one afib every few years to one every night in less than 3 mos

I am new here. My first afib occurred in 2013 as a result of too much thyroid medication. Second episode 2015. Third episode 2020. Since late June of this year the episodes have increased in frequency to the point where I have an episode every single night. The every single night business started after I got what may be the virus although my symptoms were mostly a head cold and some gastro-intestinal upset. No fever, no achiness just very tired.

Waking from a sound sleep with a wildly ping ponging heart is unnverving as hell as I'm sure many of you know. I am very eager to find out what might be responsible for this huge upsurge in episodes.

I recently came across a couple of studies that may bear on the increased afib or maybe not. The first is the Salk Institute study which demonstrates that SARS-CoV-2 Spike Protein Impairs Endothelial Function via Downregulation of ACE 2. [www.ahajournals.org]
[www.salk.edu]

The second is a German study..... [pubmed.ncbi.nlm.nih.gov]) Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19) which ".... revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis.

When I sent this to one of my docs his reply was "oh well a myriad of things could cause this uptick." I asked "like what?" His resposnse or nonresponse was mostly just shut and take your blood thinner....which I have been very reluctant to do because I don't trust that another pharmaceutical won't give me problems that I then need another drug to take care of and on and on in a infiinite regress

Has anyone had this experience of rapid increases in episodes? Any suggestiions?

When I get the episodes I have been taking metoprol.....a couple of 25mg and things generally calm down. I have converted without meds but I can't stand the anxiety of the episode going on for 5, 6, 7 hours. I am thinking of taking the metoprol twice daily instead of just when the episodes occur - as a way of maybe preventing episodes.

Any insight, suggestions would be very much appreciated. Thanks.

Kathleen wow alot to unpack. So ill assume you were never tested for covid? Maybe you still can. Antibody test? That being said afib can act many different ways. From seldom to all of a sudden constant or at least more frequent. Imo yes you right now should take the blood thinner based of an everyday episode. The good! You are converting without a med or intervention. Do you know what your heart rate has been in afib? Is there an ekg proving its afib? Metropolol is a beta blocker that simply slows heart rate while in an episode. Start taking some magnesium at a minimum. Do you have an EP? Or a cardiologist? More here should chime in on good advice but ruling out covid might be no 1 as a start. Many of us do not like meds such as eliquis but clots are worse so play it safe right now
Tom

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kathleen1986
Has anyone had this experience of rapid increases in episodes?

Hi kathleen, can you tell us a little more about yourself? Age, other health issues & meds? Activity level? CHA2DS2-VASc score? Is your doc an EP (electrophysiologist)?

I had my first episode in 2004. Initially I was having episodes every 10-14 days lasting 6-9 hours self converting. After 2 months this went to a 2 1/2 episode which was converted with a loading dose of flecainide. My EP wanted me to stay out of rhythm as my resting afib heart rate was <100. I proposed a different plan, which he accepted. My path to afib was chronic fitness. My plan has evolved to detraining and very titrated exercise, supplementation with magnesium to bowel tolerance, 1/2 tsp taurine powder, drinking water with potassium citrate over the day (I put 2 tsp of potassium citrate powder with 1 tsp of sodium chloride as sea salt in a liter of water) keeping calcium intake low and my metabolic health pristine. I asked the EP to prescribe flecainide on demand to convert myself when I do go out of rhythm (note max dose of flec is 200 mg/day for those under 154 pounds (70 kg) and 300 mg/day for those who weigh more. Over these 17 years, I've subsequently gone as long as 2 years between episodes and had as frequent as 4 days in a row. My average is about 2 episodes/year. In my case, when the episodes have become frequent, it is usually because my electrolytes are out of balance. So yes, I have had rapid increase in episodes.

Infections, for me, increase the risks of having afib episodes. Increase. Like some other things like alcohol and electrolytes imbalance.
Aside of this, your Doc wasn't all wrong saying "a myriad of things". Naming those things has little meaning, as it's mostly individual.
As previously said, it's better getting rid of infections.

Have you been tested for sleep apnea?

If you are prone to afib - heredity, over training, or luck of the draw, there are things that may contribute to the initiation of an episode (some things already mentioned). However, once it's there, there is an excellent chance that episodes will happen more and more frequently no matter what you do to try to mitigate the occurrences. Some here have been able to have some control over the frequency of occurrences, but that is the exception.

Most of us learn to manage it as best as possible with the appropriate Dr. guidance (Electrophysiologist), but most of us ultimately get an ablation to hopefully eliminate afib for as long as possible. But it will eventually come back, the question is when. I have had two ablations, the first one good for 13 years (a somewhat uncommon success story), the second one now on 1.5 years and hopefully many more.

I'm 76 years old. Hike regularly. organic diet. Only med I take is liiothyronine for thyroid. Ablation not an option for me. Just getting settled with an EP - not exactly sure that he has anything to offer me other than surgery.

I have been reluctant to take eliquis because I've heard so many horror stories about it. Is it true that you can't get off it once you start? I would love to hear peoples' experiences with blood thinners.

Chad score is three. Not sure I get how they calculate risk...do I have a one in 10 chance of stroke, 1 in 1000, 1 in 10,000? A 97 % chance of not having a stroke?

Ablation not an option? Yes eliquis can be stopped without any rebound type effect but many , millions take it everyday. Ive been on it since March and will be for many more months but i think the bleed risks are very low so long as you avoid ibuprofen alcohol aspirin and other things that increase a bleed. A fall an injury etc. if you have a good EP you must trust his direction. Idk but your thyroid med could play a role in episodes? Im 68 athletic slim and feel great but after an August ablation im hopeful for the Watchman in 2022 to end my eliquis use. We ll see. For you i get it im stubborn and hard headed too but i dont want to have a stroke. Relax and be smart. Follow EP advice

believe me i don't want a stroke but i am just trying to figure out what the numbers really mean...... one in 10 chance of stroke, 1 in 1000, 1 in 10,000? A 97 % chance of not having a stroke? I want the info in a form that's usable in order to make a reasonable decision and not just be taking another pharmaceutical out of fear....seems appropriate to calculate risk benefit ratio...have had some unpleasant experiences trusting in the supposed expertise of the medical profession

I had no issues with Eliquis, but I was only on it for two months post ablation. I was 74 with my last ablation and am in great shape. I can't imagine having a stroke or risking having one. So, meds and blood thinners that will help manage afib (but episodes will still happen), or an ablation from an expert. Easy decision. My last ablation was day surgery and the only discomfort after was a sore throat from the intubation. No pain - period, other than my throat and that was for two days. I felt 100% normal when walking out of the hospital, walked two miles the next morning. That's not the case for everyone, but it can happen.

Im just not the one to ask when it comes to odds or percentage risk of forming a clot. Its all based on age chads score how long you are out of rythm etc but i do know that EPs feel it can hsppen sooner than the old days when 48 hrs was considered safe then the risk increased. I believe now its a much more conservative approach. I do strongly also believe ablating afib before it becomes persistent and constant is a vg approach to success. I have a 76 yr old female friend. Has an episode every month or 2. Then every week. I begged her to get ablated now. She did. 1 yr ago. Nothing since.

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kathleen1986
Chad score is three. Not sure I get how they calculate risk...do I have a one in 10 chance of stroke, 1 in 1000, 1 in 10,000? A 97 % chance of not having a stroke?

The risk table from CHA2DS2-VASc (drop down just a little bit from where the link takes you. This is Annual stroke risk (%), so for a 3, it would be 3.2 or 3.9%/year, depending on the study

Annual stroke risk (%)
CHA2DS2-VASc score | Friberg 2012[12] | Lip 2010[8] | 95% CI[8]
0	 	 	 	 0.2	 0.0	 0.0–0.0
1		 	 	 0.6	 0.6	 0.0–3.4
2	 	 	 	 2.2	 1.6	 0.3–4.7
3	 	 	 	 3.2	 3.9	 1.7–7.6
4	 	 	 	 4.8	 1.9	 0.5–4.9
5		 	  	 7.2	 3.2	 0.7–9.0
6	 	 	 	 9.7	 3.6	0.4–12.3
7		 	 	 11.2	 8.0	1.0–26.0
8		 	 	 10.8	11.1	0.3–48.3
9		 	 	 12.2	100	 2.5–100

Looking at the 3.2%/year, this is the reference, that goes into the risk scoring in more detail.

Edit, if you want to dive into the details, you could read the section on "anticoagulation/avoid stroke" from the 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation (the European Society), and then follow the linked references. See: [academic.oup.com] and search on my quoted text (anticoagulation/avoid stroke).



Edited 2 time(s). Last edit at 09/14/2021 10:55PM by GeorgeN.

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kathleen1986
I'm 76 years old. Hike regularly. organic diet. Only med I take is liiothyronine for thyroid. Ablation not an option for me. Just getting settled with an EP - not exactly sure that he has anything to offer me other than surgery.

I have been reluctant to take eliquis because I've heard so many horror stories about it. Is it true that you can't get off it once you start? I would love to hear peoples' experiences with blood thinners.

Chad score is three. Not sure I get how they calculate risk...do I have a one in 10 chance of stroke, 1 in 1000, 1 in 10,000? A 97 % chance of not having a stroke?

Ablation not an option for me??

Could you explain that a little further?

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kathleen1986
I have been reluctant to take eliquis because I've heard so many horror stories about it. Is it true that you can't get off it once you start? I would love to hear peoples' experiences with blood thinners.

The horror stories you've heard are mostly in people's imaginations, and it's totally untrue that once you start you can't get off. I've known many people who've successfully come off anticoagulants following ablations, including me. Yes, of course you can find horror stories if you look for them, but I can find horror stories about aspirin, Tylenol, and just about any drug you name. I was on anticoagulants for over a decade and don't have a single negative side effect to report. This notion that people on anticoagulants easily bleed to death is sheer nonsense.

With a CHADS score of 3, you absolutely should be on an anticoagulant. You do realize what you're risking, right? Death is not the worst outcome from a stroke. Trust me, I've seen lots of strokes, and you really can't imagine the worst outcomes. And when you consider those risk numbers George posted, keep in mind those numbers are PER YEAR. So with a CHADS score of 3, you have about a 3.5% risk of stroke every single year. Over the course of 10 years, that risk is about 30%, and over 20 years it's 51%. So without anticoagulation, you have a 1-in-3 chance of suffering a stroke in the next 10 years, and over a 50% chance in the next 20. I should mention that afib-related strokes tend to be among the biggest, most severe strokes.

All that said, why do you believe ablation isn't an option for you?

Thanks for that reassurance Carey i even feel better! You are exactly right though some strokes are worse than dying
Im a hard head and in nsr since my Natale date 8/6 but take my 10 mg as my LAA isolated. I may get the chance to come off later ? Watchman? Etc
T

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Poppino
I may get the chance to come off later ? Watchman? Etc

You've got about a 40% chance of being able to come off without doing anything.

Not a lot to add other than to say I have been on eliquis for 4+ years without any issues. Good luck.

this is actually not a place for a discussion as there are some posters who use this forum as a bully pulpit

Kathleen - First, Welcome to the forum. I can relate to your challenge.
I’m writing this to offer support and encouragement.

Although I am 85, I had thyroid problems for years prior to onset Afib at age 59 (1995) and a history of three ablations (all by my EP, Andrea Natale).

The first was in 2003 and then after 11 years, developed A-flutter so had that ablation in 2014 which included isolating the LAA…and, then, a touchup 7 mos. later in 2015. Since then, during those 6 years, (thankfully) my heart has been extremely stable and calm.

I had been on thyroid meds (Synthroid) since 1989 with a long history of goiteroid tissue/nodules. Surgery for that was offered for consideration. The thyroid nodule enlargement issue persisted on and off until I was in the care of a Board-Certified Family Practice MD who practices Functional Medicine, who changed my thyroid meds to Armour thyroid and also did tests that indicated I was low in iodine.

My heart responded very well in that the AF lessened to the point where I nearly decided I would not keep my date for the first ablation… but I decided to be smart and not risk ‘fate’ so, had the first ablation. The Endocrinologist monitoring my annual thyroid evals via ultrasound was amazed that the nodules had not recurred and commented about it. I told her about the testing and supplementing with iodine and she gave me a blank stare and said… “well, keep doing whatever it is you are doing” and come back for a scan if I noted the nodules had returned. I’ve lived in NE Ohio all my life and in the area considered to be “the Goiter Belt”. I wondered then, and still do, why isn’t iodine deficiency an obvious factor to consider in people who have the typical symptoms when they present with goiteroid tissue and test these patients?

Thyroid dysfunction - Because of the arrhythmias, I was told to stop using thyroid medication… Armour 15 mg daily… since in the elderly, it may be a contributor to heart excitability. My FM MD suggested using glandular thyroid support. This did not seem to help with lethargy/fatigue and weight gain. Frustrating to be eating less and continue to gain weight. Plus many other hypo-thyroid symptoms. But, an iodine synergy supplement did help and I continue to take small amounts daily.

Now, back to post-ablation results. After the 2014 ablation, Dr. Natale told me I could resume the small amounts of Armour thyroid daily. Both my FM MD and my Family Practice D.O. refused to write a prescription… fearing the potential to stimulate arrhythmia. So, I have continued to supplement with small doses of an iodine complex-type supplement and I am both delighted and relieved that… at age 85… my heart remains very calm. At my recent, CCF annual wellness checkup, there was no physical evidence (via palpation), of goiteroid nodules in the thyroid area. I’ll be doing the annual NutraEval test later in the Fall

And just FYI… I also take half-dose Eliquis…2.5 mg twice a day…recommended by Dr. Natale…. to help manage the risk of adverse clots. I tend to have a slightly-low platelet count so the half dose helps with the problem of excess bleeding with small cuts and scratches that seem to occur (for me) with the standard dose. While I would rather not take it and much prefer using the Nattokinase enzyme that helped me survive the clot I had in my heart when I had breakthrough AF and cardioversion after my first ablation and was off the requisite warfarin.

I consult with a local EP every 8 mos. just to check on my status and for Rx renewals.

Best to you, Kathleen.

Most sincerely,
Jackie

PS.
As you might imagine…the ‘clot risk factor’ was in my mind continually,
There are more of my posts with reference related links .. just type in the search
Feature… ‘clot risk’ and you’ll find them. J.


[www.gdx.net]
[www.designsforhealth.com]

[www.afibbers.org]
[www.afibbers.org]
[www.afibbers.org]
[www.afibbers.org]

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Carey
So with a CHADS score of 3, you have about a 3.5% risk of stroke every single year. Over the course of 10 years, that risk is about 30%, and over 20 years it's 51%.

Why does the risk of stroke go up every year by 3%?
Could it have something to do with your fibrinogen levels increasing?
There has to be a reason.

BTW a 3% chance of having a stroke is also 97% chance of not having a stroke.

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colindo
Why does the risk of stroke go up every year by 3%?
Could it have something to do with your fibrinogen levels increasing?
There has to be a reason.

BTW a 3% chance of having a stroke is also 97% chance of not having a stroke.

It doesn't go up 3% each year, the risk is, for a CHA2DS2-VASc score of 3, 3.2 or 3.9%/year, depending on the study, or an average of about 3.5%/year. Each year, you have a 3.5% chance of having a stroke. What Carey pointed out, without showing the math, is that if you have 3.5% risk of something happening every year, that over 10 years the risk is about 30%. The equation is 10 year risk = 1- ((1-0.035)^10) = 1-(0.965^10) = 1-0.700=0.3 =30%. You can run the same numbers to get the 20 year risk, which is 50%. This is like playing a slot machine that has a 96.5% payout. If you pull the handle (or press the button these days) 10 times, you'll statistically have 70% of your money left. If you pull the handle 20 times, you'll statistically have 50% of your money left.

Thanks George,

Who thought that lot up?

It's got to have more to do with blood quality I would have thought.
eg. if your blood is thick and sticky it would more likely clot.

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colindo
Who thought that lot up?

It's got to have more to do with blood quality I would have thought.
eg. if your blood is thick and sticky it would more likely clot.

If you are talking about the math, that is how these statistics work. If you are talking about the 3.5%/year for a CHA2DS2-VASc score of "3" then this paper goes into how they figured the risk. With CHA2DS2-VASc, they were trying to sort out truly low risk people (a 0 or 1) from high risk people. If you look in depth at the paper, the risks go stratospheric with much higher CHA2DS2-VASc scores.

I recall from prior study that at least warfarin anticoagulation would reduce whatever the CHA2DS2-VASc risk by about 50%. I'm not familiar with similar data for NOAC's. Hence, & to your point, I've always thought it made sense to lower any CHA2DS2-VASc risk by lowering the score for any item that is possibly controllable. I'd like to have the smallest risk possible before I applied anticoagulation to the risk reduction.

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colindo
Why does the risk of stroke go up every year by 3%?

It doesn't go up. Every year it's 3% as long as your CHADS score doesn't change. But remember that the 3% risk is PER YEAR.

If you buy one lotto ticket with a 3% chance of winning, that's obviously a 3% chance of winning. But what if you buy 9 more tickets? Each one of them has a 3% chance of being a winner. So your odds of winning obviously go up by buying more tickets, right?

That's exactly what happens with your 3% PER YEAR stroke risk over 10 years. You incur that 3% risk 10 times so at the end of 10 years it's a whole lot more than 3%.

Could you consider 10 times the 97% chances of not having a stoke?

I understand your numbers, but buying 9 more tickets for the same game is not equal to buying each time one ticket for the next 9 games.

Of course, the longer you live, the more risks you have being sick. But, you must not forget you live longer. So, mathematically, you're wrong. As long as the risk stays the same (chads score), each year begins with the same 3 against 97%.

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Pompon
Could you consider 10 times the 97% chances of not having a stoke?

From my statistics classes:

For the 3.5% stroke risk it is 96.5% chance of not having a stroke. Looking forward 10 years, you'd have a 70% chance of not having a stroke.

10 year risk = 1- ((1-0.965)^10) = 1-(0.035^10) = 1-0.300=0.7 =70%


Probability of of an event happening at least once in a sequence of independent events



Edited 2 time(s). Last edit at 09/21/2021 10:19AM by GeorgeN.

George's answer is exactly correct, but the answer seems a bit more complex than needed for this question because it's aimed at mathematicians. From the same site, try the answer to this question I asked several years ago. The question is what are the odds of a building being flooded once in 50 years, but it's the same math question as asking what are the odds of having one stroke in 10 years. I think the answer is much simpler and to the point:

https://math.stackexchange.com/questions/1959519/what-are-the-odds-my-building-will-be-flooded

Not having a stroke this year does not mean I'm more likely having one next year, all things being equal.
But, of course, it's not exactly like tossing a coin. All things don't remain equal, since our chances to live longer decrease year after year.
The older I am, the more "chances" I have to die.
Going from 3.5 to 30% means you only consider the bad side of things. The good side of things is the passed ten years you didn't have a stroke despite the 3.5% "chances" having one.

The strange thing about this statistic is that if we have a 3.5% chance of stroke at age 60 then that translates to almost 100% chance of stroke if we get to the ripe old age of 90. The math makes sense but that part just seems weird.

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Brian_og
The math makes sense but that part just seems weird.

But is it really? Last I checked stroke is the #3 cause of death among the elderly.

Stroke is frequent among the elderly, but how many of those dying from a stroke were afibbers?