New to site - questions

Hi,
I'm a 69 yo male with no previous heart issues new to this site. I was diagnosed with AFib in June of this year when I went in for a knee replacement and the 6 lead ECG detected AFib. Had shoulder surgery in January with no heart issues noted. In between I received the Maderna Covid vaccine and had a horrible weekend with symptoms I later learned were symptoms of AFib. I was put on warfarin. I finally asked the EP I was seeing if there was anything that could be done to correct the AFib and he scheduled me for cadioversion. That was performed on 11/12/21 and was apparently successful. I use a Kardio to track and after about 7 days I was again showing signs of AFib.

My question to the group is if there is a doc in the Minneapolis - St. Paul area I should be seeing for next steps?

My only other heart issue I know about is slightly high BP, for which I am taking Amlodipine Besylate, 5 mg/day. I am working on diet and exercise to try to address the BP.

Thanks in advance for advice and feel free to move this if there is a better place for this post.

I don't know any docs in your area. Whoever it is should be an EP, not a cardiologist. You will get better afib advice. If you are offered an ablation, then come back here and ask again, who to go to for that is a whole other question.

When I was in the middle of a 2 1/2 month episode, 17 years ago, the EP said he could cardiovert me, but the question was how to keep me in rhythm after. The same question applies to you. Most likely a rhythm med after is the next step. There are a number. The one to avoid, because of the side effects is amiodarone.

The two big risks to afib are a stroke from a clot and spending a lot of time (many days or longer) over 100 BPM heart rate. This can lead to cardiomyopathy and then heart failure. If your average rate is > 100 BPM, in afib, then a rate control drug is in order to mitigate this risk.

My heart rate does not seem to be consistantly high. I have both the Kardia and a blood pressure cuff, both are in my bedroon on the top floor of my house. If I give myself enough time after climbing the stairs, I get readings in the low 50s on both devices, if I read right after climbing stairs, it can be over 100. As I said I am on warfarin to avoid the clotting isse. The TEE prior to the cardioversion was clean for clots.

I posted a thread on getting moderna and getting afib. It’s current.

You should sign up to v-safe and report the afib to the cdc. They need the numbers. I’m holding off getting the booster because I had a bad reaction with afib too— Two days after the second vaccine and a month later. My cardiologist plus Dr Natale’s NP told me the vaccine could be arrhythmic in some people.
[www.cdc.gov]

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rkgtstrand
My heart rate does not seem to be consistently high. I have both the Kardia and a blood pressure cuff, both are in my bedroon on the top floor of my house. If I give myself enough time after climbing the stairs, I get readings in the low 50s on both devices, if I read right after climbing stairs, it can be over 100. .

Sounds like you are in good shape on the rate & with the warfarin on the clotting. That is good.

Hello there.

I also had a bad 24hrs after my Moderna booster, here in Scotland.

It was not nearly as obvious after the previous 2 x AstraZeneca although I'd other side effects like fever.

On the plus side, despite an uncomfortable night sleeping sitting up, Flecainide 50mg at 6hr intervals kept me (just!) in NSR - and things were fine after a day or so. Without the Flec (which works great for me at 50-75mg / taken before bed) I'd 100% have had a very unpleasant episode.

I'm a huge supporter of the vax. M, and a young and active 62yo. Grateful indeed to have had the combo of AZ and mRNA. One can only imagine how bad Covid-19 could be for Afib / etc.

But I do agree with Susan that Moderna was quite a pronounced trigger.

I hope things improve for you. This is a most wonderful place for advice and support.

One of the first questions I'd ask my EP would be if I could substitute one of the newer blood thinners meds for warfarin; i.e. Eliquis, Xarelto, Pradaxa or the liike. More effecteive and fewer side effects than warfarin. Most insurances now cover at least one of these.

I agree with ggheld, I’m quite surprised that warfarin is still being used. I was on it for 18 months before my ablations 18 years ago and was very diligent about getting frequent blood tests and checking my INR but it was very tricky. My guess is that most people on warfarin are not at the correct INR most of the time.

The new ACs are much better.

Gill

Hi rkgtstrand, welcome to the forum. By any chance do you have a first name we can use? I hate addressing people by unpronounceable screen names.

Since you're in Minnesota, Mayo clinic is the obvious answer. I would try to make an appointment with Douglas Packer, if possible. He's a top guy there so if he's not accepting new patients, ask to see someone else with considerable experience. Don't just accept the next available EP because that will be the newest, least experienced one they have.

Do you have other conditions such as heart valve disease, a history of DVTs or something else? I'm puzzled why your EP put you on warfarin.

I'm George, the user name it assigned is the first part of my email address. I am on warfarin because when I signed up for Medicare, I had never been on a prescription drug for anything beyond an antibiotic so I did not sign up for Part D. The EP first said Eloquis, but that is ~$150/month for someone retired on a fixed income, warfarin is about $4/month.

I have no other known heart history, nothing noted on echo either.

Thanks, I will try Mayo, always up for a drive to Rochester. I'm a retired engineer and did a lot of work there at St. Mary's Hospital and some of the downtown clinic buildings. Didn't work on any EP or Cath labs there though.

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rkgtstrand
I'm George, the user name it assigned is the first part of my email address. I am on warfarin because when I signed up for Medicare, I had never been on a prescription drug for anything beyond an antibiotic so I did not sign up for Part D. The EP first said Eloquis, but that is ~$150/month for someone retired on a fixed income, warfarin is about $4/month.

Hi, George, much better. Send me a private message if you want me to change your user name to something friendlier.

Now that you have afib and you're old enough for Medicare, you really need to sign up for part D this year before open enrollment ends (Dec 7th, I believe). You could be crushed by medication bills in the coming years if you don't. And make sure the plan you choose covers either Eliquis or Xarelto, preferably both. Although warfarin is cheap, it's less effective, has more side effects, and is more likely to cause bleeds than Eliquis and Xarelto. It also has all sorts of interactions with foods and other meds, and it requires regular testing. Overall, it's a pain in the butt.

Once you get a part D plan, call the EP up and ask for that Eliquis prescription beginning in January.

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GeorgeS
I'm George, the user name it assigned is the first part of my email address. I am on warfarin because when I signed up for Medicare, I had never been on a prescription drug for anything beyond an antibiotic so I did not sign up for Part D. The EP first said Eloquis, but that is ~$150/month for someone retired on a fixed income, warfarin is about $4/month.

I have no other known heart history, nothing noted on echo either.

Thanks, I will try Mayo, always up for a drive to Rochester. I'm a retired engineer and did a lot of work there at St. Mary's Hospital and some of the downtown clinic buildings. Didn't work on any EP or Cath labs there though.

George- try here. I and another person have bought from this overseas pharmacy. It takes 3-4 days to get plus it has a great expiration date.,if you use the referral code, you get $50 off the $105 ($55) for month of Eliquis. It could tie you over until 2022 when you get part D.

[www.afibbers.org]

Eliquis
Brand Eliquis 5mg 56 Tablets
$105.00

Brand Eliquis 2.5mg 56 Tablets
$105.00
Same price for 2.5mg and 5mg. For those who take 2.5 it’s worth splitting the pill and order the 5mg.


And then subtract $50 using the code below:

I shop here: use the referral code
ref6604998 to get $50 off your first order.

[www.israelpharm.com]

I had a cardiac ablation 7 years ago. It worked and I have been symptom free. On Nov. 2, I received the Moderna booster and was very much not well. And then Afib showed up. Heart beat is floppy and irregular, but not fast. I wish I had known that the vaccine could set this off.

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Donna
I had a cardiac ablation 7 years ago. It worked and I have been symptom free. On Nov. 2, I received the Moderna booster and was very much not well. And then Afib showed up. Heart beat is floppy and irregular, but not fast. I wish I had known that the vaccine could set this off.

Are you still out of normal rhythm?

Does anyone know how accurate and reliable the Kardia device is for determining if AFib is present? I tried to discuss what I had seen on it post-cardioversion with my EP and he completely blew it off, had no interest in the readings on the device.

Since cardioversion on 11/12, the Kardia has shown me "Normal" to "Possible AFib" to "Unclassified" and back again. I'm going to get a werable monitor installed tomorrow to track for a couple weeks, but just wondering what anyone else has to say about Karida reliability.

AFAIK, Kardia and some other devices of the same kind give very good tracings when used the right way.
But none of them has for purpose to diagnose anything. So, they would just display "possible afib" or "suspected afib".
But afib is easy to identify on a tracing. Once you've learnt to, of course.

The Kardia is as accurate and reliable as you can get aside from a professionally administered 12-lead ECG. It's FDA approved to diagnose afib regardless of heart rate, which makes it unique. The Apple Watch cannot do that.

I've owned one since 2015 and have a lifetime premium account as an early adopter, so I have a lot of experience with it. I'm also a former EMT so I know how to interpret ECGs and I have a pretty good feel for what devices to trust. I trust Kardia. Easily worth the money, although I have my doubts about the 6L version. I don't think the average person can make any use of the additional leads.

When it's wrong, it errs in the direction of saying "possible" afib. With runs of frequent PACs you might see that or "unclassified." Fair enough. If the device isn't certain but it suspects, that's what it should say and it does.

If your EP is blowing it off, he's way behind the times and needs to educate himself. Kardia readings are accepted by most EPs these days, including the top ones. (Especially the top ones.)

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Carey
I've owned one since 2015 and have a lifetime premium account as an early adopter, so I have a lot of experience with it.

When it's wrong, it errs in the direction of saying "possible" afib. With runs of frequent PACs you might see that or "unclassified." Fair enough. If the device isn't certain but it suspects, that's what it should say and it does.

I've had one since 2014 and have a lifetime premium account also. What Carey may be unaware of (as a successful ablatee who has not had afib in a few years, thankfully) is they give you different answers if you are a subscriber or not. Around February 2021, they started adding more analyses for premium account holders. Prior to that it would always say "possible" afib. Now it will say "atrial fibrillation" for premium accounts, but will still say "possible" afib for those who aren't subscribers.

I concur with Pompon, you can learn to interpret the readings yourself. It is best to create a PDF and perhaps print it or enlarge it in a PDF reader. There are several hallmarks of afib. One is the irregularity of beat lengths, another is lack of a "p" wave before the QRS waveform. Lots of PACs can be confusing, but if you plot out beat rates or times (in ms) you can usually see a few beats of NSR in between PACs and you don't see this in afib.

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GeorgeN
What Carey may be unaware of (as a successful ablatee who has not had afib in a few years, thankfully) is they give you different answers if you are a subscriber or not. Around February 2021, they started adding more analyses for premium account holders. Prior to that it would always say "possible" afib. Now it will say "atrial fibrillation" for premium accounts, but will still say "possible" afib for those who aren't subscribers.

You're right, I didn't know that. Thank you for the news.

Not fond of that change. I understand adding new features for premium users, but making a definitive diagnosis one of them seems a bit stingy to me.

From what I've observed these are the tags non subscribers get:

From: [www.alivecor.com]

NOTE: Your EKG must be at least 30 seconds long to use the Atrial Fibrillation and Normal detectors. If an EKG is recorded that is less than 30 seconds, neither the Atrial Fibrillation nor the Normal detector will display a result.

Atrial Fibrillation Detector (Possible Atrial Fibrillation}
The Atrial Fibrillation (AF) detector detects atrial fibrillation in an EKG tracing. After you take an EKG, if atrial fibrillation is detected you will be notified within the app. This finding is not a diagnosis, it is only a potential finding for the recorded EKG. You should contact your physician to review any EKG recording in which atrial fibrillation was detected, or send it for clinician review (see section 11 on page 15). If you are experiencing any symptoms or concerns contact a medical professional.
Caution: If the Kardia app detects AF in an EKG, please consult with your physician before making any medical decision, including altering your use of any drug or treatment.
Caution: The AF detector evaluates for atrial fibrillation (AF) only. It will not detect other potentially life threatening arrhythmias, and it is possible that other cardiac arrhythmias may be present.
Caution: The AF detector only evaluates for AF after you have taken an EKG recording. It does NOT continuously monitor your heart and therefore cannot alert you if AF happens at any other time.

Normal Detector
The Normal detector notifies you when a recording is “normal”. This means that the heart rate is between 50 and 100 beats per minute, there are no or very few abnormal beats, and the shape, timing and duration of each beat is considered normal sinus rhythm. It is important to remember that there is a wide range of normal variability among different individuals. Changes in the shape or timing of an EKG might be normal for a single individual, but since the apps are used by a large and diverse population, the Normal detector has been designed to be conservative with what it detects as normal.
If you have been diagnosed with a condition that affects the shape of your EKG (e.g., intraventricular conduction delay, left or right bundle branch block, Wolff-Parkinson-White Syndrome, etc.), experience a large number of premature ventricular or atrial contractions (PVC and PAC), are experiencing an arrhythmia, or took a poor-quality recording it is unlikely that you will be notified that your EKG is normal.
It is also important to note that the Normal detector looks at the entire signal before determining if it can be declared to be normal. If you experience a small number of PACs or PVCs in a recording of otherwise normal beats in normal rhythm, the Normal detector will likely declare that EKG recording to be normal.
The Normal detector will not declare an EKG outside the heart beat rate of 50-100 beats per minute as normal, even if the EKG has normal sinus rhythm. As a result, if you typically get "Normal” results but take an EKG immediately after any physical activity that raises your heart rate above 100 beats per minute, you may not get a “Normal” result.
CAUTION: AliveCor does not guarantee that you are not experiencing an arrhythmia or other health conditions when labeling an EKG as normal. You should notify your physician for possible changes in your health.

Unreadable Detector
The Unreadable detector determines whether a recording can be accurately interpreted or not. After you take an EKG, if interference is detected you will be notified within the app that your recording has “No analysis” and given some suggestions for acquiring good quality EKG recording. You subsequently have the option to Save the recording, or Try Again. If the recording can be analyzed, the AF and Normal detectors will run on the EKG and inform you as described above.
CAUTION: After EKG analysis, the app may incorrectly identify ventricular flutter, ventricular bigeminy, and ventricular trigeminy heart conditions as unreadable. Please consult with your physician.

{Below are my words}
Unclassified
Rates below 50 BPM or above 100 BPM or between 50 to 100 BPM with an ECG waveform morphology (shape) that is not normal.


From: [www.nice.org.uk]

Published evidence
Evidence from 11 studies and 1,218 patients are summarised in this briefing, including 2 randomised controlled trials (RCTs), 1 pilot (case-control) study, 1 cohort feasibility study and 7 diagnostic accuracy studies (comparators included 12-lead electrocardiogram [ECG], external loop recorder, transtelephonic monitor, and comparison of automated algorithm in arrhythmia detection versus clinical interpretation of KardiaMobile acquired ECG). Three of the diagnostic accuracy studies were done after atrial fibrillation (AF) therapy in a monitoring setting.

KardiaMobile had sensitivity of 94.6% and specificity of 92.9%. AF recurrence was detected in 10 patients (23.8%) within 17 days of discharge, and 95% of patients found it easy to use.

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GeorgeS

Since cardioversion on 11/12, the Kardia has shown me "Normal" to "Possible AFib" to "Unclassified" and back again. I'm going to get a wearable monitor installed tomorrow to track for a couple weeks

Suggest you continue to monitor with your Kardia during the time you have the monitor on. Save the PDFs. If your wearable monitor will tell when you are in afib (if you are) you can compare that with what the Kardia says at the same time.

My EP ( Natale trained) said that he will diagnose someone purely on the evidence of a Kardia or Apple Watch

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Brian_og
My EP ( Natale trained) said that he will diagnose someone purely on the evidence of a Kardia or Apple Watch

To be fair, hard to diagnose flutter with single lead ECG. I can tell if I'm in afib and it flips to flutter as the rate is high with very little variability. Kardia can't tell.

The wearable Zio monitor started flashing an orange light the third day I had it on. Apparently coming loose, although seems tight to the touch to me. Had to remove to return and get a new one installed. I'm going to go now and shave a much larger area than the nurse did when she installed it as it wasn't fun pulling all the chest hairs out while removing it.