Afib and Pregnancy

Hi Everyone! It has been quite awhile since I last posted. I am a 35 year old female with afib. I had 3 episodes in a 3 month period about a year and a half ago. Because of this forum, I started on magnesium and it has been a saving grace for me. I have gone 14 months without an episode. I know afib is not gone, but I have felt fortunate to keep it at bay for so many months.

My husband and I have 2 kids and would love to have a 3rd. I did not have afib with my other 2 pregnancies and am terrified that it might cause major problems. Both my EP and my OBGYN have told me it is risky, but they would help me manage it while pregnant. There is just not a lot of research on this because it is so rare to have afib so young that pregnancy usually does not come up.

Has anyone experienced this or do you have any thoughts? It feels like such a hard decision - I would love to have another child, but don't want to do anything to put me (or the baby) in danger.

Thanks in advance!!
Anne

Hey Anne,

No experience, but some thoughts. My big concern would be the limitations on treatment. For example, I've used relatively high dose magnesium for 12 years to keep my afib in remission. Since whatever the baby would see would be from my serum, which is never out of line, I would not worry. However, I've also used flecainde on demand to convert myself whenever the mag did not keep me in rhythm. I would be concerned about exposing the fetus to flec, or if I couldn't use it, having to stay out of rhythm. Same would be true with electro-cardioversion.

Best of luck to you in your decision!

George

Hello Anne - Welcome but sorry you are visiting us again. I refreshed my memory by finding your first report a year ago. This is harsh but after reading it again, it’s apparent that the doctors you consulted aren’t conversant about nutritional imbalances that can influence Afib; especially since you mention you started taking magnesium and the Afib improved. There can be other nutritional imbalances as well that would be good to assess but done with a doctor who is educated in that field.

First, though, to your question…
As George so wisely mentions, there are many potential considerations for ‘managing’ AF during pregnancy that deserve consideration. Certainly the various chemical exposure in drugs, anesthesia should you need ECV and TEE as well as the ECV itself should be top priority.

Prior to becoming pregnant, one thought would be that you spend a year or so investigating through various nutritional profile testing (such as Genova’s Metabolic Analysis Profile) by working with a functional medicine or restorative medicine type practitioner to learn where there might be nutritional imbalances allowing your AF to manifest. If those could be restored and you were able to stabilize with no breakthroughs for six months or so, it might give some level of comfort that you could skate through 9 months AF free. I’d want to start with the ExaTest to learn your total profile of electrolytes which is very ‘telling’ for most afibbers.

The fact that you have improved with magnesium supplementation is encouraging, it would be best to know all about how your various systems are functioning (or why not) so that they can be adjusted with nutritional interventions. This would be useful for you regardless of another pregnancy.

Since, as you mention, you are quite young to have AF, it would be good to deal with that first, anyway and address influences such as food choices, lifestyle, environmental exposures etc so that you have every chance to reverse the AF trend – sooner rather than later on. I would also not rule out thyroid issues because most likely, the only marker looked at was your TSH and there is much more to investigate.

However, while this sounds quite negative, I feel compelled to comment that I can’t begin to imagine tolerating some of the AF events I’ve endured prior to ablation, while being pregnant, and also pregnant and having the responsibility to care for two children and a household as well. I hesitate to offer this but the grim reality is that some AF events can be extremely debilitating while others, can be more of just an “inconvenience” but the point is, if the AF escalates while you are pregnant, odds are some drugs/chemicals will be involved.

On the positive side, though, as I was typing this response, a name popped into my head for a Naturopathic Physician in the Milwaukee area. Kristi Hughes, ND. Several years ago, I had the privilege of learning from her at a weekend seminar course and wished she were in my area because I would have become her patient the very next day. If possible, I strongly recommend you consult with her soon.

I certainly wish you well with your decision. Please stay in touch.

Kind regards,
Jackie


Kristi Hughes, N. D. [www.dynamichealingcenter.com]
And this link: [www.functionalmedicine.org]

Exatest [www.exatest.com]
Genova Diagnostics [www.gdx.net]
Metametrix [www.walkinlab.com]

George and Jackie - thank you so much for your thoughts. It is so helpful to hear other peoples opinions and perspectives.

George, the concern you brought up is my main concern as well - I do not want to take any chemicals while pregnant, but know that if I did go into afib, I would need something to get me out of it. If it happened once or twice I might be ok with it, but there is no way of knowing how my body would react. I could go into afib weekly for all I know. That is such a scary thought.

Jackie, I am seeing a functional medicine doctor, so I am disappointed to hear that you don't think she is looking at the whole picture/running the right tests. And honestly I think you are right - most of the tests that have been run I have specifically asked for. I think your advice about getting the exatest done is a great idea. I have been so pleased that Magnesium alone has kept me out of afib for over a year, but i'm sure there is way more at play than just one mineral. I am going to reach out to her and find if she would let me have that along with the Genova test. They seem expensive so I think I would need help from insurance.

Was there a specific thyroid test that you would recommend? I feel like she ran a few, but it sounds like maybe they didn't paint the whole picture. My biggest struggle is finding someone in my area who knows anything about this. The doctor you recommended is actually out of Minnesota Otherwise, I would have given her a call for sure.

Thanks as always for your help and insight!!
Anne

Hi Anne,

Good advice as always from George and Jackie, and if I understand you correctly you have not had an episode in a years time? Maintaining the magnesium
repletion that seems to have helped so far ... and to no surprise for any of us here ... could well mean a small likelihood of AFIB triggering during the pregnancy in any event, and even if it does, assuming my recollection from our past conversations is correct, you still are clearly paroxysmal with not a history of frequent long episodes to begin with at this general stage of your AFIB history ... am I correct?

As such, and if I'm accurately recounting your previous AFIB pattern, the odds should be very high that even if a few episodes occur due to the big hormonal/biochemical/physiological changes during the course of pregnancy, any episodes are highly likely to remain paroxysmal and thus be self-limiting such that you may well not need to resort to drugs, shocks or ablation during the pregnancy and just ride the episodes out with the help of perhaps added magnesium and solid dietary potassium intake as a modest form of natural rate control.

I'm not sure of the possible impact a higher dose of supplemental potassium might have on the fetus, if any, but sustaining a robust dietary intake of potassium along with dietary plus supplemental magnesium which, within reason, should be fine, could well be all you need to focus on from a diet/nutrient repletion point of view along with overall very healthy and preferably organic dietary choices.

As Jackie said too, the Exatest can contribute to some very useful insights in this regard, and learning simple natural stress reduction methods that have the green light from your OB-GYN would also be high on my list of steps to include during and after your nine month term.

Checking for thyroid is always good too and make sure they test not only TSH, but Free T3 and Free T4 as well as TPO ( the common Total T4 and Reflex-T3 This last test -TPO antibody test - typically only is needed one time unless it is positive indicating likely Hashimoto's thyroiditis which is an auto-immune-mediated form of thyroid dysfunction that can swing from hypothyroid symptoms to sudden periods of hyperthyroidism as the condition slowly progresses, and which poses a particular management challenge ... especially for us afibbers. But from your history description I highly doubt you have Hashimoto's.

I checked yesterday with a true maestro AFIB ablation EP about your question regarding pregnancy since, frankly, that was a first for me as well even after all
these years of fielding the whole gamut of questions and scenarios!

This elite ablation EP said that with regard to ablation and pregnancy the obvious ideal is to either do the procedure prior to getting pregnant or wait until after birth of your child. If you had an unexpectedly severely symptomatic and very frequent or persistent AFIB during your pregnancy that could potentially make for a higher risk pregnancy, the mother could be quite safe still with a Fluoroscopy-Free ablation which can be done with reasonable safety, though potentially with a bit less efficacy than when limited RF Fluoro is also used at key steps of the procedure. However, he did underscore that they have gotten quite good results with fluoro-less ablation these days, especially for a mostly anatomical PVAI type ablation.

But in your case Anne, it's almost a certainty you would not require an ablation in any event during your pregnancy and the greater odds are for a relatively straight forward process and pregnancy even if a few short episodes of AFIB did make an appearance.

Best wishes to you which ever way you and your husband decide to go and thanks for the rare but good question!

Shannon

Shannon, thanks so much for response and help as always!

You are correct about my history of afib. I have only had 3 episodes of afib, I was 33 at the time:

April 2015 – afib 45 minutes - converted on my own
August 2015 – afib 12 hours - converted after iv meds in ER
September 2015 – afib 4 hours - converted on my own

I started on Magnesium in September 2015 and everything quieted down which means I haven't had an episode in 16 months. I still get PVCs and PACs - maybe a few a day - but nothing that is alarming. I take 360mgs of Magnesium, which isn't a lot compared to what other's take and I confirmed with my OBGYN that I could safely continue this amount through pregnancy. I also take vit D, B and K - but haven't ventured into Potassium supplements yet.

I have checked with 2 OBs and am going to talk to a perinatologist as well, but so far nobody has had experience with afib and pregnancy. I am also going to meet with my local EP and ask to have another echo, wear a holter monitor for a few days and maybe do a stress test before we move forward. I just want a workup at this point to confirm that my heart is healthy, outside of the afib. I am also going to take Jackie's advice and do the exatest. If anything comes back concerning with any of these tests, we would probably hold off.

I think my biggest fear is that pregnancy could "speed up" my afib and make it a bigger problem than it is right now. I know many people start out slow with their episodes and then things pick up at some point. I have felt very fortunate that I have gone 16 months without any issues, but know it will come back at some point. I just question if it is the right thing to do for my health - I already have 2 beautiful daughters and I need to stay healthy for them. But, with that being said, we just don't feel like our family is complete and would love to try for a 3rd. Obviously this is a personal decision that my husband and I need to make, just thinking out loud

Glad I could throw out a question that have you have never heard before Thank you again for your continued help and support!

Anne

Anne - I'm sorry that I gave incorrect info about Dr. Hughes location. Obviously, I thought she was still in the Milwaukee area. I'll work on providing the details you've requested - hopefully, yet today.

Jackie