Is AF Necessarily Progressive?

Perhaps not strictly, not in every case, but in enough that a recent paper pretty much sums up what we know about the evolution of AF. I have had some disagreements on the Mayo Clinic's site's Connect forum about this topic. I hate to see that I was pretty much correct:

[www.nejm.org]

Not progressive to date for me.
Last touch-up ablation 5 years ago, no meds (just Pradaxa), and I'm still averaging 5-6x 1h AFib/month. Mostly while digesting or resting.

Well, I certainly hope not – but I understand. However….quote: “ Never say, ‘never.”

My history

In 1995, at age 59, I had my first AF event starting with “infrequent “and progressing to
much more regularity. After eight years of escalating frequency, I had my first ablation with Dr. Natale
when he was with the Cleveland Clinic. I live in a distant suburb of Cleveland, Ohio.

2014 - A-flutter surfaced– ablated by Dr. Natale (Austin, TX) along with LAA isolation. On half-dose, Eliquis for life.
2015 – Natale flutter touchup.

I focus on a core group of heart-support nutrients as well as those for overall health plus protocols for
‘seniors.’ My Functional Medicine MD who does the Genova Intracellular Diagnostics testing for me
said at my last visit… “take all the CoQ10 you can afford.” Soon, I hope to be sharing a post that elaborates
on that focus.

Jackie

I went from 2002 to 2008 having only 1-2 episodes per year that always terminated on their own in 6 hours. And then things changed. By 2010 I was having weekly episodes lasting 12+ hours.

I think the answer is yes, it's always progressive, but how the progression manifests itself varies among individuals and it also varies in one individual over time. You might go years with no change, but odds are it eventually will.

Hi, Jackie,
I'm now taking CoQ10, something I never tried before. Too soon to comment about the effect of this supplementation, but I'm curious to read more about that stuff.

The heart, especially, is a BIG user of CoQ10 in much the same way that one's brain uses up the lion's share of available glucose in circulation at any one time. If you are taking a statin, you should most assuredly be on 100mg/day of CoQ10.

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gloaming
The heart, especially, is a BIG user of CoQ10 in much the same way that one's brain uses up the lion's share of available glucose in circulation at any one time. If you are taking a statin, you should most assuredly be on 100mg/day of CoQ10.

Thanks for your comment. No statin for me, but I'm with 100mg CoQ10/day.

Almost exactly six years since afib started. I was training for my 4th triathlon at 61, and bam afib started in the early morning. My first year with afib was a living hell with 77+ episodes. Spent the first 1/2 of the year sleeping sitting up to try to mitigate. Luckily most episodes resolved within an hour.

Started the magnesium, quit the intense exercise, fixed diet, and quite alcohol (maybe one beer a month). No meds, but have a chads score of 1 due to being > 65. Second year 10, third & fourth year 7, fifth year 4, and this year zero episodes!!!! This year had a tooth pulled, an implant inserted, and a colonoscopy with no problems.

Hoping I can keep it at bay

Strongly recommend Dr. Jon Day's book.

It's often progressive, but not always. The problem with the statistics is that only the one's that progress get entered into the medical system. They are also the ones that tend to participate in forums like this. Those with only a single episode, that say got cardioverted successfully, may not need any support. I personally know one person in their seventies who only had one episode in their twenties and none since. There would be no record of that person in any afib follow up. I know another in their 70's who has only had two episodes, both over thirty years ago. In my case, afib was indeed progressive, however it took over 40 years to progress from one episode every ten years, to the point where I needed medications and finally an ablation.

Jim

I think when you hear of people who had one isolated episode of afib and then never another, that episode was most likely due to a temporary electrolyte derangement, usually brought on by dehydration. The most common example of this is "Holiday Heart Syndrome". I think these episodes are a completely different thing because there is no underlying atrial myopathy like there is with people who have continuing episodes, and hence no progression.

Jim wrote:'...The problem with the statistics is that only the one's that progress get entered into the medical system. They are also the ones that tend to participate in forums like this. Those with only a single episode, that say got cardioverted successfully, may not need any support....'

This might have a lot of truth to it. Also true is that some patients die because they're undiagnosed, or expire before getting intervention, or get an initial intervention, but then go on to die due to their heart arrhythmias. Many years ago, someone wondered why the medical community was so successful at treating AF. That person began to sniff around and found that a great many simply didn't get back for follow-up because they had died. So much for success. So, yes, the data are undoubtedly wanting, but the point is that the data show a marked tendency for evolution, almost always towards poorer outcomes.

Mine has regressed, not progressed. Initially, for 2 months, I had episodes lasting 6-9 hours every 10-14 days. Then I had a 2 1/2 month episode, so the first 4 months, my AF burden was 57%. Then I implemented a remission protocol that I still follow, but continue to tweak. A month later, a 20 hour episode. Subsequently, I've had mostly "good" years with an AF burden of < 0.03% and even "bad" years it is 0.6-0.8% (and there have only been a couple of "bad" years in 19). One bad year was associated with an increase intake of calcium from cheese which I subsequently figured out & quit the cheese. Another with 4 C-19 vaccines.

My Afib started with a big swig of Starbucks coffee, sitting in the car on our way back from our daughter's lacrosse game. I went on to have Afib fairly often, but could always - always, stop it with a brisk walk. I went "into gear",( meaning NSR) after I got to a certain speed, I guess. Because I could make it stop, I kept putting off doing anything about it. After getting to the point where I was getting Afib every single day, usually twice day (again, I could make it stop...just couldn't prevent it), and my husband needing care (lung cancer), I finally decided to get an ablation by Dr. Natale. That ended up being a LAA ablation, as I had extensive Afib. I believe Dr. Natale said two of my pulmonary veins (?) had self ablated due to all of the Afib I had (at that point, it had been at least a year that I was getting it twice/day, so that would be hundreds of AFib episodes before having the ablation).

While getting an acupuncture needle in my left shoulder about 8 months later, I went in to Flutter. Had a touch up with Dr. Natale in June 2014, and have been Afib free ever since. (Had the Watchman implant in January 2022 and Dr. Natale said everything still looked just fine).

Barb

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tobherd

While getting an acupuncture needle in my left shoulder about 8 months later, I went in to Flutter. Had a touch up with Dr. Natale in June 2014, and have been Afib free ever since. (Had the Watchman implant in January 2022 and Dr. Natale said everything still looked just fine).

Barb

Do you know if the Flutter was typical right-sided flutter or atypical left-sided flutter? How long did the "touch up" ablation last and were you under General Anesthesia (tube down throat) or conscious or monitored sedation? Thanks.

Jim

HI Jim - I don't know what kind of Flutter it was. When I got it, it was the one and only time I had to be cardioverted, and that only lasted 2 weeks. The "touch up" ablation wasn't that long, and I recouped very quickly afterwards. I remember my sister and I walking downtown either later that day or the next morning....I'm sorry I don't have more detailed information. It must've been general anesthesia, but then again, I I was up and about pretty quickly. Compared to my original ablation, it didn't feel like a big deal.