Interesting breath-hold conversions

I've posted a number of times about breath-hold conversions. Including here and here. My working hypothesis has been that it is high CO2 levels that are the mechanism, and in the first link, I posted a link to a paper where they demonstrated that high CO2 levels in breathing air in sheep were protective against afib. My general approach was to do a "Wim Hof" style breathing practice which is 30-40 hyperventilation breaths followed by an exhale breath hold for as long as possible, lastly followed by an inhale breath hold of 15 seconds. Then repeat the sequence. What I have noticed, since I commonly have one or more monitors on during an episode, including beat to beat heart rate and SpO2 every 4 seconds, is that conversions will happen during the inhaled breath hold. In Wim Hof sequence, at the start of the exhale hold, CO2 would be low and then continue rising to the end of that hold.

Monday, a friend, Nick Heath, who is a T1 diabetic PhD & a breathing investigator sent out his weekly email on breathing. In it, he noted from a study:

"Inhalations: Sympathetic
Inhale-Pauses: Parasympathetic
Exhalations: Parasympathetic
Exhale-Pauses: Sympathetic (I had never actually thought about this one and just assumed it was parasympathetic.)"

The Inhale-Pauses: Parasympathetic was something I wasn't aware of. I wondered if that could be the reason I was converting on the inhale-hold.

Turns out I was on a week ski holiday last week. My wife's hip was acting up, so I would ski by myself & then return and do something with her that didn't cause her hip pain. While I thought I was being conservative on Monday, always nasal breathing (even at 12,000' - 3657 m), however I was pushing pretty hard with a lot of off pisté runs of the double black flavor. In the evening I did take 25 mg flec with dinner. As I was getting ready for bed, I noticed I was getting a couple of ectopics every minute. This is usually an indication for me that an episode is likely. I took another 25 mg flec and went to bed. Immediately after turning out the light, I realized I was in afib. So I got up and chewed 150 mg of flec (to get to my PIP dose of 200 mg) along with some magnesium chloride ("magnesium oil") that is my habit with PIP flec. I took a Kardia reading and put on my Polar monitor and started recording beat to beat. After a few minutes I decide to get prone and given the info on inhaled-holds being parasympathetic, started doing "triangle" breath holds. I was listening to a 6 second timer, so I would slowly inhale for 6 seconds, do an inhaled-hold for 6 and then a 6 second exhale & repeat. Though my app records beat to beat heart rate, a moving average is displayed in real time. This takes out the high afib variability. I immediately noticed the average rate was slowing down. I continued with the breathing. In maybe 3 minutes or so, I converted for short while, then went back into afib. I was intrigued & continued the breathing. I converted for good a minute or so later. I continued the breathing for a few more minutes to make sure it stayed in NSR.

The five or six minutes to convert is unusual for me. With PIP flec, I'm usually looking at an hour minimum, could be two, three or four hours as it was in January, I'm not sure much of the flec had time to get into my system.

Following are heart rate vs. time graphs, NOT ECGs.

Here is what it looked like on on the phone app - very smoothed:


Here is an Excel plot of the data, after the fact. Blue lines are beat to beat heart rate and orange dots are a 10 beat moving average.


These next two are from ancient Polar software made for looking at these data. The second graph zooms in on the conversion.




I don't know that there is any magic about 6 seconds, but this is very comfortable for me. Thought I'd post this as it might be something others could experiment with. It is also interesting as this was clearly a delayed vagal trigger & I didn't think a parasympathetic approach would work for me (none of the common vagus stimulation approaches like valsalva work for me).

You can use this app (iOS or Google) to time your breathing. In the Custom section, you can set your own times for inhale, inhale hold, exhale, exhale hold as well as total duration of the session.



Edited 4 time(s). Last edit at 06/24/2023 01:06AM by GeorgeN.

Impressive as hell George. Well done.

Thanks for the valuable information (as always).
Hope I don't need to, but I'll definitely give it a try next time AFIB strikes.
One issue with me is I am very symptomatic to the point of not being able to lay down; the flopping in my chest is too much. I have tried half heartily in AFIB to take deep breaths before. When I hold the breath, my heart feels like it's jumping out of my chest so I stopped doing it. Do you have this issue George??

Thanks

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MikeN
One issue with me is I am very symptomatic to the point of not being able to lay down; the flopping in my chest is too much. I have tried half heartedly in AFIB to take deep breaths before. When I hold the breath, my heart feels like it's jumping out of my chest so I stopped doing it. Do you have this issue George??

I could see this making it much less comfortable. Fortunately, I'm not highly symptomatic. I do Wim Hof breathing fairly frequently. Noticed it was much harder to extend the exhaled breath hold when in afib. When afib would convert to atrial flutter (which is much more regular, though fast), I could hold the exhaled hold much longer.

I picked 6 seconds for the "triangle breathing" randomly. I've done "box breathing" with much longer "sides" (inhale, inhale hold, exhale & exhale hold) when not in afib. When I do this I try to do light breathing. Meaning low breathing volume. I do breathe through my nose and into the lowest lobes of my lungs, but I don't do "big" or large volume breaths.

As I have posted before, I too have successfully used Georges methods to covert, using Flecainide PIP simultaneously.
Only 25-30% success rate, but since I try on successive nights, I have been able to forgo an otherwise necessary Cardioversions, as I have been 95% persistent (not converting on my own) with my episodes in the past.

Take it seriously if you try it.



Edited 1 time(s). Last edit at 03/27/2023 09:30PM by The Anti-Fib.

I may not have held my breath long enough, but I did try, essentially, this technique months ago and found it to be generally unreliable. I would be happy to learn of many successful uses of it.

Hi all. New afibber here. As it happens was able to convert myself twice using the box breathing technique.

Same observations as George. Have ectopics before it starts. Use half a Metoprolol to lower heartrate but during the 2 times it converted during box breathing before meds could have worked.

It doesn't always work but I seem to be able to shorten an episode with box breathing.

The Wim Hof method Was too hard for me. I read hyperventilating can be dangerous to some folks?

Anyway, Nice post!

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hds
The Wim Hof method Was too hard for me. I read hyperventilating can be dangerous to some folks?

Sure, not ideal for some. Both the low CO2 of hyperventilation and high CO2 of the long extended exhaled breath hold could be a trigger for some, especially with anxiety. The "triangle" approach I was describing above (box with no exhaled breath hold) should be pretty safe for most, especially if they adjust the time for the legs of the triangle to something they are comfortable with.

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GeorgeN
ISo I got up and chewed 150 mg of flec (to get to my PIP dose of 200 mg) along with some magnesium chloride ("magnesium oil") that is my habit with PIP flec.

How much and how do you apply this? I have tried to find info how many mg is absorbed by the body per spray (or whatever measure). I wonder if it is possible to overdose on Magnesium. Thank you!

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hds
How much and how do you apply this? I have tried to find info how many mg is absorbed by the body per spray (or whatever measure). I wonder if it is possible to overdose on Magnesium.

I've used magnesium supplementation for over 18 years as key part of my afib remission protocol. Assuming you have health kidneys (healthy kidneys will excrete any excess, unhealthy will let it accumulate in the serum, where it can be a problem), then too much magnesium most likely leads loose stools. I have an extremely high magnesium bowel tolerance. I probably take something north of 3 grams/day & have taken over 5g/day at times (when I first started, I found the writing of an obese T2 diabetic physician who got rid of his T2 neuropathy by consuming 5g/day for a year). As to form, for me, any form works in sufficient quantity. I've taken oxide, hydroxide (AKA milk of magnesia), glycinate, citrate, gluconate, malate, bicarbonate (as a liquid), acetate, sulfate (Epsom salt), chloride & I'm probably leaving something off. For chloride, I make "magnesium oil" which is a supersaturated form of Mg chloride in water. That night, as I recall, I took 3 or 4 tsps of it orally (tastes very bitter). I haven't bothered to weigh everything on a milligram scale and figure out what that represents. On a daily basis, I currently take 2 tsp of di-magnesium malate powder (about 2.4 g Mg), 2 tsp magnesium bisglycinate powder (0.5.g Mg) and 3-7 tsp of the magnesium oil (? g Mg). The Mg chloride I use are flakes that are source from Japan. They use it to coagulate tofu and call it "nigari." I purchase it in 20 Kg bags. I'm just finishing one and have an unopened one in my garage (I had a chemist friend analyze on a mass spec machine for heavy metals & it was very clean). I purchase the di-magnesium malate from an equine vendor in 14.6# bags. It is made to human consumption standards.

This is very useful information! Thank you for taking the time to write this up.

I have healthy kidneys.

I assume careful experimentation is needed. Maybe will start with one spray on leg. And gently increase it.

Currently have an episode.

Fascinating GeorgeN!

Just so happens I went into Afib upon waking two days ago (rare for me in terms of time of day), which was two days after a four-days straight of feeling sorry for myself resumption of nightly nightcaps.

Later that day I took a nap. When I awoke from the nap, somehow instinctively, I rolled to my left side a little (where I was slightly on my back and slightly on my left side) and took a very slow breath in while I slowly arched my back (to a looking up position slightly...arching backward at the thoracic spin level).---

NOTE: Normally laying on my left side makes Afib worse and can even bring it on during the first half of the night. During the second half of the night, I can pretty much lay in any configuration.

---I didn't take a full deep breath, maybe just 3/4 full. I held it very lightly trying not to create a Valsalva maneuver. I then just held it there for a couple of seconds...almost like someone would hold a toke. I could feel inside that it was "good." By good I think I may mean parasympathetic perhaps???

After maybe 4-6 seconds I converted. I then lay very still in that same position for about a minute to make sure I wasn't going to jinx it by moving around to herky-jerky-like.

I'm so stoked I did that without having read this post prior. I think that makes my experience a mild form of randomization in relation to yours I think