Fragile Rhythm Feeling

I am a 51 year old male who has recently been diagnosed with lone afib. As I think back, I guess I have has some PAC’s, PVC’s and other rhythm abnormalities for many years. I just never really paid much attention to them because they were brief and did not impair my life in any way.

About three months ago, I had my first real incident of afib. I woke up with my heart trying to punch its way out of my chest and feeling very anxious and uncomfortable. I took myself to the ER and was placed on an EKG to discover my afib. One doctor saw it as aflutter and another as afib. It lasted about 3 hours until I converted by myself.

Three weeks later, it happened again. This episode lasted about 4 hour before converting. I had a similar third episode about a week ago.

I am now having more frequent PAC’s (several times a day). I have been on a two week monitor and the PAC’s were confirmed but my EP said they were not too frequent or unusual for a person with lone afib. In addition, when I am not in afib or having a PAC, things just don’t feel right. Kind of difficult to describe but my heart rhythm feels fragile. I am not sure if that is a real symptom, or one that I am creating with anxiety. It could also be the meds I am on which include 180mg of diltizem once a day and 5mg of Eliquis BID.

My exercise has dropped to almost nothing. I used to run, bike, lift weights quite regularly. Now I only walk for exercise because of this fragile feeling and because I notice increased PAC’s when I push too much. Do others feel that?

I have a clear stress test and no evidence of any other diseases or disorders. I am in good health otherwise. My EP is sending me to his partner, Dr Patrick Hranitzky to be evaluated for ablation. It seems early in this journey to go to ablation but I want my “normal” life back. I would be interested in your thoughts on going to ablation at this stage of my diagnosis.

Thanks!

Rich

I notice increased PAC’s when I push too much. Do others feel that? Yes I do. I can lift weights at a pace but I cant do cardio stuff without causing weird beats. Im now about 20 yrs into this afib mess and its been that way ever since the beginning

If they will do an ablation based on the episodes you have had, I wouldnt wait. I would however find the best doc possible. Dont be an experiment like I have many times.

Tim

Rich

Be very careful who you choose for your ablation. Success depends entirely on the skill and experience of the person whose hands are on the catheters. Don't just go with your EP's partner - do some research first. Lots of information on this forum.

Ablations can be wonderful - I have had over 13 years of normal rhythm since mine. But they can also be a disaster if the EP is still on the learning curve. You need someone who has done a lot of them, does them often, and has high success rates.

Gill

Rich,

Our mantra here is to get an ablation from the best as Gill and Tim note. Afib ablation is much more complex than other ablations or surgeries, for that mater. There is a large amount of "art" as well as skill. If you live outside the US, the team in Bordeax, FR (Drs. Haissaguerre & Jais) would be at the top of my list. If you live in the US or anywhere, Dr. Natale in Austin <[www.tcainstitute.com] would be tops. He's done more afib ablations (8,000+) than anybody in the world. He also does ablations in San Francisco and San Diego.

As to heart feeling fragile, especially with exercise, I wonder if you have an adrenergic trigger to your afib. <[www.afibbers.org]

George

Hello Rich and welcome.

As you explore your options for consulting with a top tier EP, it’s also important that you assess potential contributing factors that set the stage for your arrhythmia occurrences. As George mentions, it may be an adrenergic trigger or it could also be other potentials such as in the following list that many afibbers have found to be triggers. These relate to lifestyle influences that may be common for some, but not for others. You just have to do some sleuthing about what might coincide with or lead up to triggering your events.

Then, it’s important to manage those influences while you consult and decide if and when you’ll go for an ablation. Some afibbers have been able to reverse the trend and have avoided the ablation procedure. In any event, eliminating the potential trouble areas certainly ensures that you’ll have the best possible chance for a successful procedure. This is just brief list of a few of the common Afib triggers. It’s by no means complete and each topic requires a lengthy explanation. I’m just offering a few so you see the potential connections.

– Low blood glucose during the night that stimulates an adrenaline response as a protective mechanism the body uses to protect the brain from low blood sugar. This could be triggered by not enough protein and healthy fat content of your last meal in the evening. It can also be from too much in the way of starchy carbs or sugar that ‘rebounds’ because your insulin response to manage the glycemic load is ‘too aggressive’.

- Alcohol consumption often causes PACs and Afib - again because alcohol acts similarly to glucose when metabolized and can be especially dramatic in sensitive individuals. Alcohol kills heart cells and also depletes magnesium which is essential for maintaining electrical stability in electrical conduction of the heart.

- This brings up the need for a proper lab assessment (Exatest) to learn if you are low in the critical electrolytes your heart needs for proper electrical conduction… including optimal magnesium and potassium… and just adequate calcium and sodium. If you are overloaded with either calcium or sodium, that can stimulate arrhythmia… just as likely as low magnesium or potassium.

- Heavy exercise that depletes magnesium and potassium is often a known culprit… as is dehydration. If you live in a warm climate where profuse sweating is common, then it’s an absolute must to know all of your electrolyte levels and make sure you replete all that are out of range… along with hydrating with plenty of pure water… free of fluoride and purification chemicals that can be detrimental to the body.

- Packaged/processed foods that contain flavor enhancers such as MSG, nitrites or other chemicals, artificial sweeteners such as Splenda or anything “diet” as in sodas, along with food dyes (for some people) are also known to be triggers.

-Thyroid issues can influence afib. Everyone should have thyroid testing that includes all of the test markers including Free T3 and Free T4 and not just a TSH to be sure they are in normal range as thyroid issues can trigger afib events.

- Stress – especially if unremitting, is known to be a problem leading to adrenal dysfunction and the arrhythmia connection. Stress can also be physical or emotional.

- Gastric upset and GI distress… both known to contribute to afib. Often related to the inability to produce adequate, natural stomach acid to break down and metabolize/digest food properly. Candida overgrowth of the GI tract can be a trigger as can other GI bugs such as H.pylori.

- Overexposure to Electromagnetic Frequencies such as WiFi, cell phones or cell towers or too much EMFs in the bedroom on top of a day spent on the computer or cell phone. All known to upset influence Afib and contribute to other health conditions as well because of the body’s reaction to these types of stressors.

There’s more. This is just a mini-preview aimed to stimulate your thinking of potential areas that connect the dots in your particular case. If you spend some time reading at the tabs… The Afib Resources and The Conference Room Proceedings, you’ll find a wealth of information for background. We can help direct you to many links if you tell us about your potential connections.

Best to you,
Jackie

I don't have much else to add, as many of the masters have already chimed in, but I sympathize with your "fragile" feeling.

I get afibs every 3-4 months now (lasting about 6 hours an episode) and somedays I feel completely fine, but some days I feel like my heart "wants" to go out of rhythm and it definitely feels fragile.

Keep up the good fight!

-Eric

Hi Rich,

I'm kind of like you...as someone mentioned here, "we are experiments of one." I'm a relative newbie to all of this as well. Athletic, great health, good heart function. I had my first episode when I was 40 after I drank a metabolic booster and converted overnight at the hospital. 16 years later I had my second episode that landed me in the hospital again overnight when I was cardioverted. Now, like you, I'm asking "WTF is going on?" like so may on this board probably have!!

I think Jackie and George are spot on to see if you can identify the path as to how you got here and what might be contributing factors. For me, it's not entirely clear though I've started a diet (or now normal eating protocol) of essentially a paleo diet. My fasting blood sugar was high "normal" and there is a strong correlation between blood sugar and AF. How is your digestive system work - GERD present? Add supplementation as well to see if I can right the ship and avoid ablation.

With regard to being a vagal type or adrenergic, it can be a little confusing to the degree that I understand it. The nighttime initial bout would suggest vagal but the exercise induced would point toward adrenergic. You could be a hybrid.

I too have been having some funny feeling in my esophagus (globus) when I exercise, that tickling feeling that I correlate with an onset. I have been careful not to ramp my heart rate up too high as I fear a recurrence potentially coming on - so spinning on the bike, hiking and weight work is all I do currently. But I do want to return to skiing, trail running and mountain biking. I'm scheduled to have a stress test to see what is going on.

A long winded way of saying that you're not alone, hang in there and have an inquiring mind.

Lastly I found this presentation to be fascinating:

[www.youtube.com]

Best of luck,

Daniel

Such great support. I am so glad to have found this group. A sincere thank you to you all.

I see a lot of comments about finding the right physician to do your ablation. That can be a difficult think to ascertain with any real certainty. I see universal support for Dr. Natale. The doctor that I have been referred to is an associate of Dr Natale and practices in TX as well as in NC. I figure just being a part of Natale’s group has to count for something. His references are strong and his experience is quite impressive. I think I am in good hands
.
Currently I am working my way through all of the possible contributing factors. Jackie your list of ideas is quite impressive, thanks for taking the time to share. I believe I am doing the proper things. I have good BP and blood sugar levels. I have switched to a vegan diet and nearly eliminated any processed foods. I have not tried any supplements yet but that is my next step. Stress is a big one for me. I have started incorporating more stress management techniques into my life.

I am still working to understand all of the types and triggers of afib. I know about vagal but I did not know about adrenergic triggers. Thanks GeorgeN, I will do some research.

I am hopeful with the lifestyle changes I may not need an ablation immediately. Bu I am planning for one just in case.
Thank you all.

Rich

Rich –

I‘ll add a personal comment here addressing that “fragile” feeling.

Over my 20+ years in dealing with Afib, having three ablations and, now a calm heart once again... my Exatests showed intracellular levels of magnesium and potassium to either be low or low in the “normal range.” It’s well-documented that afibbers are known to be magnesium deficient as it’s difficult to take in enough magnesium from food sources. Some people are magnesium wasters which just magnifies the problem, obviously.

What I noticed over a lot of time and many occurrences, is if my heart felt “fragile” or was throwing in random pauses or skipped beats, I would immediately add a generous dose of magnesium glycinate….. the Albion patented chelated version (300 – 400 mg) and a couple teaspoons of Potassium gluconate powder (NOW brand). I’d also add several potassium-containing foods or veggie juice. That always seemed to help stabilize the “fragile” feeling. If, however, I went into Afib or Aflutter… even though I’d do that routine, it often didn’t make a difference other than, perhaps, shorten the event which just served to remind me that I was undoubtedly very low and a couple doses couldn’t shore up the deficit that quickly.

In the first 10 years or so, I also relied heavily on using naturally calming herbals …. Bach Flower Rescue Remedy pastilles and the liquid drops… and later on, L-theanine - amino acid capsules. I carried the pastilled and capsules with me “just in case.” And those always seemed to help. Whether it was a true remedy or placebo effect, I didn’t care. I felt more calm and that was all that mattered.

If I was away from home, I'd always carry a stash of capsules of both electrolytes. Still do. It’s said, we afibbers are ‘scarred’ for life. I know I am. I’ll probably always carry a stash as my security blanket. But the good news is, I no longer feel distress or panic if I do happen to feel a skipped beat or two. I just tell myself, it’s a normal reset.

I’ve often commented that “I was born stressed” and have had a stressful life from then on. Learning how to eliminate what you can and manage that which lingers is extremely important. I’ve never relied on medications for stress management but do rely on L-theanine as it's just an amino acid… called the ‘anti-anxiety’ amino endorsed and recommended by doctors practicing functional and natural medicine. I also find moderate exercise at the gym, sessions with my Chi machine plus spinal alignment sessions with my chiropractor help keep my attention focused less on stressors and more on enjoying stress-free activities… or just relaxing with a good book. I'm also working on doing more meditation regularly.

Jackie

Oops... forgot to mention my passion over the past several years...Grounding or Earthing. I definitely feel huge stress relief because I know that internally, grounding does such amazing therapeutics for the entire body. There are past posts on the importance of grounding for afibbers because it helps keep red blood cells from aggregating or clumping.... plus much more.



Edited 1 time(s). Last edit at 04/11/2016 06:45PM by Jackie.

I agree with Jackie, in that it is important to look for Triggers at this early stage. You are cheating yourself, if you don't at least try to minimally analyze any underlying causal issues to your Ectopy/AFIB. The Ablation doesn't treat the underlying issues, it just creates miniature burnt firewalls in your Heart to block the Fillibration.

I doubt that you need to be on a Blood Thinner. Your AFIB is not that bad. A few bouts of 3-4 hours followed by self-conversion is not very much AFIB. Why are you on Diltazem? Is it supposed to help with the PAC's? Did you feel this "Fragile Rhythm Syndrome only after taking the Meds? Sounds like your Doctor is medicating in preparation for frequent AFIB, but your not in AFIB very much.

Some people have alleviated their Ectopy/PAC's by taking low doses of a cardio-selective Beta-Blocker like Bystolic.

Finally are you relaxed, and have relaxed breathing during exercise. Some have noticed they get less Ectopy with deeper slower relaxed breathing vs tense anxious shallow breathing while exerting themselves.

Thanks all. Jackie your post was very insightful.

I am beginning to learn my triggers and starting to get a better grip on my situation. I am still going to my evaluation for the ablation, but I think I am going to hold off on the procedure until I better understand my situation. My goal is a cure, not simple a block.

You are also right that my situation is not that bad. However, from everything I read the statement “not that bad” needs to be followed by the word “yet”. From everything I read this is a progressive disorder and early intervention is important. That is why I jumped so quickly at the idea of ablation. I am starting to see some (but few) examples of other successful interventions that do not include ablation. I am willing to explore those.

Regarding my meds. My EP did not start me on diltizem, the ER doctor did on my first episode. His theory was it will help control the rate if I were to go into afib again. He is also the one that started me on Eliquis. It is very possible my fragile heart feeling is a side effect of the meds. I can’t tell for sure. What I do know is it is up to me to own my situation and figure this out. I get one cardiologist who said I need the Eliquis and my EP who said I don’t. I have stayed on it until I have confidence in my reasoning to discontinue.

There is no question that relaxation exercises help for me. I have far fewer PAC’s when I am relaxed and have lower anxiety. Jackie, after your last post I had to good search grounding and earthling because I had no idea what that was. It sounds fascinating. Not sure I get it completely, but I know that there are many things about our bodies and our connection to our environment that we simply do not yet know.

Thanks again to those who have commented. I really appreciate your input.

Rich - definitely keep your evaluation appointment and continue to learn all about the various potentials that influence AF. You're using a smart approach.

The Earthing or Grounding is a worthwhile topic to research in your spare time as it is always useful for overall health even without Afib. For afibbers, the benefit is not only the subtle calming but also the fact that Earthing helps keep red blood cells from aggregating/clumping and therefore helps reduce the clotting tendency by natural means.

The book by Clint Ober Earthing is worth a read...

...... And you can also skim through these previous posts on how Earthing is beneficial (protective) for those who are continually bombarded with EMFs from "electropollution".... not hard these days to put 2 and 2 together when we are all connected to computers, cells phones, WiFi, Smart meters.... 24/7. It's been found that in some individuals, electropollution does influence AF.

Here are the links to previous posts (2011)

Electropollution and Cardiovascular Risk… Parts 1 and 2

[www.afibbers.org] – part 1

[www.afibbers.org] – part 2

[www.afibbers.org]

[www.worldhealth.net]

Best to you,
Jackie

Rich, and all -

Jackie brings up a most important and fascinating book on the health benefits of connecting oneself electrically to Mother earth:

Earthing
The most important health discovery ever!

Authors Clint Ober, cardiologist Stephen Sinatra, and Martin Zucher. Foreword by biophysicist James Oschman PhD, author of Energy Medicine: The Scientific Basis and more

Select pages and reviews: [www.amazon.com]


Related:
Healing Is Voltage by biophysisist Jerry Tennant MD [www.amazon.com]

Richgorman:

That is what is suspected as far as your Meds. You know when you have an episode, so why not just take the DIltziam right after an episode starts. Same thing with the Eliquis, unless your having frequent episodes. The ER Dr. plays is safe, and puts you on the Meds you would need in a worst case scenario. Your own Cardiologist and EP are more specialized Dr.s know your case better, and probably are a better judge of what meds you should be taking.

As far as AFIB being a progressive condition? Yes it is, but it usually progresses at a slower rate than you may have been thinking. Their could be obvious Triggers that if eliminated would stave off the progression of this condition for years. I had my first episodes at 30 years old, eliminated an acute Trigger, and then didn't get another episode for 12 more years later.

The main thing in the short run when you are analyzing the situation, is to control your rate if you do have an episode, and be anti-coagulated if necessary (a judgement call by you and your Dr's).

Anxiety, impending feelings of doom, PACs, vertigo, lightheadness, dizzyness are all precursor symptoms to an AF episode. I don't know why but I do know that the heart and brain are probably the two most connected organs by the central nervous system. How else could you go from a sedentary state to running for your life if a situation depended on it (fight or flight response)? If the brain can influence the heart like that, then it stands to reason that the heart can influence the brain and drive it crazy if the heart is experiencing some sort of distress.

When my AF started, I had all of those. I developed an almost "Pavlovian" response to even a single PAC. "Oh no, here we go!!!" Now I just kind of smile and remind myself of the complex chemistry that's going on. The ablation has eliminated the arrythmia and now I just keep calm through any PAC events (less frequent). It's just the atrial cells "knocking heads" a bit until they all get back into rhythm.

Rich.

You say you are under stress, then as Jackie recommends take L theanine it is a wonderful supplement.
It relaxes you, but keeps you sharp,
it lowers your heart rate,
it promotes the production of nitric oxide, which dilates and cleans your arteries, in doing so lowers your blood pressure if it's high.
I take one 150mg capsule just before bed every night, it helps me go to sleep.

Colin