, but:

Look at the bottom right of this post. See the three links? ("Reply" , "Quote", "Report") Click "Quote" on this post and see what happens.