Living a long healthy life in AFib

This is my first post on this forum. I am 73 years old and was diagnosed with afib in 2012. It was discovered when I had an EKG in preparation for a colonoscopy. It came as a shock as I had no symptoms. Since my overall health was excellent the cardiologist I saw told me only to take aspirin and return when I turned 70 or if I develop symptoms. When I turned 69 I contacted an electrophysiologist and was placed on Eliquis and metoprolol. I was taken off the metoprolol because my pulse rate went to low when in NSR. I had my first zio patch at that time and my afib burden was about 30%. My current burden is 58%. Gradually only over the last year-and-a-half to two years have I begun to notice some symptoms when in AFib. This includes lower energy and sometimes light- headedness when I bend down and come back up. I also seem to be more irritable. While I would rather not have any of these symptoms neither are they debilitating. When I read some of the problems that have been discussed concerning complications from ablation it scares me. I do not have a crystal ball so I cannot look into my future. If I knew for sure that my symptoms would not get any worse I would be satisfied with where I am at now. My understanding is that stroke and heart failure are the two most serious possible consequences of AFib. I feel I am addressing the stroke risk with the Eliquis. My question to The Forum is what do you understand the risk for congestive heart failure to be with long-standing Afib.( I could not get a clear picture of this in my Google search.) Currently, when in AFib the zio patch showed that my average heart rate was 96. My current symptoms would not drive me to undertake the risk of an ablation but if it had a good chance of having me avoid eventual heart failure then I would take the risk. I'm very interested in what your opinions might be of my situation.

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frankangelo
My question to The Forum is what do you understand the risk for congestive heart failure to be with long-standing Afib.(

The issue is long periods of time with high (>100 BPM) rates while in afib, hence your script for metoprolol as a rate control med. You may want to be able to track your rate in afib. 58% of the time is a material afib burden. If your rate in afib is <100 BPM, then not to worry (some are).

I had a lawyer in his 40's who went on permanent disability because of congestive heart failure due to afib. His ejection fraction (EF) dropped very low - I don't recall his, but I do remember reading early on in my afib journey, 16 years ago, that an EF of 18 was heart transplant country. EF's are measured during an echocardiogram. Normal EF is 55-70% (amount of ventricular blood ejected during a beat).

My mom developed heart failure while on flecainide so it was discontinued. She had af and progressive heart failure until she was 96. She had discontinued her BB because of fainting and two separate broken hip falls and a broken leg accident from a fall, crushed skull another time...the list goes on.

We both developed af the same day on January 4, 2004 and were admitted one room apart in the same hospital. I didn’t want her life so I had two ablations.



Edited 1 time(s). Last edit at 11/16/2020 01:13AM by susan.d.

5 of 8 rooms in ER were covid positive. This was a hot zone and the most dangerous place I've been this year by far. If I didn't have covid walking in, I probably have it now. Getting retested on Tuesday.

I used Andromeda strain precautions once home, showered, washed clothes took all supplements.

As far as ablation goes, I would try to do what you can to avoid it but if you do end up needing to do it, get someone experienced.

I could make a list of how I would have had things done differently in my ablation and still trying to understand that but now have another closer fire to deal with vs past history.

How did this become about COVID?

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Carey
How did this become about COVID?

I edited my post to rid any mention of covid19. However this virus does affect one’s arrhythmia health care in seeking help when prior to March they would have less concerns about elective procedures and ER visits for an ecv. Either by deliberately not going to the ER when in high tachy to get an ecv because of the risk of exposure if for example 5 out of 8 rooms has covid19 exposure ...to deciding if one should postpone their ablation to avoid undertaking the risk. How many people similar to Frank are on the fence in making the decision not to have an ablation to lessen future heart failure with the risks of the virus in the back of their minds?

GeorgeN - "if your rate in afib is <100 BPM, then not to worry (some are)."

Are there studies that back this up? This is the type of information I am seeking but haven't found yet in my search. My EF is good @63.

Yeah - Susan set a covid trap and I got caught.

But fair to say - covid is an issue - travel - stress on health resources and safety of these places.

ER yesterday am was a hot zone.

What is meant by afib burden? is it the same thing as LVE fraction?

What is meant by afib burden? Is that the same as the LV ejection fraction?

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NotLyingAboutMyAfib
Yeah - Susan set a covid trap and I got caught.

But fair to say - covid is an issue - travel - stress on health resources and safety of these places.

ER yesterday am was a hot zone.

But I edited and deleted my covid19 reference. I didn’t setup a trap. It’s a real issue for those seeking help for AF and has delayed in many people needed ablations and seeking help at the ER for ECV’s. It’s not only cardiac health concerns. In April the infectious disease expert stated higher numbers will die of cancer because they don’t seek medical care during the pandemic.

Let’s move forward and I hope Frank will live a long and healthy productive life with persistent AF and will not suffer heart failure and can safely get as needed medical care without worries... as I had mentioned my mom lived to 97 with heart failure and <185 hr.

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frankangelo
GeorgeN - "if your rate in afib is <100 BPM, then not to worry (some are)."

Are there studies that back this up? This is the type of information I am seeking but haven't found yet in my search. My EF is good @63.

I probably read that 16 years ago. I'm pretty confident @Carey or @Shannon would concur as would an EP. Here is the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS) recommendations [watermark.silverchair.com] You can read about rate control at starting at p37 (download the PDF) and draw your own conclusions.

"10.2.1.1 Target/optimal ventricular rate range
The optimal heart-rate target in AF patients is unclear. In the RACE
(Race Control Efficacy in Permanent Atrial Fibrillation) II RCT of permanent AF patients, there was no difference in a composite of clinical
events, New York Heart Association (NYHA) class, or hospitalizations between the strict [target heart rate <80 beats per minute
(bpm) at rest and <110 bpm during moderate exercise] and lenient
(heart-rate target <110 bpm) arm,487,488 similar to an analysis from
the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm
Management) and RACE trials.489 Therefore, lenient rate control is
an acceptable initial approach, regardless of HF status (with the
exception of tachycardia-induced cardiomyopathy), unless symptoms
call for stricter rate control (Figure 13)."



Edited 2 time(s). Last edit at 11/16/2020 09:35PM by GeorgeN.

Thank you all for your comments. I have an appointment this coming Friday with a new cardiologist. Hopefully he can be someone that I can work with to manage my AFib. My overall view of medical care is "less is more." And I believe the body will try to heal itself although I realize that's not always possible.

To merri: A-fib burden is the percentage of time that you spend in AFib.

You should be happy that you feel pretty good and are handling being in afib fairly well. One silver lining for me is that I have taken excellent care of myself since being diagnosed over 25 years ago, (then in my late 30's). Staying healthy is obviously important and becomes even more important with afib as we get older. My grandmother had it for over 50 years, died at 95 from complications not related to afib...and my dad is now 83 and doing pretty well also. They did not have the tools & knowledge we do now, and I am grateful to have more options.

Ablations are pretty routine for the most part, and while all procedures are to be taken seriously, risks are pretty low, while potential benefits can be quite worth this risk.

Make sure your cardiologist is an Electrophysiologist? Or at least see one before making any decisions...this might be something to consider BTW.

Good luck!

Dweller, thank you for your input. While only a sample of 1 your grandma's experience is very encouraging for me. 50 years in AFib and she was able to make it to 95, awesome! You said you have had A-fib for 25 years now. How are you doing with your afib and have you had any ablations?
I realize that there is no one solution that fits everyone. I am just very skeptical about medical interventions unless it's an absolute necessity. it may be that I will eventually go for an ablation and definitely I will seek out the most experienced electrophysiologist that I can access.