Interesting Mandrola links

Diane98683 recently posted about Dr. Mandrola's blogs and I spent a few minutes going through them. Here are some links you might find interesting.

Top 10 EP stories in 2012: [www.theheart.org]

10 facts about afib ablation: [www.theheart.org]

Lancet reviews cardiac arrhythmia: [www.theheart.org]

TIme to rethink the role of digioxin: [www.theheart.org]

Rhythm control meds: [www.theheart.org]

Long term endurance exercise: [www.drjohnm.org]

The most complicated disease, AF: [www.drjohnm.org]

George

Thanks for posting George. I intended to search through the links and you saved me the effort.

In the sixth link, long term endurance exercise, he cites a 5 fold increase in risk of developing afib in people who exercise at a high level. Keep in mind that this is a guy who is a bike racer and loves cardio exercise.

If you had told me when I was 20 that running 5 days a week might give you an arrhythmia in 35 years, would I have paid any attention? Of course not, at 20 we are all bullet proof.

Once you have it though, I think it is prudent to back down. The counter point is that there are other websites with stories of marathon runners completing the race in afib. Those guys are tougher than me.

EB

I've virtually quit exercise since my ablation as I've found that the days following exercise definitely present heart instability - as had occurred prior to the ablation. I'm hoping the heart will heal enough and perhaps change to allow more moderate exercise later on without the post-exercise instability.
PS I used to train heavily for many years.



Edited 1 time(s). Last edit at 01/05/2013 03:28PM by Tom B.

FiveBox Wrote:
-------------------------------------------------------
...
> Once you have it though, I think it is prudent to
> back down. The counter point is that there are
> other websites with stories of marathon runners
> completing the race in afib. Those guys are
> tougher than me.

Of course, those marathon runners are at significantly increased risk of stroke due to their afib and would be wise to take measures to control it, including detraining if necessary.

Diane,

I would tend disagree that the marathon runners with afib are at a significantly increased risk for stroke, unless they have other stroke risks. The data on lone afibbers are that their risk of stroke is correlated with their other stroke risks rather than just having afib. This does not mean I don't agree that moderating endurance training is wise, just not because of the stroke risk.

George

George,

What you're saying is incorrect. Anyone with afib is at a huge increase in stroke risk. Of course, if there are other risk factors for stroke, an afibbers stroke risk gets that much higher. AFib is by far the number 1 cause of stroke (the other risk factors cause fewer strokes than AFib). That's a well established fact.

Diane

Diane,

I'm not disputing that afib is a stroke risk. However in lone (idopathic) afibbers, the risk is correlated with their other, underlying stroke risks, not the afib. That is, a lone afibber, with no other risk for stroke has the same stroke risk as a non-afibber of this age. In one long term (25-30 year), large sample size, study in Olmsted County MN, where the Mayo Clinic is located, the lone afibbers had a lower stroke rate and mortality than the non-afibbers. The explanation is they probably had better cardiovascular health than the non-afibbers. Hans can speak to this better than I can as I'm on holiday and don't have the references handy.

This does NOT apply to the run-of-the mill afibber with cardiovascular disease, high blood pressure & etc.

George

Hi Diane,

GeorgeN is correct here on the relative stroke risk for the category of lone Afibbers under 65 years old and with a CHADS score under 1. This group is generally considered at no more risk than an otherwise healthy person of the same age without AFIB. It is for these folks that Coumadin is actually contraindicated as per the guidelines of both the American Heart Association and the European equivalent Cardiovascular Association.

You are correct in saying AFIB itself is a significant risk factor for stroke, but mostly that is true in the presence of other risk factors and co-morbidities such as CVD, high blood pressure, previous strokes or TIAs, familial history of CV issues, age past 65, long time smokers and several other red flags that greatly elevate the risk of stroke in a Afibber.

Anyone with AFIB should definitely learn about and adopt a blood/heart healthy diet and supplement protocol including Nattokinase, Boluke, Omega 3s, pycnogenol. magnesium and other proven aids in helping to keep blood more slippery. But the more serious steps, such as pharmaceutical anti-coagulants are usually reserved for those among us whose stroke risk rises above CHADS 1 and/or any presence of CVD/Hypertension etc.

Shannon

Diane - I agree with Shannon's advice for the heart-healthy diet and keeping blood viscosity manageable by the various aids, but emphasis should also be on testing routinely for those markers which are the indicators of thick, sticky blood or elevated blood viscosity. These are specific tests that are not typically considered routine by most doctors, cardiologists and EPs. You have to make the effort to request them (often insist on it) and then take specific action if the results are out of range. Specifically.. High Sensitivity or Cardiac C-reactive protein, Homocysteine, Ferritin, Fibrinogen, Lipoprotein (a), Hemoglobin A1C and Oxidized LDL.

Once you know those, then you'll know how aggressive you need to be by focusing on specific supplements that target each specific contributor to the hypercoaguability issue. Various ailments tend to contribute to systemic inflammation which, in turn, cause sticky blood so when coupled with afib, sets up the individual for a greater risk of stroke. Silent inflammation is a killer so testing for the various markers that help complicate an inflammatory situation is critically important to everyone, but especially, afibbers.

Jackie