Stats and questions

Having numerous afib episodes is no fun, even if they are short and always end spontaneously. However, as I've always taken notes about the circumstances surrounding those events (and sometimes single-lead ECG recordings), I've been able to draw some statistics, hoping to find something relevant.

Here are the stats from 2019...


1.- Length

The longest episode stopped after 3h. The shortest lived less than 15min. Episodes shorter than 3min have been neglected.


2.- Months and seasons

I've had 42 afib episodes, which means 3 to 4 episodes/month. Three months were above average : Jan (6), July (5) and Aug (9). Three were below : March (2) April (0) and Sept (2).
Here in Belgium, winter months are Dec, Jan, Feb (13 events), summer are Juny, July, Aug (16 events). So, only 5 episodes came in the spring, 8 in the autumn.
To note : Among the 9 episodes in Aug, 6 were very short (less than 15 min). The only other very short episode came in July.
The average length of an episode in summer was 40 min. They were longer in the winter (70 min). Both other seasons saw average episodes of 60 min.


3.- Days

I wondered if the day of the week could be involved in the afib phenomenon. In other words, if being mostly at home or at work could play a role in the process. Nothing meaningful to note.


4.- Hours - The most interesting part !

Dividing the day in 4 equal parts, here are the umber of events/part.

From midnight to 6 AM : 22 episodes
From 6 AM to noon : 1 episode
From noon to 6 PM : 6 episodes
From 6 PM to midnight : 13 episodes

To note :
- I always take the moment afib kicks in as the hour of the episode.
- I'm sure about the length of short episodes. Longer episodes may have been shorter than I took note of. The reason for that is that most of them came during the night, and considering I've found that the best way to self convert was drinking a little water and trying to sleep, If I did succeed and awoke in NSR, I didn't know the true moment I got back in NSR. However, when in afib, I usually awake so frequently that I likely don't miss the said true moment from more than a couple minutes.
- Still interesting : the episodes starting between midnight and 6 PM (time to leave my bed, usually) never did after 3:15 AM. OTOH, the episodes starting between 6 PM and midnight never did before 9 PM. Most came just after laying down in bed, before having time to fall asleep. Only five did start after some sleep. In any case, before or after midnight, I NEVER awoke in afib. Never. Afib always came while trying to get back to sleep.


To note : I'm 62, skinny (BMI 19,9), healthy heart, no sleep apnea, cyclist (reasonably). I've a weak LES and some silent stomach reflux (no heartburn). I may have lots of ectopics (PACs, PVCs). The « peaks » in ectopics are roughly the same as the « peaks » in afib episodes. IOW, I may have ectopics or ectopics leading to afib.


Questions

- What do you think about those stats ?
- Should I try something I never yet tried ? (In a jumble, since I had my first afib episode in 2015 Nov, I tried : propafenone, sotalol, flecainide, Mg, K, D3+K2 vitamins, 4 ablations, acupuncture, gluten-free and dairy-free diet, FODMAP-free diet, yoga...)
- Should I give some more explanations ?

Acid reflux or GERD is a major trigger for Afib. So when you lie down to go to sleep, acid moves up through the LES and irritates the esophagus along with the nerve (Vagus) lying next to it. The irritated nerve causes misfiring of the nerves in the heart.

Some gastroenterologists acknowledge this, and will recommend otc drugs to control acid reflux, but those drugs cause a lot of problems in and of themselves.

It is possible to get the LES tightened surgically, but most GE's are reluctant to prescribe the procedure.

You're right about GERD and stomach issues. I took a PIP drug for a tenth months, and it does not change my discomfort. It even worsened it. I don't take it any more.

I'm afraid it's not simple, and it's likely the reason why so many treatments failed to date.
I probably need a combination of conditions to really disturb my vagal tone, and it's hard to find those conditions.

Sleep apnea could be a trigger

Of course, Susan, but I've been tested for SA, with neg result.

Another way to look at my stats is to consider I've had more than 300 nights without afib. Those "normal" nights are nearly always the same. After a last meal between 6 and 6:30, I go to bed between 9:30 and 10 PM. I usually fall quickly asleep. Problems often come between 3 and 4 AM. I barely sleep till 6 (time to stand up in working days) or 7 (weekend). While I'm trying to sleep, I get ectopics. They come, they go. Moving (arms, legs, body position, anything) in bed is enough to take them away, but they would come back in a couple minutes if I lay down still. There are likely things I've not yet tried. Maybe those 12 hours or so from my late meal to breakfast are too long, but eating later or heavier (or both) would give me HR troubles before midnight, said troubles being undoubtedly relative to stomach issues, as you mentioned previously. Troubles around 3 AM are not. Nothing I've tried (meds, ablations, diets...) during the past three years have been able to change those early hours problems.

Thanks for your answer !

Pompon,

I previously wrote about my protocol for treating my stomach bloating and ectopics with supplements. I had h pylori and also other stomach issues, which I found odd as many others on this forum also suffer with but they tested negative for h pylori. I refused antibiotics and focused on my immune system along with stomach bacterial and it worked. Recently I had recommended this protocol to a few people I knew with similar stomach related issues as mine, basically anything stomach discomfort related, whether positional laying down or sudden movements or eating a big meal late, or certain heavy foods. This was more three months ago, but out of 6 people only one isn’t doing much better but he’s obese and I doubt he’s consistent with the supplements. Basically limit sugar and carbs intake and take colostrum, monolaurin, and olive leaf extract three times a day on empty stomach and within a week your issues will get much better, but don’t stop as you’ll need to take it for a few months at least, which is what worked for me and few others. I am aware that we all have some ectopics but now I never fell any of them and it’s been many months and im not sure if it’s because my stomach bacteria and inflammation disappeared or my immune system is affected somehow but I’m waiting for another couple of months and whether or not others have the same long term results as me before I post here. If you’re interested pm me and I’ll send you the links and brief instructions.

Thanks, Johnny.
I've been tested for HP too and it returned normal.
But, you're right about stomach issues.
Since the start of this year, I'm on a low carb, low fat diet. It's frustrating, not because of the diet itself, but because it's low energy food for a guy as skinny as I am.

Your pattern has some similarities to what I have experienced in the past, so you might try the following which has worked for me to maintain a low AF burden, albeit with some compromises in exercise intensity and diet. I don't take supplements other than a small amount of Mg and D_3 and have found large dosages of almost anything counterproductive.

Prop yourself up in bed and learn to sleep nearly sitting up . Remove some but not all pillows and reintroduce side sleeping if ectopics subside. Initially reserve the fewer pillows and side sleeping to periods where you feel less vulnerable

Eat a lite meal late maybe 7 - 7:30 PM, and even if you are low carb and fat consider loading with small amount of fat right before bed (perhaps peanut butter and crackers)

Recurrent ectopics and especially the short sub 3 minute runs of AF perpetuate themselves and are precursors to longer AF episodes in my case. The key for me is to actively minimize them to the extent possible. I find that the PACs and PVCs and again especially the short runs of AF can be addressed with low dose flecainide and propranolol as needed, and occasionally prophylactically. In my case propranolol works by itself, no flecainide needed. By low dose I mean a small fraction of conventional dosages. I experience no side effects at these dosages. For example propranolol at 2.5 to 5 mg as needed, or 10 mg prophylatically spread out through the day and before bed. Most MDs would consider these dosages as having no therapeutic value for the conditions they are usually prescribed to treat. You will need to work with an MD on this of course.

There isn't much to do once one of the longer episodes starts. Given your mean duration, PIP doesn't seem to make sense. You might take some comfort in that according to the latest research your AF burden does not appear to incur much additional risk for stroke. If you can reduce the frequency and get the sleep deprivation under control it seems you should be ok.

Might I ask what your EP thinks is the reason that the ablations have not been 100% effective?

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safib
Your pattern has some similarities to what I have experienced in the past, so you might try the following which has worked for me to maintain a low AF burden, albeit with some compromises in exercise intensity and diet. I don't take supplements other than a small amount of Mg and D_3 and have found large dosages of almost anything counterproductive.

That's what I'm doing for about three weeks: just 100mg Mg element (400 mg chelated form). No more D3 nor K2.
I've taken 5 to 8 times that daily dose of Mg, and came to the same conclusion.

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Prop yourself up in bed and learn to sleep nearly sitting up . Remove some but not all pillows and reintroduce side sleeping if ectopics subside. Initially reserve the fewer pillows and side sleeping to periods where you feel less vulnerable

There has been a time I couldn't sleep in bed most of the nights. I was sitting in the sofa or slowly walking in the room. Laying down was unbearable.

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Eat a lite meal late maybe 7 - 7:30 PM, and even if you are low carb and fat consider loading with small amount of fat right before bed (perhaps peanut butter and crackers)

It's something I've not yet tried. A couple months ago, I've asked about it at my GP, making the hypothesis I might have something wrong with blood sugar caused by my usual "12 hours without food". He lent me a glucometer for some days, but I stayed in the norm both while digesting or while trying to sleep with an empty stomach and ectopics.

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Recurrent ectopics and especially the short sub 3 minute runs of AF perpetuate themselves and are precursors to longer AF episodes in my case.

Precisely my greatest fear about my afib in the future.

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The key for me is to actively minimize them to the extent possible. I find that the PACs and PVCs and again especially the short runs of AF can be addressed with low dose flecainide and propranolol as needed, and occasionally prophylactically. In my case propranolol works by itself, no flecainide needed. By low dose I mean a small fraction of conventional dosages. I experience no side effects at these dosages. For example propranolol at 2.5 to 5 mg as needed, or 10 mg prophylatically spread out through the day and before bed. Most MDs would consider these dosages as having no therapeutic value for the conditions they are usually prescribed to treat. You will need to work with an MD on this of course.

Low dose (50mg 2x/day) of flec does nothing. Higher dose (100mg as PIP) has very bad effects: conduction problems when my heart reachs 115-120 BPM (it looks like runs of v-tach on ECG !). The very last time I took flec, I was in afib for more than 1 hour. I swallowed only 100mg (my maximal allowed dose) and it did succeed to convert my afib in a-flutter (at +/-125 BPM) for about 12 hours!
BB disable me. I'm like a very old guy with the lower dose (2.5mg) of bisoprolol.

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There isn't much to do once one of the longer episodes starts. Given your mean duration, PIP doesn't seem to make sense. You might take some comfort in that according to the latest research your AF burden does not appear to incur much additional risk for stroke. If you can reduce the frequency and get the sleep deprivation under control it seems you should be ok.

As previously said, I'm in a low-carb low-fat diet for more than three weeks. Last afib episode on Jan12 (5 min!). Very few ectopics for nearly one week. Last night has been fine.
But I've had "quiet" weeks in the past, and this without any diet; so, it may be just a coincidence.

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Might I ask what your EP thinks is the reason that the ablations have not been 100% effective?

I've seen 3 EPs. The last one, as you expect, isn't the guy next door. He's very skilled.
I've made a post here about my last touch-up.

All previously ablated areas were still disconnected, so I may say the ablations were effective. However, new areas were shown as "active", and new ablation lines were made.
My heart then stayed in quiet NSR, despite the drugs and procedures used to try to induce more afib.
Done ? Not yet. 5 days later, the beast was back!

Are my heart chambers like a rotten roof? You fix the holes, it's good for some days, then now holes appear?
Or are there still some discrete cells very hardly firing in the lab?

In another topic, I've asked about experiences or witnesses about ablations in the Marshall vein area, but it seems it's still a recent and nearly unknown procedure, for I got no answer to date.

With regard to the beta blocker, the dosages of bisoprolol and propranolol are not comparable. As a reference point, for treating hypertension bisoprolol dosing is 2.5 - 5 mg/day initially, increasing to 10 mg/day if necessary, and maxing out at 20 mg/day; while propranolol dosing is 40mg twice a day initially, 120 - 140 mg/day maintenance, and maxing out at 640 mg/day (these are for the immediate release variety). Hence the 2.5 - 5 mg Propranolol I was referring to is roughly 3 - 6% of the standard initial dosage, whereas 2.5 mg of bisoprolol is 50 - 100 % of the standard initial dosage. I have to repeatedly split the lowest available tablet size of propranolol (10 mg) to obtain these dosages. If I take anywheres near 40 mg of propranolol I can barely breath, especially with my low HR.



Edited 1 time(s). Last edit at 01/24/2020 02:38PM by safib.

Sorry.
I forgot saying 2.5mg bisoprolol was 2x 1.25mg for me. 2.5mg is the smallest form available here, and I had to cut the pills. This low dose was already useless relatively to ectopics.

I don't want to belabor the point but 2.5 mg/day is in the range of a standard initial dose of bisoprolol. I don't have experience with bisoroprolol. But taking a standard initial dose of propranolol would lay me out, and would actually worsen ectopics and AF, which is a typical response when using beta blockers to treat vagally mediated AF. Hence the need for much smaller dosages and experimentation.

The reason I responded and continued to elaborate was because it seems you are one of the few to report this very short (order of a few minutes) AF variant, which also affects myself. I have had some success with the approach I outlined to resolve my sleep issues (I am otherwise asymptomatic) and to reduce the stroke risk according to current data. I had hoped it might be useful to you. I guess your situation is quite different.



Edited 1 time(s). Last edit at 01/25/2020 03:16PM by safib.

I don't know, Safib. We're all so different despite afib being the same trouble. I've tried so many things !
I have notes about each afib episode I've had to date. Four years and two months, 300+ episodes.
I've had quiet times as well as chaotic weeks, and I still don't know why a drug or supplement or diet seems to work one month and don't work any more the next one.
I highly appreciate the help everyone here offers, based on experience and success, and I'm grateful for that.