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Afib Burden numbers
Posted by JDfiB
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Afib Burden numbers March 11, 2021 12:07AM |
Registered: 5 years ago Posts: 68 |
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Re: Afib Burden numbers March 11, 2021 12:30AM |
Admin Registered: 6 years ago Posts: 5,358 |
No, there's no official number. It's a very individual thing. Someone who's very asymptomatic might hardly even notice they're in afib so a 20% burden might seem like nothing to them while someone else who's highly symptomatic might find 2% utterly intolerable.
There really isn't much of a concept of serious vs. not serious with afib, except for those people whose afib causes them to pass out, or have other comorbidities and don't have the reserves to spare the small loss of heart function afib causes. Afib is definitely serious for those folks. And then there are the people who ignore or won't comply with stroke prevention and rate control who bring pretty serious consequences on themselves. For everyone else there's just varying degrees of unpleasantness ranging from mild annoyance to quality of life destroying. If you find your burden intolerable, then that's where the line is for you.
There really isn't much of a concept of serious vs. not serious with afib, except for those people whose afib causes them to pass out, or have other comorbidities and don't have the reserves to spare the small loss of heart function afib causes. Afib is definitely serious for those folks. And then there are the people who ignore or won't comply with stroke prevention and rate control who bring pretty serious consequences on themselves. For everyone else there's just varying degrees of unpleasantness ranging from mild annoyance to quality of life destroying. If you find your burden intolerable, then that's where the line is for you.
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Re: Afib Burden numbers March 11, 2021 02:13AM |
Registered: 6 years ago Posts: 920 |
Juts to add to Carey's answer, I'd say it may be worth reminding that afib burden is just a percentage. So, someone having 1x 48h afib/year has the same afib burden than someone having 48x 1h afib/year.
I may be wrong, but I don't believe it has to be taken the same way. Afib is a strange beast.
I may be wrong, but I don't believe it has to be taken the same way. Afib is a strange beast.
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Re: Afib Burden numbers March 11, 2021 10:54AM |
Registered: 5 years ago Posts: 68 |
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Re: Afib Burden numbers March 11, 2021 11:48AM |
Registered: 6 years ago Posts: 920 |
I don't know about its usefulness. As nearly always with afib, it's individual.
I'm symptomatic while in afib, but I'm nothing near falling down. I've just to be careful, say, when standing up. My EF is likely somewhat affected (unmeasured), as is my BP (measured).
I wrote about a same afib burden with multiple short afib episodes or single long episodes. I've experienced both.
The good thing with my (now) short frequent events is I'm really used to; so I don't panic. It's part of my life. I don't wonder any more if and when I'll have the next one; and once it's running, I know it'll likely stop by itself less than a couple hours later.
For me, I'd say that even 0.5% is enough to ruin a great part of my quality of life.
I'm symptomatic while in afib, but I'm nothing near falling down. I've just to be careful, say, when standing up. My EF is likely somewhat affected (unmeasured), as is my BP (measured).
I wrote about a same afib burden with multiple short afib episodes or single long episodes. I've experienced both.
The good thing with my (now) short frequent events is I'm really used to; so I don't panic. It's part of my life. I don't wonder any more if and when I'll have the next one; and once it's running, I know it'll likely stop by itself less than a couple hours later.
For me, I'd say that even 0.5% is enough to ruin a great part of my quality of life.
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Re: Afib Burden numbers March 11, 2021 01:26PM |
Registered: 9 years ago Posts: 1,087 |
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Re: Afib Burden numbers March 11, 2021 03:02PM |
Admin Registered: 6 years ago Posts: 5,358 |
Quote
JDfiB
What then is the usefulness / purpose of this number other than knowing how much afib you've during a given time period?
That's about it. It's not a hugely useful number for most people, and I've never heard the phrase spoken even once by an EP of mine (4). But knowing your burden and keeping track over time gives you an objective way of measuring progression. Is your afib getting worse, better, staying the same? If you track that number you'll know the answer. And it does serve as sort of a misery index for your EP. If you're very symptomatic and you have a high burden, the EP knows you're pretty miserable and the risks of more aggressive measures are justified. And whether you're symptomatic or not, the higher your burden, the more important anticoagulation and rate control become.
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Re: Afib Burden numbers March 12, 2021 12:02AM |
Registered: 5 years ago Posts: 146 |
I was first diagnosed with aFib during a pre-surgical work up and was asymptomatic even though my HR was spiking in the180 range. Over the years, I discovered if I was in aFib while measuring my wrist PR or BP and was asymptomatic in every instance. I do have a Kardia but find monitoring my wrist pulse rate pretty accurate and convenient. I will check my pulse rate a few times a day and definitely every evening. I also have a BP monitor which also has some type of algorithm that puts out an icon if it detects an irregular rhythm. So I guess I’m asking what is the best way to determine your aFib burden if you a asymptomatic particularly with respect to short lived episodes. In my case, I think I have been in NSR for at least 9 months but maybe then again maybe not.
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Re: Afib Burden numbers March 12, 2021 12:14AM |
Admin Registered: 6 years ago Posts: 5,358 |
If you're asymptomatic then you can't be relied upon to detect when it starts and stops, and nobody can be relied on to detect it while they're asleep. So the only accurate way is a monitor you wear for a couple of weeks that records continuously. Generically known as a Holter monitor they go by various brand names such as Zio, but they're all the same thing. They just attach to your chest and record everything for a long period.
If you're in persistent afib then your burden is easy to calculate: it's 100%.
If you're in persistent afib then your burden is easy to calculate: it's 100%.
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Re: Afib Burden numbers March 12, 2021 07:43AM |
Registered: 11 years ago Posts: 4,228 |
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walt
I was first diagnosed with aFib during a pre-surgical work up and was asymptomatic even though my HR was spiking in the 180 range. Over the years, I discovered if I was in aFib while measuring my wrist PR or BP and was asymptomatic in every instance. I do have a Kardia but find monitoring my wrist pulse rate pretty accurate and convenient. I will check my pulse rate a few times a day and definitely every evening. I also have a BP monitor which also has some type of algorithm that puts out an icon if it detects an irregular rhythm. So I guess I’m asking what is the best way to determine your aFib burden if you a asymptomatic particularly with respect to short lived episodes. In my case, I think I have been in NSR for at least 9 months but maybe then again maybe not.
A holter monitor, as Carey suggests, is most accurate. However, a recording heart rate monitor should give you a clue. I've used beat to beat recording Polar monitors for years (I can wear them overnight, for example). Afib is very obvious on these because of the heart rate variability, which you note in your radial pulse. In the last year, I got a ring format SpO2 monitor that also measures heart rate. it samples every 4 seconds, so the variability is more muted, but if your average afib pulse rate is materially above your normal rate, it should show up. I've never experimented with wrist format devices (i.e. Apple Watch, Fit Bit & ect), nor do I know over what period of time they average, but they could be an option, if the averaging is short enough. As an example of what can be seen on the Polar devices, UK afibber Mark Robinson sent these examples to me years ago and we posted here on the site: [www.afibbers.org]
Edited 1 time(s). Last edit at 03/12/2021 09:08AM by GeorgeN.
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Re: Afib Burden numbers March 13, 2021 12:39AM |
Registered: 5 years ago Posts: 146 |
GeorgeN, It seems that to accurately measure your aFib burden you must constantly monitor yourself in some way way. How often do you wear your Polar monitor or your Sp02 ring? I have been reading about the newest Apple Watch 6 series but I think comments are somewhat mixed about them with respect to aFib but I would consider one if it could get me from point A to point B with respect to monitoring my aFib. I guess I was hoping there was a more simple way to do this even though common sense would say otherwise. I did scan through the link you posted most of which was above my pay grade. However, in the first example dated 20/10/2006 the max heart rate was reported as 3333 bpm. I’m assuming that is 3,333 bpm! As I said, “above my pay grade” but what the heck! Your post gave me food for thought about purchasing the ring monitor or some other device to monitor my aFib over longer periods of time. It is a bit scary, though, to think I may not be doing as well as I think I am.
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Re: Afib Burden numbers March 13, 2021 10:41AM |
Registered: 9 years ago Posts: 182 |
To respond to the OP's question about AFIB burden and its predictive value, there is no standard protocol for whether you need to be anti coagulated based on it. Some posters here like to tout their low AFIB burden, but the literature does not support it as far as stroke risk. So they are giving a false impression, with no basis in inferential statistics. The special case of zero burden over an extended period (on the order of years) is generally thought of as predictive, but there are no guidelines with regard to managing AFIB even in this case, if by managing it you mean managing the long term stroke risk. What has been investigated to some small extent and for which there are varying views is not summary statistics like burden but other aspects of the temporal pattern of AFIB. For example, there is analysis of stoke risk associated with even very short episodes (on the order of minutes). But this work is very sketchy and there are large difficulties carrying out these studies due to measurement uncertainty, long time horizon and small sample size. You can search for these studies. I think most people here would be disappointed to find that their AFIB is not managed without anticoagulants based on these studies
It seems useful to know whether you have zero AFIB over a long period. However, even in this case there is no evidence to overrule CHADs recommendation for anticoagulation. There are other reasons why you might want to avoid pharma anticoagulants, which again seem to mostly lack evidence. Of course, you can fashion your own protocol based on your own notion of risk, which is usually speculative and uninformed, or even just based on something your read on the web without delving into it further . Managing the symptoms of AFIB which entail other types of risk is a different matter, for which there is medication, ablation, lifestyle, etc..
It seems useful to know whether you have zero AFIB over a long period. However, even in this case there is no evidence to overrule CHADs recommendation for anticoagulation. There are other reasons why you might want to avoid pharma anticoagulants, which again seem to mostly lack evidence. Of course, you can fashion your own protocol based on your own notion of risk, which is usually speculative and uninformed, or even just based on something your read on the web without delving into it further . Managing the symptoms of AFIB which entail other types of risk is a different matter, for which there is medication, ablation, lifestyle, etc..
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Re: Afib Burden numbers March 13, 2021 10:42AM |
Registered: 11 years ago Posts: 4,228 |
How long are typical afib episodes you are trying to track. Seconds/minutes/hours?
How high is your average heart rate?
I have a different situation than you. My afib doesn't convert unless I do something. With the exception of my breathing or other experiments, I've converted every episode I've had since my 2 1/2 month episode in 2004, with flecainide, I've not let the afib run days to see if it converts. While my symptoms are not huge & I can easily function while in afib, I am aware when I'm in afib & quick check of the radial pulse will confirm it. Hence I rarely wear the Polar all night. I do wear the SpO2 ring, but looking at O2.
The 3,333 is likely an artefact. It is supposed to be the highest rate seen. In that image, it could be from a very quick PAC on the right side of the graph. More likely an artefact in the data.
In Mark's example you selected, the average heart rate in the graph is 65. If your average afib heart rate was 65, and your normal heart rate was say 60, what I'm suggesting would not work. If your average afib heart rate is in the 100's, then anything that continuously tracks your heart rate should tell you the story. Again, in Mark's example, the afib stands out, even though the average rate is slow, because of the variability. For example, if you are sleeping and your heart rate goes to 150, then that is likely afib. If you also just had tachycardia, then this would not discriminate between afib and the tachy. You'd need a beat to beat record to see that (or a Holter).
I happened to catch afib on the ring. On the right size of the graph, with the SpO2 drops, was me, after waking, trying unsuccessfully to convert with an exhaled breath hold. So in my examples below, there are two cues that it is afib - the higher than normal rate and the variable heart rate.
A zoom of before and going into afib. Note the irregular beat rate, even though my afib rate during sleep wasn't that high, it was higher than normal
A normal night. This looks a little irregular, because the data display is compressed. If I zoomed in, it would look much smoother, like the NSR pre afib, in the graph above.
What I'm saying is you don't need a device that identifies the afib - just something that tracks (records) the heart rate with a short enough average to see the increase in variability and heart rate.
How high is your average heart rate?
Quote
walt
How often do you wear your Polar monitor or your Sp02 ring?
I have a different situation than you. My afib doesn't convert unless I do something. With the exception of my breathing or other experiments, I've converted every episode I've had since my 2 1/2 month episode in 2004, with flecainide, I've not let the afib run days to see if it converts. While my symptoms are not huge & I can easily function while in afib, I am aware when I'm in afib & quick check of the radial pulse will confirm it. Hence I rarely wear the Polar all night. I do wear the SpO2 ring, but looking at O2.
Quote
I did scan through the link you posted most of which was above my pay grade. However, in the first example dated 20/10/2006 the max heart rate was reported as 3333 bpm. I’m assuming that is 3,333 bpm!
The 3,333 is likely an artefact. It is supposed to be the highest rate seen. In that image, it could be from a very quick PAC on the right side of the graph. More likely an artefact in the data.
Quote
It seems that to accurately measure your aFib burden you must constantly monitor yourself in some way.
In Mark's example you selected, the average heart rate in the graph is 65. If your average afib heart rate was 65, and your normal heart rate was say 60, what I'm suggesting would not work. If your average afib heart rate is in the 100's, then anything that continuously tracks your heart rate should tell you the story. Again, in Mark's example, the afib stands out, even though the average rate is slow, because of the variability. For example, if you are sleeping and your heart rate goes to 150, then that is likely afib. If you also just had tachycardia, then this would not discriminate between afib and the tachy. You'd need a beat to beat record to see that (or a Holter).
I happened to catch afib on the ring. On the right size of the graph, with the SpO2 drops, was me, after waking, trying unsuccessfully to convert with an exhaled breath hold. So in my examples below, there are two cues that it is afib - the higher than normal rate and the variable heart rate.
A zoom of before and going into afib. Note the irregular beat rate, even though my afib rate during sleep wasn't that high, it was higher than normal
A normal night. This looks a little irregular, because the data display is compressed. If I zoomed in, it would look much smoother, like the NSR pre afib, in the graph above.
Quote
I have been reading about the newest Apple Watch 6 series but I think comments are somewhat mixed about them with respect to aFib but I would consider one if it could get me from point A to point B with respect to monitoring my aFib. I guess I was hoping there was a more simple way to do this even though common sense would say otherwise.
What I'm saying is you don't need a device that identifies the afib - just something that tracks (records) the heart rate with a short enough average to see the increase in variability and heart rate.
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Re: Afib Burden numbers March 14, 2021 12:50AM |
Registered: 5 years ago Posts: 146 |
Quote
GeorgeN
How long are typical afib episodes you are trying to track. Seconds/minutes/hours?
How high is your average heart rate?
How often do you wear your Polar monitor or your Sp02 ring?
I have a different situation than you. My afib doesn't convert unless I do something. With the exception of my breathing or other experiments, I've converted every episode I've had since my 2 1/2 month episode in 2004, with flecainide, I've not let the afib run days to see if it converts. While my symptoms are not huge & I can easily function while in afib, I am aware when I'm in afib & quick check of the radial pulse will confirm it. Hence I rarely wear the Polar all night. I do wear the SpO2 ring, but looking at O2.
I did scan through the link you posted most of which was above my pay grade. However, in the first example dated 20/10/2006 the max heart rate was reported as 3333 bpm. I’m assuming that is 3,333 bpm!
The 3,333 is likely an artefact. It is supposed to be the highest rate seen. In that image, it could be from a very quick PAC on the right side of the graph. More likely an artefact in the data.
It seems that to accurately measure your aFib burden you must constantly monitor yourself in some way.
In Mark's example you selected, the average heart rate in the graph is 65. If your average afib heart rate was 65, and your normal heart rate was say 60, what I'm suggesting would not work. If your average afib heart rate is in the 100's, then anything that continuously tracks your heart rate should tell you the story. Again, in Mark's example, the afib stands out, even though the average rate is slow, because of the variability. For example, if you are sleeping and your heart rate goes to 150, then that is likely afib. If you also just had tachycardia, then this would not discriminate between afib and the tachy. You'd need a beat to beat record to see that (or a Holter).
I happened to catch afib on the ring. On the right size of the graph, with the SpO2 drops, was me, after waking, trying unsuccessfully to convert with an exhaled breath hold. So in my examples below, there are two cues that it is afib - the higher than normal rate and the variable heart rate.
[i.ibb.co]
A zoom of before and going into afib. Note the irregular beat rate, even though my afib rate during sleep wasn't that high, it was higher than normal
[i.ibb.co]
A normal night. This looks a little irregular, because the data display is compressed. If I zoomed in, it would look much smoother, like the NSR pre afib, in the graph above.
[i.ibb.co]
I have been reading about the newest Apple Watch 6 series but I think comments are somewhat mixed about them with respect to aFib but I would consider one if it could get me from point A to point B with respect to monitoring my aFib. I guess I was hoping there was a more simple way to do this even though common sense would say otherwise.
What I'm saying is you don't need a device that identifies the afib - just something that tracks (records) the heart rate with a short enough average to see the increase in variability and heart rate.
Thanks for your reply. I confess I am not very good at understanding some of the technical terminology or data (not just in this thread) but I am trying and do feel I pick up a concept here and there. I certainly know a lot more about aFib now then before I found this forum. To that end, I have read this thread and your posts several times.
To try to answer your question, I think..... My normal heart rate tends to be in the mid 50’s. I have historically always been on the low side. I slip into bradycardia occasionally and a pacemaker was brought into the conversation at my last ECV. I declined.
My initial diagnosis resulted in a several day hospital stay and ECV. Since then, about 31/2 years, I recall 3 episodes with the last one lasting approximately 2 months and requiring an ECV. Long story there related to COVID hospital shutdowns, my EP leaving, and more. My HR rarely left the 70’s. The other episodes lasted 1 to 2 days with low HR’s and self converted using added flecainide. I detected the latter 3 episodes measuring my radial pulse and confirming with Kardia. As far as what episodes I’m try to track well that’s just it. How do I track something if, because I am asymptomatic, I don’t even know I’m having them. Hence the question about wearing an iwatch 24/7 or some other device more regularly? I do get your comment about not needing to know if it’s aFib just so you are able to somehow track the “event.” The comment up thread about aFib burden perhaps having some limited value is good to know. So maybe there are better things for me to obsess about. But, as I said, I’m trying. Thanks for your patience.
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Re: Afib Burden numbers March 16, 2021 05:49PM |
Registered: 11 years ago Posts: 4,228 |
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walt
I recall 3 episodes with the last one lasting approximately 2 months and requiring an ECV. Long story there related to COVID hospital shutdowns, my EP leaving, and more. My HR rarely left the 70’s. The other episodes lasted 1 to 2 days with low HR’s and self converted using added flecainide. I detected the latter 3 episodes measuring my radial pulse and confirming with Kardia. As far as what episodes I’m try to track well that’s just it. How do I track something if, because I am asymptomatic, I don’t even know I’m having them. Hence the question about wearing an iwatch 24/7 or some other device more regularly? I do get your comment about not needing to know if it’s aFib just so you are able to somehow track the “event.” The comment up thread about aFib burden perhaps having some limited value is good to know. So maybe there are better things for me to obsess about. But, as I said, I’m trying. Thanks for your patience.
If you are worried about episodes lasting a day or longer, then sampling once a day with your radial pulse and/or your Kardia should suffice. You can sample more often through the day to catch shorter episodes (say twice a day to catch episodes lasting 12 or more hours). If you are worried about a few minute episode or even an hour while you are asleep, then you would need a recording device. My ring device works, but I don't think I'd want to wear it all day, every day. But it does indicate that averaging your pulse (or at least my afib pulse) over 4 seconds shows enough of the variability to be able to "see" an episode. I'm not familiar enough with devices I don't own to recommend for this use.
In my opinion, the shorter the episode, the less to worry about, unless they are extremely frequent.
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Re: Afib Burden numbers March 16, 2021 11:16PM |
Registered: 5 years ago Posts: 146 |
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GeorgeN
I recall 3 episodes with the last one lasting approximately 2 months and requiring an ECV. Long story there related to COVID hospital shutdowns, my EP leaving, and more. My HR rarely left the 70’s. The other episodes lasted 1 to 2 days with low HR’s and self converted using added flecainide. I detected the latter 3 episodes measuring my radial pulse and confirming with Kardia. As far as what episodes I’m try to track well that’s just it. How do I track something if, because I am asymptomatic, I don’t even know I’m having them. Hence the question about wearing an iwatch 24/7 or some other device more regularly? I do get your comment about not needing to know if it’s aFib just so you are able to somehow track the “event.” The comment up thread about aFib burden perhaps having some limited value is good to know. So maybe there are better things for me to obsess about. But, as I said, I’m trying. Thanks for your patience.
If you are worried about episodes lasting a day or longer, then sampling once a day with your radial pulse and/or your Kardia should suffice. You can sample more often through the day to catch shorter episodes (say twice a day to catch episodes lasting 12 or more hours). If you are worried about a few minute episode or even an hour while you are asleep, then you would need a recording device. My ring device works, but I don't think I'd want to wear it all day, every day. But it does indicate that averaging your pulse (or at least my afib pulse) over 4 seconds shows enough of the variability to be able to "see" an episode. I'm not familiar enough with devices I don't own to recommend for this use.
In my opinion, the shorter the episode, the less to worry about, unless they are extremely frequent.
Thanks. I feel better and a lot more informed after reading this thread. I’ll increase my radial pulse sampling for a bit. Also, at my next EP appt I’ll tell the doc that I think I have been aFib free and let him decide if some additional sampling with a Holter or some other monitor might be warranted. I’m gonna keep abreast of the iwatch and maybe consider a purchase when the 7 series comes out.
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