Heart Rhythm Conditions – Welcome to the group

Hi there. I was a competitive runner, snowshoer, and did a lot of hard cycling. I was in the Canadian Armed Forces for 30 years, always fit, well-looked after for dental hygiene and general health, always vaccinated before deployments oversees. I developed atrial fibrillation (AF) suddenly near the end of a 10 km maintenance run. Long story short, I had all the usual tests, none turned up anything. The last diagnostic left in the list was an overnight sleep lab ( a polysomnography with a gazillion leads and machines blinking at me all night. Fortunately, I slept well for about six hours). Or....so I thought. The result that was fed to me ten days later was that I have severe sleep apnea. Who knew?!

Is your arrhythmia determined yet? Chances are that it is either PVCs (premature ventricular contractions(, PACs (premature atrial contractions), or AF. It might also be SVT, or supra-ventricular tachycardia, but the tachyarrhythmias are still in sinus rhythm...they're just quite a bit faster than necessary, often well above 130 BPM even at rest. A Holter monitor worn for several days, or a loop recorder, or maybe even an ECG while your heart is acting up one day, will determine which of those it is.

I have AFib and have made a list of “do nots” to keep the palpitations at bay. If I have missed a point I would appreciate hearing from you. I am booked for an ablation in 6 to 8 months.
-keep head propped up in bed
-no caffeine
-no alcohol
-stay on beta blocker - sotolol
-stay on blood thinner - Xarelto
- no strenuous exercise
- continue be tested by cardiologist

Welcome! I've been learning a lot from this group. I am turning 81 in January and have lived a similar active life. I let my three mile a day habit lapse when I moved to a desert house in southern Utah. I thought the five or six mile hikes were a good replacement. Then I stopped the hikes -- too hot, too early, etc. I thought my weekly pilates, yoga, and aerial yoga was enough. I developed all your same health concerns. I had a bunch of tests on a bunch of machines. Then meds prescribed and taken. I was still lethargic and fuzzy headed. I am now feeling better because we acquired an Aussiedoodle puppy -- a wild woman dog who requires a two to three mile walk on the desert every morning. I think I have found my cure...back to that daily workout to start the day. That probably isn't your answer, but thought you should know you aren't alone in the frustration of living actively, eating healthily and not getting rewarded as well as you should be. But, then again, I look at other 80 year olds and count my blessings.

I appreciate all the information and sites that you have posted. This one really hit home for me. I have had all the tests, too, and nothing is popping out other than being told my heart beats too fast. I had the sleep apnea test two days ago. I will not get the results for a couple of weeks. Please tell me how solving the apnea problem has helped you with the heart issues.
Thanks,
Dana

Dana, the sleep apnea, if it is present, has done its damage......sorry. Once your heart finds those extra electrical pathways and gets current going into your left atrium (if we're talking about atrial fibrillation, not necessarily the other arrythmias, of which there are 15), it begins a progressive path towards establishing others over time. You may control your AF effectively with drugs and some lifestyle modification, perhaps for several decades, but the aging body and heart have started even a slow progression toward permanent AF. For me, the idea was to stave off the events of AF until after I die, meaning I wanted to try catheter ablation. It didn't work for me the first time (there's a 25% failure rate of first, or what are called 'index', ablations across the medical practice of cardiology), but the second ablation, same electrophysiologist, worked, and I have been free from arrhythmia for coming up to two years now. The research shows that almost all patients, whether on drugs, self-imposed regimen, or catheter ablation, will eventually succumb to AF yet again. Might be months, might be a decade or more, but the aging heart wants to keep growing the extra node cells in places other than where the SA node is, in the rear roof of the right atrium.

A long way of saying that, while my sleep apnea is very nicely controlled, thanks very much, I still have the disordered heart it made for me. If a surgeon could somehow reverse all the ablation, my heart would immediately begin to fibrillate because the ablation only 'dams' the signal, it doesn't stop those extra electrical cells from issuing their electric current that leaks out into the atrial endothelium. To be more precise, ablation might, and must, kill a lot of those extra cells, but unless the burning goes deep into the cardiac substrate to get all of them scattered here and there, they still exist. And, as I said, the heart now grows more.

So, you'll want to control the apnea if it turns out you have it, and that is a journey all by itself with a new CPAP machine or variants that control different types of apnea. You can get information here, or at apneaboard.com, a forum that I have been on for years now. Great information there if you visit and/or join. But the arrhythmia is another doctor, more visits, more monitoring, more diagnostics, and getting used to more treatment. My own cardiologist wanted a lot of tests for ischemia, meaning low oxygen, to the heart, and I had scads of radiative imaging. I was clean, no ischemia, and all that was left to figure out the puzzle of my AF was the polysomnography. Bingo!

AFTER all that danged radiation. 🙁

Hello, I’m male, 65 yrs old. Living in Jacksonville, FL. My AF started when I was 40. So about 25 yrs ago. After cardioversion I would be put on meds and that would last about a yr sometimes less when I would go back into Afib. So the cycle would start over. Cardiovert then some new meds. I quit counting how many times I’ve been electrocardioverted. Close to 20 I think. I’m on my 3rd ablation which was done in 2013 at Mayo in Rochester. First two done in home town of Evansville, IN. The doctor(surgeon) at Mayo found some extra pathways that weren’t detected before. So my ablation took almost 8 hrs. I’ve been afib free for the past 11 yrs until the week before Christmas when for some reason I went back into afib. After a week of that was cardioverted again and was put on Eliquis. Also taking meds for high BP. Valsartan, diltiazem, carvedilol. So now I’m back in sinus rythm. Not sure how long this time tho. My surgeon in Rochester was Dr McLeod and I have found out that he is in Jacksonville also! So I’m going to be looking him up soon.

You have done very well, although I understand that you developed AF early in your life. That must have been a shock.

I would not be averse to seeing a 'newer' or different EP if this Dr. is no longer easily accessible. But, I would want that person to be as skilled and experienced as Dr. McLeod because those guys 'n gals are more likely to find what they're looking for and to send you away good for another few years.

About Dr. McLeod, you can start the conversation with, 'I remember you telling me you're always up for a challenge. Well....here I are! Again!'

Thanks for you response. In my reading, I am dealing with information that I am having trouble putting together in a relatable manner. I am attention deficit and have a brain that bounces off in many directions. So are the new electrical pathways the "remodeling" discussed in some articles? And where does "fibrosis" fit into the picture? Is the fibrosis in the heart or my lungs? Cardiac insufficiency? I have always maintained that I have had a lack of oxigen in my physical exertions during exercise. I was always advised by my PCP to just work harder. Could the ischemia be a lung disfunction? There was indication of possible cysts in the MRI of my lungs and have had two long term bouts with pneumonia.

In the order you asked:
a. Yes, the remodeling is the heart finding ways to act out incorrectly, whether with new re-entrant foci or with the fibrosis that accompanies a heart in duress; Fibrosis is damaged/scarred tissue. An enlarge atrium, for example, stretches the endothelial lining, which develops 'stretch marks', just like skin does. Those are fibrosis;

b. The fibrosis were concerned with in this case is in the heart's 'substrate' (underlying myocardium, or tissue), but also in the endothelial lining of the atrium walls that touch the blood swilling around. The electrical current that makes the atrium contract does not come from enervation; it travels like a wave across the inner lining, the endothelial lining, of the atrium and makes it contract that way. AF is where another wave gets sent into that lining at a different time from the wave that issues from the SA node in the right atrium, the normal wave that is in synch with the other three chambers;

c. I use the term cardiac insufficiency preferentially over the formal term 'heart failure'. The heart does NOT fail! It becomes less effective, mostly due to the atrial wall, ventricular wall thickening or due to valve prolapse which arises due to the malfunctioning heart chambers. Prolapsed valves do not close properly, so they don't block backwash of blood from the powerful lower chambers, the ventricles, from entering the upper atria again...which is a backwards flow. Who needs THAT!?, and

d. Ischemia is 'lack of oxygen.' You can have it in any organ, generally throughout the body, and certainly in the myocardium. The brain and heart need a lot of nutrients and oxygen. As you can imagine, they're heavy users. If your heart is beating improperly, irregularly, has long pauses, or is incapable of supplying itself with enough nutrients and/or oxygen due to blockages in its own vascular system, you betcha it will be a case of ischemia! But if the heart has ischemia, it might not follow that the rest of the body is short of blood. The heart can be so poorly supplied that it begins to die, meaning a heart attack, but it's still sending perfectly oxygenated and fed blood, from lungs and liver, to the other organs. Think of it this way: you're rolling down the pike at 80 mph, and life is good. Engine is purring, all the gauges say it's going well. But, there's not carburetor gauge to show that the engine is being starved of oxygen. The car is rolling as it should, but it begins to slow down (shortness of breath). Or, the oil gauge suddenly shows a dip in pressure. Car's still doing what you need it to, radio still works, battery and water pump are still doing their things, but now your engine is in danger of seizing....just the engine...because your oil pressure is low. The oil has nothing to do with the radio or the battery. I mean, both those things need the engine to get oxygen and have good oil in quantity, but they can run as long as the engine is generating electricity to charge the battery...etc.

Lung fibroids are a whole 'nuther kettle of fish that we needn't discuss here...but you might want to deal with that in another sub-forum here. Maybe the mods can help you with that...?

I understand. I am 76. I started having irregular heartbeat and traced to caffeine. I quit the caffeine, but lately having heartbeat issues lasting a couple of minutes, but today had one lasting longer. Am discouraged. Always considered myself a health nut. Eat better than anyone I know but not perfect. I believe it is after effects of covid I had. Not looking for advice. I do not run to the doctor for anything. Just venting my frustration.