Heart Rhythm Conditions – Welcome to the group

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!

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.

The meds lose effectiveness over time, but usually many months. It could just be that your disorder is progressing more rapidly than most and you might need an EP's intervention. I hope you can be patient and keep some positivity. It's hard, I know, when there's so much uncertainty, but have faith and be optimistic. There's a way through this, including biting your knuckles and watching the clock.

Thanks for your import, I am going to look into a ICD.

Cardiac arrhythmias do seem to progress over time, even with an ablation that seems to 'cure' the arrhythmia. An ablation, if successful (the cardiology field calls an ablation a success if the patient remains free from the treated arrhythmia for one full year), merely surrounds the re-entrant for the extra voltage with scar tissue. The voltage cannot escape the 'stockade' of scarring, so it can't cause the atrium to beat. However, the heart is always remodeling itself to an extent and it will often, not always, but often, develop new foci for the voltage issued by the migrant nodal cells being deposited here and there in the substrate. When that happens, you'll get another arrythmia, but not necessarily a return of AF. Sometimes another ablation is the ticket, while for others no amount of ablating will stop the arrhythmia.

This is an electrical disorder. It might have something to do with electrolyte imbalance in the myocytes, in which case supplements could help. You'd need, and want, a formal diagnosis of a deficiency before you start swallowing pills, so see your cardiologist. Many of us supplement with magnesium anyway and don't come to harm. As long as you don't overdose on it, you'll be fine. I have taken magnesium citrate (this is one formulation you do not want to take too much of or you'll be a frequent visitor to the bathroon!). I have also taken the bis-glycinate formulation and am currently on the malate formulation for giggles. They're all varieties of magnesium salts.

If your heart stays in arrythmia for long, it will begin to change, and not for the better. It's called 'remodelling'. Remodeling comprises the deposition of collagen in the interstitial tissue of the myocardium and fibrosis. The chamber walls will thicken and they'll become less easily changeable in shape, which is how they pump blood. Eventually, you are highly likely to develop 'heart failure', or cardiac insufficiency. So, if you are asking me for some pointed advice, find someone who can get you on a drug that controls your arrhythmia that doesn't also make you feel that life isn't worth living that way. You may have to consider a pacemaker. Literally millions live with a pacemaker.