I am suppose to have Persistent Afib

But I have been off my Flecainide 150mg x 2 for 11 days and according to my Kardia mobile (least expensive model) I have been in NSR. I do the Kardia ekg at least a couple times a day. I did get a couple unclassified readouts then got NSR on immediate followup readouts. My heart rate has gone from range of 67-72 up to 84-90 with reduction of Metoprolol from 75mg to 25mg.

So the 11 days of NSR is starting to mess with me. I was diagnosed with persistent afib over 3 yrs ago. Got ekg, echo, and stress test and sent on my way. Put on Xarelto and told to monitor and see you next year for repeat. Never felt any symptoms (some lightheadedness when bending over for period of time). 3 years later cardiologist (now fired) referred me to EP. Fluttering has made it into my file along the way. Not sure if that is because of me describing an anxious feeling in chest or it showed up on 14 day or 30 day heart monitor readings. I did get a few unusual readings while on 30 day monitor folling EP increasig Flec to max dosage. Could have been panic attacks or reaction to increase Flec or Met. Not had since)

Only changes in habits are reduction in caffeine from 24-50+ ounces everyday to less than 8 ounces. I have also been taking 400mg Magnesium daily.. I reduced my caffeine and started taking magnesium after my successful cardioversion of 3 weeks (along with 100mg of Flec/50mg Metoprolol) went back to afib at 3 week followup when I had 50 ounces of caffeine that morning. HR was 102 and BP was 150/85.

EP upped Flec to 150mgx2/Met to 75mg, I cut caffeine and NSR ever since approx 6 months ago. 6 months of medicated NSR. But now 11 days of non-medicated NSR (25mg Metoprolol). Did I really have Persistent Afib?

During those three years, did you have multiple ECGs that showed afib? Don't know how long you've had the Kardia, but did it continuously show afib during that period too?

Yes, I had an annual ECG each year with my cardiologist as well as an echo and stress test. I was also told multiple times by other doctors (primary, endocrinologist, pulmonary) when examining me. “Did you know you have afib”. I did not have Kardia.

Okay, then you had longstanding persistent afib, no question about it. Is it possible that if an effort to stop it had been made earlier it would have been successful? Maybe, and maybe even probably. Maybe you had paroxysmal afib all along but that cardiologist never bothered trying to stop it. But I don't think it changes the ablation decision much. Whether it's inherently persistent or paroxysmal, it will be back.

The one thing that would make me pause is the fact that you're asymptomatic. If I were in your shoes, I would consider just living with it. That would mean Eliquis and possibly a rate control drug for life, but there would be no more flecainide or other antiarrhythmics.

I thought about living with it but after cardioversion and going back into afib, EP tripled raised the Flec from 100mgx2 to 150mgx2 and said the only way off the Flec and Met was an ablation. He then put me on 30 day monitor. I had a couple incidents where My heart was racing in middle of night which I thought might be panic attacks or reaction to the increased Flec. The visit after 30 day monitor he said I was NSR. He still recomended an ablation at that time. I have registered NSR on my Kardis ever since for last 5 months under max dose of Flec. One week to scheduled ablation with Natale

Most of my concern arises due to the incompetence of my cardiologist. I just met another person with persistent afib who goes to the same cardiologist since 2020 and has yet to be refered to EP.

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Geocappy
Most of my concern arises due to the incompetence of my cardiologist. I just met another person with persistent afib who goes to the same cardiologist since 2020 and has yet to be referred to EP.

Even in EPs', advice can be bad. In my locale, a friend got advice from 2 EP's at our University Hospital. I told him the advice was outdated and sent him to Natale for a successful ablation (5 years ago). Another friend had 3 local EP's tell him he had VFIB, put him in a "shocker vest" and told him no procedure could fix him. Got him to Natale in 2 weeks (because of the seriousness of VFI. Natale said a) it wasn't VFIB and b) he fixed him (this was 5 years ago) . The guy's been riding his bike to work since. He still can't believe that Natale could fix him and 3 guys here didn't think it could be done and misdiagnosed him. Another friend, kinda in your part of the world (Tampa) got an ablation from an EP in 2009. It failed long ago and she's gotten poor advice since. Earlier this year i told her when she was ready for another option, let me know. She called in June and is now on the list for a Natale procedure. I could go on, but you get the point.

"Fluttering has made it into my file along the way. Not sure if that is because of me describing an anxious feeling in chest or it showed up on 14 day or 30 day heart monitor readings. I did get a few unusual readings while on 30 day monitor folling EP increasig Flec to max dosage. Could have been panic attacks or reaction to increase Flec or Met. Not had since) "

Although Flecainide helps keep people in NSR, it also can cause Atrial Flutter, especially at higher doses.

" I cut caffeine and NSR ever since approx 6 months ago. 6 months of medicated NSR. But now 11 days of non-medicated NSR (25mg Metoprolol)"

Sounds good, amazing recovery for someone with "Persistent AFIB", although 11 days isn't that long in terms of AFIB prognosis. Keep doing what works. At least by now you should know how you feel on the reduced drug regimen. Metropolol wipes out and sedates alot of people.

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The Anti-Fib
"Fluttering has made it into my file along the way. Not sure if that is because of me describing an anxious feeling in chest or it showed up on 14 day or 30 day heart monitor readings. I did get a few unusual readings while on 30 day monitor folling EP increasig Flec to max dosage. Could have been panic attacks or reaction to increase Flec or Met. Not had since) "

Atrial flutter (not "fluttering") isn't diagnosed based on anything you ever said and it has nothing to do with panic attacks. Someone saw atrial flutter on an ECG, so that's how you got the diagnosis. Atrial flutter is a specific arrhythmia just like atrial fibrillation and it can only be diagnosed with a 12-lead ECG; it's not a sensation or experience or a reaction to panic. It's pretty common for flutter to coexist with afib.

Is this flutter ?

https://ibb.co/jMj6NPj



Edited 1 time(s). Last edit at 07/31/2022 11:02AM by Carey.

Per Carey's comment on atrial flutter, atrial flutter is a very stable rhythm. Where afib heart rate is very variable also known as irregularly irregular.

This is a heart rate vs. time graph (time in minutes) of the beginning of an afib episode.

photo upload


This is a heart rate vs. time graph with a couple of flutter episodes in the middle of an afib episode. On the right is conversion to NSR.





Edited 2 time(s). Last edit at 07/31/2022 11:58AM by GeorgeN.

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Pompon
Is this flutter ?

[ibb.co]

Looks like it but hard to be sure off a single lead.

BTW, the site doesn't support attaching images, so next time make it a link instead. I edited your post to fix that.

Thanks. I wasn't sure having done the link correctly.
It's an old tracing (2018), from the last time I took flecainide.
I felt bad for some hours, my BP was low and the beats were weak.
Those meds can generate really awful unwanted effects.



Edited 1 time(s). Last edit at 07/31/2022 12:49PM by Pompon.

George, your second graph shows the weakness of the beating during flutter...

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Pompon
George, your second graph shows the weakness of the beating during flutter...

Not sure how you tell that as it BPM vs time.

I was still thinking "voltage", but nothing like that. It's misreading. The "flutter" parts have little UP and down variation, since it's a regular rhythm. Right ?

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Pompon
The "flutter" parts have little UP and down variation, since it's a regular rhythm. Right ?

Right. Afib presents as rapid changes in rate because it's so irregular. By that I mean that the R-R intervals are all over the place, so if you take, say, 5-second samples you'll see one sample measuring at 150 bpm and the next one at 40 bpm then the next at 140. But with flutter they'll all be about the same because the R-R intervals are nearly constant. Before the computer age cardiologists all owned calipers for measuring R-R intervals. Like this, for example.

But George's chart doesn't tell you anything about the forcefulness or voltages of the beats. Flutter beats are usually perfectly normal QRS complexes so the beats feel normal. It's the extra P waves in between the complexes that makes it flutter. It's also usually a faster rate than normal (but not always).



Edited 1 time(s). Last edit at 07/31/2022 04:13PM by Carey.

To follow up on Carey's comment. Below I've zoomed in on an afib part of the second graph then below that a flutter part. These data are from recording the RR beat length in ms, then converting to heart rate. The heart rates are then plotted vs. cumulative time.

Thanks. It's very clear on both graphs

Definitely flutter.
I am a frequent flyer in that club. I have seen my flutter via ecg on kardia and 12 lead.

Wow guys. I feel so naive.

So guess what? I am on day 13 of no Flecainide/25mg Metoprolol. All ready to call the nurse in Texas to say this is getting Strange after being told I have Pers Afib for 3 years. So I took my ECG in AM and went to see Endocrinologist for normal 3 month checkup. Asked P.A. If they still had Kardia Mobile (just in case mine broken). Told her my Kardia has registered nothing but NSR for 5+ months including last 12 days w/o Flecainide.

She listened to my heart and said don’t know much about Kardias but you are in afib right now. What a coincidence? I murmured under my breath what a piece of junk my cheap Kardia must be. All those NSRs and all negated by one examination with a stethoscope.

Well, I went home and sure enough I got a reading of “possible atrial fibrilation”, “unclassified”, followed by 2 more “Poss Atrial fibrilation”. However mine do not look like any of your graphs and although i was always considered smart, they do not make sense to me. Still no symptoms.

Is there a way for me to link one of them here? Does it make any sense to run over to my PCP to get a quick ECG for any reason? My ablation prodedure is next Tuesday.

I seriously doubt there's anything wrong with your Kardia. You were in NSR all this time and now that has changed, exactly as expected. It was just a matter of time. Trust the Kardia. It's not lying to you.

Ok. Getting NSRs again after getting a few “probable atrial fibrilations” and a few “unclassifieds”. None of my ECGs look like the examples above. I guess a few more days of no Flecanaide should lead to nothing but afib readings

Some of your afib events might be stress related.
Being quietly using your kardia at home is not necessarily the same as having an EKG recording done by the nurse.
It may sound stupid, but just a little stress may have strange effects on your HR, even if those effects are short lived.

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Geocappy
Ok. Getting NSRs again after getting a few “probable atrial fibrilations” and a few “unclassifieds”. None of my ECGs look like the examples above. I guess a few more days of no Flecanaide should lead to nothing but afib readings

The graphs above are heart rate vs time, not ECG's. They are completely different.

Thanks for feedback. Actually got a few “possible atrial fibrilations on Kardia now.

Update. I guess my Persistant afib has turned into Paroxysmal. I wish. After a few kardia mobile “possible atrial fibrilation” I am back to NSR after playing bridge all afternoon. That is right, bridge. Had to replace 30 hours of golfing due to inability of doctors or physical therapist to cortect back/hip problem (neurosurgeon, hip surgeon, 7 PT rehab sessons over 3 years). Need a Dr Natale of back/hips.

Anyway, still no symptoms and no Flecainide. Going to just take Xarelto from now til ablation 8/9. Along with ablation drugs and my other drugs. At least I finally saw evidence of afib for first time in 6 months since cardioversion and max Flecainide.

Now my heart is mixing it up. After driving through 2 hour thunderstorm in order to eventually put my stepson’s cat down ( only cat I ever liked) and driving back. Kardia was constan afib with heart rate of 134. Other afib readouts with HR of 75. Freaked me out so I decided to take 75mg of Flecainide to see what would happen. Finally getting to bed at 2am.

Woke up with racing heart rate at just before 7 am. My first Kardia readout was tachycardia with HR of 102( that is the 1st time i have seen that). Then I got several readouts of atrial fibrilation with HR of 95 mixed with multiple readouts of NSR with HR of 95. Don’t have any other symptoms except racing heart.

Maybe it is stress that is my big trigger and not caffeine (only drink 8 ounces a day) or both. Heart sure got active all of a sudden. Guess I should take my Flec as needed until Natale cut off date??? Better watch heart rate too??



Edited 1 time(s). Last edit at 08/02/2022 08:34AM by Geocappy.

Sorry to hear about your stepson's cat. I've had cats for 40 years and get very attached to them.

If you take the flec, you should also take the metoprolol. If you do that, then your rate should not be an issue. Should not be anyway since your procedure in a week. I'm guessing you have instructions from Natale or his staff to get off the flec a certain number of days before your ablation?

Yes, although I don’t like cats in general this cat was more like a dog than mosts dogs. It was so unexpected at 12 yrs old.

I am still taking 25mg of Metoprolol. I guess I will take A half dose of Flecainide as needed. I have directions to quit both a few days before. It was just crazy to actually see my heart go crazy for the 1st time on Kardia. Up til now I only had my Doctors feed back from ECGs and heart monitors. My Kardia showed nothing but NSR for 5 months while on max doses of Flec/Met. And another 13 days of no Flec. Still no symptoms except racing heart that I can tell

I would skip the flecainide entirely but since you're in tachycardia I would continue the metoprolol until the day you've been instructed to stop it. Taking a half dose of flecainide doesn't accomplish anything. If you're going to take it at all, take the full prescribed dose. I believe Natale will want you to stop it 5 days out.

That is correct. No Flec after 8/4(8/9 procedure). Already down to 1/3 previous Metoprolol dosage (25mg). Just stressed a little seeing tachycardia and afib plus high heart rate 102). My fast or high heart rate always seems to be in morning when I awake from dream/nightmare or when wake up anxious about something. I am just trying to take as little med as possible since I take med for so many things. I forget what the pharmacist called it. Something to do with approaching medicine saturation level

Sounds like you may have been back and forth from NSR to AFIB for those 3 years. Since you are apparently triggered by stress, or an Adrenal response, you may have been in NSR at home, then after going out to the Doctors, were stressed enough to get an episode that they caught with the ECG's/EKG's, then later reverted back to NSR.

Even though you are getting an Ablation, all this discovery recently is good to know, as even with successful Ablations, following up with preventive proactive care is important, as the Ablations are rarely 100% effective, especially long-term.



Edited 1 time(s). Last edit at 08/02/2022 10:03PM by The Anti-Fib.

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The Anti-Fib
Ablations are rarely 100% effective, especially long-term.

You base that claim on what?

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Carey

Ablations are rarely 100% effective, especially long-term.

You base that claim on what?

You want to argue about semantics? your welcome to contradict what has been repeatedly expressed on this site, and stated by Shannon also?

Tell us then that yes, Ablations are rarely not 100% effective even long-term.



Edited 1 time(s). Last edit at 08/03/2022 04:26AM by The Anti-Fib.

On this forum, ablations are rarely 100% effective, but the reasons for that are well known : happy patients very rarely come (back) here to tell they're fine.
Based on my on case, I'd say ablations are far from being 100% effective, even short-term, but it's me. And drugs are far far worse than ablations.
If I was sure it would be 100% effective, i'd run to the lab for a fifth procedure.

Quote
The Anti-Fib
You want to argue about semantics? your welcome to contradict what has been repeatedly expressed on this site, and stated by Shannon also?

I'm not arguing semantics; I'm arguing basic facts. I asked for a source and I didn't mean the experiences of people here. As Pompon points out, the people who have a successful one-and-done don't come here. They go about their lives and never think about afib. The published rates for successful first ablations of paroxysmal afib are on the order of 65-75%, and those are ablations performed by the entire EP community, not just the maestros. So 65-75% isn't "rarely successful" or even close to it.

This forum has thousands of members you don't see because they never post, and we get 3-5 new members per day, every single day. Many of those people are newly diagnosed with a scary disease they know nothing about and they've come here for information. So I get concerned when I see incorrect information posted, particularly when it's discouraging information. But that's why I asked for references. If you know of a study showing that ablations are rarely successful, I would love to see it. If it's a high-quality, credible study, I'll admit I'm wrong. Until then, I believe 65-75% to be the correct figure.

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Carey

You want to argue about semantics? your welcome to contradict what has been repeatedly expressed on this site, and stated by Shannon also?


I'm not arguing semantics; I'm arguing basic facts. I asked for a source and I didn't mean the experiences of people here. As Pompon points out, the people who have a successful one-and-done don't come here. They go about their lives and never think about afib. The published rates for successful first ablations of paroxysmal afib are on the order of 65-75%, and those are ablations performed by the entire EP community, not just the maestros. So 65-75% isn't "rarely successful" or even close to it.

This forum has thousands of members you don't see because they never post, and we get 3-5 new members per day, every single day. Many of those people are newly diagnosed with a scary disease they know nothing about and they've come here for information. So I get concerned when I see incorrect information posted, particularly when it's discouraging information. But that's why I asked for references. If you know of a study showing that ablations are rarely successful, I would love to see it. If it's a high-quality, credible study, I'll admit I'm wrong. Until then, I believe 65-75% to be the correct figure.

"So 65-75% isn't "rarely successful" or even close to it. "

I said "rarely 100% successful", not 'rarely successful'

Now who's arguing semantics? I don't see any difference between "successful" and "100% successful." When I say "successful," I mean 100% and so did the authors of the studies I'm referring to.

If an ablation only improves symptoms or reduces burden, I wouldn't call that ablation successful at all. Successful means no more afib, flutter, or any other type of atrial tachyarrhythmia.

It maybe successful for one’s 2022 version of their heart but everyone’s heart is always evolving and due to age, genetic disposition, environment, lifestyle etc new pathways not ablated before can start firing. So no matter how well one’s monkey cage was blocking signals, afib has no cure…just remission….hopefully for a long streak.

Carey: "I don't see any difference between "successful" and "100% successful."

So that entitles you to misquote me?

Actually I said "rarely 100% effective" and was referring to Ablations at large, not paroxismal.
If an Ablation was 100% effective, then after one Ablation procedure, there would be no more Arrhythmia ever.



Edited 2 time(s). Last edit at 08/04/2022 11:05PM by The Anti-Fib.

Quote
The Anti-Fib
So that entitles you to misquote me?

Actually I said "rarely 100% effective" and was referring to Ablations at large, not paroxismal.
If an Ablation was 100% effective, then after one Ablation procedure, there would be no more Arrhythmia ever.

Please lighten up. I didn't intentionally misquote you. All I ask is that you stop telling people ablations are rarely effective, okay? That's simply not true. They are 100% effective 65-75% of the time for paroxysmal afib and about 40% of the time for persistent. Those numbers have to be considered separately, and both of them are still nowhere near "rarely 100% effective." However you want to phrase it, that's just not an accurate statement.

Quote
Carey

So that entitles you to misquote me?

Actually I said "rarely 100% effective" and was referring to Ablations at large, not paroxismal.
If an Ablation was 100% effective, then after one Ablation procedure, there would be no more Arrhythmia ever.

Please lighten up. I didn't intentionally misquote you. All I ask is that you stop telling people ablations are rarely effective, okay? That's simply not true. They are 100% effective 65-75% of the time for paroxysmal afib and about 40% of the time for persistent. Those numbers have to be considered separately, and both of them are still nowhere near "rarely 100% effective." However you want to phrase it, that's just not an accurate statement.

I never meant to tell anyone Ablations were rarely effective. What I meant was that often single Ablations do not result in a permanent 100% cure of Arrythmia. Do you know how long and how stringent was the followup from these studies you are referring to? 18 months? 3 years?

For some unfortunate afibbers, even frequent ablation procedures do not always result in a 100% cure.

Not to scare the 3-5 new daily lurkers, ablation maybe 65-75% successful but according to this article quoting top rated hospitals and doctors, there is an increase of death rate after an ablation.
[www.tctmd.com]

“ Deaths After Ablation of Atrial Fibrillation ‘Concerning’ in Real-World Analysis
This should serve as a wake-up call that ablation is not a benign procedure and that operator experience matters, say experts.”

The issue is defining 100% effective or successful. One might think that it means "one and done forever". However, reality is that (just guessing here) almost all ablations are effective and successful, but for HOW LONG? My first was good for 13 years and my second is into my third year. I like to think that my ablations have been effective and successful.

I'm like Ken above in that I had two ablations from paroxysmal Afib 14 years apart, in 2007 and 2021, at ages 70 and 84, both from Dr. Natale. I consider both successful even though I might live long enough to need a third. I was hoping for one and done and I consider that happened to me twice.

Why should it be considered a failure if Afib rears its ugly head again after more than a year of NSR? I'd bet the average time between Afib recurrences is far more than one year. Hearts do continue to wear and degrade over time and we're lucky if someone can patch them up for a few more years every once in a while.

I seem to remember Carey saying that one year of NSR after an ablation means it was a success. Dr. Natale's NP quit requiring weekly Kardia traces from me after one year. I know she's still there and will respond should I need her and/or Dr. Natale in the future.

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susan.d
For some unfortunate afibbers, even frequent ablation procedures do not always result in a 100% cure.

It's a sad truth !

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susan.d
Not to scare the 3-5 new daily lurkers, ablation maybe 65-75% successful but according to this article quoting top rated hospitals and doctors, there is an increase of death rate after an ablation.
[www.tctmd.com]

“ Deaths After Ablation of Atrial Fibrillation ‘Concerning’ in Real-World Analysis
This should serve as a wake-up call that ablation is not a benign procedure and that operator experience matters, say experts.”

From the article:

Quote

He highlights a 2013 study showing that more than 80% of 93,801 ablations performed between 2000 and 2010 were done by operators doing less than 25 procedures per year.

I had a consult yesterday with Dr. Natale and Shannon, his NP. They continue to add safety measures that many centers do not use. Colchicine before and after ablation is now given to reduce inflammation. Apparently not all centers give Lasix and potassium and use collagen plugs. Also noted in the article that ablations are now being done on patients with more co-morbidities and:

Quote

Wazni noted that patients also have a responsibility, noting that they sometimes “choose convenience over excellence.”

“Patients aren’t doing their part in seeking out the best possible centers,” he told TCTMD.

Quote
Ken
The issue is defining 100% effective or successful. One might think that it means "one and done forever". However, reality is that (just guessing here) almost all ablations are effective and successful, but for HOW LONG? My first was good for 13 years and my second is into my third year. I like to think that my ablations have been effective and successful.

Your original ablation if successful after a year is monkey cage proof (scar tissue successfully placed as a barrier so firing can’t get through). However that ablation won’t protect you from areas not ablated if new afib pathways develop in other areas. Read Carey’s excellent post:
[www.afibbers.org]

Ken, 13 years is a gift. I wish I had ggheld’s success too. He to is very lucky. But it’s spilled milk for my bad luck with three ablations that were unfortunately unsuccessful and I have to accept it.



Edited 2 time(s). Last edit at 08/06/2022 04:06PM by susan.d.

Quote
Ken
The issue is defining 100% effective or successful. One might think that it means "one and done forever". However, reality is that (just guessing here) almost all ablations are effective and successful, but for HOW LONG? My first was good for 13 years and my second is into my third year. I like to think that my ablations have been effective and successful.

They have been. Ablations don't fail after a year or so. Once an ablation has proven itself successful by keeping atrial arrhythmias at bay for a full year without the help of drugs, it will never fail. The fence it created around your sources of afib will stand forever. However, afib is a progressive disease so new sources of afib can develop outside the area fenced in by the ablation. That's how you get afib again after 13 years, not by the ablation failing.