How to reverse persistent AFib?

Hello- I am a new member. I have been in and out of persistent aFib since 2021. I have had one ablation in 2022 that lasted for 1 and1/2 years.
I was then cardioverted in March of 2023. That kept me in sinus rhythm for 11 months. I am now back in persistent afib since January of 2025.

My cardiologist and EP, want me to start on Tikosyn (anti-arrhythmic drug). I really don't want to go down that road.

I am 65, very healthy, eat well, take good care of myself etc etc. Low blood pressure, no high cholesterol, all my biomarkers are good.

My Afib is very tolerable with my meds (metropolol, lisinprol and elliquis). But I know it is important to try and get back into sinus rhythm.

Any and all advice would be greatly appreciated.

I am considering going down to Boston (I live in Maine) for a second opinion...

Thanks.

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arleenkilo
Any and all advice would be greatly appreciated.

An MD with afib posted here a while back about using magnesium to convert his persistent afib & stay in NSR. He wrote a book about the experience. I'm not suggesting this would work for everyone, but the approach meets my criteria of low long term downside with good potential upside. My only caveat would be anyone supplementing with electrolytes should have good kidney function (healthy kidneys will excrete excess electrolytes).

Magnesium is foundational in the afib remission protocol I created for myself 20+ years ago and continue to follow to this day.

I have no particular advice above what George has offered. Obviously, your heart's disorder has continued to evolve and you have established a new focus/re-entrant for the recurrence of AF. I tell people that if they are normally in NSR, AND...not suffering unduly from symptoms, then they could just as well do nothing except maybe to mitigate their risk of stroke with a DOAC. In my case, and in many cases, it's the symptoms that drive us to literal distraction. You say you can tolerate how it feels. If so, and you're willing to incur the other risks accompanying progressive AF, it's strictly your call. Or, maybe you can try flecainide as a PIP (pill in pocket) if that is something your cardiologist or EP is willing to consider for you.

If it were me, I'd be quickly on a list for another ablation. It took two for me, but I am now in NSR going on 27 months. I dread the thoughts of recurrent AF, and I know it's probably going to happen before long (strictly on the basis of probability). I believe the gentleman who performed both ablations would take me on again, and in fact he invited me to contact him directly if the need ever arises when we had our parting debrief over the phone. If you have a relationship like that, would you consider trying a third ablation? It's not unheard of, especially on this site, for people to claim three, four, five, even six.

Thanks George. I do take magnesium daily. I have read that book as well as another book that suggested Magnesium infusions. "The symptoms drive us to distraction"...Yes! I also have heard so much about all the bad side effects of not being in NSR. They are linking long term Afib to dementia now

My EP told me that another ablation would more than likely be unsuccessful. He claims that people who have persistent afib will just not stay in NSR. Maybe it's time for a second opinion?

I would be curious to know what your afib remission protocol is. I do the Sinatra protocol, as well as mag, phosphorus and D3.

My reply to George was also meant for you as well! Thanks for your insight. My fear of staying in Afib can be all consuming.

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arleenkilo
My EP told me that another ablation would more than likely be unsuccessful. He claims that people who have persistent afib will just not stay in NSR. Maybe it's time for a second opinion?

Certainly yes. Read Carey's post here. Pay attention to the EP who fixed Carey - he is one I would recommend for a persistent afibber's ablation.

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arleenkilo
I would be curious to know what your afib remission protocol is. I do the Sinatra protocol, as well as mag, phosphorus and D3..

My path to afib was excessive endurance exercise. My first episode was at age 49 in 2004 after a delayed trigger from a training run on a 14,000' peak. Two months later, an episode started that became a 2.5 month persistent episode. During that episode, my EP suggested I just stay out of rhythm as my afib heart rate was < 100 BPM. I suggested a "Plan B' that included converting me, changing my training, supplementing with electrolytes and a script for flecainide to be used on demand to convert me when the rest of the plan failed ( original 2004 paper on flec on demand note max dose is 300 mg/day for those over 154#s/70kg & 200 for those who weigh less). EP agreed and I used a loading dose of flec to convert that episode. I had to work out dosing for the electrolytes as well as training for myself. I'd record beat to beat (R to R) heart rate with a chest strap during meditation. I could "see" PAC's & PVC's. I would count them and keep track of PAC & PVC counts/hour. My objective was to minimize them. What I settled on was magnesium to bowel tolerance, 4 grams of potassium (2 tsp of potassium citrate powder) in a liter of water I'd consume over the day (my version of "timed release"), 1/2 tsp of taurine powder. I later learned that excess calcium would (for me) lower my threshold for afib, so a kept that between 400 & 500 mg/day from food (no dairy). For long duration exercise, I limited effort to what is now known at "Zone 2." Basically always nasal breathing, including taping my mouth shut at night. Short duration high intensity interval training was not an issue and I continue that now at age 69 (& also nose breathe for that as well, now). I've had some perturbations along the way, including an association with C 19 vaxes & a lot more afib (i don't take more of them now). My wife went to see her 40 year old hairdresser yesterday. She asked the woman what she'd done over spring break. The answer - getting a PFA ablation for afib that was associated with a C 19 booster. Her EP said this is now known. Most years following this protocol, my AF burden is < 0.05%.

I have persistent a-fib after an ablation. I'd love to take flecanide or Tikosyn but my heart has problems that rule out both of those. So I'm going to try another ablation. (I've tried amiodarone and it didn't help me.) My electrophysiologist does not think that persistent a-fib will cause an ablation to fail, and he thinks my prospects are good with a second one. I urgently hope he's right!
I think more opinions are good, and Boston is pretty in the spring!

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GeorgeN

My wife went to see her 40 year old hairdresser yesterday. She asked the woman what she'd done over spring break. The answer - getting a PFA ablation for afib that was associated with a C 19 booster. Her EP said this is now known. Most years following this protocol, my AF burden is < 0.05%.

I am listening to an intersting presentation on another (not ivermectin) Covid19 treatment other than vaccines.

Here's the link.
[www.youtube.com]

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TomR
I am listening to an intersting presentation on another (not ivermectin) Covid19 treatment other than vaccines.

Here's the link.
[www.youtube.com]

Gauging by my default standard -- that the quality of the comments tends to reasonably reflect the quality of the content -- one would have to color me dubious, here.

YMMV, of course.