Staying out in front of afib?

I just recently had a Natale ablation on 3/20/19. How reasonable is it that one can actually stay out in front of this condition for the remainder of their lives by continuing to have ablations as needed? Is this even conceivable or will it eventually becoming a losing battle? I realize that many of you have come back for touch-ups and have had great success but is it it realistic to think that even a skilled EP like Natale can stay out in front of our condition indefinitely throughout old age? I’m just trying to get a better understanding of my long term prognosis. Thanks in advance and Happy Thanksgiving everyone!

Yes, it's totally realistic. What's also realistic is the possibility you'll never need another ablation. An ablation that's still fully effective a year later is generally considered permanent for life and doesn't ever "wear out." However, afib is a progressive disease so it's possible that you could develop new sources of afib later in life that are outside the areas isolated by the ablation, and that's what has happened when you hear about someone needing another ablation years later, but there's no reason to expect that to happen.

Thank you Carey!

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Carey
Yes, it's totally realistic. What's also realistic is the possibility you'll never need another ablation. An ablation that's still fully effective a year later is generally considered permanent for life and doesn't ever "wear out." However, afib is a progressive disease so it's possible that you could develop new sources of afib later in life that are outside the areas isolated by the ablation, and that's what has happened when you hear about someone needing another ablation years later, but there's no reason to expect that to happen.

What exactly does "afib is progressive" mean?

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katesshadow
What exactly does "afib is progressive" mean?

It means that as you get older the underlying disease can slowly get worse. For example, maybe when you had an ablation at 60 there were ectopic signals coming only from the area directly around your pulmonary veins, but now that you're 75 there are ectopic signals coming from other areas of your heart that are outside the "fence" created by the ablation to contain the pulmonary veins. The result is you have afib again. It's not that the original ablation failed -- it didn't -- it's just that the cause has progressed beyond its original bounds.

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Carey

What exactly does "afib is progressive" mean?

It means that as you get older the underlying disease can slowly get worse. For example, maybe when you had an ablation at 60 there were ectopic signals coming only from the area directly around your pulmonary veins, but now that you're 75 there are ectopic signals coming from other areas of your heart that are outside the "fence" created by the ablation to contain the pulmonary veins. The result is you have afib again. It's not that the original ablation failed -- it didn't -- it's just that the cause has progressed beyond its original bounds.

I asked because so many of us have been told our hearts are in great shape. i understood that to mean they could not see anything that caused the Afib. If you can't see anything, what is progressing? (sorry to sound clueless )

Too bad they can't figure out what is causing AF and cure it, everything is slash and burn.

Liz

Agree with ya, Liz.

/L

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katesshadow
I asked because so many of us have been told our hearts are in great shape. i understood that to mean they could not see anything that caused the Afib. If you can't see anything, what is progressing? (sorry to sound clueless )

You don't sound clueless at all. This isn't simple stuff.

It's hard to explain any better than I did last time because it's not fully understood what causes afib in the first place, but today the best treatment is to put a fence around the cells in your heart that are causing the problem. That fence lasts a lifetime when done right. But sometimes as we age new cells can begin misbehaving. If those cells happen to be outside the fence created by your ablation, you might have afib again.

That's progression. They see it by simply seeing that you have afib again years after a successful ablation.

Liz, great point, not just with afib, but all conditions. Not that Im against treatment, but at times it seems the experts get lost in their quest for the latest and greatest med and devote little time to researching the cause.

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Elizabeth
Too bad they can't figure out what is causing AF and cure it, everything is slash and burn.

How to slow or stop progression has been a question I've asked myself for over 15 years, even though I created a program for myself that has very low AF burden following a 2.5 month episode in the beginning. I've never stopped tweaking and looking at what else I could do. Not that I have the answer, but my approach is to optimize everything I can in my health, as I understand what this means (which could be wrong). Even looking at mitochondrial function as these guys did (unfortunately the full article is behind a paywall) <[www.ncbi.nlm.nih.gov]

George;'

I was able to read the full article, going to the site you posted then you can find the whole article, very long. I wonder if they are doing anything more.

Liz

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hwkmn05
Liz, great point, not just with afib, but all conditions. Not that Im against treatment, but at times it seems the experts get lost in their quest for the latest and greatest med and devote little time to researching the cause.

There are quite a few researchers who are looking for causes. Dr David Sinclair and his team is just one group who look beyond whack a mole treatments (as he terms it)

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Elizabeth
George;'

I was able to read the full article, going to the site you posted then you can find the whole article, very long. I wonder if they are doing anything more.

Liz

Interesting Liz, as when I go to that page and click for Full Text Article, I get to a page with "Purchase PDF" on it.

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GeorgeN

Too bad they can't figure out what is causing AF and cure it, everything is slash and burn.


How to slow or stop progression has been a question I've asked myself for over 15 years, even though I created a program for myself that has very low AF burden following a 2.5 month episode in the beginning. I've never stopped tweaking and looking at what else I could do. Not that I have the answer, but my approach is to optimize everything I can in my health, as I understand what this means (which could be wrong). Even looking at mitochondrial function as these guys did (unfortunately the full article is behind a paywall) <[www.ncbi.nlm.nih.gov]

George, Why have you never had a Ablation to tame the AFIB BEAST instead of the strict regiment you seem to religiously adhere to? Most could not follow the program you have developed and tweaked as necessary.
I admire your personal drive and high expectations but My little pea brain says let modern technology work its magic.

I wish I could be half as dedicated as you are. I have fought anxiety and weight gain for decades.

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Carey

I asked because so many of us have been told our hearts are in great shape. i understood that to mean they could not see anything that caused the Afib. If you can't see anything, what is progressing? (sorry to sound clueless )

You don't sound clueless at all. This isn't simple stuff.

It's hard to explain any better than I did last time because it's not fully understood what causes afib in the first place, but today the best treatment is to put a fence around the cells in your heart that are causing the problem. That fence lasts a lifetime when done right. But sometimes as we age new cells can begin misbehaving. If those cells happen to be outside the fence created by your ablation, you might have afib again.

That's progression. They see it by simply seeing that you have afib again years after a successful ablation.

Thanks -

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smackman
George, Why have you never had a Ablation to tame the AFIB BEAST instead of the strict regiment you seem to religiously adhere to? Most could not follow the program you have developed and tweaked as necessary.
I admire your personal drive and high expectations but My little pea brain says let modern technology work its magic.

Smackman, when ablations are needed, a Natale ablation is wonderful. I've referred many friends to him with a strong recommendation. However, even a Natale ablation is not cost free (I'm not talking about $$). If my LAA needed ablating, then I'd have to deal with lifetime anticoagulation or getting a Watchman or similar device. Years ago, a poster here noted that his was a "complex case" because of an early 2 month episode, even though he'd had long periods of low AF burden (meaning likely LAA work). My case is similar. As others have noted, even a Natale ablation is not a lifetime guarantee. In fact, if I got an ablation, I'd likely not change my habits, they have too many positive benefits - I was with my 32 year old son recently and a stranger asked if I was his brother. My current afib burden is about 2 hours in 18 months from two episodes. That is about 0.015%. Certainly that is not worth an ablation. I do know that afib is waiting for me if I deviate, I've had that experience.

I have a larger goal - delaying or avoiding dementia/Alzheimer's disease. I have a genetic risk for that and my mother died with dementia (never a diagnosis of what kind). Everything I do to optimize my health has this as a goal. The afib remission is a side benefit. At 64, I can be very active - skiing the steeps hard with those 30 years my junior, rock climbing & etc (however I train very carefully not to be on the wrong - too much - side of the exercise equation). Though fit my whole life, I used to weigh 45 pounds more. I now weigh what I did in grade 9. I put great focus on optimizing my metabolism, even to the point of wearing a continuous glucose monitor though I'm not at all diabetic. I fast 22 hours daily with regular 5-7 day extended fasts. I look at metabolism optimization as one of the keys to health span. Those with my genetics have shown diminished glucose metabolism in their 30's, way before dementia presents. Hence, for over 10 years, I've fueled such that I always have at least a modest amount of betahydroxybutyrate in my serum. I optimize sleep, circadian rhythm, autoimmune issues with diet, inflammation, exercise & so on. The Alz/dementia mitigation is a much more challenging problem than afib, but well worth the payoff if I can succeed (of course no guarantees here).

George:

The only way I got on was to google the article, it came up and I tapped on the address shown and it took me there, it is an old address and no longer being used I guess.

Liz

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Elizabeth
George:

The only way I got on was to google the article, it came up and I tapped on the address shown and it took me there, it is an old address and no longer being used I guess.

Liz

Still couldn't find that paper without a paywall. Did find this one Mitochondrial Dysfunction-Associated Arrhythmogenic Substrates in Diabetes Mellitus <[www.frontiersin.org] Interestingly, my friend ended up with heart failure from pneumonia which brought on persistent afib. After something like 18 months of cyclical extended (multi-day) fasting, daily time restricted eating on a ketogenic diet and exercise, he reversed the heart failure and the afib. I've asked him to write it up and post here, but he's very busy just earning a living and has never done so. He was overweight, so the article posits a potential mechanism at the cellular level. His good health has been maintained for a couple of years subsequent.

Re smackman's question (tho also very relevant to bkimura's original post and others) : I usually just glance at what's occurring on this site and don't post, due to time considerations. But Smackman's post and question to George provokes me to answer, and my answer has stuff in common with George's:

Compared to eliminating afib by diet etc, ablation = absolute last resort!!! Many, many possible horrors!!!

What's more, I've always believed that the fact that there's some sort of deeply "mysterious" cause to Lone AF which modern science hasn't supposedly identified, and which in my opinion is BOUND to eventually be revealed to be something adverse in diet and/or lifestyle, means that it is well worth searching for what factor(s) affect AF frequency etc and then experiment with them. And furthermore, if there are factors causing something as serious as AF, they are bound to be doing LOTS more long-term damage as well! That would be additional to all the other highly destructive aspects of modern diet, adjustment of which we already KNOW can prolong life. For me (and George, and others) it is an absolute no-brainer to do what one can do to identify these factors, eliminate them, and optimise healthspan!!!

My many hundreds of experiments on myself cause me to be 100% convinced that too much calcium in modern diets, combined with too-low VitD levels, is the largest factor BY FAR in Lone atrial fibrillation. George does what I do : restrict calcium intake and maintain high (very high by most people's standards) serum vitamin D -- by substantial VitD supplementation. (Full details of my own 100% successful approach are on my website -- which has badly needed updating and which I'm now doing -- but brief details below). George also does other stuff, and I also do other (different) stuff, but both of us have those two major, major threads in common and both of us also strive to optimise all factors as we (separately) see best. [Actually, the calcium and VitD are so intimately intertwined that they are effectively one single factor -- by far the largest one!]

In June on this site, "safib" reported that he too had gained full remission from AF by calcium intake reduction.

In my case (and George's now also, I have previously read), I consume a level of Ca commensurate with that consumed by all humans and all human ancestors for untold millions of years before the invention of dairying a maximum of only 5,000 years ago (but becoming more widespread for only the last thousand or so -- as also unequivocally highlighted by the lack of full human evolution to dairy foods in other ways, like very widespread lactose-intolerance). I also maintain serum vitamin D (by supplement use) right where all our millions of years of ancestors automatically had it by being outdoors and fully solar-saturated (I believe that George maintains it even higher). This juxtaposition of lower Ca intake and high blood-serum VitD (or actually evolutionarily normal calcium intake and normal VitD levels, as I say) yields superb and steady serum Ca levels. Interestingly, what is the most universal feature of all cardiovascular problems (at least in Westerners)? It is progressive calcification of the vasculature (that's how CAT-scan Ca scores work!). So, re my earlier comment : "And furthermore, if there are factors causing something as serious as AF, they're bound to be doing LOTS more long-term damage as well", well that's what I also believe -- that a totally unnatural surfeit of Ca and a serious deficit of VitD devastate our Ca metabolism and have caused, and are causing, an epidemic of vascular calcification, and I am very optimistic that I am having even greater benefits for myself than eliminating Afib (which is pretty huge itself!) by fully restoring my Ca metabolism to that which all humans naturally had for endless millions of years! Certainly my cardiovasculature seems in pretty good nick judging from my 66yo rapid thrice-weekly runs and twice-weekly sprint sessions. So that is my personal view re smackman's question "Why have you never had a Ablation to tame the AFIB BEAST instead of the strict regiment you seem to religiously adhere to?", and the related statement "let modern technology work its magic". To me, like medication, that is just putting the proverbial lipstick on the ... , and is a second-best approach. Much, much better to find the natural factors which must underlie the mysterious "Lone" afib, and change them.

If one can do that, one will virtually certainly be doing even more good for oneself than "just" avoiding afib (and ablations), as if that wasn't enough reason anyway.

Like George, as I say, I do a variety of other stuff. I eat almost entirely a diet highly plausible for our millions of years prior to just the last few thousand when agriculture took over -- 4 eggs per day; lean (basically grass-fed in US terms) beef; and the remainder mainly low sweetness fruits. [I don't regard the fruits as essential to my Afib elimination and have seen no sign that veggies wouldn't do just as well, but I'm punting on the anthocyaninins etc in dark fruits for other benefits.] Unlike George, I eat very little added fat, and I do not add magnesium.

The above is only a brief outline of my dietary approach. I stick to it pretty rigorously (finding it all perfectly tasty), but then also consciously break out from it with individual delectable treats multiple times per week, rather than just shoving in acres of the junk that surrounds us everywhere.

Great insights Steve!