My first experience with Atrial Fibrillation

[Ready]

Thanks for the advice bmncgonig. I’ll follow up on it. I did see the cardiologist this week. She scheduled me for some blood work, a treadmill test, and a heart test of some sort that I can’t remember the details of. So far I’m feeling fine since last week’s episode.

 

[bmcgonig]

There’s a new technology for afib ablations called Pulse Field Ablation that is really getting EPs excited. It’s being dubbed next generation ablation. It’s uses a technology that kills the cells in the heart and pulmonary veins that need to be killed but doesn’t damage stuff that’s close by like the esophagus, which is one of the dangers of regular ablations. Its benefit is that it’s really safe. It’s in clinical trials now around the country trying to determine its efficacy. If it works as expected it seems everyone will switch.

https://www.jacc.org/doi/pdf/10.1016/j.jacc.2019.04.021

 

[Luvtoride]

There’s a new technology for afib ablations called Pulse Field Ablation that is really getting EPs excited. It’s being dubbed next generation ablation. It’s uses a technology that kills the cells in the heart and pulmonary veins that need to be killed but doesn’t damage stuff that’s close by like the esophagus, which is one of the dangers of regular ablations. Its benefit is that it’s really safe. It’s in clinical trials now around the country trying to determine its efficacy. If it works as expected it seems everyone will switch.

https://www.jacc.org/doi/pdf/10.1016/j.jacc.2019.04.021

Thanks for posting about this but the link itself is too technical for my reading. I will discuss with my Cardiologist at my next visit (just saw him for my 6 month follow up 10 days ago).
His feeling has been that ablations work for a period of time but then I will return to Afib so we haven’t tried ablation in my case. I’ve been on blood thinners for years and this has worked fine to keep me “safe”.
I will also need to replace at my pacemaker in the upcoming year (installed 9 years ago) so it may be worthwhile to consider this new ablation method at that time in conjunction with the pacemaker change. Thanks.

 

[Exchme]

Exchme, can I ask how old you are/ were when first diagnosed and treated? It sounds like your doctor pretty aggressively treated you to stop the Afib. How long has it been since you’ve been back in normal rhythm?
I’m sure each patient and case is different. My cardiologist has never tried to correct my Afib (as other cardiologists and doctors have concurred). Treatment with blood thinners and regular follow ups with doctors has kept it under control for me.

Best of luck and stay well.
Brian

I am 61, this was this summer. The usual treatment is blood thinners and heart rate control medicine. But the common heart rate control medicine gave me dangerously long pauses between beats at night (up to 4 seconds) and any exercise would spike my heart rate to over 200. They could see some thickening and dilation of the atria, so I'd had it a while and didn't realize it. Cardiologist took one look at my heart monitor results, and called an electrophysiologist to work me in to the surgical schedule. Had surgery two weeks later, which was as quick as they could get all the pre-op labs, the TEE, the electrophysiologist and the OR scheduled.

Surgeon showed me the map of what they had to ablate, it was over 200 points! They went in through a vein in the groin and leave a collagen plug in it, there wasn't even a visible stitch left behind. So the recovery from heart surgery consisted of "kind of push on that spot when you stand up for the first couple days so you don't pop out the collagen plug". Returned to full activities in a week, now have lost weight, exercise every day and feel great.

Saved my life.

 

[Luvtoride]

Exchme, that sounds scary and glad the dr found it and reacted so quickly!
As I said, each of our conditions are different and treatments vary accordingly.

Glad you lost weight, exercise and are doing well now.

 

[youbet]

As I said, each of our conditions are different and treatments vary accordingly.

My AFIB situation sounds very similar to yours (as you described yours in earlier posts). Asymptomatic. No palpitations. Arrhythmia at all times. Electrophysiologist is not recommending ablation, rhythm correcting drugs or the Watchman. He does say that when/if falling or other bruising situations become an issue, he might suggest the Watchman and going off the blood thinner then. For now, like you, I'm just on the blood thinner (Xarelto in my case) and semi-annual follow-ups.

My BP, pulse rate, echo cardiogram and cholesterol numbers came out fine in recent testing. I'm clear to exercise. I just have long term arrhythmia which doc says increases my risk of stroke by 6X and therefore I'm on the blood thinner (which so far I seem to tolerate well).

I find it interesting how common it is for folks to assume that because I have AFIB, I have periodic bouts of palpitations or other heart rate issues, which, like you, I don't.

 

[Alan]

Exchme, that sounds scary and glad the dr found it and reacted so quickly!
As I said, each of our conditions are different and treatments vary accordingly.

Glad you lost weight, exercise and are doing well now.

+1

That is a great result.

 

[DaveLeeNC]

FWIW, I started having short periods of high heart rates a couple years ago. Generally I see HR's in the 150 to 160 range and they last 2 to 10 minutes.

My doctor is not overly concerned at this point but would really like to 'catch one of these events on an EKG'. So far they don't last long enough nor are they frequent enough (once every 3-4 months in my case) to make the use of a 24 hour or 30 day monitor of much value.

So the deal that I have with my doc is that if I have an event that lasts 20 minutes or longer I should go to the ER for an EKG. This happened once but well before I got to the ER (15 minute drive in my case) it was gone. And there was one other time where an event lasted a couple hours. And it was shortly after my system recognized my Covid booster and put me into the deepest set of flu symptoms that I have ever felt (by quite a margin). No way was I going to the ER in that condition as getting up and going to the bathroom was almost impossible at that point. My doc suspects that this particular HR event was triggered by my systemic response to the booster (where I had basically no response to the earlier 2 shots).

I was very clear with my doc regarding risks to me WRT these events and he felt like at the heart rates in the 150 range I am doing no damage. I guess that makes sense as I am a distance cyclist and (even at age 72) carry heartrates in the 140 to 150 range for 1 to 3 hours several times a week. And if they ever get a handle on this an ablation is the most likely procedure.

dave

ps. Interesting story regarding this. I had just started a bike ride and suddenly saw my HR at 165 and I was not working that hard (165 HR on a bike is something that I might keep going for a minute or so max). I just pedaled easy for 3 or 4 minutes and suddenly my HR dropped down to an appropriate level and off I went. Had I not had my HR displayed on my bike computer screen, I would have never known.

 

[Ready]

My doctor is not overly concerned at this point but would really like to 'catch one of these events on an EKG'. So far they don't last long enough nor are they frequent enough (once every 3-4 months in my case) to make the use of a 24 hour or 30 day monitor of much value.

Have you considered getting something like an Apple Watch? Mine is always on my wrist and that is how I was able to immediately begin taking ECG readings. I brought ten readings to the ER and my follow up appointment with the cardiologist and they reviewed them carefully to analyze what was going on. Without them they would have had nothing to work with.

 

[AnneG]

I have experienced afib episodes - it runs in my family. I have a small portable EKG gizmo from Emay that I use to take readings. It's fairly inexpensive and amazingly accurate. There is a forum called afibbersrs.org that has an absolute wealth of resources and information. It's helped me tremendously.

 

[DaveLeeNC]

@Ready, my doctor has some familiarity with those devices (his teenage daughter has one and she brings EKG readings to his attention quite often). We discussed that option and he did not feel that the data was adequate. But if my circumstances were more immediate, maybe the answer would be different.

I have a Fitbit primarily as a way to determine if these events are more frequent than I suspect (as what I sense during one of these events is kind of subtle). After 6 months I have only seen one short event (a night time thing) that I was not aware of.

dave

 

[DaveLeeNC]

@AnneG, thanks for the suggestion. dave

 

[Bamaman]

Nothing to be taken lightly! My brother was an elite athlete even at age 62. He developed afib and the doc said "lets keep an eye on it ".
A few weeks later he had a massive stroke that almost killed him and now five years later he's completely disabled, unable to walk or talk.

Many world class athletes suffer with heart problems. The problem is often that their hearts are conditioned to pump especially hard--and also at a very slow pace.

We had a friend that was a very, very competitive bicyclist. And we almost lost him when he had a heart attack because his heart was beating so hard.

 

[bmcgonig]

@Ready, my doctor has some familiarity with those devices (his teenage daughter has one and she brings EKG readings to his attention quite often). We discussed that option and he did not feel that the data was adequate. But if my circumstances were more immediate, maybe the answer would be different.

I have a Fitbit primarily as a way to determine if these events are more frequent than I suspect (as what I sense during one of these events is kind of subtle). After 6 months I have only seen one short event (a night time thing) that I was not aware of.

dave

It’s weird that your doc said that about those devices. My cardiologist and my electrophysiologist recommend them. Lots of cardiologists say the same. They can diagnose Afib and some other arrhythmias. Is he a regular doc or a cardiologist?

Afib is quite common among endurance bicyclists. Just be aware.

For your own benefit, this is what you might want to buy on Amazon if you don’t have an Apple watch,

“KardiaMobile Single-Lead Personal EKG Monitor “

It’s actually better than the Apple Watch (I have both) and only costs $69. It’s approved by FDA and will diagnose Afib.

 

[Alan]

+1 on the devices like the Alivecor Kardia. The cardiologists and EPs over here gladly accept them to read for incidents that only happen occasionally. I wore a 24 or 48 hour monitor 3 times, and I exercised and went about my normal routines while wearing them but they could never catch me in AFib.

Obviously they will get more complete and better readings from a multi lead ekg but the data from a single or double lead ekg (2 fingers) gives good information.

 

[DaveLeeNC]

Depending on how this goes I might well consider a personal EKG device. Or I could take the high road and rent the third floor of our local hospital for a week while they address my Afib, spinal stenosis, foraminal cyst, knees that on X-ray look like a cubist artwork (I wear a retail cost $2k brace on one knee when I cycle and I get biannual hyaluronic injections in both knees), carpal tunnel, cataracts, and competing arthritis/rotator cuff in my left shoulder. Just wake me when its over

dave

 

[Alan]

Depending on how this goes I might well consider a personal EKG device. Or I could take the high road and rent the third floor of our local hospital for a week while they address my Afib, spinal stenosis, foraminal cyst, knees that on X-ray look like a cubist artwork (I wear a retail cost $2k brace on one knee when I cycle and I get biannual hyaluronic injections in both knees), carpal tunnel, cataracts, and competing arthritis/rotator cuff in my left shoulder. Just wake me when its over

dave

Wow, you certainly have a basket of health issues to keep you busy.

 

[schellem]

I'm 59 and quite healthy. A couple years ago I woke up in the middle of the night with my heart racing. I figured I had a dream and went back to sleep. I got up in the morning walked to the office across the hall and started my normal work day.

I then remembered last nights wake up event and looked at my FitBit and noted my heart was running 80 to 90 BPM. I thought that was very odd as I should be in the low 60s just sitting in my chair after getting up. I have a very low resting heart rate of about 49-50. I don't know why as they say this is closer to what athletes typically have, I'm no athlete and don't follow any exercise regimes but I do stay busy and hike and bike on the weekends. Anyway, my heart rate stayed quite elevated over the next hour with me doing nothing other than typing at the keyboard. I finally decided maybe I should make a trip to the ER.

I got to the ER and after telling them about my high heart rate they got me in quick, did an EKG, started an IV port and left the room. Now I was also feeling very slight palpitations, no pain or anything just an odd feeling that showed up on the heart monitor also. After an hour of no nurse/doctor my wife went out to find someone and see what was going on. They came back and said EKG looked good and that my heart rate was not out of normal specs and they had more urgent things going on. It was of no consequence that my heart rate was like 30-40% above normal for no reason.

Doctor finally came and said bloodwork looked good and really couldn't explain anything. My heart rate was coming down after a few hours in the ER. He said they would stick on a 24 hour recording heart monitor and that I should follow up with PCP. Being healthy I had not been to a doctor in years so I found a PCP to follow up with a few days later. My PCP said I should quit looking at my FitBit.

A couple months later I got up one morning with my heart running 80-90 BPM again. I had experienced the occasional heart palpitation since my ER visit. This time I just called PCP and they got me right in, they did an EKG and all was fine, again doctor said quit looking at your FitBit. I had started watching my BP since ER visit and it was a bit high, I have whitecoat syndrome so readings at the office were pointless. Could/would not explain why my heart rate just jumps way up for no reason but that it's not out of spec. She also said she would schedule me to see a heart doctor if that would make me feel better.

Got in to see the heart doctor who immediately ordered a nuclear stress test and echocardiogram. I thought this was way overboard for my symptoms after doing a lot of research and talking to others. These tests showed no issues DR put me on diltiazem to bring BP down and he said that also helps for palpitations. My BP came down about 5-8 points and experienced no more palpitations. FYI, I've since learned that 80% of the population experience palpitations and usually they are not a problem.

I retired 6 months after first visiting the heart doctor then a few months later we went on vacation and I forgot my BP medicine. I went for a week without the medicine and found that my BP did not go back up so I kept monitoring BP. After 2 weeks of no BP medicine palpitations come back quite frequently. I started taking reduced amount of BP medicine for a couple weeks and palpitations went away and then over the course of another couple weeks weaned myself off of the diltiazem. I had a 6 month follow up with DR and explained all and he said good, no need to see me again.

It's been a year now and BP is fine and no palpitations. My wife says it was all work stress related. I did not feel under stress and did not ever loss any sleep over it but it is the only thing that makes since. I think what is sad that none of the doctors ever mentioned anything about life stress might be a cause for any of the issues I went thru.

Moral of the story is, if your thinking about retiring but can't pull the trigger, I hope my story may be that final straw. I actually quite enjoyed my career as a software developer and thought I would have withdrawal symptoms. It's been 1.5 years and don't miss it a bit. Live your life while you can!

 

[jabbahop]

My advice to you Ready is to aim that way, because it’s not going away so you might as well plan to fix it before it gets worse, and it seems to always get worse.

I see you’re in Southern Ca. One of the best ablationists worldwide is a guy called Dr Natale. He mainly works out of Austin but he also does some ablations in Thousand Oaks as well. I think he’s done over 11000. You’d be very safe if he did the work.

My mother’s afib doctor is Dr. Natale and she really likes him. She sees him @ Scripps in San Diego. I had my ablation done by Dr. Gibson who works with Dr. Natale @ Scripps and he is excellent - one of the best @ Watchman implantation for dealing with the appendage/stroke risk issue.

 

[DaveLeeNC]

Wow, you certainly have a basket of health issues to keep you busy.

Yeah, no drinking or smoking, regular exercise, weight under control...

What a waste

dave

 

[Ronnie S]

I'm 75 with bouts of Ab Fab for the last 4.5 yrs. I've handled my case completely different then my doctors want. I'm very active, running 5k, biking, swimming, trotting up & down the beach collecting seashells, & etc. I don't take meds or any treatments. I may be a walking time bomb but as Frank sang, I did it my way. At first my dear Wife worried so much, which made me feel terrible. Now after 4.5 yrs she doesn't know what to think & worries less. RONNIE

 

[bmcgonig]

I'm 75 with bouts of Ab Fab for the last 4.5 yrs. I've handled my case completely different then my doctors want. I'm very active, running 5k, biking, swimming, trotting up & down the beach collecting seashells, & etc. I don't take meds or any treatments. I may be a walking time bomb but as Frank sang, I did it my way. At first my dear Wife worried so much, which made me feel terrible. Now after 4.5 yrs she doesn't know what to think & worries less. RONNIE

The thought of my wife possibly having to take care of me after an AFib stroke would scare me into blood thinners.

 

[ddoorn]

Atrial Flutter here

I've had an atrial flutter for over 10 years, controlled with a pacemaker and Eliquis in case of a clot. I've been asymptomatic and only found out about this when I went to donate blood and flunked as my heart rate was only clocking at 20 bpm. With a flutter the heart is actually quivering at over 1,000 bpm, but only a few may be firm enough to qualify as a "beat."

My cardiologist says "the heart is like a house. Your plumbing is A-OK, clean as a whistle. It's your electrical that's wonky." I've heard "sick sinus rhythm" used to describe what I have.

 

[marko]

I'm 75 with bouts of Ab Fab for the last 4.5 yrs. I've handled my case completely different then my doctors want. I'm very active, running 5k, biking, swimming, trotting up & down the beach collecting seashells, & etc. I don't take meds or any treatments. I may be a walking time bomb but as Frank sang, I did it my way. At first my dear Wife worried so much, which made me feel terrible. Now after 4.5 yrs she doesn't know what to think & worries less. RONNIE

The thought of my wife possibly having to take care of me after an AFib stroke would scare me into blood thinners.

AMEN! I've mentioned here earlier that my brother was a 62 year old elite level athlete; marathons, ironmans, rode his bike 100 miles every weekend, swam 50 lap every morning before work, etc. It's all he did.

Had a massive stroke 3 weeks after his most recent marathon and is now a total invalid now after one Afib incident. The only reason he's alive at all now was that he was in the most incredible physical shape at the time of his injury. He can't talk, can hardly walk, has only one useful arm and relies on the family for everything.

I'd only need one hint from my doc and I'd be buying Cumadin by the caseload! This is nothing to mess with.

 

[ddoorn]

Eliquis is a much kinder, gentler alternative to coumadin. No dietary restrictions or ongoing INR testing.