My experience - what do I do next?

I am a 47 year old male, in seemingly good health, but for my afib.

I had my first experience at age 32, shortly after the birth of my first baby. My wife and I had a few margaritas to celebrate and then in the middle of the night, I went downstairs to grab a bottle and took a big swig of gatorade. I ran up the stairs and noticed my heart racing much quicker than I thought that it should have been. I thought something was wrong and we went down to the street to the hospital. My heart was beating very rapidly and it had gotten irregular. I don't remember it being called afib in the er, but that's what a cardiologist told me on a subsequent visit. Caffiene and lack of sleep were blamed and I was proclaimed cured.

Five years later during a period of high stress and a move, I again got up in the middle of the night to have something to drink and I felt something click. It was afib and I went back to the er. I was in new city and found a wonderful ep; she was a close friend to one of my best friends from the city that I was moving from. I had some skipped heartbeats thereafter, but no more afib so the ep told me to quit coming to see her after a few years.

Almost two years ago, I had another bout with afib at about 9 one evening, again after drinking something cold (about eight years had passed since the prior episode). I almost went to the er, but my heart was not beating superfast, and I used some xanex to calm down and get to sleep. I woke up feeling fine.

About two months ago, I was playing golf on a very hot Sunday afternoon. THe golf followed two nights of too much wine and not enough sleep. I had been having some skipped heart beats as well. I felt the click and knew something was wrong. I had my partner take me to the club house and I laid down in the bathroom. A doctor was there - he turned out to be a plastic surgeon and he could not even get my pulse. I was terrified. I called my wife and she took me the er - by the time i got there, i was in bad shape and needed to be cardioverted. When my ep saw me the next day, she prescribed toprol and told me it was time for an ablation and that i should see a new ep who did the procedure The toprol was terrible, and even with a lower dose, I could not stand it...no energy and too many skips. I went to see the new ep who specializes in ablations after over three weeks on the toprol - the new ep was a great guy, and he told me that it was probably premature for an ablation and he prescribed flecainade (100mg twice a day) and 120 mg of cartia. I stopped the toprol that day, but before i could start the other medicine, i had an attack at lunch the next day at a restaurant. unlike all of the other incidents, there did not appear to be any triggers. I called the new ep and told his office i was going to the er and he said to come to his office instead. i spent the next few hours in his office with doses of flec and shortly after i was transferred to the hospital floor (the floor below his), i got back into nsr and went home.

Since the last attack four weeks ago, i have felt pretty good with the medicine, although the last few days i had a few skips that i thought might be a precursor to afib. I am taking magnesium, baby aspirin, eating better, trying to exercise more and i have gone cold turkey on alcohol. I told the new er that i had made an appt. to go to the cc, and he was fine with that - i am going next week. he suggested that dr. packer at mayo would be better, but he certainly felt very good about cc. He likes packer becasue he says that he really thinks through why someone is having afib. He also told me that he had just done 12 cryo ablations and all had been a success so far.

SOrry about the length, but here is the question. Thankfully my afib is not worse, but it has still been a life changer. my problem with the ablation is that I don't know what "success" should be. WIth the exception of the last episode, I could have easily been convinced that i did not need medication to control the afib; certainly if someone had told me about the pill in the pocked approach, i would have been very reluctant about taking a regular medicine knowing that i could get immediate help in another way. that being said, now that i had the unprevoked incident four weeks ago, i don't know what is up. has my afib notched up? If i could be free of afib I would have the ablation in a nanosecond, but in light of the sporadic nature of my problem, the medicine basically working and the lack of understanding of the cause, i am skeptical that the ablation will totally cure me, which is what i dream about. any thoughts?

Hello John,

Forgive me my English. It won't be perfect since English isn't my mother tongue (I am Dutch).

Like you I am relatively new on this forum and have learned a lot from the other postings and the information Hans has gathered.

I have suffered LAF attacks since 2003 if I am not mistaken. It is only since last year that I learned that I was a "LAF-patient" after suffering a severe attack for which I was hospitalized for a few hours. I needed cardioversion and was sent home the same day.

So now and then I have an attack after going to bed which I can manage quite well with sotalol. Recently I learned that I can manage an attack by going out of bed immediately after I feel the onset of an attack and walking around a bit in my living room.

Am I correct that you have suffered no more than 10 attacks in a period of more than 10 years? I don't know how severe these were, but the frequency is quite when compared with mine (at least one attack every month).

My cardiologist told me he prevered to handle my attacks with sotalol and only on demand (when an attack occurs).

Being Dutch, I find it interesting to read that ablations are so often performed in the USA. Ablations are performed in Holland, but I have the impression that it is only used as a very last resort. I don't know if this is good or bad.

I am just writing this because I have the impression that your attacks are not so frequent. I am sure other members will pick up this discussion and guide you towards a wise decision.

Good luck,

Ritze

Over the course of 15 years, my attacks have not been frequent, however, the two most recent attacks this summer suggest a real change...certainly the doctor prescribing medicine for the first time confirms that. Perhaps I will feel differently after going to the CC next week, but the dilemma is whether i can know that i do have something that I know requires an ablation or even all of the medicine that i am taking it. i sense that if i was living the most healthy lifestyle, the pip approach might work...on the other hand, if i really need all of the meds i am on everyday, i just as soon have an ablation and be done with it all.

John,

You do seem to have sensed that you have given up one of your main triggers (Alcohol). We all have many of those and over time we learn to avoid them and what is the best way for us to eat to stay healthy and AF free. Like Ritze in Holland, Ablation is done as a last resort here in the UK and I have to say I am surprised you would even consider such a huge and potentially dangerous move when you have had so few bouts of AF over the past 10 years. There is a lot of learning to do with AF and you are only just on the bottom of that curve. Who knows you may manage to beat it without anything so major having to take place. Please make sure you get all the information you possibly can and weigh up the pros and cons very carefully before deciding on anything. Most people on this board who have had ablations have done so as a last resort when all other options have failed them, and you haven't even started on sorting out your options yet.

I appreciate the comments and certainly understand that given the lack of frequency with which the events have occured, ablation appears to be premature. On the other hand, two trips to the er over the past eight weeks plus very serious meds is a radical change. Yes, I believe that triggers like dehydration, alcohol, lack of sleep and stress were contributors and can be fixed, not so sure about the triggers with the second time, but if they think I need the meds, isn't that enough to fully investigate the ablation? My doctor is willing to do an ablation, but would rather me wait for the cryo; next week i will find out what the cc thinks. The problem with the meds is that they mask whether or not the triggers have really been dealt with. If i don't have the ablation done, i am thinking about asking my ep to go the pip approach. at least then we would have a better sense for how severe my afib is. thoughts?

John, one of the most frustrating parts of AF is that its "causes" are, in essence, unknown. People do identify triggers - some people, not all - but the triggers are not causes, just triggers. Someone coined the terminology, "In AF we are each an experiment of one." TRUE! There are theme but nothing universal that will apply to all of us.

Several themes will emerge as you read past and present on this board. For many people AF slowly gets more frequent and less predictable over the years. Several stalwart fighters of AF who battled it for years and years (including Hans) ultimately opted for ablations. Others fought it, and are still fighting it, by diet and supplements (see Peggy's many posts referring people to The List, a set of folks who are controlling their AF without meds for the most part).

I will comment that if your AF begins to move more towards long bouts, 24 hours and up, you need to begin to worry about stroke, which is the only 'early killer' of AF. And see Wil's many posts on the dangers of 24/7 AF, should you ever get there.

We all understand your frustration, and can only caution you to be patient, try everything, find out what works for you, and never stop learning. You have hundreds of sympathetic ears here (some talk more than others, but we all liste....), so keep on asking questions, and start using the "Search" function. And do read Hans first volume, it is a goldmine of information. All my best to you. Kagey

John, you said the last episode you had was unprovoked by any of your known triggers, but your statement, "I stopped the toprol that day, but before i could start the other medicine, i had an attack at lunch the next day at a restaurant." may have been a trigger. It is advised to slowly come off beta blockers. I was on Toprol and followed the advise of the pharmacist and cut it down until within two weeks I weaned myself off it.
I also agree with others that you are not having a lot of episodes and an ablation is a big step for someone with few episodes. I understand your problems with the medication, I dislike that and decided it wasn't for me as I am an infrequent afibber. I identified triggers, changed diet and added supplements and have been afib free since June 2006. I wouldn't even give a passing thought to ablation at this point. Am I cured? I don't think so, but I don't think the afib I have had in the past warrants ablation.

You might consider the pip approach first before surgery, sounds like a good way to make "better sense" of the severity of your afib. If you read some of the post from some, ablation did not cure their problem, altho there are many that ablation did stop their afib. Then, there are those who have had ablations and have had afib return. Some who had infrequent afib that turned into consistant afib and they chose ablation.

John, afib is life altering, but it can be lived with. I really feel that ablation is in a certain stage right now and as procedures improve, so will the success of an ablation. With all of this said, we are all an experiment of one and we must do what we feel most comfortable with. Keep searching this BB, there is a lot of good information. If you haven't ordered Hans book, "Lone Atrial Fibrillation: TOward a cure - Vol. 1. I would make that purchase, his book changed my outlook on afib. You can click on the blue bar below that list his books.

Good luck in your search for an answer, you have a lot of people searching also and we all stand together in support of each other. Sharon

John - you have received good direction here from both those having ablation and those managing to become free of afib through dietary modifications along with lifestyle changes and nutritional supplements.

I agree with all the advice and suggest you try the nutritional approach first just to see if you benefit. Even if the afib remains unaffected, a healthy lifestyle will serve you well in other areas.

You can always have an ablation but just remember if you decide to choose that, then make an educated choice of a top EP at a top hospital. There are too many stories about botched ablations to consider that just going anywhere is routine like an appendectomy. You can have some serious damage done to your heart a body if things go wrong.

I'm not anti-ablation - I had one myself after 8 years of trying everything, but I still think the best approach initially is the natural means.

You can always use the toprol as a pill in the pocket when an event starts to slow the heart rate and you may find you self-convert more easily and save yourself a trip to the ER. Most of us (eventually) didn't go to the ER at the onset of an event as we learned to ride it out as best we could at home. If the event should approach 24 hours, though, you should be thinking about getting to the ER.

As a start, I urge you to get Hans' first book at the very least.

Jackie

I thank everyone for all of their thoughts. I am going up to the CC next week and will discuss these matters with the EP that I am meeting with. That being said, I believe that I will push on more exercise, better food, less stess and more sleep, and then I will approach my ep about recuding or eliinating my meds and going with the pip approac.

John, don't be surprised if your EP doesn't acknowledge that supplements are an answer. My GP doesn't agree with anything I am doing, but he knows I will do it anyway (he has been my doctor for 27 years.) My EP is new (1 1/2 years) and he seems to be agreeable with what I am doing, but doesn't know a lot about supplements. He believes my afib will return no matter what I am doing, but as long as I am doing well, he has no objections to my continuing. So, just be prepared in case your EP is not favorable or just doesn't agree with the natural approach. Most of them just don't understand. I found that I have to stand my ground, after all, it is my body, but I could only do that after I learned everything I could about afib, so when the doctor talks I can understand and not blindly agree with their suggestions. Be sure to get Hans book and read it through, lots of good research and answers in there. Doctors like facts and good research. Sharon

Two more points, John. You mention the last attack happened at a restaurant. Allmost all restaurant meals contain MSG (MonoSodium Glutamate) which is one of the most common triggers for Afib.
Also don't overdo the exercise. Moderate exercise is good (whatever you do try to stay relaxed while doing it) but any more can cause Afib and has done so for many on this Forum