Afib decisions ("Afib Cure" book vs typical cardiologist)

Windy , you have a confirmed diagnosis? You have a recent and acceptable ECG showing the pattern? Any 12 lead ECG readouts when you were in AF? AFAIK, a 12 lead graphic lasting at least 15 seconds that shows any arrythmia will be read properly by a skilled reader (some people are fooled by what they see and they fail to diagnose an arrythmia properly...happens all the time in the medical field, even among cardiologists).

I have stated it, sometimes with blowback from readers, that atrial fibrillation is a progressive disorder. I know of exactly one person who has beaten it into submission, but the daily regimen this guy imposes on himself is rather extreme and very harsh. Even so, he admits that he still gets one or two episodes each year. He watches calcium intake and doses himself with magnesium like they were jelly beans. He says he's a magnesium dumper, so he pours it to himself daily. Literally...pours..drinks a liter of his own concoction each day. Every other person I have encountered on the www describes a progression. So, it's not something you would rather neglect and hope for the better. I admit, like a crybaby, that I was actually on cloud nine leaving my EP's office after our first meeting when he said he'd take a crack at my heart. I was unlucky the first crack, but the second ablation worked and I couldn't be more pleased. A bit heavier than I'd like, okay quite a bit, but it was a hard 18 months. I'm workin' on it...

Lots of folks abhor taking medication. As I admitted to my friends and family once I was formally diagnosed, I went from a smug, fit, and light 65 year old to a pill-poppin', chastened, and humbled wimp. I haven't had so much as a headache since I was 11 years old! I do still have my head of hair though...that counts for something!
But, a pill-in-pocket is often the resort of those who manage to keep their AF under control most of the time. My own cardiologist said I'd be on Eliquis for life, but that was before he referred me to an EP. I'm still on it, begrudgingly, but it might save me from another non-AF stroke that was down the pike for me anyway. Mebbe... I'm now into my seventh years with Eliquis. It is what it is. I'm over it. I am glad to be off of metoprolol because my dose kept rising (that pesky progression, remember?) and it eventually had be bouncing between dangerously low HR at 30 BPM, with ten second pauses at times (!!) and a normal HR above 50.

Also, I'm on a statin because the same cardio was worried about ischemic heart disease when I first went to him. Multiple tests later, including an angiogram, and all my vessels that matter are relatively free from deposits. But, I'm still on the statin, also for life. 🙁

As for finding the right EP, it's like finding the right car or house to buy...you ask, you smell, you listen, and you ask around. I wouldn't rely on those 'rate my MD' sites...they tend to get polluted by people who are PO'd because the MD didn't act as they had wanted. My own EP was the Canadian Cardiology Candidate of the Year in 2002, so not too shabby, but you should see some of the scathing reviews. Yikes!! He was brusque, and quick, no invitations to his next backyard barbecue or anything, but he was a gentleman who was clearly listening to what I told him, and he accepted my Galaxy watch's ECG when I told his office that his first crack at me was a dud (in more refined terms, natch). He called me twice and we had several minutes of conversation during which I didn't get the slightest whiff of his wanting to end the call or hurry me along. Bottom, line, know what you need from him, spell it out in concrete terms to both yourself and to him/her, and then act as your instincts tell you to.

If I have failed to address something you'd like me to comment on, please repeat or add it. I'll do my best.

Thanks @gloaming. I am a bit puzzled by your wondering if I have a diagnosis. I always feel my episodes and confirm with Kardia. But I have been in ambulance, ER and once ICU with EKG monitoring at least 12 times in 10 years. I thought that was clear.

I am in touch with the person you mention doing the magnesium dumping etc. My regimen is similar though electrolytes I take are considerably less in terms of quantity.

I am not opposed to meds in any general way. I have a kid with type 1 diabetes and epilepsy who wouldn't be alive without meds. I have done 5 years of cancer meds and 1 1/2 years of bone meds. I post on here frequently encouraging others to take meds when needed.

The problem for me is low blood pressure, making both beta blockers and diltiazem problematic.

I am on the other forum you are on though I left when the "moderator" belittled me for going to the hospital. The cardiologist I saw at MGH, like other doctors, told me I absolutely need to go to the hospital.

Reading other posts, it seems my afib episodes are different from some. My heart rate (ventricular response) goes up to 200, I am short of breath, chest and sometimes left jaw/arm pain, faint. And low blood pressure. One time, against my wishes, they gave me a bolus of diltiazem and my systolic bp was 60.

I know the triggers still. I had taken 4mg methylprednisolone for this last one. Day and Brunch, in The Afib Cure, maintain that it is not true that afib inevitably worsens. Time will tell.

I would start blood thinners with a higher CHADS score or more frequent afib. I went through the Coumadin experience with my mother. I do wonder if it worsened her dementia and of course with falls, or hitting her head, things got complicated. It was nice that Vitamin K could address her INR.

Ablation scares me. Spinal fractures have altered my thoracic structure and I am very nervous about thermal injury to my esophagus.

I went 5 months between episodes after going two years. We'll see what happens. That other forum is very opinionated and the moderator is abrasive, so unfortunately I am hesitant to use it. I just signed up for Day's newsletter.

I am forgetful and can't keep everyone's circumstances in my head, so I have to ask. I wanted to be sure you have a formal diagnosis, and with a 12 lead ECG because that's the definitive determinant, plus the skill of the reader. I hope you aren't offended by my question.

The busiest mod over 'there' is sometimes abrupt and to-the-point, I agree. That person seems firm and somewhat rigid about how to deal with AF, and doesn't feel that a person ought to go to the ER when symptomatic, even after several hours. It was all I could do to tough it out for an afternoon before I told my wife it was time to go. So, while I generally agree with that moderator that AF won't kill us, it doesn't do us many other favours. Even so, as he insists is almost always the case for paroxysmal sufferers, I did revert back to NSR within about seven to 12 hours, well under the 24 hour mark after which a rate above 100 becomes problematic.

I may not be telling you anything new, but it sounds to me like you have 'rapid ventricular response' when you go into AF. In my recent research, it suggests that it bears close scrutiny if this happens. You don't want a rapidly beating ventricle, at least not for more than an hour or two tops. Maybe if you're exceptionally fit, say an accomplished runner or cyclist, cross country skier or water polo player, for examples, but most of us don't have hearts with that kind of conditioning or capacity for hard work.

I don't understand your concern about your spine's condition as it relates to ablation....?? But the whole point of the TEE during an ablation is to minimize the risk of esophageal burns. I think the risk is very small. I can't put myself in other people's minds since I don't have their history and emotions with respect to risk-bearing and with dementia as your mother must have endured (and you), but I try to rationalize using probabilities to calm myself when faced with substantial risks or potentials. One such event for me was when I turned 60 and some friends invited me to do rock climbing by belaying. I have rappelled previously from heights, and done so for the same mental gymnastics, but I had not gone the other way...climbing into a higher risk of fatality as I gained height. But, I steeled myself and went about it, and actually had some fun, despite my discomfort. Of course, the real risk was minimal because of the experience and skills of those with whom I shared my birthday, but it could have gone bad. I think it was Mark Twain who quipped, " I have feared many things, most of which never happened,' or something close to that.

As for your AF history, mine is/was largely the same. I went two years between two bouts after the first when I was diagnosed. On both of those extra times, it was during or right after the Christmas holidays....when we had a house full of people for several days. Go figure. But, at the end of the fourth year, with so many AF-free months going by at a time, suddenly I was in the ER getting cardioverted, and they failed to get me back into NSR after the three allowed zaps. Over the next nine months I had several good weeks at a time, but rarely more than four or five, then back into AF. I did a very difficult MIBI test where I spent agonizing minutes trying to suck air through a mask in February of 2022. That event, I think, started me on a slide to the point where I was mostly in AF until my ablation five months later.

Deleting and sending PM.

@windyshores
Are you anywhere close to a Mayo Clinic? I can't state what other Mayo Clinics do by Mayo Jacksonville is outstanding. I have world reknown EP and a great Pace Clinic/cardiology department.

If you are not where close to a Mayo Clinic how about Cleveland Clinic. There many more hospitials and clinics that are outstanding but I have never been treated there so can't pass on personal information.

Anyone that's on Statin drugs I would ask you how your memory is. Statin drugs can cause dementia. Been down that road will not take them again.

Well, I would, if being scrupulously honest, not to be able to claim a decent memory at any point in my life...and it has been a disappointment. I do have grad school, and have taught at universities, so it isn't exactly bad, but in that relative population of university educators, I'd have to place myself squarely in the 50th %ile, maybe a bit less. Again...if I'm being honest.

With that said, and with my tongue in cheek, I'm not sure taking statins would have made my natural deficit noticeable. 😀

@gloaming did you convert at home without meds? Was your heart rate high? Was your bp low? Were you short of breath or did you have chest pain?

With a heart rate close to 200 I need meds but they lower blood pressure and mine is already low . I have all those symptoms. I cannot wait at home.

Windyshores, I was put on metoprolol and a statin right from the moment I met my cardiologist for the first time. The first time I felt I needed help, and went to the ER, they gave me a bolus of 25 mg of metoprolol, but it didn't convert me. They then tried to cardiovert, but that failed as well. I went home with a reduce rate, but still in AF. I converted some time later that day (I had gone to the ER at around 1900 hrs and was released around 0300). About a year later, after my index ablation, I was in and out of the ER several times, and I usually reverted to NSR after several hours on a gurney. Those times, they only gave me extra metoprolol once, and on that occasion they were about to release me having failed a cardioversion, but I reverted moments before they kicked me out.

My BP was always normal, or very close. Nothing they felt they needed to mention. I only felt short of breath the second time I paroxysmally went in into AF, about six weeks after the first time. I had to double over and told the triage nurse I wasn't doing well. She hurried me into the ER. All other occasions, at home or at the ER, it was only the chest thumping and the anxiety that ganged up on me and had me worried. Weird, but that is my story. Just the one time short of breath in perhaps 10 episodes that lasted more than a few minutes.

And despite what Our Friend might insist is the case, I don't fault you for a pico-second for not being able to abide how it makes you feel, and for hying yourself to the closest ER. Done it meself, an I would hasten to do it again. And like you, I did ask twice, separate occasions, if I was doing the right thing. I was told unequivocally that I absolutely did the right thing by going to the ER. An arrythmia is serious business.

I always feel calm. It's weird. Maybe it is a physical effect.

But I am not on any meds (cnanot tolerate them with low bp) and there is nothing I can do at home to bring the rate down from 190+. I need a diltiazem drip with IV hydration to keep the bp up. It just seems somehow that my situation isn't typical and I get responses that don't fit.

Anyway interesting that they let you go home in afib. I wonder, if my rate were to come down, if they would let me go home. When I self-convert, the rate goes down and stays down.

They always do two troponins, which keeps me there longer. Ugh. And once when it went on for 7 hours they did an echo.

I will say that last summer I had an episode that lasted until the ER door: it stopped in the ambulance (after a bolus of diltiazem with IV). The next two times, 6 weeks later, were very short and I brought the rate down and stopped the afib with Gas X. Those are the only two times I hadn't called 911.

On April 15 during my next episode, I tried to stay home. I did Gas X, one diltiazem (took my bp the whole time and did Kardia too), and walked around, played around with breathing, with bearing down, with cold water- and then drove myself thinking maybe it would stop before the ER but it didn't. So in ER all night.

The local ambulance crew know me well (from living in the same small town) and get really mad at me when I drive myself to the police station because I hate having the ambulance come to my street. They didn't know I drove myself all the way to the hospital. Ambulances cost!

But I could get the bolus of diltiazem and IV quicker in an ambulance and if my bp had been lower with my home cuff I would have called. For some reason it went high that time.

Thanks for sharing. I am meeting with the primary care NP who knows me really well tomorrow to discuss. I have not gotten the promised referral to an EP from the high calibre cariologist I saw last week, or a new Rx for diltiazem (though I have only taken it 3 times in 10 years I still want it). More importantly, my questions were not answered.
- is short term anticoagulation based on length of episode possible and appropriate
- can I have a protocol with beta blockers or diltiazem to help me take steroids (lupus, asthma) or albuterol without triggering afib
-should I avoid certain meds due to borderline QTc interval (or is that long during afib only)
-how to handle periods of stress (I feel I have gotten a lot of triggers identified and handled but stress is tough to avoid; I do walk, tai chi, art, Reiki but may need meds at times when I get the feeling that afib may occur)

By the way I was "electrocuted" (my record actually says that) in 2014, s serious shock during which I lost muscle control and landed in ER. I suspect that did something to my heart. I was also on cancer meds that eliminate estrogen for 5 years. My afbi started after both those possible factors.

Ten episodes since 2015. Triggers dehydration, eating/gas, lifting (diaphragm shift), sudden alarm (once), stress (housing search, three episodes). Like George I do electrolytes.