First Fast Afib episode since Feb 2010

That'll teach me for mentioning how well I was doing two days before another episode!

Let me start by defining what I call Fast Afib & Slow Afib, both of which I've had over the last 12 years. Both are night-time Vagal but very different & I don't recall this difference being covered on the Forum.

Fast Afib:- Comes on suddenly. Heart jumps about trying to escape the rib-cage. Very fast beat. Long lasting (over 30 hours). Even slight movements makes it worse and gentle exercise makes me feel that I'm killing myself.

Slow Afib: Begins with quite slow heart rate and increasingly frequent Pac's (Sometimes I can count a regular progression of 1 every 10 beats, one every 8, one every 6, 4, 2, then completely irregular.) Heart not jumping about. Underlying heartbeat quite slow. Exercise, even gentle, restores NSR but it comes back fairly soon; exercise has to be repeated and this sequence sometimes has to be repeated for a few hours before the PAC's stop for good.

I've been having Slow Afib off and on for a few weeks - or would have except the Pac's wake me up and I can nearly always stop it before the beat becomes completely irregular. I can see no reason or cure for this type of Afib. On Wednesday night I started to exercise as usual (just leg movements in bed) but instead of stopping Slow Afib it turned into my 6th Fast Afib episode. I tried increasing Potassium and Magnesium supplements, using an Acupressure move which is very good for quickly reducing fast beats, the Valsalva manoeuvre, carotid massage, gentle exercise (soon stopped that - frightening!). Also waited longer than ever - 36 hours - before calling an ambulance. As I neared the hospital NSR restored itself; something that also happened with my last episode. (a new cure?!)

I had blood tests done and the only thing that surprised me was that my Potassium was 4.0. Since I've increased my supplementation to about 1.25 Grams in recent times I expected higher.

The cause of this episode could well be the fact that I returned to supplements that increased my heart rate in the past i.e. Fish Oil, Co Q10 Ubiquinol (just 25 mgs), Taurine. Recently since none of these did anything I added Creatine which I think could be the main culprit.

Any thoughts about treating the Slow Afib (since I've been doing well with the Fast) would be much appreciated.

Hi Sam,

The things that come to mind reading your story above are as follows,

For the sudden very fast, jumping through the rib cage kind of AFIB that makes you very exercise intolerant even or especially from mild exercise or activity, that reminds me very much of adrenaline and/or excessive T3 surges ... and both can easily go hand in hand as part of a rapid depletion in adrenal reserve and/or perhaps triggered by a mini hyperthyroid spike that can happen in a number of biochemical scenarios even in people with otherwise mostly Euthroid thyroid panel blood test taken as a snap shot of the moment at the lab.

It also sounds like, regardless of what the actual trigger or biochemical scenario is at the time of triggering for a fast paced and uncomfortable episode, that this could be a combo of flutter possibly in a fast 2 to 1 conversion between atrial and ventricular beats and perhaps alternating with AFIB as well which can definitely cause that kind of feeling like your heart is pounding through your rib cage, and definitely is a 'no fun at all' kind of feeling!

The possible role of short or longer term adrenal insufficiency as a background factor in initiation of these episodes get further credence from your reported increase in heart rate from fish oil, Ubiquinol and Taurine which normally will have a more stabilizing and steadying influence on the heart rather than a more speedy feeling. Such all to easy and quick reaction symptoms, or even common intolerance, to either typical doses of supplements and many medications is often a tale tell sign of low cortisol and inability of the body to respond to bodily changes and even normal stresses more gracefully and easily.

Regarding the slow speed AFIB, how slow are you talking about? Do you have periods of slow and possibly irregular bradycardia? Maybe even with long pauses between some beats? (if so, that can be what feels 'scary'), possibly alternating with a bit faster irregular AFIB as well during such episodes?

In any event, regardless of the fine details of what might be the ultimate cause of your episodes, it sounds like to me, and considering your reported difficulty with some of these supplements, that it may well be high time for a good ablation for you with an Elite EP who knows what he is doing?

You have had Paroxysmal AFIB at least 12 years now, are having more frequent episodes recently, and it sounds like you have done your homework and made a good effort at nutritional/dietary control which is a key first step, but is not always a fully satisfactory answer without the additional major support of a solid ablation to buy you much more NSR time than you are apparently now getting.

The very fast speeds I know are no fun and neither is slow but very irregular and sometimes 'scary' AFIB which I also know all too well.

At a certain point, we can all continue trying to sort out every possible influence and count how many angels we can fit on the head of a pin, in an effort to try and control this beast ourselves. All of which is laudable and understandable and I think necessary for some period as part of the process of fully coming to grips with this lousy condition, but there comes a point where the better part of wisdom is to recognize when you need to take the next step before this thing flips into persistent AFIB and makes things even more complicated long term.

Your 36 hour plus episodes are a good sign you may well has crossed that line where avoiding an ablation isn't necessarily in your best interests any longer ...

Anyway, we can debate all the possible causes and biochemical nuances, and if excess adrenaline is involved then almost by definition so is low daily cortisol production and likely so is less than optimal intra-cellular magnesium (its not coincidental how often low IC mag goes hand in hand with low adrenal function either), but at this point it all might be a little academic in your case and the better question is when can you get this evaluated and addressed by the very best and most experienced Ablationist your finances and ability to travel will allow?

That would be my priority at this point Sam, as I would hate to see this continue to progress as it sure sounds like it is doing, as I went through almost the exact same symptoms and increase in both irregular slow afib alternating with pounding fast episodes in which my heart actually hurt and felt bruised from it beating so fast and hard against the underside of my sternum ... And this all started 6 months or so before I finally flipped over into 24/7 very symptomatic AFIB when living in Amsterdam a little over four and a half years ago.

Nevertheless, that is my two cents from what I can glean from your post. Have you ever, and preferably recently, seen a top ablationist yet and gotten an opinion on your case? Whatever you do now, since you've had 36 hour plus episodes after such a long 12 year history of AFIB (I was at over 13 years Paroxysmal before going persistent and then getting my first ablation 3 months later in 2008), make damn sure you only go for an Elite ablationist who is very experienced ablating more difficult cases and has no issue with persistent afibbers and those with long duration episodes.

Good luck and best wishes in sorting it all out sooner rather than later.
Shannon

Thanks for an excellent answer, Shannon.

Because the slow Afib episodes have only happened three times in the 12 years (off and on for 2 - 3 weeks each time) and I can prevent them starting by exercising when the PACs start and the fast episodes have actually reduced recently - 4 years from the first to the second, 2 years to the third then once a year for three years and then 2 years and 8 months until the most recent one - I haven't seriously considered an ablation.

This is just as well because N Ireland has just 2 EPs and it seems impossible to get a referral to them. Also we seem to have just one surgeon doing ablations and it seems he has just recently started. This means going Private outside the country at a price that would require me to mortgage my house and my wife!

I'll read through your post a few more times.

Thanks very much,

Sam

Hi Sam,
That does pose a conundrum living in Ireland with only one or two ablation EPs... Is Ireland medical and UK medical the same where you could go to England for an ablation? Though I don't of know of any considered elite ablationists there, perhaps there are a few and other UK people here could better advise on that front.

Of course, if and when it comes down to it there is always Bordeaux which would hands down be my first choice in your shoes, though $15,000 Euros in total is still a pretty penny out of pocket without question.

Keep us posted on how it goes and in the meantime read over the Strategy and other resources in the AFIB resources section of this site for added insights that might well help in keeping things a bit more steady.

Shannon

Shannon,

N Ireland is part of the U.K which does have excellent Ablation Experts especially Professor Schilling. He performs over 200 operation per year and has been doing so for quite a few years. He has the latest 3D mapping techniques & uses the Sensei Robotic Catheter System

However - the cost is high. I've just sent a request for the fee but I believe it's around £15,000 ($24,000).
There is, of course, a real possibility that two operations would be needed.

Actually the total cost of Bordeaux was $21,500 two years ago so probably quite a bit more now and that doesn't include the cost of getting there or taking someone with me.

Thanks for the reply,

Sam