Very Brief Atrial Fibrillation Episodes Study Results

Interesting study on implications of short AF duration:

NEJM Journal Watch



Edited 1 time(s). Last edit at 11/08/2016 12:49PM by safib.

Here is link with a bit more detail <[www.jwatch.org]

Can't access it. What do they count as very brief? An hour or less??

Very Brief Atrial Fibrillation Episodes Unlikely to Increase the Risk for Stroke
Mark S. Link, MD, Hooman Kamel, MD reviewing Swiryn S et al. Circulation 2016 Oct 18.
In a registry study, short bursts of AF were not associated with systemic embolic events.

It is clear that AF increases the risk for systemic embolic events (SEE, including stroke), but whether the increased risk depends on a threshold density of AF is uncertain. Several studies have demonstrated an increased risk for SEE with AF lasting >5 minutes. To clarify whether shorter episodes of AF were also associated with SEE, the current researchers examined data from the manufacturer-sponsored RATE registry, which prospectively enrolled 5379 patients with dual-chamber permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs).

Short AF episodes were defined as those that were entirely captured in a single electrogram tracing (various devices record different timeframes, but in general short episodes last <10 to 20 seconds). In a median follow-up of 23 months, 837 patients had clinical events (death, emergency-department visit or hospitalization for heart failure, atrial or ventricular arrhythmia, stroke or transient ischemic attack [TIA], and syncope); 53 had TIA/stroke. In a random sample of 600 patients, 50% had at least one researcher-adjudicated episode of atrial tachycardia (AT) or AF.

Patients with clinical events were more likely than those without these events to have long AT/AF (PPM patients, 32% vs. 22%; ICD patients, 29% vs. 20%), but no group differences were seen for short AT/AF episodes (PPM patients, 5% and 8%; ICD patients, 12% and 10%).

COMMENT — CARDIOLOGY

The frequency and length of episodes of AF that increase the risk for embolic events are currently believed to be important; however, it is not clear whether short episodes of AF increase the risk for these events. Some data suggest that episodes as short as 5 minutes increase the risk. This current trial provides some evidence that AF episodes <20 seconds do not increase the risk for stroke or other clinical events. In these individuals, therefore, the risks of anticoagulation outweigh its benefits.

COMMENT — NEUROLOGY

Hooman Kamel, MD
These results are interesting and informative. This study may have underestimated the association between short atrial fibrillation and stroke, particularly given that these investigators did not find a robust relation between longer episodes of AF and stroke, in contrast to numerous prior studies. Further, it is becoming clear that stroke risk relates not just to rhythm status but also to atrial tissue substrate and systemic vascular risk factors. We have a long way to go before we can offer truly evidence-based, personalized therapy to prevent left atrial thromboembolism. In the meantime, management decisions in this population should be individualized and based on global vascular risk factors as well as heart rhythm.

Thanks safib.

Presumably this study includes all afibbers. My own take is that almost all of the sample studied would therefore not have been lone afibbers (in so far as that can reasonably apply) and, as such, would have other significant co-morbidity factors that underlie their increased SEE risk. That said, I still take a junior aspirin daily for a number of reasons not just AF-related.

No one should ever be complacent about clotting risks during afib events but from our verbal/anecdotal reporting here for 17 years we can generally say that most afibbers have been very fortunate even with longer bouts or more frequent bouts of AF ....to have avoided clot formation when they are not on prescribed blood thinners.

That said, emphasis should continue to be about doing all we can to make sure our blood is “thin and slippery” which helps avoid the clotting tendency if the AF event is extended rather than short term. Inflammation drives sticky blood as does elevated blood glucose levels and dehydration... and other factors as well.

While the low dose of aspirin (81 mg) is a standard recommendation, there also are many other natural aids that help to ensure that platelets resist aggregation or clumping… such as magnesium, Omega 3 fish oils, C3/curcumin, Vitamin C, ginger, garlic, lycopene and, of course, the mainstay, fibrinolytic and proteolytic enzymes, such as nattokinase and lumbrokinase, serrapeptase, etc.

My history of escalating AF over eight years prior to giving in to ablation #1 and being incompatible with warfarin led my search into natural solutions that were healthy options. Fortunately, those kept me out of trouble when my events would often last 24 to 27 hours and sometimes longer. Even now, many years later, and while taking the half-dose of Eliquis, I still take much smaller doses of the natural remedies and always try to keep the inflammation marker in the low level ( HS-CRP) to avoid the negative consequences of systemic inflammation for the whole body.

We should be diligent to remind new afibbers who visit here about the importance of always making sure our blood is not “thick and sticky.” (Good advice for everyone and not just afibbers.)

Jackie

Hi Jackie-

I am about 8 weeks in to a daily constant battle with Afib, and ...?( flutter, odd beat patterns) The Afib is usually 10-20 minutes. Up to a couple of hours, and one or two that lasted 4+ hours. I am in the medical system now, my cardio doc. just suggested the 82mg aspirin, and he gave me a low dose prescription for beta blockers.
I am simply riding it out now, making some big health and life changes, losing some weight, etc. Talked to Shannon last week, and he suggested the supplement protocols. I have ordered them from iHerb.

My questions are; May I just continue to ride this out and wait for the supplement and lifestyle changes to show in my heart excitement, and calming down, without meds?

How do I know if my blood is 'thick and sticky?"

i could say more about my details, 55, male, pretty active, could lose 20 pounds (have started). Had big stress in recent years. But I see how different each Afibber is. I just want to know if I should keep trying to ride this out naturally as long as I can. I do know an ablation is a reality in the future. But can I be as natural as i can for now.

Thanks, Jeff

Hi Jeff - I wish there were a reliable, definitive answer to your question about riding it out but because we are all unique in heritage, habits, nutritional status, environment and so forth, we can only give guidelines that have been useful to the many of the afibbers who have been able to make noticeable and effective improvements.

When the core minerals (or electrolytes) are deficient and/or imbalanced, it can take time to adjust.... magnesium, being the key essential operative seems to take more time and depends on a number of factors including the health of the gut transfer areas (lumen) and then, the cell's outer envelope where receptor sites are located. If those are healthy and in 'good working order'... then, nutrient optimization inside the cells is more rapid. If not, then, people say... "I tried magnesium and it did nothing"... but the probability is that it couldn't access inside the cell.

So... it becomes a process unique to that individual. There are so many influencing factors and each one has to be recognized and addressed... even if you didn't have Afib, for overall health and longevity, it's the most important thing anyone can do.

A high stress load or burden is a huge influence and not just for your heart.

The sticky blood and inflammation issue can be addressed by specific testing as listed in this report:
[www.afibbers.org]

I strongly recommend using the nattokinase enzyme to help prevent clotting during afib events. It's easy on the stomach - unlike aspirin - and is well-known to be effective. Cardiokinase is the best brand. You can check the reports in Conference Room 39 and 40 on Nattokinase... and then read the info provided at the Cardiokinase website by Ralph O. Holsworth, DO, who is the nattokinase expert in the US.
Here are the links:
CR 39[www.afibbers.org]
CR 40 [www.afibbers.org]

Cardiokinase
[www.pureprescriptions.com]
[www.cardiokinase.com]
[www.pureprescriptions.com]



Lots more to discuss... I've sent you a PM.

Best to you,
Jackie