Inflammation and Afib

Being just recently diagnosed with Afib, I took the occasion to have a C reactive protein test. The results were very high (3 X the normal high range) indicating a powerful inflammation ongoing, but non-specific. A high CRP result may indicate the presence of cardiovascular disease, but all my cardio tests prior to Afib diagnosis eliminated cardiovascular disease. The inflammation is occurring for other reasons. I am not certain of the relationship of Afib to inflammation. I suspect a correlation, especially since a 2007 CRP test produced very low results, and at that time I was Afib-free.

I do have osteoarthritis, but nothing abnormal for a 68 year old guy who has had sports related injuries.

I would enjoy hearing any comments on this topic. Thanks.

Norm

Norm,

There is a clear, but complex, relationship between inflammation and afib. For details see:

[www.afibbers.com]

Hans

Thanks, Hans.

Norm – Check out this information on measuring CRP in people with arthritis.

[labtestsonline.org]

This does not mean you should ignore the AF/inflammation connection-- just that your numbers may be skewed because of the arthritis.

Inflammation is definitely of concern and not just because of AF. Be sure to read the links Hans has provided.

Jackie

Had CT scan done about 18 months ago and am due for another shortly. The last CT scan showed signs of inflammation which I posted on the board at the time. It was essentially fluids in the areas of the heart and lungs but 'inconsequential' and all that they wanted to do was follow up on it in a year to see if there was any change. This is being done by my pulmonologist (NOT my cardiologist/EP)

I have repeatedly asked for a CRP level to no avail but next week during my regular GP visit I am going to twist his arm with force to get a CRP level as well as all of the other serum levels that are important to one with aFib or at high risk of aFib.

I am certain that inflammation was one of the keys to my aFib as I had acute pneumonia in June 2009 putting me on life support for almost three weeks. During that period I was placed on, among other things, Metoprolol to get my heart rate down and every time they tried to reduce it my heart would do an Indy 500 imitation. It is only now, having been placed on TIKOSYN for the arrhythmia that they have begun to reduce my Metoprolol from 50mg b.i.d. to 25mg b.i.d. and now to 12.5 mg b.i.d. I find that if I eat anything outside of the home I often find myself in trouble with an elevated heart rate of skipped beats; not anywhere near the extent prior to electrocardioversion to NSR after starting TIKOSYN but just as a little "reminder" of whose in charge of things.

Had luncheon out yesterday and requested no salt on anything or in anything and no sauce on my chicken breast. Felt very assured that I had missed all of the 'triggers'. Absolutely certain. No doubt. But in there, in that meal, somewhere.... there was a trigger. MSG, salt, something. I didn't taste it and if anyone were to tell me where that trigger was I would most assuredly be shocked. But it MUST have been there as my heart rate was slightly elevated to about 95-100 BPM for a while. Then dropped back to my normal 75-80 BPM.

You need to know that aFib is a strange and elusive beast. "Triggers" hide everywhere and the best policy is to eat only at home if you can and avoid all processed foods. The ones that say "no preservatives" are generally loaded with sodium and chemicals that you cannot pronounce. We tend to eat fresh and try to stick to a paleo like or South Beach like diet. During these periods my heart seems to be exquisitely calm on the TIKOSYN.

As a matter of interest I also take meds for high blood pressure, hypothyroid, Type II diabetes (metformin) and a bunch of supplements. I cannot change so much as an aspirin while on this TIKOSYN without consultation as that is the nature of the drug. My dosage of TIKOSYN is 500 MICROGRAMS twice a day; 80% is urinated and the remaining 20% metabolized. Kidney health is critical as any change in kidney performance can create an underdose and the return of aFib while an overdose can create other arrhythmia issues of a life/death situation. I have my GP testing my creatinine level every two weeks and he will probably go to monthly at some point, but it will be checked.

The various drugs will work well for some and not well for others; side effects vary from person to person and often depend on the other meds being consumed as well as the supplements being taken in and the dietary nutrition.

I am very sorry to hear of the grief had in the attempt to terminate the aFib and return to NSR. The only thing that I can offer by way of personal experience is that you need to be dealing with the best possible cardiologist/EP that you can find and in the best possible facility that you can find. Had I done this 2 years ago I would not have had all of my grief with aFib I am sure; or at least it would have been greatly shortened timewise.

To be honest, I was deathly afraid of starting TIKOSYN after hearing of all the side effects and so on; but on starting it in hospital in December I had zero side effects but it did not convert me to NSR.... for that I had to be electrocardioverted and they did this with the latest in cutting edge technology and they did it "properly", ensuring I was on the TIKOSYN prior to the ECV attempt, ensuring that my magnesium and potassium were 'optimal' and using the maximum energy on the first shot of ECV (300 joules for me). The doc pushed the button, the defibrillator watched my electrocardiogram and predicted the optimal point to give me the jolt and did so. One shot. Normal Sinus Rhythm and 6 hours later I was at home (they were supposed to monitor me for 12 hours afterwards according to the product monograph but... what the heck, it worked).

I am grossly fatigued today but believe that to be a result of 'overdoing it' due to all of the energy I have had this past month in NSR and lack of being perpetually winded to the point that other doctors were looking at COPD as a possible. As soon as the aFib became chronic 24/7 they spotted it every time they did an ECG... in fact, I could tell the better ECG machines as they would print ATRIAL FIBRILLATION in red across the top of the strip to bring the cardiologist's attention to it immediately.

Inflammation is a loose canon as they say. It is not simply a matter of being a trigger for aFib alone and it needs to be dealt with. Playing around with thyroid meds to see what happens, to me anyway, is just not spot on. To my way of thinking it is an amateurish means of diagnosis and I would give consideration to finding a top cardiologist/EP and go there on referal from anyone that will give you that referal. But that's a story for another day.

Good luck. I am sure it will sort itself out eventually. But it's like I tell each 'technician' that comes to take blood from me when I am in the hospital, "Be gentle, I'm a screamer".

Hi, Jackie,

Thanks for sending me that link. I am certain the arthritis accounts for a portion of that high CRP result. I am gearing up for the task of reducing inflammation. It does not matter to me whether AF is causing the inflammation or whether the inflammation is causing the AF--inflammation is bad news. I want that to change for the better. Those articles in Hans' link discuss things I can do, and I am proceeding with those.

In an earlier posting I mentioned that I had begun taking supplemental magnesium. I did not change the sequencing or intensity of my exercise routine. This last week I did not experience an AF episode while exercising. That's news since I had AF each time I practiced during the prior week. I also am beginning a weak potassium supplement. Serum potassium and magnesium levels were within range in my recent blood test last week. While this outcome is positive, I also have to mention that I had two sessions of ectopic beats while out of the water doing nothing. That's new.

Norm

Norm

Forgive me if you know this already, but I wonder if you are seeing a cardiologist or an electrophysiologist (EP)? The former are plumbers, the latter electricians, and since AF is an electrical problem an EP is what you need.

Some are more skilled and experienced than others and success in fixing AF depends to a great extent on how good your EP is, so go for the best you can find. There is lots of information on this site about who the best ones are.

Gill

It is important to note what type of arthritis one is talking about. Osteoarthritis is "wear and tear" of the joints (loss of cartilage), and is not associated with systemic inflammation. Rheumatoid arthritis is quite a different matter, associated with high levels of inflammation. Others (PMR, lupus, etc, etc,) are also inflammatory. It is unlikely that osteoarthritis has any relation to atrial fibrillation. Perhaps other types of arthritis, because of systemic inflammation, do have some impact.

Regarding Magnesium and Potassium (there are others that need to be 'maxed').
I am presently taking 200mg of Magnesium twice a day and about to insert a third 200 mg. capsule at lunchtime and see what happens. I want to take Magnesium to my bowel tolerance level and 600 mg., if I tolerate it, is a good number I think.

More interestingly, Potassium seems to be a trigger for me. If my Potassium is in the 4.0 range (well within MD's 'range') I find I am still have skipped and extra beats now and then. When I work on keeping Potassium as high as possible and closer to the 5.0 range, the heartbeat is like a Swiss clock.

There are other triggers for me (I am on TIKOSYN) like caffeine, chocolate, MSG, salt, etc.... but I found it interesting, believeing my Potassium to be 'ideal' only to find out that I was still low. Thanks to Jackie for that hint. And it did work for me and continues to work for me. I drink a ton of low sodium V8 and Mott's Garden Cocktail. I use Potassium tabs (99mg) and powder (540 mg/tsp) and eat to live.... rather than living to eat. A new mindset for me.

Since my last two eating out episodes of being triggered despite avoidance; I have taken to eating out rarely and only when I have to. And I am looking at the menu for things I am pretty sure will not contain triggers (seems to be somewhat limited). We also avoid almost anything that is processed food, even frozen precooked organic chicken breast chunks for our stir fries. Organic. No preservatives. But Lord knows what the heck else might be in there. I am sure the processing included MSG at some point or salt as a preservative.... washed off and insufficient to make the label but there, nontheless.

Systemic inflammation is another thing altogether and it seems to be tough to deal with at this end. My body was badly damaged by three weeks on life support and the acute pneumonia resulting from H1N1 in 2009 and it seems to just want to remain inflamed. Sic.

murray,
i think you mean
(LOW potassium seems to be a trigger for me)
i wish you success in reducing your atrium size.
ben

Murray....Thanks for the good wishes. And I extend my own to you in return. I also am drinking that low-sodium V8, and that's about it for K supplementation. I eat loads of raw veggies and fruit, and I get plenty of potassium that way. I use about 200 mg of magnesium each day, just like you. I think that's helping. So far, I have not identified any other triggers besides intense exercise. I am not sure what that means.

Steve...I have not been diagnosed with any other kind of aggressive form of arthritis. My lumbar spine is such a mess from past injuries, however, that a CT scan revealed plenty of 'osis" and 'itis' issues, all related to inflammation. I take anti-inflammatory voltaren (dicofenac) for that and other aggravating problems. In thinking about the high CRP report, I just could not rule out this kind of inflammation as a contributor, albeit small as you indicate.

Gill...Thanks for the advice. My first AF event took place three and a half years ago. After plenty of testing along the way, I was diagnosed only last month by an EP. It was the second time I had seen him, the first being a year earlier when my cardiologist referred me. I have no ready way to evaluate him, but I do know that the cardiologists here regard him highly. That means he's the best in my state (Hawaii). You're right about this site...it's a wonderful resource.

Norm

Norm - You may eat lots of potassium-containing foods which is great, but unless you have actually documented your sodium intake as well and calculated your approximate ratio between the two, you may be weighted too heavily with hidden sodium. If you don't eat any processed, packaged, or commercially prepared foods which are typically loaded with salt, then you probably aren't at risk but most afibbers are low in magnesium and high in sodium which prevents potassium from doing its job which is to facilitate NSR. The Introduction of CR 72 explains the importance of the correct potassium-to-sodium ratio.

Jackie

Jackie,

You're right about hidden sodium. I took your suggestion from an earlier post, and I boned up on the CR 72 info. I found that very helpful and confidence-building (something I can use right now). I have not calculated the ratio between sodium and potassium in my food intake. But what I have done is educate myself on the electrolyte quotients of the veggies and fruits I do consume. I found that the ratio in fruits and veggies is definitely in my favor, but I also found that magnesium levels are weak. So a la CR 72, I am supplementing with magnesium. It's helping.

I stay away from packaged foods. I have been this way for years. (My friends say I'm boring). But until recently I used commercial salad dressings where sodium is abundant. I now make my own dressings.

Norm

Norm - In this case, boring is great! and Healthy, too. Be diligent and patient. Intracellular magnesium can take a long time to replete.

Jackie