Well it had to happen. I was hoping to go at least another week or more without an episode but no such luck. At least I got a slight reprieve and was able to go two weeks between my last episode instead of one.
This one came on at 9:45 p.m. last night (Monday night). This is starting to get really scary because my last three episodes now have been on Monday or Tuesday night at almost exactly 9:45 p.m. What are the odds of that? Afib is notorious for being unpredictable and variable. Mine you can practically set your clock by.
I literally ran out to my car to grab something and then I ran back into the house and sat abruptly down on my office chair to start working on my computer. That sudden movement of sitting down on my chair triggered the episode. That is another interesting pattern to my afib. The last three episodes were immediately triggered by a “movement down” – either sitting down or lying down. This isn’t anything entirely new, however, as almost all of my episodes have been immediately triggered by “sudden” movements going up or down.
I was really pissed off at first because I figured I would have another four-hour battle ahead of me. I waited about 20 minutes just to see if it would go away. Of course it didn’t. I took an EKG reading using my AliveCor monitor to confirm:
Eight minutes later I downed my 3 white pills of Flecainide and this time I also took 120mg of magnesium glycinate (one capsule). I went back into my office to work on my computer. My game plan was to work until I couldn’t stand it anymore and then go down into my man cave and watch TV for the next 3 hours – or however long it was going to take before the episode disappeared.
The most amazing thing happened. In the first hour I only had about 10 minutes of hell. I define hell as feeling really faint and having that awful feeling of losing your breath. In other words, I call it “hell” when the episodes are really intense. Otherwise, the majority of the hour was very tolerable. Yes, my heart was pounding away erratically, but it wasn’t debilitating. It was more of an annoyance. Because I felt relatively good, I kept working.
Then around 11:30 p.m. – just one hour and fifteen minutes after taking my Flecainide – I felt completely normal. In fact, to be honest, I felt pretty normal around 11:00 p.m. but it wasn’t until 11:30 p.m. when it finally dawned on me I had fully converted to NSR! I continued to work until just before midnight and I took another EKG reading to confirm I was in fact in NSR:
A one-hour and fifteen minute episode – with only 10 minutes of it being hell? It was too good to be true. I was so ecstatic I was giddy. I know I just got lucky. This was my eleventh episode since 2006 when I was first diagnosed with afib. None of them were ever this easy. This episode was, dare I say, “pleasurable,” – as far as atrial fibrillation goes. If every afib episode was this easy, it wouldn’t be such a big deal.
Possible Triggers
I’ve always thought that being tired and lack of sleep played a role in my afib episodes. I still believe it’s an underlying factor. But for this episode I was coming off the three best nights of sleep I’ve had since my vacation in Ft. Myers Beach, FL this spring. I had three nights in a row of 6 straight hours of sleep each night. This is unheard of for me so on this day I felt really good. I even took a 20 minute power nap the day of this episode and it was a great nap too. Bottom line – I wasn’t unusually tired leading up to this episode so I don’t think sleep was a factor.
What jumps out at me, however, is overeating. For lunch I had 3 small biscuits with a chicken breast. Even writing that is embarrassing – three biscuits? Really? One or two isn’t enough? I have to have three??? I usually don’t eat like that anymore but for some reason I decided to pig out.
Then for dinner I really went overboard. We had shredded chicken burrito bowls. These consist of chicken, beans, and rice – topped with shredded cheddar cheese and spicy salsa. I gobbled them up and went for seconds. The minute I dipped my spoon into my second heaping I knew I was going to regret it (why don’t we ever listen to that little voice in our heads?).
Sure enough, immediately after I finished my second serving I felt bloated and had that awful, “I ate too much. I feel fat feeling.” I felt this way leading right up to my episode. I have had episodes in the past where I had the same exact feeling because I ate too much during the meals prior to the episode.
For the past 2 months I have been recording everything I eat using the Lose It iPhone app. I’ve been doing this so I can stay on track and continue my weight loss efforts. When I look back at my diet for the past two episodes there is an interesting trend.
I had a couple pieces of Papa Johns cheese pizza for dinner prior to my episode on October 20th. Pizza, like rice, has a ton of carbohydrates. Because I only had two pieces and that was it, I wasn’t bloated at all. But it’s still a decent load of carbs.
Then get this, on October 13th I had white rice for dinner. Now looking back at that day, I only had about 3/4 a cup of rice and the dinner itself was pretty light. I have no record of feeling bloated that day, but again, another carbo load leading up to the episode.
Am I on to something? Probably not. It’s futile to try to determine triggers for this crap. If it was easy to identify triggers, we’d have a natural cure for atrial fibrillation by now. As hard as I try to identify what might be my personal triggers, it still seems completely sporadic and random. Still, though, I have fun trying to figure them out. Hopefully someday I won’t have to think about it because I’ll be afib free!
Hi Travis:
Does the AliveCor monitor interpret your rhythm for you or do you interpret it on your own? I was just curious if it gives you a report/interpretation that definitely state s”A-fib or NSR” or if it is up to the user to interpret the rhythm strip.
Thanks for any information you can provide.
Carrie
Carrie:
It will tell you if you’re in Afib or not. If you look at the first EKG screenshot in my post, you’ll see a small red box with the words “AF” in the lower right hand corner. That shows up automatically. You also get a message that pops up that says, “Possible AF detected.” They also encourage you to send the EKG report in via the app to be “officially” diagnosed. That costs $5. If the monitor marks it as AF, I don’t bother with the $5 reading only because I know when I’m in afib and I know what the EKG should look like. If you’re new to reading EKGs and you’re not 100% certain you’re in afib but the monitor says you are possibly in afib, then you might want to spring for the $5 just to be sure. However, I thought I read somewhere online that the developers behind AliveCor said the AF detection is something like 98% accurate so to me doing an official reading isn’t necessary.
Travis
Thank you for your response. I wondered how “user friendly” the AliveCor monitor was. I have experience in interpreting EKGs, however, wondered how much information it will provide to the average user. Does your cardio/EP support your use of this device? I think it would be really helpful to be able to take periodic readings between cardio visits and store them for review at future appointments. Thanks again for the info. Carrie
Carrie:
That’s the beauty of this device. It allows average users to take their own EKGs. Granted, you have to pay $5 to have it read but that beats a trip to the hospital or clinic for a quick and simple EKG. My EP doesn’t have an opinion on the device one way or another. I use it all the time and I store all my EKG readings in case he ever needs them, but honestly, I take the readings for my own peace of mind. This device allows me to quickly and easily determine when I’m in afib and when I’m out:) I should also mention it is FDA-approved. I can’t recommend this device enough to afibbers.
Travis
Travis, her AF was less severe? Is that like a little pregnant? lol. Im not diminishing the severity of what they call SA, it is a serious issue, I just dont believe its lethal, and I dont buy the whole assessment of it. Everyones heart does the same thing every night, based on their lifestyle/environment. If it stops and starts 23 times, youre normal, 35, borderline and so on. I would be interested in researching ways to prevent that from occurring by dietary/lifestyle changes before the CPAP. I have 2 friends with that device, one AFer, one not. It helped them sleep at night, did not prevent AF, and allowed them to continue their undisciplined lifestyle of caffeine/alcohol consumption and horrible diet. Both seriously overweight, but sleeping like babies. Awesome.
James:
I’m not an expert on sleep apnea, that’s for sure but you’re right, sleep apnea doesn’t kill you but I think there is plenty of evidence out there that it can negatively affect various conditions in the body – afib included.
Here is what David Van Wagoner, Phd of Cleveland Clinic says:
Sleep apnea leads to transient episodes of low oxygen in the blood stream (hypoxia) and changes in pressure inside the body. Hypoxic episode send a signal to the brain to increase blood pressure. Frequent episodes of sleep apnea promote high blood pressure, coronary artery disease and heart failure. This link (freely available) describes some of the major links between sleep apnea and AF. It has been estimated that one third to one half of patients with AF suffer from sleep apnea.
Then this link says:
The prevalence of OSA among patients with AF is remarkable with estimates ranging from 32%-49%. The pathophysiological connection between AF and OSA remains speculative, but appears to be the result of apnea-induced hypoxia, intrathoracic pressure shifts, inflammation, heightened sympathetic activity, and autonomic instability leading to hypertension, diastolic dysfunction, left atrial enlargement, and electrical remodeling.
Again, I’m not an expert on this but I guess if I had sleep apnea, I would want it treated “just in case.”
Travis
I dont disagree with treating CA, or any condition, just the method used. I believe just like meds, the mask is a “mask”, doesnt address the real problem. If you have GERD, and wear a mask to treat CA, the GERD doesnt simply go away, you still have it with a good nights sleep. I treated mine with diet, inclining my bed, taking a Mag at night for RLS, and BSM before bed, and the CA ceased. Im sure theres several other cures out there, but simply cutting gluten may go a long way towards improving this condition. Does it aggravate AF, absolutely. Does it cure it when we treat CA is the better question.
James:
When you say “CA” do you mean SA…as in sleep apnea? I suppose the mask is treating the symptom and not the cure so you have a great point. That’s awesome that you were able to cure your SA. What is “BSM”? And what sorts of dietary changes did you make?
Travis
Travis, thats why your 42 and Im 60, I cant keep my Abbreviations straight. Confusing CPAP for SA.
Black strap molasses, BSM, potassium/iron/Mag food for AF. Pretty simple diet changes. Basically no food 3 hours before bed is key. No carbs with protein. 1 tbls BSM with 300mg Mag. Thats it. I find that if you can get your nutrition from food or liquid, its much more effective than pill form, but Mag is harder to find in foods.
Travis, I did know there was 2 types of SA, OSA is the most common of the two. Also, the demographics of this falls mostly along ethnic lines of AA, Latinos, or Islanders, middle aged and over weight Men, which possibly leads us to lifestyle/diet? Whether it begins in the brain or the respiratory, it can all be related to a deficiency of calcium and low blood sugar. As for the brain not sending a signal to adjust to a several different physical and environmental issues, food, drink, hot cold, etc, Im not sure thats possible for one and not another. Forcing more air into your body via a mask is like giving someone oxycotin for a headache. You seemed very well versed on this subject and I would look for you to show me where an appliance or mask is not just another bandaid , but a cure. Thanks
James:
I don’t know of any specific studies at this time. I’m just going by what my EPs have told me and what other “experts” in this field have told me – that sleep apnea plays a crucial role in afib. This isn’t scientific evidence, but I spoke with a woman at an afib conference I attended this weekend and she had undiagnosed sleep apnea. After she got that treated, presumably with a CPAP mask, her afib was less severe. She did not make any dietary changes. When I get around to writing a post about this topic, I’ll be sure to cite scientific resources.
Travis
My cardio pushed me for a sleep study which I declined. The mask seems to be a crutch to ignore a greater underlying issue with sleep patterns. It could be a trigger I suppose. Does wearing a CPAP cure AF? Not to my knowledge from personal associations and researching online. Most use that mask to keep their lifestyle and diet the same. If I had apnea, I cured it myself with diet changes.
James:
I’m not sure I understand your comment about the cpap mask being a crutch to ignore underlying issues. There are two types of apneas – obstructive sleep apnea and central sleep apnea. With obstructive sleep apnea there is something physically “wrong” that is preventing you from breathing correctly when you sleep. With central sleep apnea the brain doesn’t send the correct signals that control breathing when you are sleeping. In either case, there is a lack of oxygen. The mask delivers oxygen to the body. I’m simplifying all this but the point is, the mask is essentially delivering oxygen to the body because the body isn’t getting the oxygen it needs. It has nothing to do with sleep patterns.
Does cpap cure atrial fibrillation? I doubt it but there is certainly evidence that it can dramatically reduce the severity of afib. When I get around to it, I’ll write a post on this topic because I think it’s important. There is no doubt there is a direct connection between sleep apnea and afib. Not that sleep apnea causes afib but that a lot of afibbers have sleep apnea.
Travis
Travis have you ruled out any left atrium dilation with your echo yet and confirmed everything is looking spot on? Also I assume you’ve been tested for sleep apnea and occult high blood pressure?
Ryan:
I’ve had a couple echos done over the years and everything has checked out. All the reports ever say is that everything looks normal. I have not been tested for sleep apnea but have considered it. Have you been tested for it? As for blood pressure, it’s normal and perfectly “healthy.” From everything I know about my vitals, I’m perfectly healthy…except this damn afib!!
Travis
Ah ok Travis well it’s good you have ruled out all of that, I would get tested for sleep apnea just to be sure, I am going to get tested in the next week or so just to be sure. I noticed you mentioned in your other post about Dr.JohnM is that the same EP who has his own Afib website http://www.drjohnm.org ? I noticed he has had a bout of afib before as well and it just never came back again? Weird isn’t it that he never had another since? He does ablations as well though right? You see Dr.Natale in a couple months, will be very interesting to see his point of view on cases like you and I, primarily based on the fact we have no identifiable reason for having this which is both good and bad I guess. It would be good to know the root cause but it also is good knowing there is not anything more serious going on behind the scenes.
Ryan:
I’ve been reluctant to get tested for sleep apnea just because I think it would be a big pain in the ass (if I can be honest). I have a problem getting decent sleep to begin with I can’t imagine what it would be like going to a clinic being hooked up to a bunch of wires while I’m sleeping…lol. I don’t have any risk factors of sleep apnea and other than snoring occasionally, I don’t think I have it. It’s always in the back of my mind so maybe someday I will get tested just to rule it out.
I had my meeting with Dr. Natale yesterday. I’ll be posting a bunch of stuff about it soon! Long story short, he’ll be doing my ablation in February!!
I follow Dr. John M’s blog as well. I suspect his afib will progress eventually. He might go another 10 years before that happens but if I was a betting man, I’d bet he’ll be in the same boat as the rest of us – but I’m certainly not wishing that on him. I hope he goes the rest of his life without afib. I want that for all of us!
Take care!
Travis
Yeah I agree Travis that sleep apnea is a very unlikely cause and from what I have read would show some signs of it from an echo such as left atrium dilation for example none of which has shown on your echo or mine.
In any event I am REALLY interested in what Dr.Natale had to say as much of his advice and/or perspective would be applicable to my case as well since we have very similar stories. Your blog has always been very thorough and well written and I really look forward to as much as you can relay back regarding your meeting and essentially the rationale around the ablation plan being the recommended path. I know the success rates very as well depending on what you read or who you talk too but I am curious what Dr.Natale thinks the “very” long term single ablation success rate could be for some people, such as could one ablation be a permanent fix etc.
Anyhow I will be keeping a close eye on the blog for your posts and look forward to learning as much as I can from your discussions with some of the best in the business!
cheers,
Ryan
Travis check this out as webinar as well it looks interesting, thought you may be interested in learning more about emerging treatments. http://adventistheart.org/livecast/?id=stopafib
Oh meant to add, I am now 95% gluten free. I m no health nut, but just believe that to give your body a fighting chance to digest heavy foods/meats, excluding the gluten enhances that process greatly.
James:
I have thought about looking into that – going gluten free. How long have you been gluten free and have your afib episodes subsided considerably as a result?
Travis
Travis. The short answer is yes, , altho Im not ready to attribute it solely to that diet change, other positive changes of overall well being have happened. Ive been AF free since going GF in August, however still get that feeling like Im going into it periodically, that flutter, and then it suddenly stops. Before, Id go right into it.
Interesting and too funny that Mexican food was the trigger, possibly. My first episode in Cancun after eating, get this translation in English, “Heart attack Tacos”. Not quite an attack, but for my first AF, it seemed to be a factor. I too am a nocturnal fibber. Always with movement. Laying on left side, getting up fast, sitting crooked etc. Yes, you are on to something, This condition is most likely related to nerve provocation. Hence, the elderly with osteo issues, old backs, are most prone to it, 75% over 65? Guessing. So, sure, look at the gall bladder, back issues thyroid, chronic acidosis, acid reflex, which is misdiagnosed as sleep apnea, cute name for a natural event while unconscious. Thats why I am dead set against Meds and surgery as a FIRST resort for this condition. I once used ice on my C1-4 vertebrae to self convert. Its all connected to a nerve gone wild.
James:
Thanks for your comments. I agree with a lot of what you’re saying. I believe they call us “vagal afibbers” because our primary trigger is the vagal nerve. That’s interesting that you converted with ice on your back. Did it only work one time or can you convert consistently with that technique?
Travis
Im not sure, because I havent gone into it since trying that technique. I have heard of others using that successfully. Interesting thing was my last Chriro visit in March precipitated my AF episode in March. I had an old whiplash injury, possibly moved Vert C-1-4 the wrong way.