AF back……

Hi all,
Been keeping a low profile trying to get on with life unpreoccupied with AF.
6’ 4” 200lb healthy male 61 years old. PAF since 1999. Nocturnal/vagal. Average one episode a year between 2002 and 2017.
PIP Flec used to convert 2006 to 2008. Daily Flec 100mg bid from 2008 to date. Including post ablation to try to help the ablation hold (not a true success on that basis for many/most here - but I’ve been VERY grateful for the lower AF burden post ablation - AF had become a monthly phenomenon in 2018 prior to the ablation.)
Index PVI Bordeaux Sept 2018.
AF once since late in blanking period.
Back again now - started 5-15am yesterday. Still going 32 hrs later. 22 hrs longest previously.
Keeps alternating between a regular AT at 100BPM and AF at around 110 BPM. 50:50 of each so far.
Wonder if the AT is wholly or at least partially precipitating the AF………
In touch with Bordeaux keen to go back for redo. I recall PC here similarly needing a redo.
Biggest dilemma as I write - should I be trying to get a cardio version before 48 hrs ticks around?? (I am taking 5mg bid of elequis since yesterday morning anyway.) I’d like rid of the AF. But am curious to see if and when I convert! What do you folks think??
I took an extra 200mg Flec yesterday morning at onset but it simply didn’t work. Am considering trying again if I don’t go for a cardio version (potentially problematic here in the UK at the moment - if I presented with the 100 BPM regular rhythm I wouldn’t be surprised if they just sent me on my way with no CV).
Will provide a bit more info/detail later.
Cheers,
Mike



Edited 1 time(s). Last edit at 10/26/2022 08:18AM by mwcf.

I'll be surprised if they'll be willing to CV you with a rate of 110 and no anticoagulants until yesterday. More likely they'll just give you metoprolol or diltiazem and send you home.

I know it’s only a suggestion but drinking two 5.5oz low sodium V-8 and try to relax (Valium or biofeedback) has converted quite a few people. It’s possible to get an ecv without being on a NOAC if you can convince a dr to perform a TEE for current clots if any. Also if you had traveled outside the country recently many ER drs still won’t ecv you even if you are on Eliquis without a TEE. Happened to me in 2019. I needed a TEE. I just flew a 16.5 hour flight today so I know it maybe difficult even with a successful sealed watchman and Eliquis to get ecv if I get the wrong er dr.

Hey Mike, sorry to see you back here! No opinion, just wishing you the best!! George

Every re-occurrence of AFIB is like running in to your ex-girlfriend in the grocery store after the restraining order has expired.

Yeah, it's that bad.

Well….. still rocking and rolling with this episode….
But some interesting developments.
I am most privileged to have had Prof Pierre Jais in Bordeaux kindly review my ECGs (I’ve managed to get both alternating arrhythmias - the rough jagged classic 110BPM AF and a 115BPM AT it alternates with on 12 lead ECGs) and he concludes that I have highly likely got ‘atrial dissociation’ which is apparently super rare other for where people have a lot of aggressive ablations or extreme digoxin toxicity neither of which apply to me. As in one atria is fibrillating whilst one is running at a “very organised” 115BPM fuelled by a single rogue focus. I’m finding that the AT is increasingly driving the ventricles far more than the AF. This is lucky for me since whilst a bit fast the AT is only very slightly noticeable and, more importantly, is relatively easy to ablate. Pierre also agrees with my hopes that this AT focus (I’ve had this alternating arrhythmia situation ever since I started with AF over 20 years ago) is likely contributing to or even initiating the AF I get.
The downside is that being so organised the AT is unlikely to convert back to NSR unaided. So I need to get a DC shock organised in the next month or two. The AT has definitely become more established/dominant since my PVI 4 years ago than it was previously. Although I have often had episodes of AF start with a minute or two of fast AT. In the meantime it’s propranolol to try and get the 115 BPM down to 85 or 90, although I think I’ll be doing well to get it down to much less than 100 if my albeit modest propranolol intake today is anything to go by. I’ll head to Bordeaux for a redo either late this year or early next.
Will keep you all posted and thank you the replies. (Carey you were right as usual - they’d have only DC shocked if I’d been running a 210BPM AF or 1:1 Aflutter or suchlike.)
Cheers,
Mike

Try taking liposomal vitamin C twice daily, it has worked for me.
As an anti oxidant it reduced Oxidative stress


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