here we go again, looking for advise on where to begin

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GeorgeN
When you meet with your EP, you might request an on demand (also called PIP or "pill in the pocket") prescription for flecainide or propafenone, if appropriate for your situation. See the original paper here: [www.nejm.org] Note that for flecainide, the max dose is 300 mg/day for those weighing over 154 #'s (70 kg) and 200 mg/day if you weigh less. Flecainide is also commonly prescribed with a prescription for a beta blocker to mitigate a low probability of flec converting you to atrial flutter with 1:1 conduction. Propafenone has a built in beta blocker so doesn't need this.

If you had this and it worked for you, you would not need to be as concerned about having an episode. I've used flec this way for over 18 1/2 years.

Chronic fitness was my path to afib 19 years ago at age 49. I subsequently learned that for long duration endurance exercise, limiting my intensity to a "Zone 2" level made exercise not a trigger for me. See paragraph 2 in this post for more info. [www.afibbers.org] There is also a lot of beneficial reasons to train at this level.

Were there any common things you did before your episodes, like hard exercise the day before, increased alcohol consumption, high levels of other stress??

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gloaming
Yes, if your AF comes and goes, and if it reverts to NSR on its own (even after two or three days [..GULP!..]), it is considered to be paroxysmal. That is the best kind. However, the disorder tends to progress over time. People who feel they're getting away with the odd run now and then eventually, often, find suddenly that they're getting more frequent runs, and maybe also longer/intractable runs. If you're ever going to consider a mechanical repair, as opposed to continuing to rely on medications, the wisdom here is to get into a line with a competent electrophysiologist sooner rather than later. Do this before your repair becomes more tricky, or even essentially impossible. IOW, while you are still in paroxysmal AF, and when you notice that it is coming on more frequently, my advice would be to carefully consider a catheter ablation procedure.

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Marco
Thank you for the info. have you seen anyone else in their 30s doing the procedures you mentioned?

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Marco
As far as common things before the episodes, the first two times I elevated my heart rate suddenly. The first time by sprinting back home from a walk, and the second with a panic attack. However, this last time I had just finished a simple, short and light work out at the gym, 3 exercises 2 sets each with low weight. At the end of the work out I thought I would do a yoga pose called "corbra". As I was breathing in deeply, I felt something clicked and my heart started to race, and I was too scared to admit to myself it was again the Aifib. I do not believe this last time my heart rate was elevated right before the event. One thing I did, I had increased my DHEA 3 days prior the event, and I cannot point this as the trigger, as I did not notice any increase in heart rate with it the days before or that same morning. I have a doctor who is monitoring my hormones

What I believe has more to do with it, especially the first time and this last time, is a feeling that something is almost "stuck" in my stomach. As I was breathing in deeply for the cobra pose, I almost felt pushing either my stomach or something that clicked my heart into Aifib.
I was also experimenting for 3 o 4 days before the event, with mixing my protein powder I have along breakfast with heavy cream. No alcohol, I maybe drink a glass or two per year, some emotional stress the day before, but nothing extreme.


I personally don't even get to zone 2 cardio. Since the first episode in the 2020, I have been a bit scared to raise my heart rate above 115/30. I generally aim for 10'000 steps per day, ride the bike at moderate intensity, or walk up and down the stairs for 20 min or so. I do also some moderate resistance training, nothing too stressful.

I'm assuming the type of cardio training where there is a 30 to 60sec sprint, recover then repeat for several times, may not be the best for us, what do you think?

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gloaming
Marcvo: '..'m assuming the type of cardio training where there is a 30 to 60sec sprint, recover then repeat for several times, may not be the best for us, what do you think?'

Aerobic exercise is where you can sustain a pace almost indefinitely. Walking and even running can be aerobic, but as soon as your blood lactate level rises beyond a certain point, you will move into anaerobic exercise, which is much more strenuous for the heart. So, the cyclic sprinting or hill climbing, or stairs repeats, is likely to push you over your aerobic threshold, and you'll put more strain on the heart. Whether or not this means AF for you is up to you and your heart. Many find that they can walk with impunity, while others find that even laughing during a sitcom can set their heart off. Mine was the latter case.

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GeorgeN

As far as common things before the episodes, the first two times I elevated my heart rate suddenly. The first time by sprinting back home from a walk, and the second with a panic attack. However, this last time I had just finished a simple, short and light work out at the gym, 3 exercises 2 sets each with low weight. At the end of the work out I thought I would do a yoga pose called "corbra". As I was breathing in deeply, I felt something clicked and my heart started to race, and I was too scared to admit to myself it was again the Aifib. I do not believe this last time my heart rate was elevated right before the event. One thing I did, I had increased my DHEA 3 days prior the event, and I cannot point this as the trigger, as I did not notice any increase in heart rate with it the days before or that same morning. I have a doctor who is monitoring my hormones

What I believe has more to do with it, especially the first time and this last time, is a feeling that something is almost "stuck" in my stomach. As I was breathing in deeply for the cobra pose, I almost felt pushing either my stomach or something that clicked my heart into Aifib.
I was also experimenting for 3 o 4 days before the event, with mixing my protein powder I have along breakfast with heavy cream. No alcohol, I maybe drink a glass or two per year, some emotional stress the day before, but nothing extreme.


I personally don't even get to zone 2 cardio. Since the first episode in the 2020, I have been a bit scared to raise my heart rate above 115/30. I generally aim for 10'000 steps per day, ride the bike at moderate intensity, or walk up and down the stairs for 20 min or so. I do also some moderate resistance training, nothing too stressful.

I'm assuming the type of cardio training where there is a 30 to 60sec sprint, recover then repeat for several times, may not be the best for us, what do you think?


Some afibbers have "vagal/parasympathetic" triggers, some "adrenergic/sympathetic" & some both "mixed." See here: [www.afibbers.org] The sprinting & panic attack sound adrenergic to me, the cobra sounds vagal.

Briefly, an adrenergic exercise/stress trigger causes the afib to happen during the activity. Vagal episodes can happen later, when you are settled, resting or eating. Sometimes digestion issues can cause a vagal trigger, hence "What I believe has more to do with it, especially the first time and this last time, is a feeling that something is almost "stuck" in my stomach. As I was breathing in deeply for the cobra pose, I almost felt pushing either my stomach or something that clicked my heart into Afib" sounds vagal to me.

Some examples.

In January, I drove 14 hours through high winds, snow and very icy road conditions. After I finally quit for the night, I was all settled down & ready to go to bed and had an episode. I call this vagal as it was when I was resting.

I know not to do long duration high intensity exercise, however in March, I was skiing by myself and pushed myself on the aggressive off piste runs all day. Four or five hours after I got back to my accomodations & was ready for bed, went into another vagal episode.

Some folks can have a vagal trigger drinking a cold or icy drink quickly. Also indigestion or gas can do this to some people.

A friend was deer hunting, shot a deer and when he started packing it out on a steep hill, went into his first afib episode. This was an adrenergic trigger.

"I'm assuming the type of cardio training where there is a 30 to 60 sec sprint, recover then repeat for several times, may not be the best for us, what do you think?"

Depends on the person. I do a workout on a fan bike with 15 seconds as absolutely hard as I can go and then 15 seconds at 50 watts (recovery) and repeat 8 times. I don't have an issue with this. However a bunch of hours in Zone 3 or too many of the 30 to 60 second sprint repeats would create a vagal trigger for me.

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Marco
interesting, I assume the vagal/parasympathetic has something to do with the Vagus nerve correct?

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gloaming
Marco, yes, but it was getting more and more ornery with each passing week between the time I had my first ER visit since being diagnosed in 2017 and my first ablation last July. Then, in October, I had another episode, five weeks after the Holter monitor. By the time I had my second ablation, I was into atrial flutter and increased bouts of AF to the point where I was up to taking 175 mg of metoprolol from 25 mg inside of an eight week period.

Everyone is unique ( motherhood ), but AF is manifested differently between individuals as much as anything else two people can have in common. Some hardly progress at all with the disorder, whereas I seemed to be plummeting quickly and was becoming desperate to have a redo of my first ablation before I fell into persistent AF. We don't know what your trajectory is, or will be, but the advice stands: before this gravely affects your quality of living, and certainly before it becomes much more difficult to treat due to its evolutionary stage, you really ought to speak to a good EP and decide between the two of you if/when you should get into line and at least try one ablation.

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GeorgeN

interesting, I assume the vagal/parasympathetic has something to do with the Vagus nerve correct?

Absolutely.

Years ago, we had a virtual "Conference Room" here. This is a link to the archives: [research.afibbers.org]

One of our members, Peggy Merrill, created what she called "The List." Whenever somebody had some success in keeping their afib at bay and posted about it, she would reply with "The List" in the subject, so it could be searched later. Then she compiled all these stories here: [www.afibbers.org] This will give you a good idea of how varied a condition afib is.

By the way, on your question about age, we've had folks in their teens, twenties & thirties here (and my son-in-law got his first episode at thirty - now 37). Granted the younger people are less common that the older ones, but it isn't totally rare for younger people to get afib.

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Marco
do people who are paroxysmal get triggered by different things than those that trigger the other type of AiFib?

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Marco
Do people who are paroxysmal get triggered by different things than those that trigger the other type of AiFib?

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Marco

is the book below still the bear read on AiFib or you would recommend also something different?

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Do people who are paroxysmal get triggered by different things than those that trigger the other type of AiFib

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Daisy

do people who are paroxysmal get triggered by different things than those that trigger the other type of AiFib?


Paroxysmal just means that you aren’t in Afib all the time—that it comes and goes with varying frequency. So your onset for episodes could be vagal, adrenergic or mixed—most people seem to me mixed—but still paroxysmal unless you move into persistent Afib. The concept of lone Afib doesn’t hold anymore as researchers and clinicians have realized that Afib has underlying changes in the heart tissue—sort of fibrosis—that predisposes you to develop Afib.

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Marco
could then "this type of fibrosis" be the main reason why the heart goes into AiFib? do we know what cause the fibrosis of the heart muscles and how to reverse it?

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Marco
HI Daisy, thank you for your response. could then "this type of fibrosis" be the main reason why the heart goes into AiFib? do we know what cause the fibrosis of the heart muscles and how to reverse it.

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GeorgeN

could then "this type of fibrosis" be the main reason why the heart goes into AiFib? do we know what cause the fibrosis of the heart muscles and how to reverse it?


Here is a review article on atrial fibrosis from 2017 [www.ncbi.nlm.nih.gov]

Here is a rat paper from 2013 where they reversed atrial fibrosis. I'm not aware of any trials in humans. [www.ahajournals.org]

I think it is understood that persistent afib can create fibrosis (there is a saying, "afib begets afib"). Hence minimizing time in afib has always been my objective (I had a 2.5 month episode starting 1.5 months after my first 19 years ago).

From the forward by the late EP, Philippe Coumel, MD, to Hans Larsen's book you asked about earlier in the thread.

"Quite a few years ago, I suggested a pattern showing that cardiac arrhythmia results from the combination of three factors which can be identified anytime but hardly weighted in percentage.[2] This pattern involves a cardiac arrhythmogenic substrate {i.e. fibrosis}, influenced by the autonomic nervous system (ANS), with a trigger starting arrhythmia."

Fibrosis progression can be a reason that afib returns years after a successful ablation.

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Jeff W
Hi Marco. I understand your concerns and confusion. I have had afib for 17 years and it is gradually getting better because I am getting healthier and more respectful of my limitations. It’s really important to figure out what your triggers are. I know for me any stimulants or metabolic stimulants, such as Alcohol, coffee, chocolate candy, coq10, DHEA or even vitamin D3, food additives which is everywhere in processed foods Will predictable ftrigger my fib - just a clean, natural, whole food diet is best. It’s my philosophy that the body knows what it needs and just a natural diet is all it need. A lot of people play amateur chemist with supplements, and create more problems and confusion, that will certainly drive you crazy. Stay natural and your heart will be happier. . Jeff👍

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Daisy

HI Daisy, thank you for your response. could then "this type of fibrosis" be the main reason why the heart goes into AiFib? do we know what cause the fibrosis of the heart muscles and how to reverse it.

Another overlooked factor in creating fibrosis is significant mitral valve regurgitation. I head severe regurgitation (now repaired) and Dr. Natale warned me ahead of time that this would mean a more complex ablation. I also found articles linking fibrosis and severe mitral regurgitation.

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GeorgeN


is the book below still the bear read on AiFib or you would recommend also something different?



It is dated, but it reading it realizing that would give you an excellent background to start. I gave it to my son-in-law and my daughter to prep them when they had a visit with a military EP. Between that and coaching from me and moderator Shannon, they had a short visit and got exactly what they wanted, a script for on-demand flecainide.

I would also suggest this, written by two EPs.

Do people who are paroxysmal get triggered by different things than those that trigger the other type of AiFib

Pretty much if you are persistent, you don't get triggered as you are always in afib. That being said, paroxysmal afibbers can get triggered by lots of things.

In my case, my triggers are pretty limited - excessive endurance exercise, not enough magnesium or potassium or excessive psychological stress. In 2012, I increased my intake of calcium through food and other things became triggers including cold drinks consumed quickly, the time immediately after orgasm, being prone on my left side and also nothing in particular. Took me a year or so to figure out that calcium intake was possibly an issue. When I cut my calcium intake these "new" triggers went away. More recently, an increase in episodes has been associated with C19 vaxxes (both mRNA & old school). Of course, I have no proof as this has just been an association (& I've never had C19 despite visiting a relative in the nursing home 4-7 times/week for years & they usually have a "we are in outbreak mode" sign at the door). In any case, I started getting episodes with no apparent trigger, including one the morning after a J&J (non mRNA) shot. This was in 2021. After about 6 or so months in with this increase, I started on 50 mg flec/day in the evening. That settled everything down. As I'm a minimum effective dose person, I cut it to 25 mg/day after two months (EPs and the data suggest this should have no benefit). After 5 months I tried to cut to zero and had an episode after 4 days, so went back on 25 mg/day. Tried again to stop it after another four months and failed & then had an mRNA booster. So went back on the 25/day. Now, about 9 months after the booster, I'm trying again and am 10 days at 12.5 mg/day with two of those being 0 mg/day. My hypothesis is that I may be far enough away in time from the booster that any impact will be gone. I'll probably stick with the 12.5/day for a bit just to see if I do fail at zero, I could maybe come back to 12.5.

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Marco
thank you for the data. Would an eco pick up the fibrosis?

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Carey
Incidentally, I'm a big skeptic of triggers. They exist, but most people suck at identifying them. They are way too influenced by coincidences and tend to latch onto them based on a single occurrence. I've seen many people give up things for life that they enjoy based on a single incident, which was probably completely coincidental.

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Marco
was perhaps the calcium you were ingesting coming along with casein protein and lactose like you would find in dairy food? were the dairy products raw or pasteurized?

I remember seen in the forum last year some concern about calcium intake, but Calcium in the cells does not get overly activated by itself, I believe. Certainly, taking extra Magnesium would almost act as a calcium channel blocker though.

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Marco
To my understanding, triggers then are not really the root cause here, they are just the tip of the iceberg.

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GeorgeN

was perhaps the calcium you were ingesting coming along with casein protein and lactose like you would find in dairy food? were the dairy products raw or pasteurized?

I remember seen in the forum last year some concern about calcium intake, but Calcium in the cells does not get overly activated by itself, I believe. Certainly, taking extra Magnesium would almost act as a calcium channel blocker though.



Yes, I started consuming material quantities of brie cheese, the only dairy I was consuming. Subsequently I've not consumed any dairy as testing has shown sensitivity to it (even ghee, which contains no protein).

Steve Carr, an aussie, was very diligent about doing n=1 experiments to control his afib. Calcium reduction was part of his protocol. Here are his posts: [www.afibbers.org]

As to magnesium, I've taken a lot daily for over 18.5 years. It is a key part of my remission protocol. Any magnesium form will work for me, in sufficient quantities. I currently take around 4.5 grams a day (measuring only the magnesium, not the other elements of the compounds). Right now this includes 2.4 g from 2 tsp di-magnesium malate powder, 0.5 g from 2 tsp magnesium bisglycinate powder and 1.6 g from 3 tsp magnesium chloride as "magnesium oil." I make this as a supersaturated solution of magnesium chloride in water. My bowel tolerance to magnesium is unusually high. Most would be on the toilet all day from this quantity. There are people who "waste" a lot of magnesium, and I am likely one of these people.

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Marco
That is allot of Magnesium, do you ever check your serum and RBC? I checked my Mg RBC after the first time, and it was 4.9 on a scale 4.2-6.8, I generally supplement with 400 to 800mg daily, for the past several months probably only 300/400mg at bed time. I believe there must be a balance between Ca Mg, too much of one can interfere with the absorption of the other

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GeorgeN

That is allot of Magnesium, do you ever check your serum and RBC? I checked my Mg RBC after the first time, and it was 4.9 on a scale 4.2-6.8, I generally supplement with 400 to 800mg daily, for the past several months probably only 300/400mg at bed time. I believe there must be a balance between Ca Mg, too much of one can interfere with the absorption of the other


Serum mag is a useless test IMO. My last serum was in Dec 2020. 2.4 mg/dL range 1.7-2.6. Calcium on that test was 9.4 mg/dL with a 8.5-10.5 range. My last RBC mag was in Aug 2022 and was 7.2 mg/dL. It usually runs in the 7's, which I'm well aware is high. I titrate intake to a level that keeps afib at bay. When I try to back down on quantity, afib can rear its head. So the dose is empirical for me. I also have a number afib and non-afib friends who are in the multi gram range for mag. A hair mineral analysis done at the same time showed high calcium. When I started this afib journey, in 2004, I got an ExaTest (intracellular) which showed mag as off scale low, I haven't repeated this test as it is more of a pain to organize getting (need to find an integrative doc who will order it, and so on).

Mag bowel tolerance is very individual. My wife tops out at 400 mg/day & know people who top out at 200.

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Marco
very interesting about the hair test picking up high calcium. Perhaps some experts out there are right about staying completely away from Calcium. I usually keep my calcium intake about 600 mg daily tot, from food and a bit of bone meal. With my magnesium supplementation the ratio goes in favor of magnesium.

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GeorgeN


Some afibbers have "vagal/parasympathetic" triggers, some "adrenergic/sympathetic" & some both "mixed." See here: [www.afibbers.org] The sprinting & panic attack sound adrenergic to me, the cobra sounds vagal.


HI George, does the vagal afib present itself with lower heart rate compared to the adrenergic?

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Marco
HI George, does the vagal afib present itself with lower heart rate compared to the adrenergic?

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sldabrowski
Hi, I was diagnosed with AFIB at 30. Ablation was not available at the time. I waited until I was 58 to get my first ablation when meds no longer worked and ablations results were getting better. Wish ablation was available back then. So much advancement on the procedure and treatment options. I do not think age is a factor. As you will see in the forum, this condition is unfortunately progressive for many.

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GeorgeN
See paragraph 2 in this post for more info. [www.afibbers.org]