Guidelines on "Afib Burden"

I'm guessing that over the past 11 months, I've had between 50-70 hours of afib. Also, about 2-4 times a week (depending on the week), I wake up in this goofy state where I'm having heart palpitations, and 80% of the time, if I get up, they go away, but every now and again, I'll get a afib from it. This is the only way I have afibs now. (For the past 3-4 months).

Now I'm wondering, what if that weird state I wake up in, really is a mini-afib, but it just goes away, that would add another 2-10 mins a week of "afib burden".

I'm pretty certain there is a big genetic factor in my afib, and i'm starting to think I should lean toward ablation sooner, rather then later. I've been trying the protocol, and while it's helped get rid of any day afib, I'm still having these very specific issues at night.

Is there a known breaking point where your afib burden gets so high that ablations become that much more difficult?

For a long time now, I've been thinking about wearing a monitoring device when I am sleeping, is a polar strap kind of device accurate enough to diagnose afib? or would I need something like an alivecor monitor? If I captured afib this way, would it be something I could show to my EP/cardio?

I'm setting up a meeting with Dr. DiBiase this week, is this the kind of thing I should talk to him about?

Thanks!

-Eric

"Is there a known breaking point where your afib burden gets so high that ablations become that much more difficult?"

I'm no expert, but I think a) when they don't convert on their own and/or b) they last for days/weeks before they convert. For example, though my episodes convert in an hour or two with flec and I can go (most recently) 15 months without an episode, I had an episode that lasted 2 1/2 months 10 years ago. I'd be a complex case.

"For a long time now, I've been thinking about wearing a monitoring device when I am sleeping, is a polar strap kind of device accurate enough to diagnose afib? or would I need something like an alivecor monitor? If I captured afib this way, would it be something I could show to my EP/cardio? "

They aren't used to looking at Polar output - heart rate vs. time, though this is a display option for some Holter monitors. It is not what they see. I'd caught my mom in afib on a Polar and I took it in to her doc, a friend of mine. I had to explain what he was looking at. An AliveCor can be used to diagnose afib, though it is just one lead (I or II display). An AliveCor is not appropriate for long term monitoring, like during sleep. A bluetooth Polar H7 strap with the HRV logger app would work. What shows up on a Polar is the wide variation in beat durations (or said differently, heart rates). If you look at the Polar charts displayed in CR 52 and 52a <[www.afibbers.org] <[www.afibbers.org] you can see what I mean. You can also usually tell the difference between afib and bi or tri geminal PAC's (PAC every 2nd or 3rd beat). These PACy rhythms can "feel" like afib in your pulse, say if you use your finger on a pulse point. They will look different on the Polar.

You might consider some organic powdered ginger spice a) before bed or b) on the nightstand to take when you wake up in a "weird state." I've found that ginger can have an almost instant change in rhythm for the good in these (vagal) circumstances.

If afib is getting worse (more frequent, longer duration, not converting on own), I'd be heading for the ablation with a top guy. If you can see progress the other way, then you're OK to wait - at least that's how I make these choices for myself.

George

I went for a regular physical in Dec 2011. I was in AFIB and did not even know it! My resting heart rate was 95 bpm but when I stood up it shot above 200. I was immediately checked into the Hospital.
In the Hospital, I never converted to NSR; I had to be on a blood thinner for 3 months then I was cardio verted electrically.
I was in Permanent AFIB. I guess I just ignored the Paroxysmal phase (?).
Anyway, I went a year with no issues taking the poison Amiodarone and Pradaxa then I ihad to be shocked 3x within 2 months between Sept. 2013 and Nov. 2013.

With the hekp of these wonderful people on this forum, I was lead to Dr. Natale in Austin, Texas; A 8 hour drive from my house.

Cutting to the Chase, I had my Ablation done in Feb. 2014 and have been in NSR ever since. I take nothing for my Heart except a Aspirin 1X a day.

The Ablation has been very successful for me.

That's fantastic Smackman !
Congrats.

Duke

Eric it sounds like the remodeling is progressing. For some of us it is gradual, but then all of a sudden everything seems to be a trigger and it ramps up fast. The time to go down the ablation road is when it is affecting your lifestyle significantly. As you are doing, and as George suggested, it is a good idea to go down parallel paths, trying to tame the beast while you are searching for the right EP. Finding a good EP is sometimes not as easy as just going to your local guy. They all sound good and competent, but the reality is there is a wide range of experience and competence because the procedure is so new.

I interviewed three EP's at different hospitals before making a choice, and asked them lots of questions about their success rate, complication rate, mortality record and the number of ablations they had performed. Also if they would be the one doing the ablation or would/could there be students or other unknown doctors on the controls. This process took several months, so it is a good idea to start the process. You can ask the administration people at the hospital for a brochure or written material to start the process.

I put off having my ablation for much longer than I should have because of some pathetic excuse or another. Its been 14 months since the operation and I could not be happier being in NSR. It is a very safe and quick operation and recovery, and very successful in the hands of the right EP.

Best, Ron

Eric -- I delayed for at least a year and probably two and it was time wasted. When you get to the point where you are asking for this sort of advice you know it has taken over your life. It did mine. Dr. Natale ablated me in SF just a few weeks after Smackman. I have enjoyed six months of NSR -- I am still on Xarelto only because I await one more test -- my fault for delaying -- and I feel like I did pre-AFIB. My procedure was not complicated according to Dr. Natale -- the LAA was ignored -- and I am pretty much back to my old life. I must admit that I still run just about every morning -- I still enjoy French wine -- and I have not been carefully following any supplement regime. But I am very careful about sleep apnea. Good luck. Deluge.

I agree, when it's affecting your life best to get it done (ablation) unless you are sure you are controlling it (no hidden AF) with supplements, diets and/or trigger identification and avoidance. I thought I had fixed it with Iodine - went 6 mths without a noticeable incident. But AF came back strong. It plays with our minds like Descartes' Evil Demon..
I realize some people are scared of the procedure and the deliberate scarring. I got answers that satisfied me on that score.

I just wonder how old you can be to have an ablation..I'm not getting any younger.I just had lung surgery so I guess I'm not too old, or just in good health as my Drs. tell me....I've had Afib for about 15 years....but my Cardio never mentioned Ablation..I'm in constant AFib, but doesn't bother me much..My resting rate is between 70 and 80.I also have Polymyalgia so I don't do much running around shopping and etc..Hurts my legs, although I do try to exercise as much as possible..
Does anyone believe your gut has an affect on your Afib? .....Nel

Nel, Jackie is 77 and just had one. I'm guessing it has to do with your overall health and ability of your body to withstand the procedure, not just age. George

Some Cardios believe in benign neglect when it comes to AF. I had one like that. He said drugs (presumably he meant Flec) were 'nasty' and that ablation had some risks and wasn't always effective, and that if AF wasn't bothering me to just live with it. But he went on to prescribe Flec anyway - I told him AF was bothering me - if not physically then pyschologically. Note no mention made of stroke risk. I dropped him and found an EP and a new Cardio.

I take 100mg of Metoprolol now instead of 50mg since the last episode three years ago, and he also put me back on coumadin.(I hate that, but think he'll be changing that soon) I also take Diovan and Furosemide..They don't seen to both me. Nel