A couple of questions arisen during fear phase of AF attack

This morning, upon getting ready to depart for ER after fearing my latest AF episode would become permanent it self converted after 16 2 hours. So am now again in the second fear phase of waiting for highest chance for stroke 72 hours period to pass. This incident I believe was triggered by alcohol on empty stomach while awaiting table in restaurant and thus I was stressed over delay getting seated and then ate large Italian dinner. During the fear phase of last nights episode a couple of questions came to mind that possibly some posters on this site might be able to answer: 1.) Of the many on this site who have dealt with Dr. Natale (foremost in ablations) ---- has anyone ever asked him for his expert opinion re wide use of Digoxin prescribed for AF and its possible proarrhythmia effect? And, 2) Poster’s on this site frequently mention their episodes and duration but I have never read of a stroke afterwards --------- can it be presumed those who did have strokes were debilitated and thus not able to describe? I will, of course, ultimately, Per #1, be in a position to ask since I must beat this thing and ablation is the way to go that is if my concern in #2 does not precede!

Finally. This AF episode was the easiest to contend with as far as symptoms -------irregular heart beat pattern seemed more akin to PACs. I can only attribute the gentleness of this attack to the high levels of Chelated Magnesium I have been taking over the past couple of weeks. Lost count but I must have taken in excess of a dozen during last nights attack.

Stephen

Correction of typo error------------ was 16 1/2 not 162 hours. Im sure if 162 hours I would not be in any shape to write.

Stephen

Stephen -

I am under the impression that blood doesn't start clotting until about 48 hrs after onset of an afib episode. If this is so, then your 16 1/2 hr episode should not warrant fear of stroke. Someone please correct me if I am wrong.

Lorraine

Stephen,

Earlier this year I had an episode that lasted 35 days (840 hrs). I don't believe I took aspirin or anything else to prevent clotting (not a good idea in hindsight). I have never heard of anyone suffering a stroke as a result of an episode of A-Fib, but as you point out such an event might by itself account for not hearing from a person who had.

My impression is the same as Lorraine's. The critical period occurs some time after the episode ends. While I do take aspirin when I remember to do so, I don't feel it is critical to start as soon as the episode starts. This may just be laziness on my part, and I'm not advising anyone to go counter to what his or her cardio/EP has instructed. I guess I'm just saying follow whatever advice you have been given and try not to worry too much. Fear itself is probably harmful for the condition.

You touched on digioxin. I have never used it but the propafenone I had been taking daily had become pro-arythmic and I feel much better since I have gone to using it on demand only. My episodes are on average shorter and almost entirely at night, i.e., they begin AND end at night! The SAME night!!

John S.

People, trust me on this, I passed a clot and was lucky to only lost most of my kidney. At the time, my AF lasted only about 20 min. to 1 hr. max. so, don't believe the thought that no clots are formed for at least after 48 hours, for me it was not trure.

JRBABB

JRB,

Myself and a LOT of other people here sure will be hoping that you're the exception rather than the rule!!

Can you please clarify whether or not youy were using fish oil and/or other nutritional forms of blood thinner at the time of your clot? How long ago was this? How frequent were your AF episodes at the time?

Mike F.

2 things come to mind on this topic. The first is, of course, that i am glad JRB has survived to tell about this, and i second Mike F's questions about what exactly you were doing [supplement-wise] when this happened.

3 things, actually. Is there anybody else in this reading audience who has had a stroke subsequent to an afib attack? If there is only one, that is very significant.

The third thing is, Stephen's description of 'the fear phase' of an afib attack seems to me like useful terminology. One of the worst things about an afib attack is the deep visceral fear involved in it. It is this, i think, that distinguishes lone afibbers from the [apparently very large] group of afib sufferers who are unaware that anything unusual is going on.

4 things, it turns out. Hans, maybe this question is for you to answer. How many people are regular respondents to this board?

Peggy

Peggy,

Good question. Also, given that there are 2.2mn AFrs in the US who are diagnosed..... makes you wonder how many more people in the US have undiagnosed AF and either dont' know about it, or don't feel symptomatic enough to bother going to the Doc.

Mike F.

JRB, is it possible the clot was caused by something else, or that you were in afib prior to the short attack for some period of time? According to the medical journals that you find links to here, clots should not be an issue until somewhere in the 48-72 hour time period. I wonder if there were other contributing factors?

JohnS-I have been considering taking propafenone only when I have episodes, but haven't researched it yet. I know the purpose of the drug is to help regulate regularity of the heart rate, but I don't know how long it stays in the system. For instance, I only afib late at night, and generally only in connection with gastronomic distress. At first, a couple of years ago, I was taking propafenone 3 times daily, 150mg, I think, and then went down to 2 times daily, morning and night. I am wondering if the morning dosage does any good. My episodes for the last few years last a few hours only, and I don't want to experiment and put myself into afib for an extended time.

Does anyone have any info on this or links to good sites? Thanks, John.

The other real creepy thing about the risk of stroke is just what Stephen and John S mentioned, that of course we only hear from the people who either never had a stroke, or were still able to communicate afterwards. This thought first ocurred to me way back in '99 when i had my first attack and was doing internet research to try and find out more about what it was that was the trouble with me. If this site existed then i didn't find it. I wish i had, it might have saved me a lot of trouble, worry, and expense.
Peggy

What I'm endeavoring to establish from any posters who experienced strokes from AF episode and sustained faculties to report to this site is simply ------ how long after AF attack did their strokes occur? Thus, what should the fear of stroke time frame be. Medical literature varies from being in AF for 24 to 48 hours as risk of causing stroke time frame. But, ER room told me if my AF doesn't convert in 12 hours then come in for conversion. On the other hand, my cardio said when I have an attack ------sleep on it and if still in AF in morning see him. But, he also said if I presented to him with AF he'd immediately send me to ER for conversion. Dumb, scenic route to ER room! Moreover, he has never placed on Coumadin nor do I want to push issue. He is well aware my episodes run from 9 to 16 hours (yesterday's terminated at 16 ½ hours). Obviously, if Han's conducted survey of time expired after AF, and duration thereof, to establish when fear period for strokes expires survey results would be flawed if all who had strokes caused by AF episodes can't participate due to being incapacitated and thus no longer posters. During this week-ends's attack -------- I actually started showing my wife were my business stood financially as of yesterday and how to wind it up if AF causes stroke and I survive it but only to be a vegetable. Now that's spreading the fear! As for my intentions ----- I'm mad as hell and not going to take it anymore! Thus an ablation is in the offing notwithstanding my cardio said ablations won't be perfected for two years and if I wish one I should wait. But, until then the fear factor remains and I refuse to deal with it. I can deal with AF attacks but not the fear that they won't terminate and priority fear that when they do convert how long before stroke risk passes 72 hours (I read somewhere) or the full "four" weeks as shown in most medical literature since that is time after conversions blood thinner must be used. I must accept the four weeks as the norm because this site may never be able to track all who were hit with AF caused strokes to provide statistics.

Stephen
(Still in heavy duty fear since only 21 hours after AF self terminated)

Here's one statistic. My mother! As I recall, in or about 1980 she was admitted to hospital due to AF. I do not know how long she was in AF since I had no idea what it was and thus time in AF not an issue. I don't even know if blood thinners were used back then prior to conversion nor do I know, if they were, if she was on for four seeks prior to conversion. I doubt it or I would have recalled she was scheduled for conversion.

She was electro converted the next morning and discharged. That afternoon she had a stroke. So in less than 24 hours. She suffered severe mental problems thereafter and although through re-association regained some memory but ultimately her mind completely deteriorated as a result of AF stroke and she died in convalescent hospital in 1984.

Stephen

Peggy,

I am afraid I don't know how many afibbers are regular participants on this board. However in my survey of 159 lone afibbers reported in the July/August issue of The AFIB report not a single one had experienced a stroke. Of course it is more than likely that anyone experiencing a disabling not to mention fatal stroke would not have participated in the survey.

Five afibbers (three in permanent afib) had experienced a TIA (transient ischemic attack) over a 1145 year exposure period. This gives an annual rate of 0.4% per year. It is estimated that one stroke occur for every 3 TIAs, so based on this the estimated stroke rate would be 0.1-0.2 % per year. The "normal" incidence in TIAs in the general population aged 50-59 years is estimated at 0.4-0.8 % per year.

There is rapidly increasing evidence that the stroke rate among low-risk lone afibbers is no greater than among the general population ie. about 1.0% per year. Obviously some among us are going to have a TIA or stroke, but the risk is no greater than for the general population even without anticoagulation. This of course assumes that none of the risk factors for stroke (hypertension, angina, diabetes, previous heart attack or previous TIA or stroke) are present.

Hans

John,

Sounds like your protocol on propafenone is working for you.

John s.

Stephen

I don't think the fear factor and worrying about a stroke will do any favours for your AF. The worry will make AF worse, thus becoming a vicious cycle. You need to read carefully what Hans has written. I for one believe that our chances of stroke are less than the average population. I had AF for 20 years and never had a stroke or TIA that I know of. However, it would be prudent for you to take blood thinning foods or supplements. This is what most of us do if we do not take aspirin or coumadin. When you have something like AF it is an advantage over others as AF is a warning that things are not quite right - and you have the chance to do something about it. High nutrient food, loads of antioxidants, fish oil and magnesium spring to mind. I d it all through food.

Fran

Stephen, it sounds like what panics you out about afib is having seen your mother decline and die subsequent to an afib attack. I wish i could help with that fear, but i don't think i can. If i had that experience it would scare the bejabbers out of me too.

If i were in your position i think i would be considering ablation too. About it's not being perfected yet, several respondents to this board have had success with it recently. reading back a ways will tell you who they are and where they had it done.

Stephen, have you gotten a second opinion on your condition from another cardiologist not affiliated with yours? Sometimes a fresh viewpoint can be very helpful.

Strength and courage.

Peggy

Peggy:

No I haven't got another opinion which would probably merely be change of meds I'm sure. That's about all cardios can do with AF other than possibly agree with my own toss-the-dice decision for an ablation.

Stephen

John S.

I had a 24-hour episode from Sun. 9:30 AM to this morning. When the a-fib started, I took 300 mg. of Propafenone, then 6 hours later took 150 and another 150 before going to bed last night. I was still fibbing when I got up at 6 AM today, took 300 mg. prop. about 7 and converted about 2 1/2 hours later. I'm still slightly woozy from it all!

From April 10 to Sept. 27 I took 150 mg. Prop. three times daily. I had to be cardioverted at the beginning of July and had a 36-hour episode Sept. 25-27 (self-converted) - so the drug did not eliminate episodes, nor make them shorter.

What I'm slowly getting at, is that the drugs don't necessarily stop episodes; so now I'm taking the Prop. on demand and it seems to be working. From Oct./02 to July/03 I was cardioverted 7 times. My new cardiologist said I should try the doubled Prop. dosage and only after about 36 hours go to ER. He has also put me on a waiting list to see an EP; here in Canada those waits can be quite long!

Stephen,

My mother also died from a stroke, but it took almost 2 years of agony. She had an operation about 2 months before the stroke, but I have no idea if she had a-fib. She did occasionally complain of irregular heartbeats, but I don't think her doctor ever diagnosed it. I too have a slight fear of stroke in the back of my mind. When an episode starts I take a full-strength aspirin (sometimes two, because of headache), also for a few days after the episode. It's really hard to know what exactly to do, but you will eventually get rid of the biggest fear and ride out your attacks (like most of us here do).

Cheers and keep well, RK

Stephen -

I'm only relating this because I was able to get over the fear factor a long time ago. Maybe not smart; maybe I should have worried, but for 8 long years, I was on drugs that did not totally control the afib and I rode out many a long, long event.... many around the 22 -24 time range and a few going 36 - 39....

At the beginning of afib, I always took a vitamin E and one 325 mg. aspirin. I carried them with me as my security blanket. Stroke prevention.

Later I added some magnesium to my emergency regimen. I found the magnesium helped calm me down and affected conversion sooner.

Dr. Natale is my EP (recent ablation on 11/12) but digoxin was never discussed nor did I have reason to bring it up.

At one point my cardiologist prescribed it but after reading in Hans book about the studies of dig, I decided it was one drug I never wanted to take.
It is too difficult to regulate and also seems that it is proarrhythmic although it was the standard of choice for years...and apparently still is in parts of this country. From what I read, there are much better choices.

I was able to control fear of stroke because the research I did indicated it was not all that common...although very possible....but people with afib were not dropping over weekly with an epidemic of related strokes.

This does not mean I take the risk lightly - on the contrary - the risk is there - I just choose to keep my blood naturally thin as my own insurance policy.

With the medical liability issue here in this country what it is, the emphasis on the Standard of Care is great. Lots more emphasis on preventive measures than when I started 8 years ago. Fear of litigation does that.

Age can be a factor if you are over 65 regarding stroke issues.

Lastly - keep taking that chelated magnesium.... it definitely helps lessen the effects while during afib and I found that it helped convert it. I also think it helps to take some natural potassium in the form of high-potassium containing foods.

Jackie

This was posted by Jerry a week ago, it might be worth reviewing for some of you....

In addition they also have spreadsheets based on research that predicte CHD and others might be worth a 2nd look.

Joe

Author: jerry (---.proxy.aol.com)
Date: 11-11-03 16:18

Estimating the Risk of Adverse Outcomes Following Atrial Fibrillation Using Data From the Framingham Heart Study -there is a chart at this link to figure out your "stroke scores potential"-jerry

[www.nhlbi.nih.gov]

I was 36 at the time of my clot and was not on any medication or taking any vitamins. I was also told at the time the risk factor was small, so I thought the same as most on the board.

I have no known heart disease, so it came as a shock to me and the doctors. It actually took them a FEW days to diagnosis me. First thought it was a kidney stone, based on age and others factors. Finally got a specialist involved and placed on blood thinners and it was finally over.

I now have one side effect of coumadin. Its called rusting. My legs from the knees down look like i have lots of rust and I am loosing all hair.

Anyone have this problem.

JRBabb,

I am not familiar with the use of the term rusting as it pertains to your situation and coumadin. However, I have come across it in my studies on Heart Health. Rusting as it is used with heart Health deals with the deterioration of the cardiovascular walls from plaque and damage from free radicals.

The following is an excerpt from Dr. Mathhias Rath and his book about the heart:

Protect your cardiovascular pipelines from rusting.
Biological rusting, or oxidation, damages your cardiovascular
system and accelerates the aging process. Vitamin C, vitamin E,
beta-carotene, and selenium are the most important natural
antioxidants. Other important antioxidants are bioflavonoids,
such as pycnogenol. Dietary supplementation of these antioxidants
provides important rust protection for your cardiovascular
system. Above all, stop smoking, because cigarette smoke
accelerates the biological rusting of your blood vessels.

This book can be found in it's entirety here:
www.dr-rath-research.org/literature/ heart/heart_book.pdf

I am sorry to hear of your condition, perhaps someone else may be able to help more.

Joe

Hi JR,
I would bet the bank that you were in a-fib longer then you thought. I've worked in a trauma er for 22 years and if what you say is the truth you would be in the books. Do you have a family history of strokes?? Please understand that I'm not calling you a liar but merely suggesting that what we sometimes swear by is not the case at all. Best regards, Allie