Advice?

Hello all, new member here to the forum, so please excuse the long post as I seek to introduce myself and my situation. Love the diversity of opinion and could use some advice from different perspectives. I am 64 and in very good health. Walk or ride bike 5-6 miles/day. Had my first afib event 2 1/2 years ago. Thought it was a one off due to overexertion. Found I was low on Thyroid. After supplementing thyroid hormone and adding magnesium glycinate (800 mg/day), I had no afib events for a year! I did continue to have ectopics the entire time (I can't tell whether PACs or PVCs), however (3-5 a day). With no change in diet or lifestyle, after a year I had another afib event that lasted 7 hours. Then ten weeks later another for 9 hours. Then two weeks later one that lasted 1 1/2 hours. Then two weeks after that one that lasted 3 hours. That was one week ago now. Always return to NSR on my own after 1-9 hours. I notice that the events seem to happen almost exclusively in the evening (from 10:00pm to 2:00pm) and when I'm horizontal (i.e., trying to sleep). I've tried sleeping on my right side, left side, back, stomach, elevated with wedge pillow--no difference noted. I also notice that it's worse when I'm gassy (eating cruciferous veggies bothers me). I'm wondering if perhaps I have a hiatal hernia or some type of inflammation/irritation that is occasionally impinging on the heart muscle. I have an endoscopy scheduled. Of course, when I went in for an echo today, nothing happened and nothing showed up the entire hour they were doing it. Wearing a holter monitor now for a week. The ectopics ebb and flow in frequency, usually between 3 and 12 a day. Sometimes a short flutter accompanies them. They usually resolve if I stand up and walk around a bit. I could use everyone's advice regarding ablation. For me, that would be a course of last resort. The idea of damaging healthy tissue to prevent afib seems to me to be swapping one problem for another. And I read about the problems some folks have with them (seemingly common recurrence or seeming ineffectiveness, subsequent elevated heart rate, etc.) and I'm leery of doing it. But between ablation and powerful drugs, there does not seem to be much choice. Can those who've had wonderful experiences with ablation chime in to put me mind at ease? Can any fellow sufferers offer any other advice?

I've always a gassy sensation while in afib, being it after meal or around 2AM (which means at least 7hrs after my last meal). Drinking water induces burping, but the gassy sensation remains. It subsides when returning to NSR.
My afib episodes are like yours, always self ending. No meds.
I can't count the number of times I thought it was food or stomach or guts related. My exams said everything is normal.
I've tried lots of diets. In vain.
I'm sure (in my case) the gassy sensation is the consequence of some vagus nerve irritability. And when my vagal tone turns crazy for a while, so do my heart and my stomach.



Edited 1 time(s). Last edit at 07/19/2021 02:04PM by Pompon.

Nightime afib is classic. Vagal. The problem with this condition is: it does not get better and almost always progresses …….so imo. You remind me of a close female friend older than me 75. Im 67. She started with short self termination episodes a few yrs ago. They became more frequent and longer lasting but still self terminated no meds no cardioversion. I begged her to see an EP not! A cardiologist thats not EP. i told her : youre an easy ablation. Fixable before it progresses. She finally did last Sept. so far 10 months of zero point zero. Now. Im pro ablation with a top notch guy! I waited from 2006-12 and it got bad. My ablation held great 9 yrs and i had progressed to propafanone and cardioversions , til i now have left atrial flutter
So think about trapping this enemy soon before the army grows. Now thats just me but right now youre no meds no cardioversions etc. you are in the infancy stage. Unlikely to stay there. Oh! Do not sleep on your left side. Always right side
Tom

Chiming in here TarHart!

Many years of highly symptomatic paroxysmal AF, episodes becoming more frequent and lasting longer as time went on, then 18 months of 24/7 AF, felt as though my life was over.

Ablation in Bordeaux January 2003, another 3 days later because AF recurred. Since then normal rhythm though I do get a lot of ectopics. That is over 18 years (and counting) of having my life back.

Don’t know how much longer it will last but I call that pretty wonderful!

Gill (pronounced 'Jill' and female)

PS. If you decide on ablation go to an expert. Many EPs do them, very few are experts.

Gill

Yes Gill Jill is correct. Just plug in your state here and youll get some recommendations or travel like to Bordeaux or Austin. But its all about the operator and his her experience! And number of ablations

Before you consider an ablation I would suggest you try taking Kefir yogurt for a couple of months and see if that improves your gut health first.
[www.bbc.co.uk]
Also avoid all alchol .

Colindo,
Do you have a personal experience with Kefir?
A more detailed explanation is appreciated.
kind regards,

Ben

Thanks so much, Gill (and others), for your helpful responses. I live in Michigan, and I've been seeing Dr. Albano (an EP) at the a-fib clinic here. Does anyone have any familiarity with him and his work?
Yes, I've read about how "a-fib begets a-fib" and how I should expect things to get worse. My confusion centers around the fact that I went an entire year without an episode after having this track record:
11/19/2018 2 hrs
03/17/2019 2 hrs
05/16/2019 2 hrs
06/19/2019 2hrs
07/16/2019 3 hrs
09/12/2019 6 1/2 hours
11/17/2019 2 1/2 hours
and then a year without any at all, before it picked up again in February of last year (see above for episodes since then).
Had a holter monitor attached yesterday. So I thought I'd give them something to look at. I ate on the recliner, had a beer, slept on both left and right sides--and absolutely nothing happened. Best day I've had in ages. I'm beginning to think it might be mental. I don't want to go the ablation route until I've closed off all other possibilities. I've been doing the yoghurt thing (though not Kefir), and also probiotics/prebiotics for a while. There are so many variables that it's hard to determine which, if any, is having an effect and which is not. Could my no a-fib stretch be due to increased Mg dosage (now at 800mg/day without bowel difficulty)? Maybe. Could it be due to having a tablespoon of ACV after meals to help with digestion? Maybe. Could it be due to avoiding food triggers (e.g., broccoli, brussels sprouts, etc.)? Maybe. There are so many moving variables that take time to have their effect that I can't figure it out. Another fear I have with the ablation centers around the accounts of so many of continuing ectopics afterward. For me, the ectopics are almost worse than the a-fib. It's like death by a thousand cuts. I want to make absolutely sure I've exhausted all other options before I go with an irreversible procedure, even thought I know that ultimately it may be necessary.

Honestly, your progression looks pretty typical. You can try all sorts of things, but in my opinion trigger avoidance is almost always a losing strategy and it leaves you constantly depriving yourself of things you like and walking on egg shells. That's a major hit to quality of life that can be as harsh as afib itself.

I agree with Carey about trying to find and avoid triggers. All you're about to find is coincidental. As you know, there are so many variables that it's impossible to isolate them and find which are good, neutral or bad, except for the obvious : alcohol, stress, poor sleep.
When you're vagal, it's the sad truth : nobody knows.
I agree with you about ectopics. They are awful, possibly more than afib, but they are benign and don't disable you like afib, as they for most don't lower you ejection fraction. I hate them, but I don't fear them as much as afib.

Quote
TarHart
Thanks so much, Gill (and others), for your helpful responses. I live in Michigan, and I've been seeing Dr. Albano (an EP) at the a-fib clinic here. Does anyone have any familiarity with him and his work?
Yes, I've read about how "a-fib begets a-fib" and how I should expect things to get worse. My confusion centers around the fact that I went an entire year without an episode after having this track record:
11/19/2018 2 hrs
03/17/2019 2 hrs
05/16/2019 2 hrs
06/19/2019 2hrs
07/16/2019 3 hrs
09/12/2019 6 1/2 hours
11/17/2019 2 1/2 hours
and then a year without any at all, before it picked up again in February of last year (see above for episodes since then).
Had a holter monitor attached yesterday. So I thought I'd give them something to look at. I ate on the recliner, had a beer, slept on both left and right sides--and absolutely nothing happened. Best day I've had in ages. I'm beginning to think it might be mental. I don't want to go the ablation route until I've closed off all other possibilities. I've been doing the yoghurt thing (though not Kefir), and also probiotics/prebiotics for a while. There are so many variables that it's hard to determine which, if any, is having an effect and which is not. Could my no a-fib stretch be due to increased Mg dosage (now at 800mg/day without bowel difficulty)? Maybe. Could it be due to having a tablespoon of ACV after meals to help with digestion? Maybe. Could it be due to avoiding food triggers (e.g., broccoli, brussels sprouts, etc.)? Maybe. There are so many moving variables that take time to have their effect that I can't figure it out. Another fear I have with the ablation centers around the accounts of so many of continuing ectopics afterward. For me, the ectopics are almost worse than the a-fib. It's like death by a thousand cuts. I want to make absolutely sure I've exhausted all other options before I go with an irreversible procedure, even thought I know that ultimately it may be necessary.

You probably know that ablations are not always successful unless you make some lifestyle changes as well.
Without an ablation I have, along with a few others afibbers on the forum, have reduced our afib events down to a very minimum. You should read this post [www.afibbers.org]
In particular read about The Anit-fib success story, and Dean, who had a bad time with ectopic and has been free of afib for about 15 years.

Quote
ben saif
Colindo,
Do you have a personal experience with Kefir?
A more detailed explanation is appreciated.
kind regards,

Ben

Yes I take it every 2nd day and Natto on the other days.
I recently started taking it, I think it helps and it's delicious, specially the mango flavour.
IMHO gut heath is a big problem for afibbers. Get that right, check your vitamin D levels, and that will go a long way to reducing your afib events. If not then get an ablation.

Over the years I have read here of many many attempts to stop AF via other means. Sadly very few of them have made any difference. Cause and effect can so often be confused - just because X happens after Y doesn’t mean that Y caused X.

Seems to me that AF is capricious and random.

Gill

I agree with the randomness of AFIB. However for me there are deterministic triggers as well. If I over exercise, drink 3 or more beers, or accidently eat foods fortified with calcium (greater than 500 mgs), guaranteed I will have AFIB during the night. By cutting out the three deterministic triggers I went from 77 afibs my first year to now about three per year with each lasting less than an hour. Thankfully I have been like this for the last three years. I am having this luck adhering to what others are doing on this forum that have had success:
I eat Natto every other day, get lots vit D from the sun, no milk or dairy, supplement 600 mg Magnesium, try to eat 9 fruits or vegetables a day, and most importantly for me use nose breathing during exercise as per GeorgeN. Going to ride this wave as long as I can...hopefully right up to the beach



Edited 1 time(s). Last edit at 07/21/2021 01:27PM by MikeN.

MikeN Congrats on the improvement. Were all 77 of those afib episodes as well as the current 3 per year caused by those specific triggers? Prior to my retirement I was averaging one every 3 weeks. Currently it has been 1 every 3 months and recently even better than that. I cut back on alcohol consumption, sleep better and now supplement with 600 mg Magnesium while also trying to watch my hydration. I'm not totally convinced those were specific triggers but I do know less work stress coupled with those lifestyle changes have made me feel healthier. So maybe they were round about triggers due to lesser general health quality.

JDfiB,

I was an exercise 'junkie', just finished a triathlon and training for another when I got afib at 61. My cardiologist said the exercise had nothing to do with afib so keep training for the triathlon. I knew deep down he was wrong but I still tried to keep the vigorous exercise up. I would stop the exercise, my afib burden would drop, I would then start to train again, my afib would start up again. I kept this yoyo going for about 6 months before I finally kicked my exercise addiction and only do moderate exercise (walking 1-2 hrs per day and lift weights). Along with taking magnesium and cutting calcium did my burden drop to where it is now. It seems my 3 a year right now are when I over do the exercise especially while dehydrated and a few that seem to be random.

One thing to note is when I go 6 or 7 months without any afib I start to get overconfident. For example last year I dropped magnesium to 400mg and started to do more strenuous exercise. That's when I got a run of two afibs a week apart. Going to stay diligent this year and see what happens.



Edited 3 time(s). Last edit at 07/22/2021 06:33AM by MikeN.

Have you tried any arrhythmia drugs like Flecainide? I was successful for 15-16 years until it stopped working. I went 5 years completely free of afib, then an episode from vomiting, then 4 years, then an episode from vomiting until my afib was more often.

Flecainide may buy you some time until the pulse technology is perfected.

susan.d,

Trying to stay off drugs as long as I can. I typically convert in less than 1/2 hour. My worst was 3 hours (only one), around 10 at one-two hours the rest less than 1/2 hour. I do have a prescription for metroprolol but I will only use as a PIP if I don't convert in 1/2 hour. They really lessen the symptoms for me and seem to help me convert.