List of things I've tried that haven't worked. Any suggestions?

Since having persistent AF I've tried and hasn't had an effect:

acupuncture - [www.ncbi.nlm.nih.gov]

taurine - [www.ncbi.nlm.nih.gov]

Steve Carrs protocol - > D, < calcium, precise EPA/DHA, cranberry extract

Eliminating all alcohol, caffeine, sugar and carbs (glycation) and other AF triggers even if not identified in me

Reduction of hsCRP - now in range via CPAP

Dr. Davis mag water

George's mag/pot/taurine water

Relaxing 'keto' diet to 100gms + a day

Zero D and near zero calcium

Zero water - highly filtered water 4 stage and then through zero water filter.

Weight loss (Prash Sanders has been discussing this for some time) - [www.ncbi.nlm.nih.gov]

Ginger

MulTaq

PIP Flecainide + met suc

Sustained flec and met suc

ECV worked but NSR appeared more 'challenged' over time and failed at 90 hours.

And practically every combination of these all at once.

I keep thinking sooner or later my heart rhythm wants to revert to the mean. (NSR!)

It did so for 56 years reliably and there's just something root cause here that I'm missing.

Any ideas ? Anything I'm missing ? Patience ? LOL

Thanks all and Happy mother's day to all mommies out there.

Tikosyn, amiodarone, ablation.

It's extremely unlikely you're going to stop and prevent persistent AF with supplements.

Carey,

Would amiodarone be better choice over MulTaq for or after next ECV ? I had it before and tolerated it.

I think, but can't be sure, original meds from hospital were amiodarone, met tartrate and dilziatem

Recall 1st ECV - current cardi had me on MulTaq and met suc and NSR only lasted 90 hrs.

I haven't tried tikosyn.

I think I am willing to try more drugs with ECVs before ablation. I just want to be in NSR.

I feel like my life is on hold in AF.

Thanks -

I'm guessing nothing will convert you short of an ECV. The question, then, is how to best prepare your system to maintain NSR after an ECV? I'm personally not a fan of amio for a long duration. I think I'd take an ablation over long duration use of amio, but that is just me.

I think that optimizing electrolytes plus a med, and which one is the question, would be the best you can do prior and post ECV.

Amiodarone is the most potent of all the antiarrhythmic drugs, but as you probably know it has a number of dangerous side effects. I would only take it short-term. Tikosyn is probably your best bet. It's successful for most people and doesn't have the horrid side-effect profile of amiodarone, nor does it have a half-life so long you have to stop it a month or more before an ablation. Its only real downside is it requires a 3-day hospital stay to start it. I know people are freaked out about going to a hospital right now, but I would if necessary. Just avoid the ER. In units like cardiology, all the COVID patients are going to be segregated into a separate area of the hospital. Everyone coming in the door is tested before being admitted, and staff are also tested. So right now hospitals are safer than grocery stores.

If Multaq didn't work the first time, it's not going to work a second time. I give it zero chance of preventing persistent AF.

I would vote for starting Tikosyn and once you've cleared the 3-days of observation, do a cardioversion.

Some differences this time - lower D and calcium, no met suc this time and way more 'saturated' going into it. Last time maybe 4.5 days of MulTaq, this time 21 days so it's possible MulTaq will work this time. (hope so anyway)

By the way is MulTaq size dependent, would a 50kg person need less than a 100kg person.?

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NotLyingAboutMyAfib
By the way is MulTaq size dependent, would a 50kg person need less than a 100kg person.?

No, sorry, the only recommended dosage is 400 mg twice daily. That's because clinical trials showed that age, weight, kidney function, and liver function just don't matter. It's what you might call a "mild" drug.

I don't think it's a promising solution for your persistent AF. With persistent AF, you're going to need to start with the stronger drugs, and Multaq isn't one of them.

Hate to ask this but is my cardi not being aggressive or thoughtful about this?

1. He had me on MulTaq and met suc for # 1 ECV. Probably would have insisted same for # 2 if I hadn't told him that HR was in the 40s with both.
2. Discourages use of flecanide because of higher CAC score but no history of 'structural heart' issues - I noticed my ejection fraction at hospital ER was noted as 62 while in AF. So that's good right?
3. As noted before, doesn't know Dr. N or is being obtuse - it's a bit like an NFL player stating he doesn't know who Patrick Mahomes is. (how could you be a cardi and not know? (in the world, in the usa, yet alone in Texas!???)

I probably need a new cardi and need to start looking today.

I take it your cardiologist isn't an EP. That's the only way he wouldn't know who Natale is. That also means he's probably not up to date on the state of the art in EP. It's not surprising at all that a general cardiologist isn't up to par in treating AF. We've seen that time and again with general cardiologists.

It's quite the list of things that don't cardiovert. Acupuncture has calmed me, but has never reverted me, either.


My 2 cents, as an OT, and someone observing my own lone AF for 20 years, would be: Have you tried patience, and kindness. Seriously. Internally, for you. You say it with a laugh, but it may be your best bet, short of an ablation. And even with, or in preparation for, ablation. I follow several aspects of GeorgeN's protocol (Mag, Taurine, short eating window, nasal breathing...) to support my electrophysiology, but the most impact I have on my lone AF has been literally 'taking myself to safety'. Usually, this means Emotionally. (apart from a silly dehydration episode!). Since my physiology ticks all the active healthy boxes, that leaves stress. Stress that I'm aware of, and stress I'm not aware of. Somatic Experiencing (sessions delivered by a doctor) has been instrumental, as has practicing TaKeTiNa (an embodied rhythm meditation). Both affect vagal tone, both can bring the nervous system into safety, optimising HRV.
How are you sleeping? and are you matching circadian rhythms?
I am not 100% AF -free, but I have a low AF burden, which has been reduced by implementing embodied emotional coping strategies aka : Patience, Kindness. This last year I have reliably self-reverted all 4 episodes within 3 days of onset. Certainly not a tactic for everyone, but if you, like me, are keen to stay in NSR and avoid the knife / burn... It's been worth it for me. My cardiologist (a Natale colleague) advises me of patients who have met success with similar strategies, and avoided the knife, but that the research is lacking to back this up.

I work on handling stress differently. I am getting better at realizing that barking dogs, cars without mufflers, booming stereos are just a fact of life anymore. At heart I am drawn to these quiet peaceful places like the upper peninsula of Denmark. Nature - relaxing and not worrying about much other than enjoying time and family.

My AF may possibly be contributed to by immediate family - at 57 I have a 4 yr old boy that is pure 4 yr old boy. I can't be without him though and hoping things get easier with time. (probably won't! lol)

Cycling, swimming are meditative to me, walks in the park, etc. Anytime I can let my mind go blank.

I sleep well - can fall asleep mid sentence and get a solid 7-8 with one nature break (very hydrated)

Friends, love, sex, work, money - all good.

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NotLyingAboutMyAfib
Any ideas ? Anything I'm missing ?

I converted an episode with an exhaled breath hold. It is described here, as well as a link to a sheep study that might explain it.

After I posted that, I got a email from an afibber relaying his sister's experience with the same kinds of breath holds, posted here.

George,

Thanks - yes in those initial episodes I tried valsalva - modified valsalva and cool water immersion because they were the first tips I cam up with. As always multi-interventional but initially it appeared that valsalva had some merit.

This co2 approach is different. In that it's a deep exhale that initiates the hold. I have an spo02 to check what's happening.

I'll report back later.

How many ECV's have you had? 1-2? I would give the George-Holds a try first, but more ECV's probably necessary to get back in NSR, and then all of the things you are doing may keep you there. Also if you need to figure out if your Vagally Mediated or not, if you haven't already. Amioderone may not be a very good choice for Vagal AFIB. Norpace and Flec are the best AAM for VMLAF. Have you tried no AAM/BB/CCB after ECV? that is what worked me.



Edited 1 time(s). Last edit at 05/13/2020 06:52PM by The Anti-Fib.

Anti - sorry but I don't know what AAM/BB/CCB are. Can you please explain?

I think first ECV failed because cardi had me taking MulTaq and Met suc. I was told later that met suc isn't helpful for vagal - which is how my AF appeared to be initiated before becoming persistent.

Only 1 ECV.

What's different this time. Lower D, should be lower calcium, lower BNP. lower weight, more MulTaq saturation, no met suc and fingers crossed.

"Anti - sorry but I don't know what AAM/BB/CCB are. Can you please explain?"

AAM--Anti-Arrythmic Medications
BB--Beta-Blockers
CCB--Calcium Channel Blockers

Most all of these Drugs slow down the Heart as they are Beta-Blockers, or have Beta-Blocker properties. I only used 1 CCB, Diltizem, and I wasn't able to maintain NSR until I quit taking it. It took me 4 ECV's last year to figure out that Diltiazem was helping to trigger my AFIB. In my case over a 12 year period, it is clear that these Drugs made my Vagal AFIB worse.



Edited 4 time(s). Last edit at 05/13/2020 11:03PM by The Anti-Fib.

Anti -

I recall reading this kind of information when I first left hospital - still in AF, still with elevated heart rate and 3 drugs - amiodarone, met tartrate and diltiazem. (not to mention my insurance company hit for $20k) criminal.

I have data recorded that shows my AF is vagal in nature - how did you end up solving yours?

Thanks

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NotLyingAboutMyAfib
I have data recorded that shows my AF is vagal in nature

What data shows that?

This event, # 3, recorded with my overnight spO2 and HRM. I've posted before. Screenshot of notes to my cardi at that time.


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