Back in AF - 9 days after ECV - on MulTaq

So this ECV (#2) went a little better with MulTaq only and no MetSuc. I noticed I wasn't feeling right the last 30 minutes and confirmed with my pocket EKG - back in AF.

I'm OK with having another ECV and trying propafenone next time.

I can't identify any trigger that may have caused me to pop out.

I'm considering stopping the multaq and trying PIP flecainide and diltiazem as soon as it's safe. I already took my pm dose of Multaq today so the clock starts at about 6:00 PM Central friday.

Monday AM for flec ?



Edited 2 time(s). Last edit at 05/31/2020 09:28PM by NotLyingAboutMyAfib.

Sorry to hear that.

Sure, try the flecainide PIP once you've been off Multaq long enough. The half-life is 13-19 hours, so 2 days should be enough, 3 for sure. But I think you probably know where this is headed. ECVs aren't a long-term solution; they're just a band-aid

Thanks Carey. I've been reading around and about to try the old V8 trick or take 2 tsp of potassium citrate (George) so I don't have to run to the store. I'm disappointed in the failure and trying to think what if anything I did wrong,

This paper states propefenone is the best choice after an ECV,

[www.ncbi.nlm.nih.gov]

Tikosyn better than rythmol? Thanks -

Propafenone (Rhythmol) is in the same class as flecainide, so there really isn't much difference between the two. Tikosyn is a step up in effectiveness from both of them. If I were in your shoes right now, I would opt for the Tikosyn without further delay. I think you're kidding yourself with the propafenone and PIP and such. I've been down the road you're on and I've seen many others go down it, and it always ends the same way. You get some temporary relief but you never achieve freedom from AF.

"it always ends the same way"

I agree with Carey, but its been 9 months NSR for me, and I am not even getting PAC's. Several years ago I went 18 months. I may be an anomaly, but "temporary" might mean many months.

I would also add asking your Dr. about Norpace as an option. It's supposed to be one of the best Anti-Arrythmic's for Vagal AFIB, although it's not used very much. They won't Rx it if you ever had Heart Failure.

Getting on Tikosyn means 3 days in hospital ?

If it's effective and harmless I am willing to do that.

Anti-Fib - you're on Tikosyn?

I still think there is something root cause about this like the low DHEA and T, or too much D and calcium, more weight loss or all of the above (the tide).

What bothers me is that I see many histories where an ablation does not work and my sense is that there is still a root cause unaddressed in these cases.

It's like the years I wasted (and also a likely contributor to my AF) as a T2 diabetic - with all of the great MDs, RDs, pills we just couldn't get that "gosh darn A1c" down on the MD recommended 50% carbs med diet.... "gosh willy gee"????

I fixed it in 10 days flat by not eating any more carbs. It was as simple as that.

The impetus was "you're going to have to go on insulin". Even as an untrained idiot I knew that made as much sense as giving an alcoholic more alcohol to treat their problem.

Overall strategy

1. Continue addressing probable root causes concurrently
2. Try proven methods along the likely path to ablation
3. Spend the least amount of time in AF and remodeling as possible

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NotLyingAboutMyAfib
What bothers me is that I see many histories where an ablation does not work and my sense is that there is still a root cause unaddressed in these cases.

The root cause in failed ablations is almost always an inexperienced EP who doesn't know how to make durable lesions or doesn't know how to find and ablate sources of AF outside the pulmonary veins. It's not some metabolic disorder you can fix with diet or supplements. Comparing it to diabetes is to totally miss the mark.

I would either opt for the Tikosyn or an ablation with a highly experience EP. Yes, Tikosyn requires a 3-day hospital stay, but that's actually not so bad. You're not sick, so the staff pays very little attention to you. You have to wear a monitor all the time, but that's it. None of this waking you up every four hours for vitals and such. Plus you're free to roam around as much as you want as long as you stay within telemetry range. I brought a pair of sweatpants and t-shirts so I didn't have to wear those ridiculous gowns they provide. I also brought a laptop and cell phone, so it was pretty much just a 3-day vacation.

Carey - I get that I may be on the inevitable path to an ablation and it will be with Dr. N.

But at the same time this forum is equally full of people that were able to find a solution w/o an ablation. If this wasn't the case, there'd be one sticky reading "get an ablation" and no other posts or information.

Ever Dr. N in a recent interview stated fix the co-morbidities (root causes (OSA, diet, weight) or otherwise you'll be back as the shift from left upper chamber to right upper chamber disease.

[twitter.com]

The better my soil and habits are going into an ablation will create success in the short and long term.

I won't be using an ablation as an excuse to go back to the bad habits that got me here in the first place.

I have a call Monday AM and will request Tikosyn - BCBS TX should be ok with this.

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NotLyingAboutMyAfib
But at the same time this forum is equally full of people that were able to find a solution w/o an ablation.

That's not really true. There are a few people here who have found ways to control their AF to minimize episodes, but no one claims complete control. (Well, Steve Carr does, but his sample period was so short that I'm extremely skeptical.)

I'm not suggesting you don't try every reasonable thing you can, and certainly not that you don't eliminate comorbidities. Hey, I spent years doing the same things, including two years of controlling my flutter-from-hell that was resistant to all AADs with an approach that every doctor I spoke to swore I was going to kill myself. So I get it. I just think you're putting off the inevitable with approaches that have little chance of success.

Anti-Fib - you're on Tikosyn?

No I stopped all Anti-Arythmics/Beta-Blockers after my last ECV.

"I still think there is something root cause about this"

Have you tested your Intra-cellular Mg levels using the Exatest?

There are posters on this forum that have to have more than one ablation, even with Dr. Natalie, and they sometimes have to have closure of their LAA which means they have to than be on a blood thinner for life. AF doesn't always have an easy outcome.

I was Paraoximal AF for around 20 years, I got only a few episodes a year in the beginning and always converted on my own, the last few years I did get AF more frequently but again I always converted on my own. I did take Propafanone during much of that time, I took it only before bedtime as I was vagal and only got episodes during the night. I went into AF last Nov. and I am still in AF, I did get Cardioverted in Jan. which did not hold, strange i don't hardly feel the AF and it makes me only slightly fatigued when doing a lot of walking/work. I am supposed to spend the 3 days in the hospital this July to see if I can take Tikosyn and then get cardioverted again, if this doesn't hold, then I will just stay in AF and a blood thinner and skip the Tikosyn.

If I was in my 50's and I did everything I could to be in NSR, than I would opt for an Ablation. My Holistic doc. said that he was exercising and went into AF, he said he took some Hawthorne berry and came out of it. It didn't work for me but who knows it might for some.

Liz

Anti-fib - no Exotest yet but I've definitely been on the Mg path since this first happened and all of my RBC tests have been in range (but yes I know that means little)

Liz - I'll investigate Hawthorn berry - thanks

I'm going through Hans's 12 steps with my md and cardi. I still want to believe there's a root cause that does not require a high wire act with a dozen different molecules.

Most of my life - most everything I ate and did was tolerated (until it wasn't) so I find it hard to believe that x amount of substance A, B and C but no more e, g and f and a precise amount of H will find me in NSR.

I'm really most excited by the DHEA and T - Shannon's feedback on same, the papers I found and the Occam's razor root causeness of getting older and having these hormone deficiencies.

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Elizabeth
My Holistic doc. said that he was exercising and went into AF, he said he took some Hawthorne berry and came out of it. It didn't work for me but who knows it might for some.

Liz

FWIW, i took Hawthorn berry extract after my 2nd CV for a few weeks and after that i drank Hawthorn berry tea for a year or so. I stayed in NSR for over a year (forget exact time now).
It may have helped one way or another. There was no down side and i had nothing to loose except a few $.

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NotLyingAboutMyAfib
Most of my life - most everything I ate and did was tolerated (until it wasn't) so I find it hard to believe that x amount of substance A, B and C but no more e, g and f and a precise amount of H will find me in NSR.

I completely agree with you. One thing to keep in mind is that AF is most likely caused by fibrosis in your atria. Fibrotic tissue is pretty much inert, physiologically inactive stuff (which is THE root problem -- it doesn't transmit electrical signals). Not much affects it or makes it go away, including hormones, DHEA, what you eat, etc. So all you can really affect with metabolic interventions are the triggers, not the underlying cause.

Carey - I appreciate your involvement and assistance and do see the whole fibrotic/damaged tissue glycation issue but none of that explains how I was able to maintain NSR for 9 days. It seems at face value that a damaged heart wouldn't be able to maintain NSR for any period at all. At it's core isn't AF an over conduction issue and that's what ablation seeks to remedy?

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NotLyingAboutMyAfib
At it's core isn't AF an over conduction issue and that's what ablation seeks to remedy?

No, quite the opposite. Keeping in mind that the mechanism of AF isn't fully understood, the basic problem is electrical barriers in your atria. When your sinus node fires, the signal travels as a smooth wave across the atria. That wave should move at the same speed through all the tissue. But fibrosis will create areas where the wave travels more slowly, which essentially breaks up the wave into multiple waves that depolarize atrial tissue at slightly different times. The result is the irregular, uncoordinated rhythm we call AF. The same thing happens with ectopics. You get "rogue" cells firing on their own (in the PV veins, for example) that produce the same uncoordinated wave fronts.

How does such a heart maintain NSR for 9 days? That's one of the mysteries no one has fully explained, but my guess would be the AF heart is mostly working as it should, but it's susceptible to one event at just the wrong millisecond to start a self-perpetuating uncoordinated cycle. In any case, I think your 9 days of NSR is more random chance than anything else.



Edited 1 time(s). Last edit at 05/31/2020 04:55PM by Carey.

NLAMA - On the fibrosis topic, if you haven't read CR Session 24, you may find something there offers a connection to your situation.

[www.afibbers.org]

Jackie

Thank you Carey and Jackie.