New Member Seeking Advice

Hi All-
I was diagnosed with Afib about a year ago, and have just crossed the rubicon to consider ablation. Sotalol and diltiazem seemed to have backed it into a somewhat predictable corner (episodes coming on roughly weekly, as I sleep, often converted via a moderate walk), but lately the walk hasn’t been as effective and I’ve had a handful of episodes that have lasted for multiple days. On Thanksgiving I contracted a pretty nasty respiratory virus (not Covid) that wiped me out for the better part of the weekend, and hasn’t quite relaxed its grip yet. It seems to have triggered an episode on Saturday night that still hasn’t converted. Even moderate exercise struck me as so unpleasant as to be unwise, but this evening I got fed up so walked purposefully for 20 minutes or so. I didn’t convert, but I was gifted with a pretty sharp thump at one point that registered more through my back than my chest. It kind of freaked me out, so I stopped the walk. I am also awaiting a follow up appointment with a sleep specialist in about 2 weeks to read the results of the sleep study I just performed (pretty confident it will show sleep apnea). My initial consult with the EP was, coincidentally, yesterday, with an expected ablation date of late January.

Basically, I’m fishing for insights/advice, here. Has anyone had a similar pattern where light to moderate exercise helped convert? My cardio’s PA seemed surprised when I told her that was a pattern that had been holding for me for multiple months. Also, as we’ve virtually all experienced, the sensation of Afib feels like our hearts are “weak”, and that the grim reaper is going to just take out its batteries at some random moment and that will be the end of things. I know intellectually that such a worry isn’t rooted in overwhelming fact, but it’s a sense that’s difficult to shake. The weird hard beat I had this evening shook me up on that score a little bit more. Any insights/advice/questions/comfort from the community on this? Also: sleep apnea. I would not be at all surprised if sleep apnea is responsible for bringing on my Afib. I am eager to get CPAP to see if it could help me feel more rested, but also see if it eases my Afib. Any thoughts/experiences on this? Lastly, ablation. I know it’s a pretty common procedure, but man does it make me squeamish. Is putting it off to see if CPAP or somehow dropping fifty pounds or whatever brings significant relief a ridiculous notion? Should I just go for it? And if so, I’m in Albany, NY: any thoughts on Dr. Ian Santoro?

For reference, I’m a 45 year old white male, 6’2, 260 lbs, middle school teacher, married father of three. Thanks for this forum, and for any advice you feel like throwing me.



Edited 1 time(s). Last edit at 11/28/2023 08:54PM by Ted S.

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Ted S
Basically, I’m fishing for insights/advice, here. Has anyone had a similar pattern where light to moderate exercise helped convert? My cardio’s PA seemed surprised when I told her that was a pattern that had been holding for me for multiple months.

I had my first afib episodes in 2004, at age 49. For a few months I could convert them with exercise, then I had an episode that lasted 2.5 months and was converted with flecainide. Over the years I've been here, this is not uncommon.

If appropriate for you, you might ask for an on-demand (PIP or pill in pocket) prescription for conversion see: [pubmed.ncbi.nlm.nih.gov] I've used flecainide sucessfully for 19 years this way. It could give you time to try lifestyle stuff.

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Ted S
Also: sleep apnea. I would not be at all surprised if sleep apnea is responsible for bringing on my Afib. I am eager to get CPAP to see if it could help me feel more rested, but also see if it eases my Afib. Any thoughts/experiences on this?

I've taped my mouth at night for many years. It can help with mild to moderate sleep apnea. In my case, I could see apnea patterns in my beat to beat heart rate without tape and it was smooth with tape. I have images here {image fixed on link} Anyway, it is a very simple solution if it works. The link is a whole thread on the topic.

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Lastly, ablation. I know it’s a pretty common procedure, but man does it make me squeamish. Is putting it off to see if CPAP or somehow dropping fifty pounds or whatever brings significant relief a ridiculous notion? Should I just go for it? And if so, I’m in Albany, NY: any thoughts on Dr. Ian Santoro?

LIfestyle can help. Don't know your doc, but we advocate finding the best ablating EP you can. See this pinned post.
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Edited 2 time(s). Last edit at 11/29/2023 06:46AM by GeorgeN.

If your Afib is vagally triggered (parasympathetic nervous system) aerobic exercise can sometimes convert you. I used to powerwalk to convert. It didn’t always work but often did. I also would get the occasional big thump and yes it was unsettling. Not sure what it was but I suspect it was related to Aflutter which I had as well as Afib—people often have both. Since you’ve only been diagnosed for a year and may have sleep apnea and would like to lose weight, it might be worth working on those before going for an ablation. Also, how about asking to try another drug, like Flecainide?

I waited too long (years) to get an ablation and my Afib became more complicated and harder to ablate. Still I traveled to one of the best EPs and so far so good. It does really matter who does the ablation. Good luck.

Thanks so much, George, for taking the time to provide those thoughts. I really appreciate it. Now to investigate “taping”…

Thank you, Daisy. I just messaged my doc asking for other conversion approaches. Maybe he’ll give me a script for a different pill to try; it’s getting tiresome!

Yes, sleep apnea is highly associated with incipient AF. Been there, and I have been on CPAP therapy since four months after my diagnosis of paroxysmal AF. The cardiologist had be undergo numerous tests until the only option left was an all-night stay at a sleep lab in the next city. Bingo...'severe obstructive sleep apnea', But there are other potential causes: high neck circumference (17" or more), BMI higher than 28, excessive epiglottal tissue, malformed jaw, poor occlusion, etc, etc...Even sleeping supine, on one's back, is bad for some and eventually puts them over the proverbial edge. If your pillow eventually forces your head upward, jaw toward the chest, you pinch off the trachea or higher. Sinus problems, allergies...the list goes on.

Exercise? Prior to my second ablation, when we were watching TV, if I got up to begin pacing, my wife knew I was in AF. Pacing helps...or helped me, anyway. If nothing else, the effects on my body of the footfall shock helped to mask the sensations in my chest wall.

My AF only progressed after its onset, which took place near the end of a 10K maintenance run. Once I had it under control, with metoprolol on low dose initially, it was well-controlled for the next three years. I had one or two episodes near the holidays two years running, at family Christmas gatherings (who said they are innocuous?!?), but eventually the episodes became truly intrusive and lasted longer. This was already three years into what I have come to learn is almost enviably good and effective CPAP therapy. My morning data shows me with an AHI of only 0.6 over five and a half years in therapy.

So as not to blow smoke on you, AF tends to be progressive. With other amelioration to correct concomitant problems and co-morbidities, you may get several good years with only metoprolol. I don't think George does anything more than to make sure he gets a whack of magnesium every day, and other than that it's PIP for him. You may need more intervention, and whatever it is may not last long, or be effective long. I advise you to go slow, learn all you can, monitor yourself, and get into the good books of a top tier electrophysiologist as soon as you can. If/when things go sour, you won't want to have to begin all the legwork and have to wait for several months before an EP sees you, and then another four months for the ablation...IF...he/she agrees to perform it.



Edited 1 time(s). Last edit at 11/30/2023 01:59PM by gloaming.

Deeply appreciate you sharing your experience with me. Very helpful. Any advice on how to identify the best available EPs in my area? Is there a data base or rating system specifically for ablations?

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Ted S
Thanks so much, George, for taking the time to provide those thoughts. I really appreciate it. Now to investigate “taping”…

This is the tape I use. It is pretty inexpensive and works well for me. My 33 year old daughter uses 1" 3M Micropore tape, which is available almost anywhere. There are other specialty tapes. Some find a tiny strip vertically works well enough. I find I need to tape horizontally across my lips for best results. You might try taping while awake for a bit to get used to it. I have a mustache and kind of come up under the mustache hair from the bottom. I wipe my lips off first. There are some stupid mouth taping videos on YouTube, so be careful what you pay attention to. If you have questions, post them and I can make suggestions.

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Deeply appreciate you sharing your experience with me. Very helpful. Any advice on how to identify the best available EPs in my area? Is there a data base or rating system specifically for ablations?

I don't know about Albany, but there are some big centers in reasonable driving range. Moderator Carey may have some ideas as he lives in the NE.

For lifestyle thoughts, this is a good book (I understand as haven't read it) and the authors are legit EP's. There are studies showing that lifestyle changes can reduce afib burden (time in afib).

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Ted S
Deeply appreciate you sharing your experience with me. Very helpful. Any advice on how to identify the best available EPs in my area? Is there a data base or rating system specifically for ablations?

There isn’t anything that’s reliable and objective, or at least comprehensive. But if you post your location and how far you’re willing to travel members will point you toward the closest top tier ablation EPs—they are well known to some of the senior member ps here. Many of us chose to get on a plane and travel to one of these heroes. The one I went to made it easy for those traveling from out-of-town, organizing things so that you could do it all in one trip. You sent your medical records, he reviewed them and then scheduled a video appointment, before you actually made the trip.

I had an immediate positive effect from CPAP therapy. I used to need afternoon naps - could barely keep my eyes open by 3pm. A good sleep study, whether in-patient or at home will help with a possible diagnosis. I havent gone a night w/o CPAP therapy in 6 years. I can't say it did or didn't affect my # of episodes, because a week after starting CPAP therapy, I had a Natale ablation.

I did have months of PVC's over a 9-12 month period in the last couple years, but they have diminished to almost none. Whether or not losing 15-20lbs. aided that reduction of PVC's I dont know. But weight loss is not a bad suggestion.

I would recommend losing the weight for two reasons. It may help with your AFIB, and it would help with your sleep apnea. For comparison, I'm 5' 11" currently weigh 215, I was at 250. Losing the weight did help with my sleep it didn't help with my AFIB, but I was already in constant AFIB at the time. It should also help with medication dosages.

Sleep apnea will contribute to AFIB being worse, get the CPAP because it should help.

Unfortunately, respiratory colds do seem to increase AFIB episodes. Hopefully, once you are over it, your AFIB will settle down to a more "normal" pattern. Be careful with OTC medications, some can cause your AFIB to be worse than others. I ask the pharmacist if I am not sure.

Find a way to deal with your anxiety, either a group you can talk with, this forum or others, and you could ask your doctor for something to help with it.

I would go for the ablation (I did), it is a fairly safe procedure and has had remarkable results with many people.

One thing not really mentioned is to try and eliminate stress. This is a big factor for a majority of people. Next up would be taking away things like coffee or other caffeinated drinks, at least until you can determine if it is a problem for you. If you smoke, just quit, it is a big problem with AFIB. Read through the site, there is a lot of good information here.

Try not to worry about it too much, you can get through it.