Findings from LAFS II � Part 4
A. Effect of Supplements
There was, however, a statistically significant trend for vagal afibbers who took supplements to have significantly shorter episodes (p=0.04). This effect was independent of age. There was also a trend for people who took multivitamins to have longer lasting episodes; however, this trend could be confounded by the fact that afibbers who took multivitamins were less likely to take magnesium as well. Respondents who took large amounts of calcium tended to have more severe episodes; however, these people also tended to be older thus possibly confounding this finding.
Sixty-four respondents with paroxysmal afib gave an opinion as to whether they had, subjectively, found supplementation to be beneficial � 44% said "Yes", 19% "No", and 37% were not sure. Somewhat surprisingly, there was a statistically significant correlation between how respondents felt about the benefits of supplementation and how severe their afib was. Afibbers who felt that supplements were beneficial spent an average of 50 hours in afib during the six-month survey period. This was almost 4 times less than the 194 hours spent in afib by those who did not believe supplementation was beneficial. Respondents who were not sure whether supplements had helped spent an intermediate 76 hours in afib. These differences were statistically significant (p=0.02). Afibbers who had experienced afib for a long time were more likely to say that supplements were beneficial (p=0.005) and older afibbers were less likely to take multivitamins (p=0.04). Fifty-three per cent of chronic afibbers found supplements beneficial even though they did not affect their afib.
The finding that there is a statistically significant correlation between how afibbers feel about supplementation and their episode severity may indicate that most afibbers are very observant as to what works and what doesn't work. On the other hand, the finding could also be interpreted to mean that afibbers who believe something works will actually make it work � in other words, a very strong placebo effect. A fascinating subject for a future clinical trial!
Sixty-four per cent of adrenergic afibbers felt that supplements were helpful as compared to 42% of vagal, 36% of mixed, and 53% of chronic afibbers.
The following supplements were used by more than 10% of the respondents who reported use of supplements:
The following supplements were taken by less than 10% of respondents:
Adrenergic and mixed afibbers who took multivitamins tended to have longer lasting episodes (p=0.02) independent of age. There was a highly significant trend for vagal afibbers who took calcium to have longer episodes (p=0.002); this effect increased with larger dosages (p=0.001).
There were trends (statistically non-significant) for vitamin E to decrease episode frequency and severity (p=0.08) and for high calcium intakes to be detrimental (p=0.08); this was especially true for vagal afibbers. Mixed afibbers tended to have shorter episodes and spent less time in afib if they took magnesium (p=0.06).
Afibbers who believed that supplements were helpful were more likely to take vitamin C, B- complex, and magnesium and less likely to take calcium than were those who did not believe supplements to be helpful. These differences, however, were not statistically significant.
Chronic afibbers were less likely to take multivitamins and magnesium, but generally took higher dosages of vitamin C and calcium than did paroxysmal afibbers. These differences again were not statistically significant.
In contemplating these findings it should be kept in mind that some sample groups were small and that the possibility of confounding by other variables is likely. I hope to eventually be able to put all the questionnaire data through a more powerful statistics program that will sort this out. Nevertheless, I believe it is safe to conclude that this survey does not support the idea that there is any one supplement that will "magically" reduce episode severity for all afibbers. This does not mean that supplementing is not beneficial. Many respondents commented that their overall health and well-being had improved since they began supplementing even though their episode frequency and duration had not changed.
B. Effect of Relaxation/Breathing Therapies
One respondent had found walking to be beneficial, one had found prayer to be effective, and one reported benefits from using the Heart Lock-In technique developed by the Heart Math Institute. Two respondents had tried hypnosis but did not find it useful. Three had tried biofeedback with two observing some benefit and one reporting no benefit.
Closer scrutiny of the collected data revealed some intriguing correlations. Although these were statistically significant they should, because of the very small sample sizes, be taken with a very large grain of salt.
C. Effectiveness of Dr. Lam's Protocol
This concludes the evaluation of our second major LAF survey (LAFS II). Next month we will bring you the analysis of our latest survey conducted in May 2002 (LAFS III).
Many of you do not regularly visit the Bulletin Board and therefore would be unaware of the exciting findings posted there. Here is a very important one I want to share with you.
I would like to "publicly" thank Hans for one of his many pearls in the most recent AFIB Report. The part to which I refer is: "Drugs for conversion only - One vagal afibber has found that taking 225 mg of propafenone at the beginning of an episode helps speed up conversion usually converts within a few hours. One mixed afibber has found that taking flecainide at the onset of an episode speeds up conversion. Both of these findings are in accordance with the results of clinical trials aimed at testing the efficacy of flecainide and propafenone for conversion."
Accordingly I did some research and dug up the below articles to support his statement. I have VMAF and found that flecainide (Tambocor) has some nice anticholinergic properties. After looking at side effects more in depth, I talked to my cardiologist about flecainide and about the single dose of 300 mg just after onset of AF recommended in the articles. He suggested I try 200 mg as an initial trial. Last night 30 minutes after going to bed I slipped into AF. I immediately took the 200 mg and sometime within 2 to 4 hours after that I reverted to NSR. Normally for me these episodes occur every 10 days or so and last 18 hours or so. Fortunately my ventricular response rate is very slow. Nonetheless, shaving 15 hours off an episode is quite exhilarating. The nice thing about this approach is the limited nature to the medication - one time just after onset. I don't recommend a flippant approach to any of these antiarrhythmics, but this might work for some of you too. Thank you Hans. PC, MD
The following are two recent articles on the phenomenon to which Hans referred.
1) Ital Heart J 2001 Jan;2(1 Suppl):41-5
2) Pacing Clin Electrophysiol 1998 Nov;21 (11 Pt 2):2470-4
 Alboni, Paolo, et al. Efficacy and safety of out-of-hospital self-administered single-dose oral drug treatment in the management of infrequent, well-tolerated paroxysmal supraventricular tachycardia. Journal of the American College of Cardiology, Vol. 37, February 2001, pp. 548-53
The relationship between exercise and lone atrial fibrillation is a complicated one. It is clear that regular exercise improves lung performance and cardiovascular function. It is also clear that overdoing it promotes oxidative stress and may be counterproductive in the long run. Exercise has a profound effect on the autonomic nervous system by shifting the balance from sympathetic to vagal predominance. Exercise also reduces the level of norepinephrine, the adrenergic neurotransmitter, which in excess can initiate an AF episode.
So is exercise good? That depends. Strenuous daily workouts and marathon runs markedly increase vagal tone and this would not be a good thing for vagal afibbers whose vagal tone is already excessively high. So for vagal afibbers moderation is the key. Many adrenergic afibbers, myself included, have found that workouts may set off an episode so have backed off from regular, vigorous exercise. This is a mistake. Adrenergic, and perhaps mixed, afibbers need exercise in order to increase their vagal tone and reduce their sympathetic (adrenergic) activity and norepinephrine levels. So what to do? I have kept track of when my episodes began for over 12 years now and have observed that I have never had an episode begin between 11 am and 1 pm. This period, according to Traditional Chinese Medicine, is when energy flow through the heart meridian is at its peak. Is this relevant? I don't know, but it's intriguing. I have now scheduled my workouts for around noon and so far have not encountered any problems. So for adrenergic and mixed lone afibbers it would make sense to do your daily exercise in the time period during which you seem to be the least vulnerable to episodes. But please do try to get some regular exercise unless your doctor disapproves.
 Coats, Andrew J.S., et al. Controlled trial of physical training in chronic heart failure. Circulation, Vol. 85, June 1992, pp. 2119-31
In the June issue I discussed the idea of a possible connection between cortisol levels and LAF. I mentioned that I was having a cortisol profile done and would let you know the results. I have received it now and it supports my contention that, at least the adrenergic variety, could be associated with a low cortisol or DHEA level.
I have been keeping a record of the timing of my episodes over the past 12 years and have found that the vast majority of them begin around 4 pm. This observation was actually what gave me the idea that some hormone with a strong diurnal variation could be involved. Cortisol is one such hormone. It peaks in the morning and is at its lowest at midnight. My profile showed a pronounced dip at 4 pm at which time the level (2.12 nmol/L) was barely above the lower limit of the reference range (1.0 nmol/L). Of perhaps even greater significance was the finding that my DHEA (dehydroepiandrosterone) level (0.275 nmol/L) was way below the accepted lower reference level (0.800 nmol/L). So I am now working on increasing both my cortisol and DHEA levels and already suspect that achieving close to normal levels will make a big difference.
For those of you who have been considering having the salivary Adrenocortex Stress Profile done I would say go ahead, especially if you had a stressful childhood which is known to lead to low cortisol levels in adult life. Please do the test when you are in normal sinus rhythm. I would definitely recommend the saliva test rather than a blood test as it is far more indicative for our purpose. I would suggest that you ask your physician or naturopath to order the Adrenocortex Stress Profile from the Great Smokies Diagnostic Laboratory in Asheville, NC. It will be much easier to compare results if we all use the same test and laboratory. Great Smokies has a good reputation for accuracy and reliability. You can find out more about the test at http://www.gsdl.com/assessments/adrenocortex/. Please let me know your results so we can add them to the database.
New stroke prevention drug
Non-drug stroke prevention in AF patients
Magnesium helps prevent ectopic beats
Accurate test for pheochromocytoma
All beta-blockers are not equal
The AFIB REPORT is published monthly by Hans R. Larsen MSc ChE
1320 Point Street Victoria, BC, Canada V8S 1A5
Phone: (250) 384-2524
E-mail: [email protected]
Copyright © 2002 by Hans R. Larsen
The AFIB REPORT does not provide medical advice. Do not attempt self- diagnosis or self-medication based on our reports. Please consult your health-care provider if you wish to follow up on the information presented.