New Confused member Part 2

Part 1 see down thread

Everything here is tentative same it is just my memory of what was said, a clinical letter follows. Well had my second meeting with Dr Ernst. As she put it the good news is that my hart is in good form EF 70% . That begs the following statement: the Bad News is that I have a very large left Atrium (bother!). 48 hour monitor showed 10% ectopics and HR 40 to 55 bpm something like that. Good news I am back on my bike.


Awaiting letter nut options are
1. Flecainide- all the time. Pill in the pocket not suitable since there is a link between the frequent ectopics and AF
2. Ablation with mapping and elimination of ectopics as well. This could be very long I think because (I think) of the time spent mapping ectopics. Maybe 60% first time success rate given what we know so far.
3. Part of the current trial which maps using CT Scan merged with nuclear mapping of sympathetic nervous system I think. Shorter time in lab (half to a third) with increase of first time success in this sort of case.

Likelihood of serious complications very small for 2 and 3 given my personal health etc.

So sitting here wondering what to do next. I suspect my main focus is to try and get my left atrium to shrink somewhat. Ideas anyone?? I ama aware form somewhere that size does respond to removal of causes. causes seem somewhat vague but in my case
1. Weight- I have lost 10 kg (22lbs) and am sure I can lose another 10 kg.
2. Rhythm- neither ectopics nor Afib help there seems to be a positive feedback operating here. Options above.
3. Keeping a lid on my cycling: not sure whether this means limiting overall distance or whether I should limit effort. Currently cycle at about 120 bpm average. I cycle about 400 km (250 miles) a week. This is very much part of 1 above as well.
4. Fiddling with diet?? Looking at the 48 hour monitor there is a positive correlation between decrease in ectopics and caffeine so unlike some coffee seems to steady my HR. I suspect a correlation between sugar intake and increase in irregularities. I should have mapped that more carefully. I am anyway inclined to build and increasingly low GI diet. I am already supplementing Mg. K intake is quite strong and I have a preference for natural sources. I also aim to increase my HDL level.

Any thoughts anyone sorry to think out loud on the forum as it were but did say would update on my journey.

Les

How often are you in AFIB? % of ectopics is not that big of a deal, since they are benign, unless they flip you into AFIB.

I would try to stabilize the situation, and give Mg supplementation a try for several months, use Mg to bowell tolerance, and also use Mg water (Waller Water).

Any sleep Apnea? I am wondering snoring (sleep apnea) could contribute to an enlarged Atrium.

Thanks...Ectopics are a trigger...maybe the trigger: I have also found them obtrusive recently. The comment on them was '10% of atrial ectopy with aberrancy or with narrow QRS conduction'.The classic answer is they are harmless...but then I have heard that said about AF as well. No signs of snoring, nor pauses during the night. I am working on the Mg. Les

A tough decision, I know, but in your shoes I'd look at significantly reducing your exercise volume and approach the weight issue with diet.

<[www.drjohnm.org]
<[www.drjohnm.org]

George

Thanks George,

I am aware of some of this debate and continue to read up. However despite cycling distances I do so at an easy pace...usually in Zone 1/2. Events I join are never races. A lot of the available data comes form those who are professional level athletes doing interval training daily, or near daily. It is also fair to say it is a large part of what makes my life worth the living. You can be sure however that I am now watching my HR monitor and AliveCor very closely.

I am minded to go ahead with the trial and if I do will benefit form some of the close subsequent monitoring it will be interesting to see what happens to the size of the atria.

I agree with reducing your exercise----at least until you have a system that allows you to continously monitor your heart during exercise. After I was diagnosed with afib (asymptomatic---I was just lucky the nurse found it), I continued to exercise, with the blessing of the initial cardiologist. I began using a chest strap monitor and noticed all of the high aberrant readings but didn't realize what was going on initially. Knowing what I know today----had I known it at the beginning of my afib journey last year, I would not have exercised as vigorously as I did.

Get a chest strap monitor that is reliable. I went through several before trying the Polar H7, which works well with my Iphone 5. I have found it to be incredibly reliable. I had problems with the Garmin models....but in retrospect, it could have been the erratic behavior of my heart.

If you can't continuously watch your heart rate continuously because you are on the bike and need to focus on the road, I suggest getting an app that will track it and show you your continuous heart rate throughout your exercise period. Polar has an app but I've never used it. I use DigiFit. The app is free but you have to pay a couple of bucks to register the chest strap sensor. It allows you to edit each session, thereby putting a description of how you felt, or what you did at each minute. If you see spikes during your workout, it could be that you are going in and out of afib. The app also has a variety of other features. You can Google it.

I went through the same trials that you are now trying. None of them worked---until my ablation with Natale.

Best wishes.

Ken

DId a 200 km bike ride Saturday: good to be out and about. Heart rate monitor with an irregular heartbeat is a bit hit and miss: can misread by + 15 bpm. It might be because during my quite frequent ectopy the R and T peaks are similar in height. Once I took a Betablocker (normally not a good idea since I am bradycardic, I got a much steadier rhythm and greater accuracy. I was managing on the bike OK with average heart rate of about 100 which is good news since it means I am fine to carry on. Les

Sustained NSR is your best, and really only, good shot Les at significantly lowering your LA diameter. The catch 22 is that you are not likely to get sustained NSR short of getting a going on Tikosyn which is often not a fun drug to take long term and they likely would not give it too you anyway with your type and degree of AFIB ... or Amioderone which you generally want to avoid if at all possible as well.

An expert ablation 'process' is thus your likely best bet for long term reverse remodeling to set in and lessen that enlarged LA size.. BTW Les, what is your LA diameter now?? But that assumes your EP .. in this case Dr Ernst ... feels comfortable ablating someone with a very enlarged LA .. and by very enlarged I mean >50mm La Diameter.

Most typical ablation EPs balk at doing AF ablations above 50mm while Professors Haissaguerre/Jais in Bordeaux or Dr Natale and a handful of others do larger than 50mm LA ablations everyday and twice on Sunday with high degrees of success over a limited run expert ablation process. SO it all depends on where you start from and with whom you partner.

Sleep apnea does, indeed, encourage an increase in LA diameter as Anti-AFIB noted, just as it encourages more AFIB as well. But a reduction in sleep apnea, if not also accompanied by a commensurate reduction in AFIB .. meaning stopping all AFIB in its tracks ... will do little indeed to start the reverse remodeling process that can successfully reduce one's LA diameter.

All food for thought as you move forward, but I would listen carefully to both George who is a very accomplished athlete, and Ken about not pushing things very hard until on the cycle until you get the lid put firmly back on this kettle. You will have many years of worthwhile living in any event, once things get better sorted out with the ticker.

All those things are good to try to accomplish, but the fastest way to a smaller LA is also taking the fastest road to achieve sustained NSR, and there-in lies the choice for the most experienced advanced AFIB ablationist you can marshall the funds and wherewithal to go see.

Again, all this argues mightily for not messing around too long with trying to manage... but not yet with near perfect control ... your on-going AFIB episodes by medical and life style means alone. That is, assuming those efforts are not yet working to a fabulous degree within 3 months of beginning any dedicated AAR/rate control drug routine, or if you still don't have near total suppression of AFIB episodes after 6 months of hard core dedicated life style risk factor modification ( including religious following of the Strategy good vitamin D sufficiency and you can even through in a bushel of cranberries for good measure if you are not on Coumadin at least.

But if you are still getting some degree of periodic breakthroughs in spite of a dedicated but somewhat limited in time effort at personal AFIB control with drugs and natural means, then by all means continue with all the risk factor reduction protocols, but also then add in the key expert ablation at that point and not mess around any longer because we would like to think we are going to out smart this thing and are determined to get the best of it on our own.

That kind of hubris over time is what often leads to a whopping big LA diameter in the first place, and often a case of 24/7 persistent AFIB to boot, all while we imagined we were making some progress and figuring this thing out, even if still with some unsettling regularity of periodic breakthroughs, but surely the next new trick up our sleeves with be the answer to persistent NSR again ... and on it goes.

Don't wait until your case graduates to needing an LAA isolation on the first procedure.

Cheers!
Shannon

SO down for ablation with Dr Ernst 18 June. I am in NSR for sometime now (but no P wave).
Les

Don't despair.....just hang on.....it's coming! Just around the corner!

I thought a "P" wave was a requirement of NSR???

Ken

Apologies for the delay in responding to your post. I hope this may be of some interest to you. I am under the care of Drs. A. Verma and Y. Khaykin at the Heart Arrhythmia Centre at Southlake Regional Health Centre in Newmarket, Ontario as well as P.A.C.E. Cardiology (they appear to work hand in hand).

I have a grossly enlarged left atrium. It was well over 60mm. although I must confess that I do not know what the number means but I do know that it was obtained generally using echocardiograms and once or twice using CT scan (with contrast?). It has shrunk to about 55mm. and there it seems to want to sit.

What I have been told is (a) that the smaller my left atrium the greater the chance of success with regards to the ablation; and (b) the best means to reduce left atrium size is to remain in Normal Sinus Rhythm. There are no guarantees that your left atrium will shrink in any event and if you are going ahead with catheter ablation despite having an enlarged left atrium you (a) want the best and most experienced hands doing the job; and (b) once you decide on an electrophysiologist (there are surveys online as to proficiency/results) you may have to wait. For instance, in Ontario, Canada, the cost for residents is zero but the wait can be extensive (My wait has been 2 years or more depending on how you look at it).

I would very much like to know the experiences of AFIBBERS who have undergone ablation (say LA over 50mm for instance). What was your LA size and what were your results? I will start another thread so as not to hijack YOUR discussion here.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.