Newly onset Afib

I posted just the other day about typical triggers for AF. It's a long list, but dehydration and electrolyte imbalance would be typical for aged people, or for active people out in the sun. Alcohol is usually tolerated, but each AF patient has to learn if it's a no-no for them. I have seen it be due to calcium in some, too much in their diet. Caffeine in others, so no colas or tea/coffee/dark chocolate or sports drinks. Poor sleep. They have undiagnosed sleep apnea (my hand is up).

AF goes through four stages, and you are in the earliest where it's easiest to manage or to ablate. I have had two ablations (first one failed, but the second worked and I'm 38 months free of AF). In the right cases, the right electrophysiologist (EP), they work. Sometimes they last a lifetime, sometimes an ablation lasts only a year. They can be repeated, but if they fail in a few months or years it means the heart is actively attempting to build new rogue circuits for the signals to take over the heart's rhythm.

@kevincurtin
I see @gloaming has already posted an answer to your question. Great advice and quite frankly don't have any better response to you than @gloaming gave you.

I also had first afib on a holiday with high stress, coming off of covid and drinking one glass of wine (which never got finished)! I was told the covid took out my thryroid which started the chain reaction. That was over 16 months ago. Cardioversion did not work but an iv of amiadorone did and I left the er within 4 hours on eliquis and metoprolol. I quit drinking right, sucks, still miss a glass every now and then but not worth the er trip. Some say that the irritation of the esophagus triggers vagal afib but have no idea if that is true. I do get gerd and alcohol does trigger that, so another reason to stop. Have not seen a cardioligist in a year. The last one told me no need to see him more than once a year and stay on the eliquis, dropped metoprolol. I meet a new one (insurance change) next month and will ask about eliquis. There is also a test called the Has Bled that includes alcohol on the criteria as alcohol is also a blood thinner, something my first Dr. never asked me about or considered.

found a site with both chadvasq and has bled, thought I would share: https://chadsvasc.org/

I had an ablation for arvnt 14 months ago. I was so thankful to be free of the tachycardia that plagued me all my life. But last night my heart woke me up. Something new. Had to go to ER and they said I was in afib. This has never happened and to be honest I am so depressed now. I was just getting my life back, finished a year long therapy of medications for cardiac tamponade and post cardiac injury syndrome that was the result of my first and only ablation. Now they have me on 5 mg of eliquis and 25 mg of metoprolol and I’ve been sick for the last few hours. I know ablation is recommended for afib but with what happened during the first ablation I’m nervous to go that route again. I was low in potassium and usually have bananas daily but skipped two days as I was out.

I was just so hopeful and now back to square one but with something worse. And advice is appreciated. Exercise instructor of 45+ years, no alcohol, no other issues, no other meds. Just feeling quite down about this. Could it be a one and done or the start of another bad journeys?

@red350 I hope you'll accept that I sympathize fully. I was horrible when in AF, and people said I looked distinctly grey in the weeks before my first of two ablations for AF. I was in the ICU with a runaway HR six days after my index ablation, and also placed on amiodarone for seven weeks. Then, about two months later, visiting my youngest with her little toddler, I was hunched over so he could hold my pinkie while we walked down the sidewalk and I got that familiar swelling feeling and then the thump and bump. Back in AF. I got fast agreement from my EP that he would attempt a redo, and the second one worked.

Getting a follow-on arrhythmia is unfortunately common. Those whose hearts begin to have more PACs will often find themselves in AF inside of a few months. Those whose AF seems to have been nubbed by a successful ablation often find that they're now in flutter (which is much easier to ablate successfully.....thank the Big Guy!). My point is that once the heart decides it's going to be electrically disordered, it runs the show. Everything else we do is palliative (if you know the official definition of that term...it doesn't mean 'terminal).

I, too, was given two large horse pills for low potassium. My dad, now departed, went to hospital three times in his last seven years due to low sodium, or hyponatremia as it is called. Electrolyte imbalance in the aged is common, often because of poor nutrition, but also often due to simply dehydration. When I make a cuppa coffee for me and my missus each early afternoon, I sprinkle some table salt and some potassium salt (same place on your local grocer's shelves) into the drip carafe first. Life gets more......ummm.....'involved'....as we age.

Not to be argumentative, but you're not back at square one. With the aging heart, none of us ever can be. We have an aging heart, it continues to advance in degeneration along with our organs, our skin, and unfortunately our brains. Ablations can stop the accelerated degradation of the heart that AF and other tachyarrhythmias can cause, such as valve prolapse, vessel thickening or enlargement, and ultimately heart failure. But they won't stop the heart from looking for new paths to confound its own internal wiring. AF, for sure, is a progressive disorder. But, it's not a lethal disorder....it won't kill us. It can make us WANT TO die if we are highly symptomatic and have a lot of anxiety or sleepless nights, but virtually every AF patient will eventually die from something else. AF doesn't kill its hosts.

I do, absolutely, now how it makes you feel. A bit defeated, maybe even cheated. Bummed at the very least. 😀 As I alluded to initially, my first ablation failed, almost a disaster. I was almost worse off! I was in that unhappy statistic that 25% of all ablations fail to control the arrhythmia, at least for AF. Why me?!?!? I have never been lucky, or so I told myself at the time. Looking back on everything that has gone right in my life, I'm wwwwaaaaaaaAAAAAY ahead of the game. I should be laughing...literally. And, my second ablation has had me in blissful NSR for 38 months now. What price for that!?

Try to be optimistic. One worked, you got that nasty opportunistic new arrhythmia, so common, but it's also treatable the same way. If you can stand one suggestion, it is to seek out the very best, busiest, and widely reputed EP you can afford and travel to...if you must. You want someone who can deal with 'complex cases', which you are now.

Thanks so much for your response. Of course I was writing in the depths of despair. 14 months without SVT/Avrnt would have been wonderful had I not been clawing my way back to health from postcardiac injury syndrome. But I got there and had 3 wonderful weeks off all meds. My electrophysiologist specializes in ablations and does the surgery 3-4 days a week every week in Madison-UW Health. But with what I went through with the cardiac tamponade and the year long quest to get better, I’m not sure if I want to roll the dice on another ablation. I’m hoping that I don’t get a fib often. I’m not sure if I need to actually be on Eliquis or metoprolol as I only had the one episode-now 12 hours past and fully in the front of my mind . I will wait to hear back from my doctor to see what her thoughts are hopefully tomorrow. I do appreciate all of your words of wisdom. Thank you very much. May I ask where you have your ablations done and with who? I’m still working, so I am bound by insurance and who they will allow me to see.

@red350 It's a grind, unfortunately, but I urge you to keep your nose to the stone. It will keep turning. 😀

You should be on Eliquis/apixaban or another DOAC like Rivaroxaban as long as you have a formal diagnosis for AF, and unless you have a full year free of AF after some kind of treatment or if you have had a Watchman device implanted in your left atrial appendage (LAA), or a mini-MAZE procedure or the like. IOW, even with meds to control rate and arrhythmia, you can still fibrillate, say when you're asleep, and that is when the greatest danger commences, minutes after onset. But what many don't understand is that long after a few hours of AF, and it has stopped, your risk of a clot dislodging from the LAA is about 5 times what it would be for a normally 'flushed' LAA when the heart is behaving. Bottom line, you want to be on a DOAC unless you have gone months free of AF, treated or it just went away. Ask your EP or cardiologist about why the risk continues for some time after the last bit of AF.

I am in Canada and had two ablations by the same gentleman in Victoria, on Vancouver Island. The two best EPs I know of in the USA (there ARE many excellent ones, but I have no knowledge of them...) are Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin (travels widely and has privileges at many hospitals....he's a crackerjack!), and Dr. Pasquale Santangeli at Cleveland Clinic. I believe, not certain, that both were students of Dr. Pierre Jais in Bordeaux, France....the Great Guru. Natale for sure studied under him.

Thank you. I will keep on the meds and keep focusing on the future and treatment. Of course I’m hoping it doesn’t come back or if it does not for a long time - one can hope. But we all know hope is for suckers as my sister says and you have to figure things out! What I am focusing on is that a fib originates in a substrate of the heart muscle and even after it is treated and abladed successfully, there can be other electronic glitches in another substrate of the heart that can cause a fib to occur there. So it seems to me that it’s an issue of stamping out little fires throughout the rest of your life and hoping that each stamp gives you longer arrhythmia free time.

I’ve also upped my potassium and water intake today. And time to go back to total anti inflammatory diet. I was inching into some dark chocolate……and sorbet.

Thanks again for your response. Appreciate it.

@red350
I feel for you as I've experienced a lot of complications and unexpected adverse effects from procedures and meds. 5 years into afib and I still can't commit to ablation because of other conditions I have that make me more high risk than average for collateral damage. But I would like to mention the eliquis. Because I don't typically do well with meds and have missing enzymes to metabolize most meds properly, I was hesitant to take eliquis. I had several retinal TIAs that caused me to lose all or part of my vision for a couple minutes, all happening right at the end of a long afib episodes which is when clots tend to be thrown. My retinal specialist was freaking out that I wasn't on eliquis. Finally, I had a cognitive TIA (mini-stroke) right after a 30 hour afib episode where I couldn't speak or type any real words for few minutes. Very scary and I thought that was finally the big stroke as it was happening. Another clot thrown. It did do some lasting damage in my communication center, but just annoying stuff. It got my attention though and I finally went on eliquis after that. That was 7 months ago and I have not noticed any change is bleeding after blood tests, minor cuts or finger pricks. No extra bruising. I have had many more afib episodes since I started eliquis, but no more TIAs. Will I ever get the ablations (they told me 2-3 for me)? I don't know, but I intend to stay on eliquis and will encourage others to do the same. Best of luck to you in all of this. You've been through a lot. I pray that was a one-off afib episode and you're on your way to stress-free healthy living.