Not sure what's going on - getting worse. Daily AAD or ablation? Or keep trying?

Hi,

I typically get 1-3 episodes of afib a year since my first episode 3 years ago. This year I had an episode in May and then again in Sept and both converted within 2 hours with PIP.

About 2 weeks after my last episode I started to get bad ectopics and they have been with me since, on and off. I went through a really bad time about a month ago and I was getting daytime runs of ectopics which I have never had before. I'm very vagal. The day time runs were of a vagal nature as well. By the time I got in to see my EP things had settled down considerably and he gave me a script for propafenone 150mg twice daily to replace my PIP if I felt things were worsening.

Since the end of Oct I get runs of these ectopics that sometimes turn into afib but I can always flip it back by doing a valsalva or a quick run. So I've been getting 30 sec or less runs of afib once weekly now or so.

The weird thing is mag and K seem to make them worse. I tried every possible combination when things were bad and only by stopping them altogether did things settle down.
Yesterday I was in meetings all day and I ate a very big lunch. 20 minutes later I had to excuse myself to run up 3 flights of stairs to put my heart back into NSR. This is a first for me, an episode at noon and one that disrupts my work. I'm pretty stressed about that.

Tonight I was having a few minor palps at 9:00 so I took 1200mg of K and took a warm bath. It seemed to settle things until I went to bed then all heck broke loose and I started getting terrible non stop ectopics and it flipped into afib at least once. When I was in the bath I had very bad esophageal spasms suddenly (i do have occasional nutcracker esophagus). Stomach issues are a HUGE trigger for me and I have been getting some heartburn lately but I really hate taking PPIs for it.

Now I'm not sure what to do. I really don't want to take propafenone daily for the next 30 odd years (I'm 40 now) but for an ablation I'd have to go to Bordeaux and the whole prospect scares the crap out of me. I just keep hoping things will settle down but they don't.

The other thing is I have metoprolol 25mg that I take before the PIP. Sometimes (a lot lately) I take 1/2 - 1 at bedtime and it settles things down. Adrenaline seems to really make my heart sensitive and kick my parasympathetic system into overdrive so by blocking that it seems to help. The thing is I was thinking it might be making it worse and so I didn't take any yesterday. I took some just now since there's no way I can sleep without it tonight (took 1mg of ativan too).

I'm open to any and all advice since I'm getting to the end of my rope. I could handle the odd episode twice a year but near daily short runs are way worse even though it would take a year of them daily to equal the time spent in afib from one of my "typical" epiosdes. The ectopics are the worst.

Any advice or experiences are welcome.

Monty

Monty, not sure of course, but sounds like your afib is progressing just a bit......which is often the case.....as you probably know I had an 8/21 ablation here in Charlotte NC (I am 59).........my thought is......do not have fear in good hands. Bordeaux? you could not be in better hands......yes a tough decision......maybe propafanone buys you time? maybe not......are you sure you are not eating your way into afib? MSG, high Na to K, alcohol? have you tried dumping Na out of your life? large meals never a good idea, I also have/had stomach triggers

You can read about my ablation......not a walk in the park but almost. I am 3.5 months now of nothing.

Tom

Monty:

I had meal-induced afib and adrenaline-induced afib daily for 9 months prior to my Oct 23 ablation at Cleveland Clinic by Dr Tchou. Before the ablation, I found on my own that stopping one of the prescriptions I was taking eliminated the meal-induced afib episodes. The drug was Evoxac, a cholinergic drug that stimulates parasympathetic nervous system activity to increase tears and saliva (I had started it 8 yrs prior due to a severe dry mouth/dry eyes condition. While Evoxac worked great for the dry mouth/eyes, I realize now that it also created meal-induced afib.

Are you taking any prescription drugs that might induce afib? I would check that first, but don't fear the ablation. I am happy I did it. My afib was daily and I was gradually getting more hrs of it per day - since the ablation 5 wks ago I have had zero afib.

Best wishes for your decision-making,
Gary

I've been taking Potassium as KCl up to 15000mg daily - it seemed to help a very hard heartbeat, but since I have been taking it I have been getting a LOT of ectopics (though no AF) at night. Last night I didn't take any and I slept better, but this could have been chance. It's worth changing supplements around from time to time to see if anything helps. I was probably taking too much Potassium - I will probably take 500mg daily from now (about one thirtieth of what I was taking!).

If heartburn is a PERSISTENT problem it should probably be checked out. Get a test for Helicobacter pylori and an endoscopy to check for a hiatus hernia or any other stomach issues. I find a lot of carbohydrates especially in combination with alcohol makes heartburn worse - my diet is low-carb by world standards, but would be classed as moderate by some people here (less than 200g always, but most of the time less than 100g). Heartburn can be fixed by a fundoplication surgery - it's worth researching.

Have you tried getting fitter and slimmer? I think it is worth eliminating internal (visceral) body fat which you can only really do through exercise - though don't become an elite athlete - that only makes things worse! Professor Jimmy Bell in London has been involved in MRIing patients for internal fat and he found that even slim people have quite a lot of fat round the organs IF THEY DON'T EXERCISE. He gives these people the name "TOFI" - thin-outside-fat-inside. Personally, I haven't had an attack of AF for 14 months now - it may be just luck or it may be that I have cut my body fat % significantly and I am quite a lot fitter. I am not taking any medication.

Jimmy Bell's study: [www.ncbi.nlm.nih.gov]
Media comment: [www.guardian.co.uk]
Left Atrial Epicardial Adiposity and Atrial Fibrillation: [www.ncbi.nlm.nih.gov]

Montos-FWIW i would not take 1200mg of K+, via supplemen, in one sitting for fear of it causing an irregular HR. Sometime I take a lot of K+ but spaced over a full day and with a lot of Mg. When I was on Sotalol my HR was erratic. It is much more stable without the Sotalol. We need to be careful of not making things worse with meds and supplementation. Good luck,Dennis

If my K goes over 4.5, I will begin to get PVC's (ectopics) when it approaches 5 I will get them every three or four beats - this has not changed since before my ablation 6 weeks ago (and shouldn't since PVC's are ventricle foci-based). No matter where the location of the resultant arrhythmia focus, too much or too little ion supplements will wreak havoc even with a normal heart. I recommend getting a cardymeter and keeping the range of potassium where you are the most stable. Unmonitored consumption of large quantities of potassium or magnesium supplements is not a good idea, IMO.

I'm using my cardymeter every day now to re-establish an optimum potassium dietary intake based on my current daily food intake (ie, how much orange juice, half or whole banana, two servings daily of this or that? etc.) The cardymeter is an essential tool for maintaining my heart stability.

Tom

For those interested in the Cardymeter more information can be found in Conference Room session 74 [www.afibbers.org]

Hans

Monty,

Propafenone (Rythmol) can be problematic for vagal afibbers. I would try flecainide (Tambocor) instead. The usual starting dose is 50mg every 12 hours with a daily maximum of 300mg. Continuous use of metoprolol is contraindicated for vagal afibbers so maybe that could be a problem as well.

Hans



Edited 1 time(s). Last edit at 11/28/2012 03:41PM by Hans Larsen.

Monty:

I am vagal and I take 1 tab. of propafenone (150mg.) at night before bed, it helps me a lot, we are all different indeed. I cannot take supplements of Potassium, it seems to me you are taking a lot, as Tom says cut down or try not taking anything for a few days then add your supplements slowly.

Liz

Monty - have you evaluated your intracellular magnesium levels by Exatest?

Mark m... the 15,000 mg of potassium is a very high dose...and unless your intracellular stores of magnesium are optimal, that much potassium can cause arrhthhmia to become worse instead of improving.... your symptoms are probably a signal that you are taking in too much supplemental potassium.

Jackie

Jackie,

No I never have but I would like to. My family doctor is not agreeable to the idea. I need to find an ND or someone who will do this.

Monty