AFIB is a Progressive Disease

[Tekward]

This article helped me past my hesitation on cardiac ablation. Perhaps it will help others.

https://draseemdesai.com/afib-begets-afib-an-electrical-cancer-of-the-heart/
"AFib can affect people from all walks of life. AFib is a progressive disease, meaning every episode of AFib causes changes in the heart to make it easier to have more episodes. The abnormal rhythm causes electrical and structural changes in the heart’s electrical tissue. This is why the phrase “AFib Begets AFib” is often used."

My procedure is 12 December with a possible pacemaker as a bonus.

 

[audreyh1]

Best wishes that everything goes well with your procedure. Let us know how you are doing.

 

[Silver]

Thank you for starting this thread.

I have had only one episode of AFIB during a hospitalization in June for surgery then sepsis after my gall bladder ruptured. I converted back to normal sinus rhythm within 1.5 hours. I was immediately started on an anticoagulant and am still taking it. I have had some "flutters" recorded on a 14 day event monitor, but no further AFIB.

I have seen two cardiologists, the second was for a second opinion. This cardiologist is also an electrophysiologist who specializes in AFIB and performs a couple hundred ablations a year.

His recommendation for me was to have an embedded loop recorder for 6-9 months to figure out for sure what my heart is doing. So I am having that procedure this coming Tuesday, 12-5-23. It's done under local anesthesia, and is a small cardiac monitor inserted under the skin on my chest.

I may be also headed for an ablation, but it will be good to have the data to be sure that's the right move for me.

 

[Peter]

Following this thread. Thanks for starting it. I've had several episodes of Afib over the years, most recently resulting in an ER visit and an admission. My cardiologist is keen to do an ablation, claiming that recent advances in technique have made it a very successful procedure.


That linked article has made me think quite seriously about following the cardiologist's recommendation.

 

[Dawg52]

Thank you for starting this thread.

I have had only one episode of AFIB during a hospitalization in June for surgery then sepsis after my gall bladder ruptured. I converted back to normal sinus rhythm within 1.5 hours. I was immediately started on an anticoagulant and am still taking it. I have had some "flutters" recorded on a 14 day event monitor, but no further AFIB.

I have seen two cardiologists, the second was for a second opinion. This cardiologist is also an electrophysiologist who specializes in AFIB and performs a couple hundred ablations a year.

His recommendation for me was to have an embedded loop recorder for 6-9 months to figure out for sure what my heart is doing. So I am having that procedure this coming Tuesday, 12-5-23. It's done under local anesthesia, and is a small cardiac monitor inserted under the skin on my chest.

I may be also headed for an ablation, but it will be good to have the data to be sure that's the right move for me.

Thanks for the info on the embedded loop recorder. Might be something I need in the future.

Early October I had a racing heart episode. First one in 4 years. Back then it was concluded that it wasn't AFib but anxiety related. But this last episode I was able to record it with an Kardiomobile EKG device and it read possible AFib. I showed it to my cardiologist and he confirmed that it was AFib. Just this week I had a stress test and echocardiogram. The NP overseeing the stress test said she did not see any AFib during the test and I felt fine during and after the test. I should get the results from the Dr next week on everything. When I saw the cardiologist a couple of weeks ago he just wanted me to take an 81mg aspirin, record any future episodes and get the info to him. So it will be interesting to see if there is anything in the test results that requires prescription medications at this time.

 

[aaronc879]

Hope you have a positive outcome. My Dad did not have a successful ablation. They tried that after 3 failed attempts at cardioversion. Now he has a dual-chamber pacemaker which works better than anything else did.

 

[youbet]

AFIB manifests in many forms. I have had permanent AFIB for years. In my case, there are no episodes of racing heart, flutter or short term rhythm issues. Rather, I'm out of rhythm at all times, 24X7. I check my rhythm (a feature of my BP monitor) most days and haven't seen a single instance of it being "normal" in years.

I have absolutely no recall of ever being in a stage of AFIB where symptoms were intermittent (where I had episodes.) My EKG's were normal all my life until they weren't. And once the rhythm irregularity was discovered during a routine physical by my PC doc, instances of "normal" rhythm have never reoccurred.

I appear to have jumped straight into permanent AFIB without the more common progression indicated in the chart published in the article.

I take Xarelto to lower the risk of stroke. I had an attempted Watchman placement last spring which was unsuccessful due to the shape of my left atrial appendage so looks like anti-coagulants for the rest of my life.

My BP is well controlled with small doses of Metoprolol and Irbesartan. My heart rate stays within reasonable limits when I'm at rest or exercising. I'm asymtomatic except for some generalized fatigue (which might be related to now being 76 yo). I do have severe sleep apnea and use a CPAP machine.

My electrophysiologist and the rest of the cardiac team says that in my case they feel the risk of corrective measures such as ablation, drugs or chemicals is greater than just going on the way I am. So, for now, I just take my (expensive) Xarelto pill daily and try to live a heart-healthy life.

Interesting article. Good discussion.

.

 

[Exchme]

This article helped me past my hesitation on cardiac ablation. Perhaps it will help others.

https://draseemdesai.com/afib-begets-afib-an-electrical-cancer-of-the-heart/
"AFib can affect people from all walks of life. AFib is a progressive disease, meaning every episode of AFib causes changes in the heart to make it easier to have more episodes. The abnormal rhythm causes electrical and structural changes in the heart’s electrical tissue. This is why the phrase “AFib Begets AFib” is often used."

My procedure is 12 December with a possible pacemaker as a bonus.

Yes, by the time I had an ablation, they said the heart wall was thickening and there was A/V node damage due to injury from the AFIB, apparently I'd had it for a while. While wearing a monitor looking for the AFIB, I tried exercising and my heart rate was 205 BPM and I couldn't take the heart rate control medicine as my pulse when asleep would drop to 15-20. So an ablation was the only option.

The electrophysiologist showed me the electrical map they make while you are under to show them where to freeze (or burn) to interrupt the extra electrical signals. He remarked at what a mess the electrical pathways were. There were excess conductive pathways around each of the main blood vessels as well as a loop around the entire heart. To get it all, they had to burn over 200 spots on the heart.

They put me on Tikosyn for a few months after the surgery to help the heart. That was the largest part of the ordeal in that it required 48 hours of monitoring in the hospital as it can cause dangerous arrhythmia if the dose is wrong. Apparently there are other medicines that don't require the hospital stay, I never inquired as to why they wanted that one for me, maybe the heart wall and A/V node damage that had been done.

Surgical recovery itself was a breeze, they went in through the groin and sealed it with a dissolving plug, so the biggest instruction was to push on that spot when I stood up. Hard to get sympathy over your big heart surgery when that's the extent of the recovery instructions.

All has been well since, no return of the AFIB, so I was eventually able to stop with the blood thinners and now just take a baby aspirin each day. They ordered a sleep study which revealed sleep apnea and since the breathing stoppages can promote AFIB, I now have a CPAP.

Good luck with your surgery, I'm sure it will go fine!

 

[Keim]

I had several ablation in my mid 30s (52 now) for complications arising from a congenital issue. Received a pacemaker and meds at 39. This has worked well for me. Good luck w your decision. Let me know if you have questions.

My .02: Try ablation. They usually work, and you want to avoid heart remodeling caused by afib.

 

[Tekward]

They put me on Tikosyn for a few months after the surgery to help the heart. That was the largest part of the ordeal in that it required 48 hours of monitoring in the hospital as it can cause dangerous arrhythmia if the dose is wrong. Apparently there are other medicines that don't require the hospital stay, I never inquired as to why they wanted that one for me, maybe the heart wall and A/V node damage that had been done.

They have the same 3 night hospital plan for me. It was explained that they have to give me that med because my HR is normally low so they needed a different med and the period of observation. I'm glad to hear it was only for 3 months in your case.

 

[O2Bfree]

I've had an ablation as well, for supraventricular tachycardia. They really got that procedure down. My only regret was that I didn't get it sooner.

 

[aja8888]

I've had an ablation as well, for supraventricular tachycardia. They really got that procedure down. My only regret was that I didn't get it sooner.

I had SVT 5 years ago. One ablation and gone for good!

 

[Montecfo]

I have had several episodes of afib. The most serious one resulted in a trip to the hospital for a cardioversion. My rhythm returned on 3rd.attempt.

Despite the article my episodes of afib have gradually become more rare. Been a few years now.

OTOH a close friend has had ongoing episodes, multiple cardioversions and several ablations. He is in the "pro" camp as he has gotten relief from ablations.

All the best with this procedure.

 

[Tekward]

AFIB manifests in many forms. I have had permanent AFIB for years. In my case, there are no episodes of racing heart, flutter or short term rhythm issues. Rather, I'm out of rhythm at all times, 24X7. I check my rhythm (a feature of my BP monitor) most days and haven't seen a single instance of it being "normal" in years.

... My heart rate stays within reasonable limits when I'm at rest or exercising. I'm asymtomatic except for some generalized fatigue (which might be related to now being 76 yo). I do have severe sleep apnea and use a CPAP machine.

My electrophysiologist and the rest of the cardiac team says that in my case they feel the risk of corrective measures such as ablation, drugs or chemicals is greater than just going on the way I am. So, for now, I just take my (expensive) Xarelto pill daily and try to live a heart-healthy life.
Interesting article. Good discussion.

I have a similar situation, albeit at 66YO. I have AFIB daily but minimal symptoms, in spite of very intense exercise (max HR 170s, resting HR low 40s). But I've seen a big drop in my exercise VO2max (20% over 18 months) and my cardiologist explained that my fitness has masked the symptoms, "your heart is an 8 cylinder engine, but only 6 cylinders are in time, and you can run on that." The thought of "remodeling" my heart via AFIB enables me to justify the surgery & hospital stay after 2 years of hesitation. I'll keep everyone updated.

PS: I've asked for the pacemaker with the Turbo option.

 

[RonBoyd]

AFIB manifests in many forms. I have had permanent AFIB for years.

I, also, have had permanent AFIB for at least 25 years... perhaps 5 years longer than that.

I, too, am asymptomatic (which is why I don't know how long I've had it) and had no change in symptoms in all that time.

I take Warfarin for which I have zero co-pay rather than the outlandishly priced other blood thinners. (And, of course, a Beta Blocker.)

My cardiologist, also, recommends against surgery. He did, however, try to get me to consider the "Watchman" device to replace the Warfarin. I considered it but will pass... only because of my friendly relationship with Warfarin.

https://www.watchman.com/en-us/home.html

 

[ls99]

I, also, have had permanent AFIB for at least 25 years... perhaps 5 years longer than that.

I, too, am asymptomatic (which is why I don't know how long I've had it) and had no change in symptoms in all that time.

I take Warfarin for which I have zero co-pay rather than the outlandishly priced other blood thinners. (And, of course, a Beta Blocker.)

My cardiologist, also, recommends against surgery. He did, however, try to get me to consider the "Watchman" device to replace the Warfarin. I considered it but will pass... only because of my friendly relationship with Warfarin.

https://www.watchman.com/en-us/home.html

Whoa! With that flashy spalshy watchman marketing blurb, I would pass even if that was the last resort.

 

[Alan]

My first episode of Afib was in 2015. Over the next 3 years the frequency and lengths of the episodes increased and in October 2018 I had a cryoablation. Over 5 years now and no further instances, so far so good, but I still expect issues in the future, if no Afib then some other irregularities.

 

[RonBoyd]

Whoa! With that flashy spalshy watchman marketing blurb, I would pass even if that was the last resort.

Oh! After much research into the product, I was quite impressed. I am unsure what turned you off.

My main reason for preferring Warfarin was the lack of any cost but other than that Watchman has my vote.

I didn't mention it before but another reason I have for using Warfarin is that I visit my PCP every 2 months for a pro-time test (amount of time blood takes to clot). The cost for this was up until this year a $15 co-pay -- this year it is zero.

That way my health has been closely monitored on a routine basis -- including other blood tests taken giving the doctor something to justify the visit. <chuckle>

 

[O2Bfree]

I had SVT 5 years ago. One ablation and gone for good!

On the day of my procedure, I had what the eletrophysiologist called a "quiet heart day". He had trouble triggering an episode. Burned a couple spots though and my episodes stopped. But then I started getting them again a year later, after the new year and my deductible reset, of course! Had a second ablation in 2017, and they nailed it that time. Since then I've had just the occasional PAC.

 

[Koolau]

Whoa! With that flashy spalshy watchman marketing blurb, I would pass even if that was the last resort.

Yeah, I filled out the "quiz" to see if I might be a candidate. THEN they require all your personal info to get the results. Go pound sand!

 

[Koolau]

I take Xarelto to lower the risk of stroke.

.

May I ask (if you know) why you and your doctor chose Xarelto rather than Eliquis? I take the later due to paroxysmal AFIB. My episodes seem to come about once a year and convert on their own (1 to 6 hours.)

I've had no significant problems with Eliquis except some really impressive bleeding (all over the operating table and floor) from my IV for a back procedure. I ruined at least one pair of white shoes (the guy who was w*rking with my back doc to deal with my back pain.) Anyway, the doc said it wasn't a problem - probably didn't stop my Eliquis in time, though I followed the doc's instructions pre-op.

Anyway, just wondering if I or my doc missed something or if it's 6 of one and half a dozen of the other which drug to use.

Thanks.

 

[Keim]

May I ask (if you know) why you and your doctor chose Xarelto rather than Eliquis? I take the later due to paroxysmal AFIB. My episodes seem to come about once a year and convert on their own (1 to 6 hours.)

I've had no significant problems with Eliquis except some really impressive bleeding (all over the operating table and floor) from my IV for a back procedure. I ruined at least one pair of white shoes (the guy who was w*rking with my back doc to deal with my back pain.) Anyway, the doc said it wasn't a problem - probably didn't stop my Eliquis in time, though I followed the doc's instructions pre-op.

Anyway, just wondering if I or my doc missed something or if it's 6 of one and half a dozen of the other which drug to use.

Thanks.

I have used both. Switched when insurance changed their formulary. My cardiologist had no preference.

 

[Koolau]

I have used both. Switched when insurance changed their formulary. My cardiologist had no preference.

Thanks. DW took one and I took the other. Neither doc ever explained their choice. (Both on Eliquis now.) Aloha

 

[Luvtoride]

I, also, have had permanent AFIB for at least 25 years... perhaps 5 years longer than that.

I, too, am asymptomatic (which is why I don't know how long I've had it) and had no change in symptoms in all that time.

I take Warfarin for which I have zero co-pay rather than the outlandishly priced other blood thinners. (And, of course, a Beta Blocker.)

My cardiologist, also, recommends against surgery. He did, however, try to get me to consider the "Watchman" device to replace the Warfarin. I considered it but will pass... only because of my friendly relationship with Warfarin.

https://www.watchman.com/en-us/home.html

YouBet and RonBoyd, my story is very similar to both of you. I have had Permanent AFIB for about 15 years. My cardiologist has never suggested any procedure to get me back into normal rhythm. I have been treated with blood thinners, starting with Warfarin (which I never liked as the monitoring process was cumbersome) to Eliquis, which I've been using now for years. Very few issues other than going off it for dental work and other medical procedures occasionally.

I do have a Pacemaker implanted, but it is not due to my AFIB. My heart rate tends to be on the low side (other than when working out) and I am on blood pressure medication, which could lower it even more. As a protective measure, I had the pacemaker implanted after a mild heart attack 11 years ago, while in the hospital (cardiologist knew I would need it eventually). I just had the pacemaker replaced with a newer model that requires no outside monitoring and connects to an app, which Medtronic and my electrophysiologist can read as needed.

Good luck to all who are undergoing procedures for Afib.

 

[Qs Laptop]

This article helped me past my hesitation on cardiac ablation. Perhaps it will help others.

https://draseemdesai.com/afib-begets-afib-an-electrical-cancer-of-the-heart/
"AFib can affect people from all walks of life. AFib is a progressive disease, meaning every episode of AFib causes changes in the heart to make it easier to have more episodes. The abnormal rhythm causes electrical and structural changes in the heart’s electrical tissue. This is why the phrase “AFib Begets AFib” is often used."

My procedure is 12 December with a possible pacemaker as a bonus.

Tekward, I wish you all the best with your ablation procedure.

I was diagnosed with Afib in March 2015. I had my ablation in April 2022. I had been on Sotalol and then Metoprolol to regulate heartbeat (plus Xarelto for stroke prevention.) I consulted an electrophysiologist and he explained the exact same things in the article you posted. Of particular concern was the fact that "Afib begets Afib." I fit a lot of the ablation critieras pointing to a positive outcome and I was told I was in the 80% success bracket for a cardiac ablation.

That closed the deal for me. That, plus following various discussions here on ER.ORG about Afib and ablation procedures. (Thanks to Alan, and others for your posts.)

I was told they had to zap 23 sites inside my heart to seal off all the possible areas. My electrophysiologist said that was a lot of sites, but wow, Exchme with 200 sites must have some sort of record.

So far as I know I haven't had any episodes with Afib since. I did wear a heart monitor for 2 weeks a couple of months after the procedure and I showed no irregular heartbeats. No more meds for heart rhythm. No more meds for stroke.

My suggestion to anyone on the fence regarding this procedure is if you are a good candidate for ablation success, I would urge you to get it done ASAP.