First afib episode - perfect health?

First some background; I am a 48 year old male. I had my first known afib recently on Jan 11th and went to the emergency room. My highest Heart rate was 170-180. Pulse was just as high. They finally put me on 25 mg metoprolol tartrate and 5mg apixaban the next day which put me back to sinus rhythm within 6 hours. I was released on Jan 13. The hospitals were full so it took a day to get a bed. Otherwise, I’d probably would have been released sooner. I am still currently on the same meds which I take twice day. Everything so far is going well and nothing notable.

The cardiologist found nothing wrong with my heart, no heart disease, everything looks perfect including the valves and vessels, normal blood pressure around 110/60, they could not find any reason to cause this, but possibly from heavy caffeine use. Also, I don’t not smoke and don’t drink at all. I am not obese and have a low body fat %. I do 150 minutes of liss cardio a week And I do split body routines for muscle building about 5-6 days a week for less than an hour a day. Lastly, my resting pulse is 68-71.

I don’t understand what happened. I thought I was doing everything right. I Get to talk to my cardiologist in two weeks for a follow up, but that is a long wait with so many questions. Anyone else out there in a similar situation or has advice?

I just want to get off the meds if possible and get back to almost normal asap. I read about “pill in pocket” as a possibility. I have no problem cutting out the caffeine so it is a non issue. I just want to get back to my weight training and cardio and just be the best version of myself again. I don’t care about getting a certain heart rate percentage and/or vo2 max. I say this because that all I read that people talked about was getting your heart to a certain percent to get a good workout. I have never cared about that. I just eat well, weight lift and do cardio.

Sorry to ramble, just trying to figure this all out.

Oh, forgot to add that my blood work came back perfect as well.

Quote
adamh
First some background; I am a 48 year old male. I had my first known afib recently on Jan 11th and went to the emergency room. My highest Heart rate was 170-180. Pulse was just as high. They finally put me on 25 mg metoprolol tartrate and 5mg apixaban the next day which put me back to sinus rhythm within 6 hours. I was released on Jan 13. The hospitals were full so it took a day to get a bed. Otherwise, I’d probably would have been released sooner. I am still currently on the same meds which I take twice day. Everything so far is going well and nothing notable.

Sorry to ramble, just trying to figure this all out.

Sorry to say, but likely your exercise. Read this thread [www.afibbers.org]

I'm 66 and was 49 with my first episode. Mine were self converting for 2 months, every 10-14 days, then had an episode that didn't convert until I took a loading dose of flecainide and I converted in 20 hours, but the episode lasted 2 1/2 months. I was fit, didn't usually push that hard, but would occasionally do hard races. For me, I learned that exercise was a trigger with the product of duration times intensity. I created a remission plan that the EP accepted, it has evolved to electrolyte supplementation (magnesium to bowel tolerance, potassium citrate in water consumed over the day, some taurine, also limiting calcium intake), limiting longer duration endurance type activity to Zone 2 level. Lastly, I use a loading dose of flecainide to convert myself if I do go out of rhythm (200 mg for those under 70 kg (154#) 300 mg for those over). I assume your kidneys are healthy, otherwise don't supplement electrolytes.

I maintain excellent fitness, but put these constraints on myself. I can do HIIT like Tabatas without issue as they are short duration. I do a short duration set of max 20 second sprints once or twice a week.

The thing is we are all different. How much is too much exercise is very individual. Others have done the Zone 2 limit at my suggestion and found it beneficial. In my opinion, not all fit folks will get afib, even at the extreme end of the spectrum. There is likely a genetic component, too. Also, more exercise has been shown to be beneficial for sedentary afibbers.

“The cardiologist found nothing wrong with my heart, no heart disease, everything looks perfect including the valves and vessels, normal blood pressure around 110/60, they could not find any reason to cause this, but possibly from heavy caffeine use. Also, I don’t not smoke and don’t drink at all. I am not obese and have a low body fat %. I do 150 minutes of liss cardio a week And I do split body routines for muscle building about 5-6 days a week for less than an hour a day. Lastly, my resting pulse is 68-71.”


You said you have low body fat so be aware if you start Flecainide as a PIP you have to weigh more than 154 pounds to take a maximum 300mg within 24 hours or you risk a dangerous overdose. If you weigh less than 154 pounds the max dose within 24 hours is 300mg.

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

What is your CHAD score? It determines if you can stop Eliquis. You should see an arrhythmia specialist- a cardiologist EP.



Edited 2 time(s). Last edit at 01/16/2022 03:06PM by susan.d.

Quote
adamh
I had my first known afib recently on Jan 11th and went to the emergency room. My highest Heart rate was 170-180. Pulse was just as high. They finally put me on 25 mg metoprolol tartrate and 5mg apixaban the next day which put me back to sinus rhythm within 6 hours. I was released on Jan 13.

The prime risk of a sudden unexpected A-fib episode is for a blood clot to form, get into your brain and cause a stroke. A stroke can often end your life as you knew it. So they put you on apixaban, an anticoagulant, which reduces the chance of a stroke. When your heart is in normal sinus rhythm the apixaban is actually a bit of a risk because it can cause internal bleeding including a bleed into your brain, but you want to stay on it, taking it as directed, until the specialist says its OK to get off.

They give metoprolol to lower your heart rate. It isn't an anti-arrhythmic drug. The pill in the pocket idea is to carry an anti-arrhythmic drug, it seems many people carry fleicanide, which they take when an episode starts to help end the episode. You may want to read up on anti-arrhythmic drugs a bit to prepare for a decision about how much you want to be involved with them.

I was in a somewhat similar position to you 3 1/2 years ago when I had my first A-fib episode. They gave me an appointment to see a cardiologist and it seemed like ages away. I wanted to talk things over with a cardiologist right away. I wanted to never experience A-fib again.

In my case, although I thought I was very healthy, I was stressed out. It was a lifetime high stress event that I couldn't just forget about, so I thought. It turned out that after I learned more about how to have stress this intense have less of an effect on my body that my A-fib went into remission for 3 1/2 years. It was quite the process making the decision to decline treatments the cardiologist was insisting on to go for learning about stress reduction. It seemed like very high stakes. My heart.

The doctors were fairly casual after my first episode. No one knows if you are going to be the patient they tended to call in the past a Lone A-fib case, i.e. one episode and it goes away for a very long time if not forever, or if you are going to progress into the next stage, paroxysmal A-fib, which is often defined as occasional episodes all lasting less than 1 week.

I was put on an anticoagulant and metoprolol, just as you were. After the second and third episodes that followed in quick succession, the doctors got more serious.

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adamh
The cardiologist found nothing wrong with my heart, no heart disease, everything looks perfect including the valves and vessels, normal blood pressure around 110/60, they could not find any reason to cause this, but possibly from heavy caffeine use. Also, I don’t not smoke and don’t drink at all. I am not obese and have a low body fat %. I do 150 minutes of liss cardio a week And I do split body routines for muscle building about 5-6 days a week for less than an hour a day. Lastly, my resting pulse is 68-71. I don’t understand what happened. I thought I was doing everything right.

You don't say how they "found nothing wrong" with your heart. Even if you had an echocardiogram and nuclear stress test on this first presentation with A-fib, finding "nothing wrong" doesn't mean that there is in fact nothing wrong. These tests, if available, have their limits.

What I didn't do 3 1/2 years ago was to reach out to other A-fib patients. I've learned a lot just reading what others have to say on this forum - the way they feel, the knowledge they have about this disease and how to cope with it, what to look for in the specialists you might be seeing, etc. So you're in one of the right places to be.

The standard of care seems to have changed in the last 3 1/2 years. Then, if the episodes repeated, they would tend to recommend an antiarrhythmic drug (AAD) first. These drugs can have horrendous side effects, especially amiodarone, although some patients do OK for periods of time. They aren't that successful as long term treatments. My cardiologist seemed to be handing out amiodarone like it was candy, telling me he could monitor for any side effects before they happened, so there was no danger. I didn't believe him. Your mileage may vary.

But they probably won't be insisting that you try long term therapy with an AAD. They'll start talking to you about ablation. In the past the protocol was give patients AADs and if that fails, offer ablation. There is some great information here about ablation, and what to look for in a specialist who says they can perform one for you. Keep in mind that basically, an ablation is where they slide a catheter up your vein into your heart and start killing parts of your heart that they think are firing erratically to cause your A-fib.

I thought, if I can change any risk factors I have to reduce my chance of an A-fib recurrence, I'll do whatever, to avoid having to take AADs or submitting to an ablation. But the promise of ablation is it can be a cure - no more A-fib for a very long time or for a lifetime. The best results come from the most skilled practitioners, there is no doubt.

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David_L
The standard of care seems to have changed in the last 3 1/2 years.

Indeed it has. Ablation has become recognized as a recommended first line treatment. Previously, ablation was considered appropriate only for patients who had failed medical management with at least one AAD and/or rate control drug.

David L.
says {You don't say how they "found nothing wrong" with your heart. Even if you had an echocardiogram and nuclear stress test on this first presentation with A-fib, finding "nothing wrong" doesn't mean that there is in fact nothing wrong. These tests, if available, have their limits))

When I first got AF there wasnt anything wrong with my heart, I got Graves Disease (hyper thyroid) that put me in AF. So there are reasons we get AF and, yes our heart can be just fine.

This podcast is an interview with Dr. John Day entitled "How to Exercise Without Getting Atrial Fibrillation".

Actually, your heart is not just fine. You have atrial myopathy, as proven by the afib. The problem is, doctors don't (yet) know how to detect and measure atrial myopathy. All they can do is wait until the first symptom appears, which is often afib but can also be atrial flutter and/or frequent PACs.

I'm confident that some sort of diagnostic method will be developed in the not-too-distant future that can detect atrial myopathy before symptoms appear, possibly leading to preventative treatments.

I also think a cure will be found and it will come from gene therapy.

thank you to everyone that responded

Quote
susan.d
You said you have low body fat so be aware if you start Flecainide as a PIP you have to weigh more than 154 pounds to take a maximum 300mg within 24 hours or you risk a dangerous overdose. If you weigh less than 154 pounds the max dose within 24 hours is 300mg.

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

What is your CHAD score? It determines if you can stop Eliquis. You should see an arrhythmia specialist- a cardiologist EP.

I see the cardiologist for the first time on Jan 27th. I only know the information the hospital has provided so far.

Quote
David_L
The prime risk of a sudden unexpected A-fib episode is for a blood clot to form, get into your brain and cause a stroke. A stroke can often end your life as you knew it. So they put you on apixaban, an anticoagulant, which reduces the chance of a stroke. When your heart is in normal sinus rhythm the apixaban is actually a bit of a risk because it can cause internal bleeding including a bleed into your brain, but you want to stay on it, taking it as directed, until the specialist says its OK to get off.

They give metoprolol to lower your heart rate. It isn't an anti-arrhythmic drug. The pill in the pocket idea is to carry an anti-arrhythmic drug, it seems many people carry fleicanide, which they take when an episode starts to help end the episode. You may want to read up on anti-arrhythmic drugs a bit to prepare for a decision about how much you want to be involved with them.

I was in a somewhat similar position to you 3 1/2 years ago when I had my first A-fib episode. They gave me an appointment to see a cardiologist and it seemed like ages away. I wanted to talk things over with a cardiologist right away. I wanted to never experience A-fib again.

The doctors were fairly casual after my first episode. No one knows if you are going to be the patient they tended to call in the past a Lone A-fib case, i.e. one episode and it goes away for a very long time if not forever, or if you are going to progress into the next stage, paroxysmal A-fib, which is often defined as occasional episodes all lasting less than 1 week.

I was put on an anticoagulant and metoprolol, just as you were. After the second and third episodes that followed in quick succession, the doctors got more serious.

You don't say how they "found nothing wrong" with your heart. Even if you had an echocardiogram and nuclear stress test on this first presentation with A-fib, finding "nothing wrong" doesn't mean that there is in fact nothing wrong. These tests, if available, have their limits.

What I didn't do 3 1/2 years ago was to reach out to other A-fib patients. I've learned a lot just reading what others have to say on this forum - the way they feel, the knowledge they have about this disease and how to cope with it, what to look for in the specialists you might be seeing, etc. So you're in one of the right places to be.

The standard of care seems to have changed in the last 3 1/2 years. Then, if the episodes repeated, they would tend to recommend an antiarrhythmic drug (AAD) first.

But they probably won't be insisting that you try long term therapy with an AAD. They'll start talking to you about ablation. In the past the protocol was give patients AADs and if that fails, offer ablation. There is some great information here about ablation, and what to look for in a specialist who says they can perform one for you. Keep in mind that basically, an ablation is where they slide a catheter up your vein into your heart and start killing parts of your heart that they think are firing erratically to cause your A-fib.

I thought, if I can change any risk factors I have to reduce my chance of an A-fib recurrence, I'll do whatever, to avoid having to take AADs or submitting to an ablation. But the promise of ablation is it can be a cure - no more A-fib for a very long time or for a lifetime. The best results come from the most skilled practitioners, there is no doubt.

Yes, I have done nothing but research the topic since my release from the hospital. That's how I found this place.

if I remember correctly, the cardiologist said cardioversion is the next step and then lastly ablation. I have done a lot of reading, and it seems ablation is the go to if you want to get back to exercising fully. Also just read about another ablation style which is by freezing the heart tissue - cryoablation. He did say he will get me off the blood thinner ideally in about 4 weeks and have me on aspirin instead. That's all I know so far on that for treatment so far.

At the moment I am optimistic about everything and getting close to back to normal as possible. I just need to find the trigger. That's how i feel anyway for now.

I really feel the issue is either my undiagnosed sleep apnea(going to get tested) or my very serious GERDS issues. If its GERDS related, I assume my vagus nerve could be the culprit. I am talking out my a** and just regurgitating things I have read and thought about though.

Quote
Carey

The standard of care seems to have changed in the last 3 1/2 years.

Indeed it has. Ablation has become recognized as a recommended first line treatment. Previously, ablation was considered appropriate only for patients who had failed medical management with at least one AAD and/or rate control drug.

Yes, for Athletes, ablation is recommended from what i have read and seen videos on.

here is one video out of many:

[www.youtube.com]

one more:
[www.youtube.com]



Edited 1 time(s). Last edit at 01/17/2022 07:22PM by adamh.

Quote
Elizabeth
David L.
says {You don't say how they "found nothing wrong" with your heart. Even if you had an echocardiogram and nuclear stress test on this first presentation with A-fib, finding "nothing wrong" doesn't mean that there is in fact nothing wrong. These tests, if available, have their limits))

When I first got AF there wasnt anything wrong with my heart, I got Graves Disease (hyper thyroid) that put me in AF. So there are reasons we get AF and, yes our heart can be just fine.

Yes, i think the trigger was either sleep apnea or my intense gerds which can affect my vagus nerve(i think?). i will talk to my cardiologists about it.

Quote
Carey
Actually, your heart is not just fine. You have atrial myopathy, as proven by the afib. The problem is, doctors don't (yet) know how to detect and measure atrial myopathy. All they can do is wait until the first symptom appears, which is often afib but can also be atrial flutter and/or frequent PACs.

I'm confident that some sort of diagnostic method will be developed in the not-too-distant future that can detect atrial myopathy before symptoms appear, possibly leading to preventative treatments.

I also think a cure will be found and it will come from gene therapy.

I meant fine in the sense they don't know what happened. It is not the normal culprits like obesity, high blood pressure, heart disease etc etc.. They cant point to anything other than it possibly being my caffeine abuse over the past decade.

Here is one test results if it helps and maybe someone understands more than me what it says, to me it seemed ok overall. i just need to find the trigger i assume if even possible;

TRANSTHORACIC ECHO (TTE) COMPLETE - Details

Height: 177.80 cm Weight: 90.72 kg
BSA: 2.09 m2 Heart Rate: 81.00 bpm
BP: 112.00 / 60.00 mmHg

Conclusions:
- Normal left ventricular cavity size. There is mildly
increased left ventricular wall thickness. The left
ventricular systolic function is borderline reduced. The
visually estimated ejection fraction is between 50-54%.

- There is trace aortic valve regurgitation.
- There is mild mitral valve regurgitation.

Findings:
Left Ventricle
Normal left ventricular cavity size. There is mildly increased left
ventricular wall thickness. The left ventricular systolic function is
borderline reduced. The visually estimated ejection fraction is between 50
54%. The calculated ejection fraction is 45% by biplane method. Normal left
ventricular mass. The calculated mass index is 79.56g/m2 by 2D measurement.

Right Ventricle
Normal right ventricular cavity size. The Tricuspid Annular Plane Systolic
Excursion is 1.75 cm. The Right Ventricular Base is 3.76 cm.

Atria
Left atrium is normal in size. Right atrium is normal in size.

Aortic Valve
There is a trileaflet aortic valve. There is no aortic valve stenosis. There
is trace aortic valve regurgitation.

Mitral Valve
Normal mitral valve structure and function. There is no evidence of
calcification of the mitral valve. There is mild mitral valve regurgitation.

Pulmonic Valve
The pulmonic valve is likely normal. There is trace pulmonic valve
regurgitation.

Great Vessels
All visible segments of the aorta are normal in size.

Venous
The inferior vena cava is normal in size and collapses greater than 50% with
inspiration.

Here is my ECG 12-LEAD results from when I was first admitted in the ER, to a few hours after returning to sinus rhythm.






Edited 1 time(s). Last edit at 01/17/2022 08:06PM by adamh.

another test:

XR Chest 1 View - Details

Study Result
Impression
Impression:

1. No acute pulmonary disease

Dictated on: 1/11/2022 9:21 PM

Narrative

XR CHEST 1 VIEW

History: Palpitations

Comparison: None

Findings:
The cardiac silhouette, pulmonary vasculature is normal. No consolidation. There is no effusion or pneumothorax.



Edited 1 time(s). Last edit at 01/17/2022 08:09PM by adamh.

All blood tests came back in normal range. so nothing to report there. Let me know if i missed something that anyone would be interested in.

Sorry to post to much, but I want to learn as much as possible about this and maybe help others that come along later to read this. just like I have learned from reading others posts here.

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adamh
Yes, for Athletes, ablation is recommended from what i have read and seen videos on.

For ablation, most here would recommend a very high volume ablation center with an EP who has done many thousands of ablations. Also one who has good success rates with the very toughest cases (not that you are a very tough case, just you want someone with that skill level). Skill at ablation is part art and part technical skill, some are just better at it and the more they've done, the better. That said, an EP can medically manage your case. Also an EP will do a better job medically managing afib than a cardiologist, generally. Think of cardiologists as plumbers and you have an electrical problem.

Where do you live - US (state)/International (country)?

Folks here can give you suggestions on the best ablating EP's.

Also, pulsed field ablation is the coming technology. It will likely be standard shortly. If you can either get in a trial with this technology (with a top EP) or manage your afib till it is standard, that might be a good thing.

Yes, I understood what you meant by everything being fine. Many of us here had the same evaluations when first diagnosed. I was just trying to underline the subtle point that what's not fine is something that can't be measured at this time. So you can search for explanations all day long, but you're not going to find one in any report you received from a doctor. It's likely your athleticism was a contributing factor, and it's very likely your DNA was a contributing factor, but it's a 100% certainty that your atrial myopathy was the causative factor. Now if only doctors knew what atrial myopathy actually is and how to diagnose it.

Frustrating disease, is it not?

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adamh
here is one video out of many:

[www.youtube.com]

one more:
[www.youtube.com]

Regarding the video on that second link: the patient, Eddie Judge, apparently was in constant A-fib for more than six months. You've been in A-fib for a few days in total so far? Because you are taking it so seriously now the odds are that you have an even better chance than Eddie of a very good outcome.

The general belief is that the longer a patient is in A-fib, the more the heart is damaged, and the more damage, the more susceptible the heart is to more A-fib. A-fib begets more A-fib, is what they say. Some say the heart can recover somewhat the longer you manage to stay in normal sinus rhythm afterwards. The general feeling seems to be its far easier to damage the heart than it is for the heart to recover.

The doctor that Eddie in the video eventually went to for his ablation, Dr. Andrea Natale, is highly thought of on this forum, and everywhere else. If I type "best electrophysiologist in the world" into Google on my computer, the name that comes up is Dr. Andrea Natale. Natale specializes in attempting to cure the most difficult cases, using techniques beyond the accepted standard of care if he deems it necessary.

If I could consult someone of Natale's stature and after he reviewed my history he recommended ablation, I think even I would go for it. He might caution you to see if just reducing your risk factors might keep you out of A-fib for a very long time. Or he might not. He's called an electrophysiologist, or EP. He's years of study beyond a cardiologist, and possibly tens of thousands of ablations beyond your average EP.

Quote
adamh
if I remember correctly, the cardiologist said cardioversion is the next step and then lastly ablation. I have done a lot of reading, and it seems ablation is the go to if you want to get back to exercising fully.

If you are liking the idea of getting an ablation you want to get an appointment with an EP, the best you can find. Start learning about what to look for in an EP.

Quote
adamh
Also just read about another ablation style which is by freezing the heart tissue - cryoablation.

Read up on PFA, Pulsed Field Ablation. It is the newest method of ablating heart tissue, still in trials in the US.

The two currently most used methods of ablating heart tissue kill by heating the tissue (Radio Frequency Ablation) or cooling it (Cryoablation). The problem is that heat or cold affects any other tissue nearby that happens to get heated or cooled as well. In the case of ablating the heart, there is the esophagus and the phrenic nerve that EPs worry about. They do their best to avoid damaging these tissues, but no matter what precautions they take, some patients are damaged, and a few die. Seeking out the best EP you can find is important not just to improve your chances of succeeding in becoming A-fib free.

With Pulsed Field Ablation, the particular electrical waves used don't heat or cool. They selectively kill heart tissue while hardly affecting nerves or the esophagus. Types like Natale are very enthusiastic about it. Eg: "Pulsed field ablation poised to revolutionise the treatment of atrial fibrillation"

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adamh
At the moment I am optimistic about everything and getting close to back to normal as possible. I just need to find the trigger.

I think optimism is important. I find it hard to be optimistic when I am in A-fib. When I come out of it its like the Sun has come up. I've accepted that there are a number of risk factors I can do something about, that I will have to keep in mind for the rest of my life.

Quote

(...) "If I type "best electrophysiologist in the world" into Google on my computer, the name that comes up is Dr. Andrea Natale. " (...)

Ask this question in Chinese, French, Danish or any other language, and the answer will likely differ. Not only because of the languages, but because there's a different perception of what one's allowed to say publicly. In some countries, names of doctors or hospitals are not supposed to be typed directly in a forum thread, for it's perceived as "advertisement" or, conversely, "smear campaign".

That said, it's not a competition. No one knows who's the best, if even there is one.
I've strictly nothing against Dr Natale. He's undoubtedly a top grade EP, and if you live in the US, you'd likely hear about his skills, but he can't ablate the whole afibbers' world...

You mentioned heavy caffeine use, and stopping it would be no problem for you. That may be your ticket out. From what I've read, any stimulant can be a trigger, and for me, stress is a stimulant. Stress is hard to avoid, so it may help if you can give your body a break from it several times per day by practicing meditation, deep breathing or yoga, (which is much more exercise than most people think) I've had over 150 episodes of Afib, finally after ablation, none, except for a short bout of episodes during a super stressful time. My episodes would last 10 to 20 hours generally before self converting (before I knew about Flec. pill in a pocket thanks to THIS FORUM) Out of 9 different cardiologists and or EPs not ONE offered it to me. I had to ask.

On several occasions, I'd walk into a yoga class in Afib, and walk out in NSR. I've staved off a couple of episodes by doing some stretches and deep breathing at the beginning of the episode, or taking a short walk outside breathing deeply. AF is a crazy monster and very individual. All suggestions you get here are good, I just didn't see anyone mention stress reduction.

Avoid conflict if possible, monitor what you read or watch on TV until you get this figured out. If you don't already have a meditation ap on your phone, there are many! When in AF, a 10 minute meditation would bring my heart rate down as much as the metoprolol. (about 10 beats per min). Meditation on a regular basis BEFORE Afib starts may prevent it from happening. MSG may also be a trigger. The Glutamate is excitatory so I keep GABA on hand. If I eat something I fear may have had MSG in it, I'll take a little GABA to counteract the Glutamate. Both are created in the body, but too much glutamate is not good. Therefore, I avoid MSG like the plague.

Since both stress and exercise deplete your body's magnesium stores, Get your RBC Mg checked to see if you are below 5.5mg/dl, if so, you need to supplement with MgCL or Mg Glycinate Chelate TRAACS formula. NO Mg Oxide! George has electrolyte supplementation nailed down, has great advice on that. (you may want to read his prior posts) You can buy the test at www.Requestatest.com or many other discount labs like that. Your doc may not be familiar with the test. Eat Avocados every day, sweet potato often but don't spike your blood sugar, pepitas, almonds, and anything green. Easy to get potassium from food, but Mg is harder. I still take a little potassium every day as a back up. We need 3,000 to 4,000 mg a day, especially if you exercise and sweat it out,

Dr. John Day, in the book The Afib Cure states that blood sugar spikes cause fibrosis in the heart which lead to arrhythmias. Dr. Denis Goodman explains Mg in Magnificent Magnesium, and James Nestor talks about breath in his book BREATHE. Good luck!! you will do fine! you are in good company!

During my 15 year long road managing afib (two ablations and over 200 documented episodes) I have found that coffee/caffeine/Mt. Dew have had NO relationship with afib. Coffee every morning and a glass of Mt. Dew in the evening to stay awake until 10:30.

Stress? Possibly, but I have little stress and maybe 2-3 episodes related to stress that I recall. Coincidence or cause?

I've stopped counting all the things I've thought being possibly involved in my afib episodes (more than 400 in 6 years). Coincidental in most cases.
As my episodes appear at rest or after meal or at rest after meal, maybe should I try getting rid of those two bad habits.

Thank you all again for all the responses.

Got to see the cardio doctor earlier than planned on Tuesday. I am off the blood thinners and now take a daily aspirin instead. I just take Metoprolol Tartrate 25mg twice daily. I got the all clear to exercise; via cardio and weight training. He just said to no push to hard for a little while at least. They put an EVT on me that I have to wear for 2 weeks.

I have an appointment with an EP on Feb 10th. I'm in the Orlando, FL area by the way. I believe someone asked above. The doc will discuss all available options for me. It sounds like they want me off meds if possible due to my age and good health condition. Maybe that is just how I interpreted it though. If he talks about ablation, I will ask about pulsed field if he doesn't mention it.

I signed up for sleep study to test for sleep apnea as well. I am waiting for the home kit now. I have had sleep issues over 10 years or so. Could have been the trigger?

Diet changes: no caffeine at all, just plain water. Also will be more cognizant of food and drink choices. I need to better control acid reflux issues that were getting way out of control for a few months.

Anxiety: I will try yoga and meditation and see how it goes. I want to avoid any medications(like SSRI's) if possible.

Quote
adamh
I meant fine in the sense they don't know what happened. It is not the normal culprits like obesity, high blood pressure, heart disease etc etc.. They cant point to anything other than it possibly being my caffeine abuse over the past decade.

I understood what you meant, but my entire point was that none of the things you mention as the "normal culprits" are actually known to cause afib. They're only risk factors, not causes. The world has more obese, hypertensive, heavy drinkers with heart failure who don't have afib than it does slim, normotensive, non-drinkers in perfect cardiovascular health who do have afib. Think about that for a moment.

Clearly, this suggests that the actual cause simply isn't known to medicine. Obesity, hypertension, sleep apnea, hyperthyroidism, alcohol abuse, and a dozen other things are known risk factors, but none are known causes.

Your situation actually describes a large number of people here. It's not unusual, and analyzing all your medical tests and reports isn't going to lead you to an answer. If it could, we all would have been there by now.

I'm not trying to deter you from investigating and pursuing more avenues, just trying to paint a picture of the current reality. Have you looked into your genetic history? Did others in your family also had afib? There's a good chance they did even if they were never formally diagnosed.

Hi Adam,

You got there the same way I did. Exercise maybe. We were just born with thin atrial walls and we stretched them out even thinner with cardio. My guess. For what it’s worth.

Don’t despair. An ablation will likely kick it to the curb for a good long while. “Caffeine abuse”. That’s a good one! Doctors always trying to figure a way to blame the patient when they don’t have an answer. I say this an an a-fibber catching up on the forum with a neat whiskey in my glass. “Oh, no! I’m doomed!” Or not.

Humans are complicated. Nobody really fits into a box. It’s a journey, and we all figure ourselves out. Welcome to it, and we’ll walk along with you.

Quote
LaniB
All suggestions you get here are good, I just didn't see anyone mention stress reduction.

When I had my first A-fib episodes 3 1/2 years ago I was experiencing a lifetime high level of chronic stress. I didn't do much research into A-fib before I concluded that a high level of stress maintained over a long period of time could prepare the way for my heart to go into A-fib, and single stress events could trigger episodes. I didn't understand things exactly in that way then.

I became highly motivated to learn. I studied how to meditate by reading Jon Kabat-Zinn and about his Mindfulness Based Stress Reduction (MBSR) program that he pioneered at the University of Massachusetts Medical school. The head of the local Zen group is also the main teacher at the local Mindfulness Northwest MBSR center, so I also spent time at the Zen center. I meditated every day for 1/2 hour to 1 hour.

I only had one episode of A-fib after I took up meditation back then and it was far less symptomatic. It responded to cardioversion. After that I was in remission for 3 1/2 years. As the months of being A-fib free went by I gradually felt better and better, until after a year or two I felt I would never experience A-fib again. Looking back, it seems I became a bit complacent about looking after my ability to handle stress.

I've had two recent episodes, one in late October 2021 and one in mid November 2021. Both fit into the pattern I experienced years ago. I can't say I was again in a lifetime high stress situation but I was stressed out. I was already meditating, but I was not a rigorous about the practice as I was.

I believe a long period of chronic stress led up to my having A-fib again. I could just drop out of this stress situation so I did. I didn't expect to suddenly cure myself and get back into being completely normal just as I was.

I made a number of changes. Instead of meditating for a certain period at the same time of day each day, I meditate more often, and especially when I feel my heart being affected in a bad way. It took me a while to redevelop my ability to tune into how my heart is doing enough for me to believe I could feel when whatever I was doing was bad for my heart. I felt I had let myself drift into this situation over a fairly long period of time, so it made sense that it might take a long period of time to lift myself out of it.

I decided I would be patient and slowly ramp up my activity over weeks and many months, always guided by my perception of how my heart is doing, and by my overall impression of how my body is doing. For the first few weeks I just dropped any pretense of trying to accomplish anything in particular, as if I was on vacation. I guess I could say I took a vacation without leaving home. I felt relaxed.

I found a few studies on acupuncture and heart arrhythmias. My cardiologist agreed there were promising studies in the literature, but because only small numbers of patients were involved he said he wasn't convinced. I found an acupuncturist and started weekly treatments. I felt immediately after the first session that these treatments were going to do me a lot of good.

I changed what I eat and drink. I cut out all alcohol. I increased the amount of fresh fruit and vegetables. I started taking Mg supplements. My BMI was slightly into the "overweight" category so I have lost enough weight to be classed as "normal", and I'm continuing to lose a bit more weight, aiming to be in the middle of the "normal" range. I'm walking 45 minutes to an hour a day. Eventually I'll get back to exercising more vigorously. I'm not in a hurry.

I haven't had another episode. I have become more open to the idea of having an ablation, but I'll see if I can keep up being in remission for a few years or the rest of my life first. Maybe I can make it until PFA becomes the standard of care and there will be even less risk than there is now.

Thank you everyone for your responses and taking the time to respond. It is much appreciated.

If anyone is interested, i got my results back from wearing my EVT for two weeks. Looks good overall i assume, but i'm not a doctor. I see the EP on the 10th. Waiting on the results of my sleep apnea test.

Interpretation Summary

This was a 2-week event monitor and the underlying rhythm was sinus rhythm with an average heart rate of 71 bpm.
The heart rate ranged between 41 and 120 bpm. There were occasional APCs representing less than 1% of total.
There were occasional to frequent PVCs representing 1% of total.
There were 2 pauses over 2 seconds, the longest 2.9 seconds occurring at 1:10 AM with sinus rhythm heart rate of 86 bpm. (this doesn't look good at all, could be apnea?)
There were no episodes of atrial fibrillation

Event recording started on 1/19/2022. Event recording stopped on 2/1/2022. Total Days: 13
Min HR: 41
Max HR: 120
Average HR: 71

EVENT SUMMARY
Automatic triggers: 22
Preliminary Findings: · Pauses >2 seconds occurred 1 time(s) with longest pause 2.9 seconds
· 24 events were transmitted
· Patient monitored for 13d 8h 20m
· Heart Block occurred 2 time(s) the most severe 1°; slowest 48 BPM
· 5,430 PACs with PAC burden of <1%
· 13,826 PVCs with PVC burden of 1%

Event Summary Details are listed below.
Urgent Events Summary:
No Urgent events found

Auto Triggered Event Summary
Strip# Date Findings HR
3- 01/19/2022 | 11:59:46 EST Baseline - Sinus Rhythm 65
4- 01/19/2022 | 14:35:18 EST Sinus Rhythm 75
5- 01/20/2022 | 15:19:56 EST Sinus Rhythm 74
6- 01/21/2022 | 03:45:18 EST Sinus Arrhythmia 51
7- 01/21/2022 | 09:23:02 EST Sinus Rhythm 83
8- 01/22/2022 | 09:06:59 EST Sinus Tachycardia 106
9- 01/23/2022 | 04:11:41 EST Sinus Bradycardia with PAC(s) 43
10- 01/23/2022 | 05:51:29 EST Sinus Bradycardia 45
11- 01/24/2022 | 04:30:26 EST Sinus Rhythm 82
12- 01/24/2022 | 11:29:42 EST Sinus Bradycardia 57
13- 01/25/2022 | 04:00:24 EST Sinus Bradycardia 42
14- 01/26/2022 | 01:10:10 EST Sinus Arrhythmia 51
15- 01/26/2022 | 01:10:49 EST Sinus Bradycardia with 1st Degree AVB and 2.9 Second Pause 48 <-- woah my heart stopped for 3 seconds?!
16- 01/26/2022 | 02:32:52 EST Sinus Bradycardia 41
17- 01/27/2022 | 12:50:41 EST Sinus Rhythm 90
18- 01/28/2022 | 05:15:03 EST Sinus Rhythm 84
19- 01/28/2022 | 10:35:03 EST Sinus Bradycardia 54
20- 01/29/2022 | 02:18:18 EST Sinus Rhythm with PVC(s) 100
21- 01/30/2022 | 10:39:12 EST Sinus Rhythm 75
22- 01/31/2022 | 03:10:10 EST Sinus Rhythm with 1st Degree AVB 63
23- 01/31/2022 | 03:11:08 EST Sinus Rhythm with 1st Degree AVB and PAC(s) 64
24- 02/01/2022 | 09:40:59 EST Sinus Rhythm 6 (data cut off i think, im sure it wasn't just a heart rate of 6)

Quote
adamh
There were 2 pauses over 2 seconds, the longest 2.9 seconds occurring at 1:10 AM with sinus rhythm heart rate of 86 bpm. (this doesn't look good at all, could be apnea?)

Possibly, see: [journals.lww.com]

A simple answer could be taping your mouth shut at night. See my post here, as well as the whole thread: [www.afibbers.org]