Medical and other procedures triggering afib episodes

Posted by anngunion @anngunion, May 16, 2023

I have paroxysmal afib episodes that seem to be primarily triggered by specific body positions, breathing patterns, acid reflux and swallowing too fast. Wanting to learn if others have encountered problems with appointments that require/involve specific body positions and/or different breathing patterns. In my case these situations have/may trigger afib episodes. I basically need to have my head in an upright position. I have had to terminate dental appointments as the required reclining position of the chair triggered an episode and also required that I change my breathing pattern. I breathe primarily through my nose - taking in air through the mouth is often a trigger. I have also avoided having a colonoscopy since this requires specific reclining positions, and am also concerned that swallowing prep liquid before that procedure might be a trigger. Another situation might be having a hair treatment that involved putting the head in different positions. Any suggestions on how to manage such appointments would be greatly appreciated!

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

I don't do hair appointments and my dental hygienist modifies my position. I do at home DNA testing (ColoGard) rather than colonoscopy. I also cannot bend my head back at all due to spinal cord issues so not only because of afib.

I find that GI gas it the biggest trigger and positioning makes a difference. Ironically the ambulance and ER put me in the worst possible position. If they would let me move around and find the right position I think the episodes would be shorter!

Swallowing too fast and GERD could create gas bubbles the press on the heart. At least that is how it feels to me. I cannot confirm medically!

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This is a good question, and I hope you find some work-arounds. I'm curious to know if you are getting any treatment generally for the atrial fibrillation? I've read that in a small percentage of people it can be associated with high blood pressure?

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My experience with afib and medical procedures: I have had persistent afib since 2020. I started on Tikosyn in 2021 and it was effective for about a year and a half and then I started having breakthrough episodes of afib that were becoming increasingly more frequent and intense. I had an ablation late last June and it stopped the afib episodes. I remained on Tikosyn during the blanking period. The plan was to stop the Tikosyn in October or November. Unfortunately, I had to have abdominal surgery under general anesthesia at the beginning of October and I had several episodes of afib, along with frequent PACs, for about a month afterwards. I have been afib free again since then, except for when my EP tried stopping the Tikosyn in January. Fortunately, I went back into NSR immediately after restarting the Tikosyn. But now, I worry about general anesthesia. I am having hand surgery next Wednesday and I convinced the surgeon to do it without general anesthesia because of my concerns. I am having a second ablation this coming November, so hopefully it will take care of all of this. Good luck to you.

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I read a little bit about atrial fibrillation here: https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

Years ago I was having some occasional symptoms of feeling like my heart would "flutter" when I bent forward, like reaching down to pick something up, sometimes but not always. This seems to have resolved itself, though I don't know why-- I did change a lot about my diet and other habits between then and now, though. And I never had a diagnosis for what exactly it was.

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On the subject of the fickleness of incident paroxysmal atrial fibrillation:

This (what follows) sums up just about everything I have come to know about the fickle & very often infuriatingly unpredictable nature of paroxysmal atrial fibrillation (AF), whatever its genesis (whether it's iatrogenic or "Lone" AF or AF caused by myocardial damage from incident myocarditis...which was further caused by administration of the mRNA COVID-19 vaccines or by a COVID-19 infection)--& I quote the first lines of this erudite & lengthy tract (which I heartily encourage others to read):

"It is likely that LAF only develops when three conditions are met:

1) The autonomic nervous system is dysfunctional.
2) The heart tissue is abnormally sensitive and capable of being triggered into and
sustaining an afib episode.
3) A trigger or precipitating cause capable of initiating an episode is present."

An abnormally sensitive heart tissue, if triggered, becomes a source of premature atrial complexes (PACs) or ectopic beats that, if frequent enough, may run together to create atrial fibrillation. German researchers have recently confirmed that the majority of afib episodes are preceded by a series of premature atrial beats. The origin of these beats is the left atrium in almost 80% of all cases."

See: https://www.afibbers.org/resources/aldosterone.pdf, entitled "Aldosterone: Villain of the Peace?" by Hans Larsen, MSc, ChE

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Hi anngunnion,
I feel for you A-FIB is SO frustrating.
I refer to it as insidious or evil because you can’t ever develop an approach or game plan to mitigate it.
I wrote a post I believe in March or early April titled No Rhyme or Reason.
If you can go back and look at it it details my frustrations with the unpredictability of A-Fib.
All the Best!

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@shoshin

On the subject of the fickleness of incident paroxysmal atrial fibrillation:

This (what follows) sums up just about everything I have come to know about the fickle & very often infuriatingly unpredictable nature of paroxysmal atrial fibrillation (AF), whatever its genesis (whether it's iatrogenic or "Lone" AF or AF caused by myocardial damage from incident myocarditis...which was further caused by administration of the mRNA COVID-19 vaccines or by a COVID-19 infection)--& I quote the first lines of this erudite & lengthy tract (which I heartily encourage others to read):

"It is likely that LAF only develops when three conditions are met:

1) The autonomic nervous system is dysfunctional.
2) The heart tissue is abnormally sensitive and capable of being triggered into and
sustaining an afib episode.
3) A trigger or precipitating cause capable of initiating an episode is present."

An abnormally sensitive heart tissue, if triggered, becomes a source of premature atrial complexes (PACs) or ectopic beats that, if frequent enough, may run together to create atrial fibrillation. German researchers have recently confirmed that the majority of afib episodes are preceded by a series of premature atrial beats. The origin of these beats is the left atrium in almost 80% of all cases."

See: https://www.afibbers.org/resources/aldosterone.pdf, entitled "Aldosterone: Villain of the Peace?" by Hans Larsen, MSc, ChE

Jump to this post

Further quoting (because I have spent so much time thinking about, observing, operationalising my observations in an Excel spread sheet, & conducting simple tests of hypotheses...about my own experience of paroxysmal AF...& finding much of what Hans Larsen observes...in his own experience...to obtain in my own case):

"The violent movement and stretching of the atria and ventricles caused by the fibrillation result in the release of ANP and BNP. These hormones immediately start dumping Na+ and water through the kidneys causing increased urination and normalizing the Na+/K+ ratio. ANP partially blocks the calcium channels in cardiac myocytes and thereby helps slow the heart rate. ANP also suppresses not only aldosterone and cortisol production, but the entire RAAS causing aldosterone to leave the stage. This frees up beta to concentrate on converting cortisol to inactive cortisone resulting in a normalization of cortisol levels.

Once the Na+/K+ ratio and cortisol levels have been normalized the factors sustaining the afib have been removed and the ANS will once again be able to take control and terminate the episode. The return to normal sinus rhythm can sometimes be facilitated by light exercise, which is known to release additional ANP.

The duration of the afib episode will depend on the vigour of the ANP response. This response is less pronounced in older afibbers and in afibbers with LAF of long standing because of the progressive fibrosis of the heart tissue caused by many episodes."

So I have completely & religiously implemented the Sinatra metabolic cardiology protocol (e.g., increased level of Co-Q10 supplementation, added D-Ribose, hawthorne, glycine, BCAA, & L-glutamine) ...and have added almost all of the Patrick Chalmers et al. Afibbers.org metabolic supplemental protocol (including the basics, that is, taurine, potassium, magnesium taurate)--& tested each addition as I either added or removed the metabolic supplement.

Further re-reading ( I have read & re-read this Hans Larsen piece 8 times--& followed up with a search & review-- via PubMed, of a number of basic & clinical research articles investigating the biological/metabolic phenomena referenced by Hans Larsen)...has brought me to my latest n =1 case adventure:

So this week I am testing a new line of metabolic-hormonal intervention: I am seeking to re-regulate the cortisol response to bring the RAAS-potassium-magnesium dysregulation to something more normative.

As I do not have access to...eplereonone (& not sure I'd be comfortable using it anyway)...I am using...500 mg of ashwagandha b.i.d. (on an empty stomach)--& I take the evening dose just before I go to bed (in addition to all of the above-mentioned metabolic-cardiological supplementation; & I have completely re-revamped all of my supplementation, which is too much to go into in this post).

Ashwagandha--like other supplements, is NOT a concentrated chemical formulation & does NOT evince immediate & drastic effects. So time takes time.

Add to this the always present & powerful...placebo effect (the most undervalued medical intervention in the world)...& my experience (yesterday & today) of re-regulation of this cortisol-RAAS-potassium-magnesium deficiencies precipitating the onset of ectopic beats & AF...has me (as always) hopeful that this morning's absence of AF, a substantial drop in my average heart rate (RHR overnight also dropped dramatically), & normal orthostatic function/performance (which I first rise from bed in the morning)...indicates at least the potential for better management of my paroxysmal AF.

More will be revealed.

Final note: I say: "Stop guessing; start testing!"

I have taken up in earnest the use of blood-based in-home testing...to know with objectivity...where I stand. All of the testing I do (apart from using the Horiba potassium meter to gauge my extracellular potassium levels) uses...dried-blood testing technology through a certified lab (that uses silicon photonic sensors)...to assess/measure key biomarkers, including cardiac & inflammation biomarkers (& to guide my metabolic-cardiological supplementation).

I refuse any longer to be a passive slug relying exclusively upon the orders of a fee-for-service physician I do not know & who hardly knows me or how my biological-psychological life is lived...to order & oversee my testing (& much of my health care). Home testing, decentralised science & decentralised medicine....are the future (& that's not just my opinion).

Stay safe & all the best!

REPLY
@shoshin

Further quoting (because I have spent so much time thinking about, observing, operationalising my observations in an Excel spread sheet, & conducting simple tests of hypotheses...about my own experience of paroxysmal AF...& finding much of what Hans Larsen observes...in his own experience...to obtain in my own case):

"The violent movement and stretching of the atria and ventricles caused by the fibrillation result in the release of ANP and BNP. These hormones immediately start dumping Na+ and water through the kidneys causing increased urination and normalizing the Na+/K+ ratio. ANP partially blocks the calcium channels in cardiac myocytes and thereby helps slow the heart rate. ANP also suppresses not only aldosterone and cortisol production, but the entire RAAS causing aldosterone to leave the stage. This frees up beta to concentrate on converting cortisol to inactive cortisone resulting in a normalization of cortisol levels.

Once the Na+/K+ ratio and cortisol levels have been normalized the factors sustaining the afib have been removed and the ANS will once again be able to take control and terminate the episode. The return to normal sinus rhythm can sometimes be facilitated by light exercise, which is known to release additional ANP.

The duration of the afib episode will depend on the vigour of the ANP response. This response is less pronounced in older afibbers and in afibbers with LAF of long standing because of the progressive fibrosis of the heart tissue caused by many episodes."

So I have completely & religiously implemented the Sinatra metabolic cardiology protocol (e.g., increased level of Co-Q10 supplementation, added D-Ribose, hawthorne, glycine, BCAA, & L-glutamine) ...and have added almost all of the Patrick Chalmers et al. Afibbers.org metabolic supplemental protocol (including the basics, that is, taurine, potassium, magnesium taurate)--& tested each addition as I either added or removed the metabolic supplement.

Further re-reading ( I have read & re-read this Hans Larsen piece 8 times--& followed up with a search & review-- via PubMed, of a number of basic & clinical research articles investigating the biological/metabolic phenomena referenced by Hans Larsen)...has brought me to my latest n =1 case adventure:

So this week I am testing a new line of metabolic-hormonal intervention: I am seeking to re-regulate the cortisol response to bring the RAAS-potassium-magnesium dysregulation to something more normative.

As I do not have access to...eplereonone (& not sure I'd be comfortable using it anyway)...I am using...500 mg of ashwagandha b.i.d. (on an empty stomach)--& I take the evening dose just before I go to bed (in addition to all of the above-mentioned metabolic-cardiological supplementation; & I have completely re-revamped all of my supplementation, which is too much to go into in this post).

Ashwagandha--like other supplements, is NOT a concentrated chemical formulation & does NOT evince immediate & drastic effects. So time takes time.

Add to this the always present & powerful...placebo effect (the most undervalued medical intervention in the world)...& my experience (yesterday & today) of re-regulation of this cortisol-RAAS-potassium-magnesium deficiencies precipitating the onset of ectopic beats & AF...has me (as always) hopeful that this morning's absence of AF, a substantial drop in my average heart rate (RHR overnight also dropped dramatically), & normal orthostatic function/performance (which I first rise from bed in the morning)...indicates at least the potential for better management of my paroxysmal AF.

More will be revealed.

Final note: I say: "Stop guessing; start testing!"

I have taken up in earnest the use of blood-based in-home testing...to know with objectivity...where I stand. All of the testing I do (apart from using the Horiba potassium meter to gauge my extracellular potassium levels) uses...dried-blood testing technology through a certified lab (that uses silicon photonic sensors)...to assess/measure key biomarkers, including cardiac & inflammation biomarkers (& to guide my metabolic-cardiological supplementation).

I refuse any longer to be a passive slug relying exclusively upon the orders of a fee-for-service physician I do not know & who hardly knows me or how my biological-psychological life is lived...to order & oversee my testing (& much of my health care). Home testing, decentralised science & decentralised medicine....are the future (& that's not just my opinion).

Stay safe & all the best!

Jump to this post

I too have the urination problem and have stated that before.
As far as the rest of your post I think you are way above my pay grade (-:
I left you a personal message last week, however you never responded ?
Click on the head icon in the upper right corner and go to messages you should see it.

REPLY
@shoshin

Further quoting (because I have spent so much time thinking about, observing, operationalising my observations in an Excel spread sheet, & conducting simple tests of hypotheses...about my own experience of paroxysmal AF...& finding much of what Hans Larsen observes...in his own experience...to obtain in my own case):

"The violent movement and stretching of the atria and ventricles caused by the fibrillation result in the release of ANP and BNP. These hormones immediately start dumping Na+ and water through the kidneys causing increased urination and normalizing the Na+/K+ ratio. ANP partially blocks the calcium channels in cardiac myocytes and thereby helps slow the heart rate. ANP also suppresses not only aldosterone and cortisol production, but the entire RAAS causing aldosterone to leave the stage. This frees up beta to concentrate on converting cortisol to inactive cortisone resulting in a normalization of cortisol levels.

Once the Na+/K+ ratio and cortisol levels have been normalized the factors sustaining the afib have been removed and the ANS will once again be able to take control and terminate the episode. The return to normal sinus rhythm can sometimes be facilitated by light exercise, which is known to release additional ANP.

The duration of the afib episode will depend on the vigour of the ANP response. This response is less pronounced in older afibbers and in afibbers with LAF of long standing because of the progressive fibrosis of the heart tissue caused by many episodes."

So I have completely & religiously implemented the Sinatra metabolic cardiology protocol (e.g., increased level of Co-Q10 supplementation, added D-Ribose, hawthorne, glycine, BCAA, & L-glutamine) ...and have added almost all of the Patrick Chalmers et al. Afibbers.org metabolic supplemental protocol (including the basics, that is, taurine, potassium, magnesium taurate)--& tested each addition as I either added or removed the metabolic supplement.

Further re-reading ( I have read & re-read this Hans Larsen piece 8 times--& followed up with a search & review-- via PubMed, of a number of basic & clinical research articles investigating the biological/metabolic phenomena referenced by Hans Larsen)...has brought me to my latest n =1 case adventure:

So this week I am testing a new line of metabolic-hormonal intervention: I am seeking to re-regulate the cortisol response to bring the RAAS-potassium-magnesium dysregulation to something more normative.

As I do not have access to...eplereonone (& not sure I'd be comfortable using it anyway)...I am using...500 mg of ashwagandha b.i.d. (on an empty stomach)--& I take the evening dose just before I go to bed (in addition to all of the above-mentioned metabolic-cardiological supplementation; & I have completely re-revamped all of my supplementation, which is too much to go into in this post).

Ashwagandha--like other supplements, is NOT a concentrated chemical formulation & does NOT evince immediate & drastic effects. So time takes time.

Add to this the always present & powerful...placebo effect (the most undervalued medical intervention in the world)...& my experience (yesterday & today) of re-regulation of this cortisol-RAAS-potassium-magnesium deficiencies precipitating the onset of ectopic beats & AF...has me (as always) hopeful that this morning's absence of AF, a substantial drop in my average heart rate (RHR overnight also dropped dramatically), & normal orthostatic function/performance (which I first rise from bed in the morning)...indicates at least the potential for better management of my paroxysmal AF.

More will be revealed.

Final note: I say: "Stop guessing; start testing!"

I have taken up in earnest the use of blood-based in-home testing...to know with objectivity...where I stand. All of the testing I do (apart from using the Horiba potassium meter to gauge my extracellular potassium levels) uses...dried-blood testing technology through a certified lab (that uses silicon photonic sensors)...to assess/measure key biomarkers, including cardiac & inflammation biomarkers (& to guide my metabolic-cardiological supplementation).

I refuse any longer to be a passive slug relying exclusively upon the orders of a fee-for-service physician I do not know & who hardly knows me or how my biological-psychological life is lived...to order & oversee my testing (& much of my health care). Home testing, decentralised science & decentralised medicine....are the future (& that's not just my opinion).

Stay safe & all the best!

Jump to this post

I meant to mention in my previous reply to you regarding your last post about 1 hour ago. Your Shoshin brain/mind must have really been working overtime.😀
I like it!!

REPLY
@shoshin

Further quoting (because I have spent so much time thinking about, observing, operationalising my observations in an Excel spread sheet, & conducting simple tests of hypotheses...about my own experience of paroxysmal AF...& finding much of what Hans Larsen observes...in his own experience...to obtain in my own case):

"The violent movement and stretching of the atria and ventricles caused by the fibrillation result in the release of ANP and BNP. These hormones immediately start dumping Na+ and water through the kidneys causing increased urination and normalizing the Na+/K+ ratio. ANP partially blocks the calcium channels in cardiac myocytes and thereby helps slow the heart rate. ANP also suppresses not only aldosterone and cortisol production, but the entire RAAS causing aldosterone to leave the stage. This frees up beta to concentrate on converting cortisol to inactive cortisone resulting in a normalization of cortisol levels.

Once the Na+/K+ ratio and cortisol levels have been normalized the factors sustaining the afib have been removed and the ANS will once again be able to take control and terminate the episode. The return to normal sinus rhythm can sometimes be facilitated by light exercise, which is known to release additional ANP.

The duration of the afib episode will depend on the vigour of the ANP response. This response is less pronounced in older afibbers and in afibbers with LAF of long standing because of the progressive fibrosis of the heart tissue caused by many episodes."

So I have completely & religiously implemented the Sinatra metabolic cardiology protocol (e.g., increased level of Co-Q10 supplementation, added D-Ribose, hawthorne, glycine, BCAA, & L-glutamine) ...and have added almost all of the Patrick Chalmers et al. Afibbers.org metabolic supplemental protocol (including the basics, that is, taurine, potassium, magnesium taurate)--& tested each addition as I either added or removed the metabolic supplement.

Further re-reading ( I have read & re-read this Hans Larsen piece 8 times--& followed up with a search & review-- via PubMed, of a number of basic & clinical research articles investigating the biological/metabolic phenomena referenced by Hans Larsen)...has brought me to my latest n =1 case adventure:

So this week I am testing a new line of metabolic-hormonal intervention: I am seeking to re-regulate the cortisol response to bring the RAAS-potassium-magnesium dysregulation to something more normative.

As I do not have access to...eplereonone (& not sure I'd be comfortable using it anyway)...I am using...500 mg of ashwagandha b.i.d. (on an empty stomach)--& I take the evening dose just before I go to bed (in addition to all of the above-mentioned metabolic-cardiological supplementation; & I have completely re-revamped all of my supplementation, which is too much to go into in this post).

Ashwagandha--like other supplements, is NOT a concentrated chemical formulation & does NOT evince immediate & drastic effects. So time takes time.

Add to this the always present & powerful...placebo effect (the most undervalued medical intervention in the world)...& my experience (yesterday & today) of re-regulation of this cortisol-RAAS-potassium-magnesium deficiencies precipitating the onset of ectopic beats & AF...has me (as always) hopeful that this morning's absence of AF, a substantial drop in my average heart rate (RHR overnight also dropped dramatically), & normal orthostatic function/performance (which I first rise from bed in the morning)...indicates at least the potential for better management of my paroxysmal AF.

More will be revealed.

Final note: I say: "Stop guessing; start testing!"

I have taken up in earnest the use of blood-based in-home testing...to know with objectivity...where I stand. All of the testing I do (apart from using the Horiba potassium meter to gauge my extracellular potassium levels) uses...dried-blood testing technology through a certified lab (that uses silicon photonic sensors)...to assess/measure key biomarkers, including cardiac & inflammation biomarkers (& to guide my metabolic-cardiological supplementation).

I refuse any longer to be a passive slug relying exclusively upon the orders of a fee-for-service physician I do not know & who hardly knows me or how my biological-psychological life is lived...to order & oversee my testing (& much of my health care). Home testing, decentralised science & decentralised medicine....are the future (& that's not just my opinion).

Stay safe & all the best!

Jump to this post

Great post @shoshin. And afibbers.org has been helpful to me as well.

The ambulance and ER put us in the worst position and prevent us from moving around. But I need the diltiazem drip because my blood pressure is low and it needs to come on board slowly.

Next time I am going to ask to be comfortable and ask for instructions on how to get up and move on my own despite the monitors and tubes.

Also- I prefer looking at the monitors because there is immediate feedback to whatever I am trying in order to stop the episode and the hospitals tend to have us facing away.

I would love your list of current/new supplements if you ever have time.

REPLY
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