Breath hold conversion

Brief afib history. First episode July 2004, vagal trigger after training run on 14,000’ peak. Afib a day or two later (common delayed vagal). 2 months of 6-9 hours afib every 10-14 days self converting or with exercise. Then 2.5 month persistent episode converted with 300 mg flecainide. Proposed plan to EP & accepted, which has evolved to high dose magnesium (to near bowel tolerance), high dose potassium as citrate consumed over the day (2 tsp in a liter of water), detraining from intense, long duration exercise (can do short high intensity or long low intensity, in the link look at links for Zone 2, MAF and nose breathing during exercise). PIP flecainide to convert when the prior fails. This has worked very well over 16+ years. Afib burden is low – currently 4 episodes totaling 3 hours over two years. In 4 days it will be 3 episodes in two years. In 2012, was eating lots of brie cheese and learned that the calcium from that was not good for my afib and increased the AF burden materially. I currently consume no dairy or calcium supplements.

In 2018, learned that high serum CO2 might be protective and might also convert, but a period of time after a long exhaled breath hold might be a risk period. Found a sheep paper indicating this. See this post. I converted one episode with a breath hold. I started working on increasing my CO2 tolerance, but “gently” meaning without extremely strong breath holds. Recently have been making my breath holds stronger. From personal correspondence, an afibber who generally needs to convert with electro cardioversion has had a 25% success converting episodes with very strong breath holds combined with flecainide.

This morning had an episode that started while I was sitting quietly. I happened to have a beat to beat recording heart rate monitor and a recording pulse oximeter on. After a moment, decided to try an exhaled breath hold (exhaling first to get to low O2, high CO2 quicker, then extending the breath hold). {edit What I'm describing is to a) fully exhale, then b) hold your breath out as long as possible, but without pressure.} The urge to breathe will get strong. This is due to increased CO2.} That did convert me. The total episode time was maybe 3 minutes 20 seconds (my normal episode times are 60 minutes and converted with flecainide - so the episode self-converting is an unlikely explanation).

Below is the beat to beat heart rate vs. time graph as well as the pulse oximeter graph. Note the conversion happens when the SpO2 drops into the 80s(%). I’ve labeled as to what I thought happened at certain times. I was not looking at these data. I was looking at an app that uses the camera & light as a plesmograph to see both the pulse wave character and heart rate. Both started changing as I started my breath hold. I could see the heart rate dropping a bit. When I converted to PAC runs, wasn’t sure I’d converted, but then the PACs dissipated. I play with breath a lot, so the “out of air feeling” is familiar. From free divers, you have a few minutes after the out of air feeling before you really run out of O2. In other breath holds, I’ve run my SpO2 into the low 40’s without issue, so 80 isn’t a big deal for me.

My hypothesis, from the sheep paper, is that high CO2 could convert, but looking at these data wonder if it is low SpO2, or higher O2 to the cells because of the Bohr effect from the higher CO2 and a right shift of the oxyhemoglobin dissociation curve. Lots of questions on method of action, but happy it works! I think the likelihood of this working is enhanced if tried soon after afib initiates. My two successful attempts were started quickly after the afib initiated. My one unsuccessful attempt was when I waited a long time to try the breath hold. If it is the low SpO2, I could increase the effect by doing an exhaled breath hold during exercise, or doing rounds of 30 hyperventilation breaths before the exhaled breath hold (per Wim Hof Method). This attempt did not require doing this. In James Nestor's book, Breath, he describes a researcher as well as citizen scientists experimenting with elevated CO2 breathing mixtures. This would make an interesting study on afibbers, under supervision.

Note - breath is powerful, I play with it a lot. If you want to emulate, please do your homework!

Wide view:

Zoomed in:

Tachogram wide view:

Tachogram zoomed:


{Edit} Posted this later down in the thread. Putting it here for somebody looking at this in the future

Looked at the heart rate graph, zoomed in to the center of the afib section. Notice the difference in the character of the beat variability. I hypothesize I started the breath hold (just) before this section. It wasn't a conversion yet, but something was happening. In the plesmograph phone app, I could see this change in heart rate, though it wasn't graphed like this.





Edited 11 time(s). Last edit at 01/19/2021 09:09PM by GeorgeN.

Thanks for the post George!
I use breath also when my HR goes 'funny' but can't describe it well. All i know is that so far it gets the HR feeling back to normal.

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Joe
I use breath also when my HR goes 'funny' but can't describe it well. All i know is that so far it gets the HR feeling back to normal.

Yes, my son-in-law says he uses breath holds when he gets a funny feeling that might presage afib (possibly PACs or PVCs). He says it works and clears it up.

Is this the mechanism at play when one does valsalva or modified valsalva?

Not sure if this will make sense, but how can this relate to Sleep apnea? That is also a non breathing situation but one that contributes to AFIB. I am not disagreeing with your method just wondering how they may relate.

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NotLyingAboutMyAfib
Is this the mechanism at play when one does valsalva or modified valsalva?

No, valsalva increases parasympathetic (vagal) response. It usually doesn't work for vagal afibbers, but may for those with adrenergic triggers.

Valsalva is generally an attempted exhalation against a closed airway, can be with a full inhale. Like bearing down in a bowel movement.

What I'm describing is to a) fully exhale, then b) hold your breath out as long as possible, but without pressure. The urge to breathe will get strong. This is due to increased CO2.



Edited 2 time(s). Last edit at 01/15/2021 08:51AM by GeorgeN.

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JDfiB
Not sure if this will make sense, but how can this relate to Sleep apnea? That is also a non breathing situation but one that contributes to AFIB. I am not disagreeing with your method just wondering how they may relate.

I'm not a sleep apnea expert, but I think you stop breathing. CO2 will rise (and some with sleep apnea can have quite high CO2 tolerance), but, depending on the person, the stopped breathing may go to the point of where O2 triggers breathing. Then there is an adrenaline surge to start breathing again. That adrenaline surge could kick someone into afib. I also think it may be a matter of degree. Someone with bad apnea can have many episodes an hour.

I'm in communication with a type 1 diabetic. He had gotten his A1C (a measure of average glucose) down to 6.5% through diet and exercise, which is considered excellent for a T1. When he started doing breathing exercises to increase CO2 tolerance as well as intermittent hypoxia exercises, his A1C dropped to 5.4%, which is in the normal range and stellar for a T1. He was surprised and intrigued. This guy is a PhD, so started looking for papers on intermittent hypoxia and insulin resistance. There are quite a few. Again, they show it is not good to be hypoxic all the time, but as a hormetic exercise, it has benefit.

In this post, I show what happens to heart rate when I don't tape my mouth during sleep. Taping will correct mild to moderate sleep apnea in many cases.

Someone with more knowledge of sleep apnea may correct me.

This is a book by a breathing instructor on the topic. The instructor is well regarded.

{edit} On why apnea may be bad - when breath is held out, as the CO2 builds and approaches a person's tolerance, there is a sympathetic response. In me, my heart rate can rise from ~55 to the 80's on a long breath hold. Others may have a stronger response which is enough to be a trigger.



Edited 4 time(s). Last edit at 01/15/2021 09:07AM by GeorgeN.

Last spring when I had 5 a-fib episodes about 4 months after my ablation, I tried the breath holding technique a couple of times with no benefit. I am familiar with breath holding (lots of skin diving, spear fishing pre college days), plus breath holding swims with competitive swimming training. As I recall, I once made a 75 yd. underwater swim without breathing "back in the day". If I have another bout of a-fib, I will try again.

George:

How about this do you think it has any merit?

[www.resperate.com]

Liz

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Elizabeth
George:

How about this do you think it has any merit?

[www.resperate.com]

Liz

Yes, it has merit, but you don't have to spend the money to do the same thing. The idea is to get you to breathe through your nose at a rate of around 5.5 breaths/minute (4-6 or even 4-10 is the range). The search terms are coherent breathing, slow breathing or paced breathing. An Italian cardiologist by the name of Lombardi has done a lot of work on this. Here is one paper of his [breathe.ersjournals.com]

a journal search: [www.ncbi.nlm.nih.gov]

A (now) friend who is a PhD & T1 diabetic found that breath work improved his glucose control materially. He has a website and talks about slow breathing [www.thebreathingdiabetic.com]

James Nestor, who wrote a fantastic book, Breath, has this as his number one breathing suggestion. Nestor has a number of breathing instruction videos on his website and I think this is the first one: [www.mrjamesnestor.com]

Many times I will do breathing with a 4 second inhale, and an 8 second exhale. I set up a timer app to beep every 4 and 8 seconds (5 breaths per minute) or just use my heart beat as a timer. I will do this for 15 minutes. Having the exhale as twice the inhale increases parasympathetic tone and can materially reduce blood pressure.

Ideally, breathe through your nose, breathe using your diaphragm (belly), where your stomach will move on the inhale, not your chest. However your lower two ribs should also expand laterally on the inhale. Breathe per the time and then see if you can relax and breathe less volume on the inhale. If you need to take a big inhale, you've pushed the less volume thing a bit too much. Start at 2 minutes or whatever is comfortable and work up to longer times.

{Edit} Hey Liz, you recall Hans playing with Freezeframer/Heart Math back in the 2004-5 timeframe? We were using them to record and "see" beat to beat heart rate. The HeartMath folks still exist and the real purpose of their product was biofeedback - they would measure heart rate variability (HRV) in real time and by breathing, your objective was to maximize it. Generically, HRV is maximized around 5.5-6 BPM. This is not a good option for you, since you are in continuous afib. I remember trying this when I was in afib. It was pointless, though the breathing would still work.



Edited 1 time(s). Last edit at 01/15/2021 09:00PM by GeorgeN.

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JDfiB
Not sure if this will make sense, but how can this relate to Sleep apnea? That is also a non breathing situation but one that contributes to AFIB. I am not disagreeing with your method just wondering how they may relate.

Please look at this research Linz is the expert.

[pubmed.ncbi.nlm.nih.gov]

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JDfiB
Not sure if this will make sense, but how can this relate to Sleep apnea? That is also a non breathing situation but one that contributes to AFIB. I am not disagreeing with your method just wondering how they may relate.

I have looked at NLAMA's link, but your question prompted me to put
intermittent hypoxia arrhythmia
into a Google Scholar search

Just scanning the papers, intermittent hypoxia seems to be one of those things where a little can be good (a hormetic stressor) and chronic can be bad. Sleep apnea being one of those instances where there is potential to be chronic.

This site (this link is a search of his site on intermittent hypoxia and some of the studies he's summarized) is created by a guy who is both a PhD and a type 1 diabetic. He'd gotten his glucose control into the excellent range (for a type 1), with diet and exercise. Then he started doing breathing training: nasal breathing, taping lips during sleep, light breathing exercises to increase CO2 tolerance, paced breathing (what Liz is referencing above) and intermittent hypoxia (exhaled breath holds till a strong lack of air feeling) exercises. He was shocked to find his glucose control improved dramatically, from an A1C (measure of average glucose over ~3 months) of ~6.5% to 5.4% (which is a spectacular result for a T1).

He has a good primer on breathing basics.

George : So having a live recordable CO2 reading would even clarify things more?

I have hospital grade CO2 machine, need to see if it records, then sync with live SPO2 which I have.
Good job getting this recorded, its cumbersome for me to get all hooked up and monitored.

My experiments show a rapid shift in increased CO2 is more conducive to conversion, as to effect change before the body can react with a compensatory reaction.

I just remembered, their is a lag in the readings back to the CO2 machine of about 10 seconds or so, so a Blood-Gas test right after conversion would also be helpful, but I think this require being in the Hospital.

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The Anti-Fib
George : So having a live recordable CO2 reading would even clarify things more?

I'm sure. Since I thankfully have infrequent episodes (it will be back to three in two years on Monday), I haven't made the investment in trying to track CO2, though that would be interesting, just in the breathing experiments without afib. However, I've played with breathing enough, I'm very familiar with the "out of air" signal that increasing CO2 brings (my own "capnometer"). As mentioned above, I've tried not to push this too hard in training, after my experience with the after training higher afib risk as CO2 goes back to my normal level, in 2018.

BTW - I was lucky to have the monitors on when the episode started.

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The Anti-Fib
I just remembered, there is a lag in the readings back to the CO2 machine of about 10 seconds or so, so a Blood-Gas test right after conversion would also be helpful, but I think this require being in the Hospital.

I know there is a lag on the SpO2 reading, on the fingertip pulse ox I wear during exercise. It is a watch form factor with a wired finger cuff. The data in the graphs I posted above are from a recording SpO2 ring. I've also not tried to correlate both devices against each other. As to SpO2 lag, for example, I can be jumping rope and doing an exhaled breath hold. I'll stop so as to not push the out of air feeling too far. It might take a while, while stopped, before the SpO2 drops from the mid-high 90's. It can drop as low as the 60's (%). As mentioned above, I've dropped it into the 40's when I do 30-40 hyperventilation breaths before the long breath hold (Wim Hof technique). When I do this I'm sitting or reclining. If you don't hyperventilate before the breath hold the urge to breathe will get very strong long before you deplete your O2, so passing out is really not a risk. If you do hyperventilate, it depletes CO2 and pushes back the urge to breathe much farther in time. Hence, you can run out of O2 suddenly and pass out. If you are reclining, this is not a big deal - you just start breathing. It could be dangerous if exercising and fatal in water (shallow water blackout). Also, the higher the CO2, the stronger the Bohr Effect (from my OP), hence cells can get more O2, even though SpO2 is lower.

Speaking of the lag - I may have stopped my breath hold prior to the lowest SpO2 reading and the conversion. I remember thinking that I hadn't held it as long as I could have.

I've thought about doing the exercise breath hold to get a stronger effect during a conversion attempt, if the straight breath hold didn't work.

I also think starting the breath hold shortly after the start of afib may have helped with success. I've tried three times and succeeded twice. Both times I succeeded, I started trying shortly after the afib started. The try that failed was when I had an unusual (for me) episode that started during exercise. I was going up a steep side canyon with essentially no trail with a 60# climbing pack and BFR (blood flow restriction) bands on my arms & legs. The BFR intensified the already intense exertion. I felt myself go into afib, but waited till we got to the climbing area before I tried a breath hold conversion. It failed & I had to hike down and go home and get some flec, which worked its normal magic and converted me in an hour.



Edited 6 time(s). Last edit at 01/16/2021 06:23PM by GeorgeN.

Looked at the heart rate graph, zoomed in to the center of the afib section. Notice the difference in the character of the beat variability. I hypothesize I started the breath hold (just) before this section. It wasn't a conversion yet, but something was happening. In the plesmograph phone app, I could see this change in heart rate, though it wasn't graphed like this.

As young teenagers we did a breathing and breath hold exercise that got us hallucinating - a short 'trip' of 20 to 30 seconds (completely passed out und unconscious).
One kid would lock his arms around the subject's ribcage from behind. Then the subject would take 15 to 20 deep in and out breath with the assistant squeezing the chest on the outbreath to expel all air.
After the last full breath in the subject would hold his breath with the assistant squeezing the chest hard. The subject felt a little crack/pop inside his chest and would pass out - experiencing a pleasant hallucination.
What happened physiologically????
I've asked a well known physicist who became a medical doctor and could not get a sensible explanation.
BTW, we only did this for a short time (maybe 10/12 times over a few weeks) because we suspected that it wasn't too good for us.

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Joe
What happened physiologically????

I'm no expert... The hyperventilation, with your assistant squeezing will create an alkaline environment by lowering your body's CO2 dramatically. If you hold your breath out at the end, the "urge to breathe" will be pushed far out in time on the breath hold. You are also restricting O2 to the cells because of the previously linked Bohr effect. You could hold your breath long enough to pass out from a lack of O2 (you continue to use and lower body O2 as the breath hold continues). Not sure exactly what is happening. How long was the breath hold at the end? Was it on an exhale? Maybe some variant of DMT breathing? [www.google.com]

My recollection is that if you take a deep breath and someone squeeze's your chest, the thoracic pressure increases to the point of collapsing your vena cava and the blood stops moving to your brain - and you pass out.

Thank you George and Ken!
Not sure about DMT breathing relationship. We did not hold after the last out breath. The breath hold on the last big inhale is only a few seconds, that is until the pop sound in the chest happens.
Ken's mention of the vena cava collapsing could explain the single pop sound (scary!)

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Joe
We did not hold after the last out breath. The breath hold on the last big inhale is only a few seconds, that is until the pop sound in the chest happens.

Looks like something similar is still going around in the younger crowd: [www.hertsad.co.uk]

" teachers felt they needed to intervene after some pupils started to copy a trend on social media known variously as the ‘Pass-Out Challenge’, ‘Space Monkey’, ‘The Choking Game’, or ‘Suffocation Roulette’.

To complete the challenge, teenagers deliberately hyperventilate until they lose their breath and feel light-headed, then a friend compresses their lungs by pushing on their chest, making them faint."