Heart Rhythm Conditions – Welcome to the group

Interesting, thanks. I am not sold on having another CA. My 3rd one was at Mt Sinai, NYC w/ a top doctor. Normal sinuis rhythm lasted 3 years.

Interesting, thanks. I am not sold on having another CA. My 3rd one was at Mt Sinai, NYC w/ a top doctor. Normal sinuis rhythm lasted 3 years.

@gloaming I watched the whole video, thanks.

Most of us knew this but these guidelines are definitive on the failure of aspirin to avoid stroke from AF.

I was glad they addressed "lifestyle factors" though it came last and should come first!

I am troubled that a case like mine, and I have no idea how common or uncommon my type of case might be, is not addressed at all. These MD's say that for symptomatic paroxysmal AF ablation in "selected patients (generally younger with few comorbidities).....in whom rhythm control is desired, catheter ablation can be useful as first- line therapy to improve symptoms and reduce progression." (This does leave room for addressing individual cases, with qualifying language.)

I hope this does not mean that ablation is considered after one episode. For that matter, I hope that medication and anticoagulation are not considered after one episode, for all patients. The trouble with guidelines is that the clinician needs to use discretion after discussion with the patient and evaluation of the whole picture. They should not be and are not written with the intent that they be used absolutely and universally- but will doctors use them that way?

I have gone 10 years without daily medication, any anticoagulation, or ablation- with episodes happening generally every year or even every two years. When they do happen my heart rate is near 200 and I land in the ER due to low bp's barrier to treatment. Even the ICU. Yet so far, my AF has not progressed, knock on wood.

My mother had permanent AF and heart failure, and had a stroke when taken off Coumadin for 5 days for a procedure, so I know what can happen. That said, the bleeding episodes she had were concerning- nose bleeds, GI bleeds, and from falls, and she had severe anemia as a result. She also had dementia from the AF and micro bleeds in the brain.

I am grateful that my EP gave me a "pill in the pocket" anticoagulant (as well as PIP diltiazem which I continue to prefer doing with a drip in ER) because once I reach 75 (when my CHADS goes up) there will be more pressure to do an anticoagulant, and I know I am not invulnerable. The video does not mention episodic use of anticoagulants and I wish this targeted use was mentioned.

Again, this video does address "lifestyle factors" which generally means weight, high blood pressure and diabetes. I have none of these risk factors but my CHADS is 2 due to gender and age, soon to be 3. Thanks to a poster on afibbers.org a few years ago, I started drinking low sodium V-8 for potassium. For several reasons I also take magnesium and calcium. I added CoQ10. Identifying triggers has helped a lot: eating and reclining, eating after 6 so closer to bed, reclining after eating, GI gas (simethicone helps) lifting heavy things, and sudden alarms have all been triggers.

One hospital did an echo after my one episode greater than 2 hours (7 hours) to make sure there was no clot- probably not entirely reliable- since I declined anticoagulation. Now, with pill in a pocket, I would have that resource.

Last year I bought "The Afib Cure" by cardiologists Day and Bunch, who posit that progression is not inevitable and that for some, slowing progression or even "curing" afib is possible with hard work. This book also covers medications and ablations and the title is a bit misleading. But it did confirm that some of the things I and others were doing were indeed helpful. I say this with respect for the challenges faced by many for whom this type of thing is not going to work. I am mainly addressing concern for people like myself who are faced with doctors recommending medications and anticoagulation- or even ablation- after one episode when frequency is not yet known.

I have requested monitoring from time to time to make sure I am not having subclinical AF, and the results show no afib in a month. Some flutters, some tachycardia, some bradycardia, basically seconds of each. I have a Kardia and keep the battery active.

Guidelines are like recipes. Over the years, with my health issues, my daughter's and my mother's, I have seen that some doctors use them that way, and some go beyond to individualize after real discussion with the patient. I know doctors have liability concerns and following evidence-based protocols is protective, but they are also protected if they offer and we decline.
I would love to hear a cardiologists say that progression does not always happen. Day and Bunch write that in their book but I have yet to hear it in person, and I don't know if it is true. Time will tell!

I posted the video mainly for its update and confirmations that early treatment of AF is far better for most patients than to let it go and to let it ride for a while. Also, that CA is a better treatment, all things considered, than just monitoring or even rate/rhythm control meds. Yes, each case should be treated as the individual person they are, and with sensitivity to the patient's circumstances and wishes. And I will say that not every cases appears to progress, but it takes some serious considerations by the wearer. The information I have seen all state that it is a progressive disorder, but clearly there is a substantial range in speed and in outcomes.

@gloaming I watched the whole video, thanks.

Most of us knew this but these guidelines are definitive on the failure of aspirin to avoid stroke from AF.

I was glad they addressed "lifestyle factors" though it came last and should come first!

I am troubled that a case like mine, and I have no idea how common or uncommon my type of case might be, is not addressed at all. These MD's say that for symptomatic paroxysmal AF ablation in "selected patients (generally younger with few comorbidities).....in whom rhythm control is desired, catheter ablation can be useful as first- line therapy to improve symptoms and reduce progression." (This does leave room for addressing individual cases, with qualifying language.)

I hope this does not mean that ablation is considered after one episode. For that matter, I hope that medication and anticoagulation are not considered after one episode, for all patients. The trouble with guidelines is that the clinician needs to use discretion after discussion with the patient and evaluation of the whole picture. They should not be and are not written with the intent that they be used absolutely and universally- but will doctors use them that way?

I have gone 10 years without daily medication, any anticoagulation, or ablation- with episodes happening generally every year or even every two years. When they do happen my heart rate is near 200 and I land in the ER due to low bp's barrier to treatment. Even the ICU. Yet so far, my AF has not progressed, knock on wood.

My mother had permanent AF and heart failure, and had a stroke when taken off Coumadin for 5 days for a procedure, so I know what can happen. That said, the bleeding episodes she had were concerning- nose bleeds, GI bleeds, and from falls, and she had severe anemia as a result. She also had dementia from the AF and micro bleeds in the brain.

I am grateful that my EP gave me a "pill in the pocket" anticoagulant (as well as PIP diltiazem which I continue to prefer doing with a drip in ER) because once I reach 75 (when my CHADS goes up) there will be more pressure to do an anticoagulant, and I know I am not invulnerable. The video does not mention episodic use of anticoagulants and I wish this targeted use was mentioned.

Again, this video does address "lifestyle factors" which generally means weight, high blood pressure and diabetes. I have none of these risk factors but my CHADS is 2 due to gender and age, soon to be 3. Thanks to a poster on afibbers.org a few years ago, I started drinking low sodium V-8 for potassium. For several reasons I also take magnesium and calcium. I added CoQ10. Identifying triggers has helped a lot: eating and reclining, eating after 6 so closer to bed, reclining after eating, GI gas (simethicone helps) lifting heavy things, and sudden alarms have all been triggers.

One hospital did an echo after my one episode greater than 2 hours (7 hours) to make sure there was no clot- probably not entirely reliable- since I declined anticoagulation. Now, with pill in a pocket, I would have that resource.

Last year I bought "The Afib Cure" by cardiologists Day and Bunch, who posit that progression is not inevitable and that for some, slowing progression or even "curing" afib is possible with hard work. This book also covers medications and ablations and the title is a bit misleading. But it did confirm that some of the things I and others were doing were indeed helpful. I say this with respect for the challenges faced by many for whom this type of thing is not going to work. I am mainly addressing concern for people like myself who are faced with doctors recommending medications and anticoagulation- or even ablation- after one episode when frequency is not yet known.

I have requested monitoring from time to time to make sure I am not having subclinical AF, and the results show no afib in a month. Some flutters, some tachycardia, some bradycardia, basically seconds of each. I have a Kardia and keep the battery active.

Guidelines are like recipes. Over the years, with my health issues, my daughter's and my mother's, I have seen that some doctors use them that way, and some go beyond to individualize after real discussion with the patient. I know doctors have liability concerns and following evidence-based protocols is protective, but they are also protected if they offer and we decline.
I would love to hear a cardiologists say that progression does not always happen. Day and Bunch write that in their book but I have yet to hear it in person, and I don't know if it is true. Time will tell!

Can I have bradycardia and afib concurrently?

Hello Eileena,

No, the implant is not an ICD. The Watchman does not affect the abnormal heart pumping, but rather acts as a dam to permanently close of the Left Atrial Appendage (LLA), Closing off the LLA can prevent a blood clot from blocking blood supply to the brain. I was on Warfarin for 14 years for A-Fib until my body could no longer tolerate it; the following 3 years on aspirin only and the Watchman implanted 14 months ago.

Tresjur

Hi, I'm 81, have had afib for 2 years, now classified as persistent afib- measured on Kardia and frequent EKG, but I have very few low grade noticeable symptoms. On Eliquis and Diltiazem. Had 2 cardioversions, lasted about 6 months each, but they don't want to do any more. Suggesting a drug Tikosyn (have to be in hospital 3 days to titrate, plus regular EKG checkups). I don't feel comfortable about that because I have allergic or non tolerant reactions to almost 20 drugs, listed in my chart records, and this one I really don't feel secure about. Suggested follow-up Walkman, to allow me to go off blood thinner (I did have one fall that caused a small subdural hematoma.) I feel PF ablations would be better, we are in discussion about this now (coming week appointment). I am confused, scared, have all new doctors due to retirement or relocation, so don't have anyone I know well enough to feel comfortable with. If I do nothing, I'm told it will continue to get worse and won't be able to be corrected. I just feel lost about how to make these decisions. I can't get in to see my new regular cardiologist until May - Previous one moved out of state. Now working with EP Cardiologist - new to me and new, very young to hospital system. Sorry for the long intro -(this sounds like the continuous obsessive thoughts that run through my head constantly so .....) Would love to hear from anyone who has had these hard decisions to make.