On the heels of my annual physical, I had my annual heart checkup with my local EP on October 24, 2018. I’ve been feeling so good the past year that I was tempted to cancel it but I’m glad I didn’t. I got peace of mind and I learned some things that I’d like to share with you.
Echo Results
My morning started off with an echo. I have had an echo every year since my ablation three years ago. This would be my third echo. You might be wondering why I continue to have an echo every year when I’m perfectly healthy and free of afib.
I ask for one every year just for peace of mind. While it might be expensive, it’s a harmless screening that assures me that my heart is healthy and functioning properly. I’m convinced if my dad would have done the same he would be alive today. He died from heart failure that I’m 99% certain could have been avoided had he just had a simple echo done on a yearly basis.
My EP told me my heart looked perfectly healthy. My ejection fraction was a strong 60%. Last year it was 57% and the year before that it was 63%. It’s completely normal for your ejection fraction to vary from echo to echo so don’t look too deep into those numbers. The main takeaway is I’ve had a perfectly healthy ejection fraction since my ablation.
Side Note on Ejection Fraction
Ejection fraction is the percentage of blood flowing out of the two lower chambers of the heart (ventricles) with each contraction. A normal range for adults over 20 is 53-73%. If our ejection fraction is well below or above that range it can spell trouble.
My Heart Rate, Blood Pressure, & Heart Rate Variability
My heart rate was 55 bpm and my blood pressure was 106/80. My heart rate for the past year has been anywhere from 52–60 bpm, and my blood pressure has been between 100/70 – 110/80 so I wasn’t surprised by these numbers.
What I was surprised about, however, was my heart rate variability (HRV). I had heard about this term before but never gave it any thought. Heart rate variability is a measure which indicates how much variation there is in your heartbeats within a specific timeframe. High heart rate variability is an indication of good cardiovascular health and overall health.
My EP didn’t do any specific HRV measurements, but he listened to my heart with his stethoscope as I took deep breaths. When we take breaths in and out it changes the speed of our heart. Greater Heart Rate Variability (a higher HRV score) at rest is generally indicative of better health, a younger biological age, and better aerobic fitness. It’s a sign of great health!
Just by listening to my heart he said he could tell I have “great” heart rate variability. He said it, “sounded incredible.” He said it basically means my heart is working great and that such a “strong heart rate variability” is a great indication that my overall health is great!
Pill-in-the-Pocket + Beta Blocker – “Just in Case”
After my exam was over and I was given a clean bill of health, I decided to take advantage of the time I had with such a respected EP and ask him a handful of questions I had on my mind leading up to this appointment.
Every year during my annual checkup I always ask to have my flecainide and Eliquis prescriptions renewed. Again, you might be asking, why in the world would I bother getting prescriptions when I’m perfectly healthy and free of afib?
The answer is simple: so I’m prepared “just in case.”
Having battled afib for nine years and having had to go to the ER four times to be cardioverted, I am all about being prepared for the worst-case scenario. I hope I never have to deal with afib again but the reality is there is a chance my afib will return. It could come back tonight, tomorrow, or ten years from now. If it returns, I want to be ready for it. I don’t want to be caught flat-footed!
I always keep a month’s supply of flecainide and Eliquis in my medicine cabinet “just in case.” Fortunately, I’ve never had to take them since my ablation three years ago but if the beast returns I’ll be prepared!
While my EP was making a note to refill my prescriptions I asked him about adding another medicine to my arsenal “just in case.” I asked him about adding Bystolic to the mix.
Bystolic is a beta blocker. The reason I asked specifically for Bystolic was because I thought it had the least effect on your blood pressure. Beta blockers will usually lower your blood pressure so if you have low blood pressure to begin with as I do, beta blockers can practically put you in a coma. O.K. I’m exaggerating a bit, but the point is they can make you really lethargic and tired.
My thinking was I could pop the Bystolic along with the flecainide during an episode and the Bystolic would help keep my heart rate lower without lowering my blood pressure too much. We had a lot of back and forth conversations about this, but the bottom line was he recommended metoprolol over Bystolic.
His reasoning was that Bystolic stays in your system about twice as long as metoprolol. In fact, when looking up the half-lives of these drugs, Bystolic has a half-life of 12 hours while metoprolol has a half-life of only 3-4 hours. He was right. Bystolic definitely stays in your system much longer.
His concern was that if the flecainide converted me relatively quickly, say within 6-8 hours, I’d still be walking around with Bystolic in my system. In short, I may be one tired person until the Bystolic wears off. Instead, if under the same circumstance I took metoprolol, it would be mostly out of my system around the time I converted back to normal sinus rhythm.
That all made perfect sense, but I was still concerned about metoprolol having more of an impact on my blood pressure than Bystolic. He said he didn’t have the same concern. He said the Bystolic was more likely to negatively impact my blood pressure than metoprolol. This didn’t make any sense to me as it was completely opposite of everything I had heard from other afibbers, but he’s the doctor so I wasn’t going to get into a debate with him about it.
He agreed to give me a prescription for a very small dose of metoprolol to take if my afib returns and I need some relief from the episode. However, he told me not to take it right when I take the flecainide. He said I should take the flecainide first and then wait. If I didn’t convert in 6-8 hours and was miserable, then I could take the metoprolol to take the edge off.
If my afib returns, my “emergency only protocol” is to pop 300mg of flecainide and 5mg. of Eliquis. I’ll ride it out for 6-8 hours and see how I’m doing. If I convert, life is good. If I don’t and I’m just miserable, then I’ll pop 25mg. of metoprolol and go from there. Hopefully, I’ll never have to engage the “emergency only protocol!”
Side Note on Preparing for the Next Attack
Being prepared for an afib episode can go a long way in giving you peace of mind and helping you get through an episode with much less stress and anxiety! It took me a long time to figure this out. Don’t wing it! If you have paroxysmal afib, have a game plan so you’re ready for the next attack! Take control of your afib. Don’t let it control you!
When Is It Time to Go to The E.R.?
I’ve been asked this question so many times from afibbers and I’ve never had a good answer. I always assumed the answer was a technical one, that if your heart rate was over X beats per minute you had to go to the E.R. My assumption was wrong.
My EP said the answer wasn’t a technical one at all. He said it varied from person-to-person, but it was based strictly on your symptoms. If you’re having obvious, or “scary” symptoms, then it’s time to go to the E.R.
If you’re having an afib episode and you’re feeling really faint and practically passing out, or if you are having extreme shortness of breath, these would be considered obvious, or “scary” symptoms. You should go to the E.R.
On the other hand, if you’re doing o.k. and managing, you probably don’t need to go to the E.R. He said we all know when something just isn’t “right” so he said we just have to listen to our bodies. He said most of us will know when it’s time to go. He also said that some people will go to the E.R. regardless just to be safe and that’s perfectly fine too.
When I look back at the times I went to the E.R. during an afib episode, I definitely went prematurely. I didn’t know any better at the time. I just assumed an afib attack automatically meant a trip to the E.R. I also panicked a lot back then during my episodes so that only reinforced the idea that I had to go to the E.R. immediately.
Looking back, I probably could have avoided all those trips to the E.R. and saved myself thousands of dollars in the process! My episodes back then were never insufferable. Miserable, yes, but never too extreme to bear.
The Cardioversion Window
Speaking of going to the E.R., I talked to him about the “cardioversion window.” This is the window that doctors will do a cardioversion without requiring you to have a TEE first.
A transesophageal echocardiography, or TEE, is a test that produces pictures of the heart. While painless, a TEE is not the most comfortable procedure and one that you’d like to avoid having if you can. A TEE is done by placing a tube down your throat and into your esophagus. Sounds fun, right? It’s especially fun when you’re in a full-fledged afib episode – NOT!
The cardioversion window is 48 hours. Let’s say you have an afib episode at noon on a Monday, doctors in any E.R. will do a cardioversion “on the spot” without requiring any further tests as long as the cardioversion is done by noon on Wednesday – 48 hours from the time the afib episode started. If you walk into the E.R. at 3 pm on Wednesday, most doctors won’t do the cardioversion. They’ll require a TEE first.
The reason a TEE is required after 48 hours is because there is the possibility that clots can form in the heart after 48 hours. The concern is if you have a clot it can dislodge after the cardioversion and travel up to the brain and cause a stroke!
The exception to the cardioversion window is if you’re on an anticoagulant, or blood thinner, such as warfarin, Eliquis, Xarelto, etc. If you’ve been on a blood thinner since the afib episode started, most doctors will do a cardioversion without any further testing.
I asked him if I took the Eliquis right when an afib episode started if that would count as being on a blood thinner so I could avoid having a TEE in the event I needed a cardioversion after 48 hours. He said as long as I was on a blood thinner during the entire 48-hour period I would not need to have a TEE. What he did not say was that I would beprotected from clots. That’s an entire article for another day.
The point is if I wanted to avoid having a TEE after 48 hours I had to be on a blood thinner – period.
Side Note on Taking Eliquis “As Needed” to Prepare for a Cardioversion
You’ll note that my EP did not say if I would be protected from clots if I took Eliquis “as needed” when I had an afib episode to prepare for a cardioversion. I have no idea if you’d be fully protected or not. You’ll have to do your own research on this topic. I’d start with this study.
Amiodarone
I have read so many horror stories about amiodarone and its “unusual” features and side effects that I wanted to get my EP’s take on it.
He confirmed what I already knew, that it was the most effective antiarrhythmic drug available today. When no other drugs will work, amiodarone usually will (at least in the short-tem). However, he also confirmed it has the potential to be the most toxic antiarrhythmic drug. It can become toxic for just about every organ in the body but especially the lungs and thyroid. Even your skin, hairs, and eyes are vulnerable to its toxic effects.
When you’re on amiodarone it’s imperative to be monitored. He said his group is very diligent about monitoring their patients who are on it. They also do regular testing and monitoring after their patients are taken off of the drug for a period of time. The reason being, the half-life of amiodarone is measured in weeks and months! This drug stays in your system for a very long time so you need to be monitored for a while after you’re done taking it.
My primary question for him was, given its potential toxic effects is there even a reason to prescribe it? I was expecting/hoping that he would say he’s not a fan of it but instead he seemed somewhat enthusiastic about amiodarone. He said it has been a “very successful” drug for many of his patients. And even more surprisingly, he said very few of his patients suffer any harsh side effects from it. He said instances of toxicity are also very rare in his experience.
I was glad to hear, however, that he doesn’t use amiodarone as a first line of treatment, nor does he use it as a long-term solution for younger patients. He said he uses it very strategically and typically reserves its use primarily for patients with life-threatening arrhythmias that don’t respond to other drugs and treatments.
He didn’t seem to be as “scared” of amiodarone as I am. His general take was that it can be a highly effective and successful drug for some patients and that all the “hype” about its potential toxicity and side effects were overblown. By that I mean, the instances of patients experiencing severe or life-threatening side effects were rare in his experience. His general belief was that as long as you do regular monitoring while you’re on it, it’s o.k. to take amiodarone.
He put my mind at ease a little about amiodarone, but I will still avoid it like the plague. I will only allow a doctor to give me that “poison” if all else fails and my life depends on taking it. Otherwise, I will always look for other options, but that’s just me.
Digoxin
I ended my appointment discussing digoxin. My interest in this drug is a personal one. My dad was taking digoxin for his afib. His doctor put him on it in the late fall or early winter of 2014. He would die just months later in June of 2015 from heart failure.
I have no way of knowing if digoxin played a role in my dad’s death but the sad irony is, just a few months before his death I shared this article about digoxin with him as a warning to get off of it. I was concerned this drug would do more harm than good.
My dad shrugged my warning off and gave me crap for being so “positive.” His words to me were something like, “Gee thanks, son, for cheering me up. Don’t worry about me right now. Just focus on your ablation and after that we can talk about my heart issues.” I wasn’t trying to be Debbie Downer, nor was I trying to scare him. I was just concerend he might be taking an unnecessary and potentially dangerous drug.
My EP said digoxin has very little utility today. It’s a very old drug whose day has come and gone. There was a time when it was a mainstay drug for the treatment of heart failure and afib, but not anymore. He said there is a very small niche of patients where digoxin makes sense. The example he gave me was patients with permanent afib. He said he has patients in this group who take a very low dose of digoxin and a low dose metoprolol and they do “extremely well over the long-term.” He said there were other, “small niches of patients,” where a low dose digoxin makes sense but it’s very small. In general, however, it is not a drug he uses that often today.
I asked him about its potential role in my father’s death. He said it was unlikely it caused my father’s death, but it very likely didn’t help any. In other words, there was no reason for my dad to be on it. My EP didn’t say this, but I’m convinced that the digoxin only made his health worse.
Here’s why I say that. Digoxin is primarily eliminated by the kidneys. If you have bad kidneys you can become toxic on it because the kidneys can’t eliminate it. When my dad was in the I.C.U. guess what else was failing besides his heart? His kidneys. In fact, he had ZERO kidney function by the time he was admitted. How long had his kidneys been failing prior to being admitted? My guess is in addition to suffering from heart failure by dad was also experiencing digoxin toxicity to some degree.
What’s Next…
I’m praying for continued good health and a relatively calm heart for the next year. I’m so grateful to God that I’ve been afib-free for over 3 1/2 years now. I’m praying for at least another 3 1/2 years of afib freedom!
I am 54 and recently diagnosed with Afib. I am on flecainide (50mg) and metoprolol (25mg) and aspirin (blood thinner). I am in NSR most of the day but occasionally (maybe 3 times per week) it seems like the flecainide wears off after about 8 hours and I get intermittent Afib (feels like periodic “flutters” every 7th or 10th NSR beat – sometimes only happens every 20th NSR beat).
I have never been in “full Afib” where I needed to go to ER to get cardioverted. My question is about having an ablation. How does one become a candidate for an ablation and what disqualifies one for an ablation? Also, is it safe to exercise moderately if I am NOT in NSR?
Dave:
Anyone that has afib and is under the age of say 85 is a good candidate for an ablation. That’s the criteria. However, it’s imperative you have the ablation done by an experienced and elite-level EP to ensure your best odds of success (i.e. ending the afib).
At your age, you’re a perfect candidate so don’t let any doctor tell you otherwise!
As for exercising while you’re in afib, it’s usually o.k. as long as your heart rate isn’t “off the charts high” and you’re not experiencing any obvious symptoms (i.e. light headedness, fainting, shortness of breath, etc.). Some people are actually able to convert to NSR when they exercise while in afib. The main thing is to listen to your body. You’ll know if you’re overdoing it. I would talk to your doctor as well as I don’t know your specific health history so he/she may advise you to avoid exercise based on your history.
Travis
What if exercise actually triggers afib? Should you not do any exercise to reduce afib episode?
Richard:
Does any level of exercise trigger your episodes? If it’s only “heavy” or “rigorous” exercise that triggers your afib then I would still do low to moderate exercise if you can. But if you’re telling me that any level of exercise triggers your afib then I would probably avoid it until you get your episodes under control.
Travis
Great article. I’ve had paroxysmal for 30 years. One episode each 10 years, until this year, where I had 6. None lasting more than 36 hours, while 50% this year were less than 3 hours. All converted on their own, although because of time constraints, I had 2 electrical CV this year. All were present with RVR.
Binge drinking did play a role in my first two at 30 & 40 and low potassium played a role in my third one at 40. This is strictly based on anecdotal evidence. The ones in 2018, have no known causation, as they are still defined as lone AFib. Slightly dilated LA after a 30 hour episode in April. No continuing drug therapy.
The EP that I really trusted retired a couple years ago and have been to several others, although getting confusing answers, from blood thinners (chad2vas score of 0) to daily metoprolol, to daily flecainide, to ablation etc. I’m not a fan of daily medication.
Noticed several of y’all have seen EPs at TX Cardiac in Austin, TX. I’m scheduling an appointment with Dr G this week to try and get a reliable answer if anything should be done at this point or not. I’ve also looked at the mini maze procedure. Anyone looked into that?
Best New Years to all
Hi Travis
Excellent post!
I was AFIB free for more than 4 years but had an AFIB attack in May 2018. Everything went well and after one night in ICU and on Cordarone X(intravenous), I got the TEE treatment (mine was not that bad because I was “put under”).
I think amiodarone is the generic name for the drug Cordarone taken orally.
My Dr suggested that I go straight to ER if I have an AFIB attack because then I do not have to sleep over in hospital and I also do not have to do the TEE thing.
I am blessed that my medical aid will pay for an ER visit.
I usually also visit my Dr with a list of questions.
Praying for a long AFIB free life for you and keep up the good work.
Janco Vorster.
Thanks Janco. I hope you are able to get control of your afib again! Sorry to hear it returned. Have you ever had an ablation? Regardless, you should consider having another one to get final control over this beast!!
Travis
Hi Travis:
I have corresponded with you previously when my AF really blew up earlier this year. I had an ablation done by Dr. Natale on July 11 of this year, but surprisingly my recover has been awful. I say surprising because I was a clear case of lone AF with no other health or heart issues, and very athletic – logging about 3,500 miles of cycling per year, with an excellent heart healthy diet. My AF since the ablation has been replaced with paroxysmal Atypical Atrial Flutter, which to me feels like AF light. It’s not bad enough to check into the ER, but it still really sucks. On average, I have an episode every two weeks or so, and they tend to last a few days. My only coping strategy is Diltiazem slow release to slow my HR. I was taken off Flecainide as it was determined by both Natale and my local EP to be “proarrhythmic.”
I met with Dr. Natale a few weeks ago and he is recommending another ablation, and suspects my Left Atrial Appendage may be a source. My second ablation is now scheduled for February 4 of next year. If he has to ablate the LAA then I will need to be on a NOAC blood thinner the rest of my life, and/or have a Watchman device installed. All of this is very distressing as I assumed mine was a relatively simple case of recent onsite lone AF. Dr. Natale said to me “sometimes the athletic cases are the most difficult.” As some point I will submit a detailed summary of my case and experiences, but I am still in a “wait and see” mode regarding ablation and my AF prognosis.
I have two questions for you. In this report, you state that your resting HR is now down to 55. But I remember that when you first discussed your ablation recovery, your resting HR was in the mid-80s. How long did it take for your resting HR to drop back to 55, and do you feel that a slower resting HR makes you more susceptible to AF? My resting HR post-ablation is now about 75, whereas pre-ablation it was 55.
Also, since Flecainide is apparently proarrhythmic for me, Dr. Natale prescribed Multaq (Dronedarone) as an alternative to take when I have an episode. I am now skeptical of all AA drugs, and have not taken Multaq yet as it is supposedly related to Amiodarone which has horrific side effects. Can you comment on your knowledge of Multaq?
Hi Doug. Sorry to hear about the rough time you’ve been having.
Being a Multaq user, I wanted to share what I know about the drug. I have been taking it for several years and my experience with it has been generally positive. In my case, it has been well tolerated, nothing like Amiodorone with its scary side effects.
As far as I know, Multaq is not meant to be taken when one has an episode. Rather, it is recommended as a daily maintenance drug (one dose in the AM and one in the PM) in order to maintain a steady blood level. It is supposed to help prevent (or at least lessen the frequency of) AF episodes, not to treat an acute attack.
For the first few years, the Multaq seemed to work quite well for me. Although it did not completely eliminate my AF, it did lessen the frequency of my episodes. However, A-Fib typically tends to get worse as we age (at least mine does) and so for the last couple of months, my episodes have been getting more frequent, despite taking the drug. I’ll be seeing my cardiologist soon, hoping to find out exactly why this is happening.
Bottom line…I think Multaq could be helpful, but it should be taken in the manner and dosage recommended by the manufacturer. It is NOT a scary drug like amiodarone. (I’d be interested in hearing about the experiences of other Multaq users.) Good luck!
Hi Dora:
Thanks very much for the response. I think Dr. Natale prescribed Multaq to help keep me in SR before I can get my second ablation. For some reason Flecainide became “proarrhythmic” for me after my ablation, so I guess he thought that Multaq was worth a try. I don’t see much discussion of this drug on the this and other support sites. I have taken it for a few days now and don’t seem to have any significant side effects other than a little drowsiness.
My AFib started in 2016 with an occasional short lived episode, but really came on strong in early 2018 when I had to go to the ER with an irregular HR of 150. They gave me 200mg of Flecainide in the hospital and I converted in about an hour. So, yes, it is a progressive condition for most, but not all, people. Have you had an ablation yet?
Is this Dr. Natale with Texas Cardiac Arrhythmia? Just curious, I see a doctor there.
Best of luck to you and that medicine. I’ve not heard of it.
Hi Doug,
I have not had an ablation yet, but it’s beginning to look like there might be one in my future. Up until recently, my AF was fairly well controlled with a combination of Multaq (twice daily) and Atenolol (as needed). But lately, my episodes have become a lot more frequent even though I am not doing anything different, medication-wise. The thing that scares me about the ablation is that it seems like so many people require a second one, and even then there can be lingering issues. I hope that for you the second time’s the charm! Please keep us posted.
Doug:
Sorry to hear you turned out to be a more difficult case than expected. That is very common. I thought I was an easy case as well but Natale told me I had a rather complex case of afib. They had to ablate everything but the LAA. If my afib returns, the LAA will be the only thing left to ablate. I was shocked as I thought my case was going to be very simple. This is why it’s so important to go to someone like Natale because you never know how difficult your case is going to be until they actually do the ablation!
I wouldn’t fret about the lifetime blood thinner or the Watchman device. If it were me, I’d opt for the Watchman device all day long. These are simple to install by EP’s like Natale. I wouldn’t have ANY fears of having a Watchman device installed by Natale or someone experienced like him. These elite EPs have the installation of Watchman devices down pat. If I ever need my LAA ablated I’ll be going straight to the Watchman device without any questions or fear!
The other thing you have to be positive about is that once your LAA is ablated, you should be good to go. Your afib should be put to rest for good. There is a minuscule chance that a touch up LAA ablation may be necessary but once the LAA is fully “buttoned up,” that’s pretty much it for afib so keep that in mind! You will be making one step closer to ending your battles with afib!!
Regarding your questions…it was probably a year before my heart rate went down to the 50’s. I honestly didn’t feel any different when my heart rate was in the 80’s or what it is now in the 50’s. I feel exactly the same and haven’t been at any greater risk of having episodes.
I’m not familiar with Multaq but from what I’ve heard it works similar to Amiodarone but does not come with the toxic side effects. I wouldn’t be nearly as concerned taking it vs. Amiodarone! Plus, you have to trust Natale. If he’s recommending a specific drug it’s because he’s confident it will be the best drug given your situation. If you still have concerns you should talk to him about alternatives (whatever those might be).
I hope you are doing better. Keep in touch.
Travis
Congratulations on your good annual check up. Enjoy and cheers!
Concerning digoxin: I wonder if that could have caused my sick sinus syndrome, tachy Brady. I took digoxin a year and a half after being diagnosed with radiation pneumonitis (breast cancer treatment) and afib and really the digoxin never helped the symptoms. I’ve always had a low heart rate averaging around 52, even when in afib my HR was never high and I asked the Dr. numerous times about the digoxin since it was not helping and I had read negative reports concerning digoxin.
Then after I fainted, hit my head, was taken to ER, diagnosed with sick sinus syndrome and received an emergency pacemaker I was still kept on digoxin along with diltiazem and flecainide and xarelto. The EP finally let me stop the digoxin and use the flecainide as a pill in pocket. The PM leads are an issue but the Afib is quiet for now.
Cantrell:
I have no idea if your side effects were the result of digoxin. Glad to hear you are off of it. Did your side effects go away after you were taken off the digoxin? If so, that would be confirmation of a direct correlation:)
Travis
Hi Travis,
Im Glad to hear that you are doing well!!!
I don’t know if you remember me. I have had my ablation before yours and wrote here in your blog a few times.
Cheers,
Christian
Thanks Christian! I hope you’re doing well. I trust your afib hasn’t returned!
Travis
Great article. Long story but I was on amiodarone for a year and 1/2 but had to be taken off it because of a severe cough. It went away 2 weeks and 2 days after stopping it. I also had nausea and vomiting (now gone) for no apparent reason and numbness in both feet which I still have.
I’ve been off the amiodarone since July with no detectable A-fib symptoms yet but have a return visit with EP in April (unless needed sooner). My ablation will be done on return of symptoms if before that time. Thanks, Travis. Very informative.
Holly:
Based on what I’ve read about amiodarone, all the symptoms you had are hallmark symptoms of amiodarone. Glad to hear some of your symptoms have improved or have gone away since going off of it. I wish you well!
Travis
Thanks so much Travis, as always very informative and inspiring! So glad for you that your check up was good and you’ve been AFib free, may that continue permanently! Also glad you got some answers to your questions, it’s so hard these days to get time from doctors to even ask! I’m also sorry about your father, I can relate to your story.
Ironic I am seeing this post now, as I just got back from my 6 month cardiologist appointment, and had my 6 month EP visit 2 weeks ago. Luckily, I’ve not had any AFib since April, just small “blips” of non-sustained VTach (which are “normal” for me), and everything else (DVT, pulmonary emboli & all that entails) looks good and healing!
I do believe as you stated that AFib (among many other issues) are/is possibly genetic (my Dad, Mom, several siblings have/had it), and perhaps not caused by food, and also had to laugh because my last episode of AFib w/RVR made me stop drinking my beloved beer cold turkey. I thought I had caused my AFib by enjoying a few cold brews, as I had always been told alcohol is the worst. Funny, I felt better having the occasional cold brew than after quitting cold turkey. You may be on to something! ;O)
Best always,
Cheryl
Travis – great article on your questions to the EP. I have not had an ablation, and when I was due for a cardioversion I scared myself straight – right back into NSR! So I use a pill in pocket strategy. But I have not used Eliquis in that mix. I am crazy nervous about strokes but my only risk factor is I am female at this point, so I have been taken off anti-coagulants.
If I did take Eliquis the minute I went into AFIB, how long after converting back to NSR would I continue the Eliquis? I want to ask my EP this but the soonest appointment I can get with him is Feb 6. I just had an episode of AFIB last Friday night and only had baby aspirin, along with the PIP. Thanks for your comments on this.
Stephanie:
As far as I know, there aren’t any studies or guidelines as to how long you should take an anticoagulant after converting back to NSR. Furthermore, Eliquis is not prescribed or recommended to be taken “as needed.” Yes, it’s true my doctor gave me a prescription for Eliquis but it was with the understanding that I would take it “ongoing” if my afib returns and I continue to have regular afib episodes.
These new blood thinners such as Eliquis are so new that we don’t have any data/research on them as far as their efficacy when taken on an “as needed basis.” Quite, frankly, they were never developed with that purpose in mind.
I did find a brief article/study on how long you should be on blood thinners after an ablation. See this article:
https://www.ncbi.nlm.nih.gov/pubmed/26763380
The key quote from that article is:
“As cardioversion can transiently impair left atrial pumping function, anticoagulation is usually maintained for 4 weeks after the procedure.”
When we convert to normal sinus rhythm after taking a drug such as flecainide, does it “transiently impair left atrial pumping function” as a cardioversion can? I have no idea. And if it does, should we then take blood thinners for 4 weeks after we convert to normal sinus rhythm? Again, I have no idea.
Unfortunately, in situations like this you have to do your own research and then come to your own conclusions. I never took a blood thinner during any of my cardioversions or after my cardioversions. I never took blood thinners during any of my episodes. Was I rolling the dice and I just got lucky or was I fine because I was at such a low risk of getting blood clots in the first place? I have no idea.
If you talk to your doctor about this I would love to hear what he has to say so be sure to come back here and provide an update!
Thanks,
Travis
Quite interesting. I had my ablation on Friday 2nd November. I’m healing well so far and my first follow up visit is in a month’s time.
Peter:
Congrats on your ablation! I wish you a rapid and full recovery. Keep us posted.
God Bless,
Travis
Hi I’ve had episodes of Bradycardia during my first month post surgery prior to follow up, have you ever heard of this happening before? My doctor is talking about putting in a pacemaker.
Bear in mind, I did bariatric surgery in 2015 and may have malabsorbtion issues.
Peter:
I haven’t heard of bradycardia after an ablation but I’m sure it’s possible. How bad is it? What is your heart rate? Do you get light-headed or pass out? If the bradycardia is manageable, I would not go the pacemaker route just yet. For years my heart rate was in the 40’s. Today it’s in the 50’s. I’ve been bradycardia most of my adult life. Since your doctor is recommending a pacemaker, however, I’m assuming you are having serious side effects from it – i.e. passing out, light-headedness, etc.
Travis
I’m actually asymptomatic but my heart rate has been as low as 32. This has presented itself in holter tests pre-PVI. The Dr had previously mentioned that I may need a pacemaker at some stage. I guess that time has come.
Ya, that’s pretty low. You may very well need a pacemaker.
Travis
Travis, thanks for your article, very informative. I had my ablation in June of this year and am doing well so far. I’m still taking Eliquis, probably for the rest of my life.
My question: I’m taking Bisoprolol 2.5 mg at the moment. What is the difference between Bisoprolol and Metoprolol?
Susanne:
Congratulations on your ablation! Regarding bisoprolol vs. metoprolol, I don’t know the technical chemical differences between the two or how one works differently than the other. What I can tell you, however, is that they are beta blockers so the result is generally the same – lower heart rate and lower blood pressure.
Based on my conversations with various EPs over the years all of these beta blockers generally work the same. As I mentioned in my post, some may stay in our system longer than others but generally speaking, they all do the same thing. If you’re curious to know, bisoprolol has a half-life of about 10-12 hours so it stays in the system twice as long as metoprolol. Bisoprolol is also usually prescribed once a day whereas metoprolol is a twice-daily prescription (unless you’re taking extended-release metoprolol).
The reason one patient might be on bisoprolol while another is on metoprolol is just a matter of personal preference. Some people just respond better to one drug vs. another. A person’s specific health situation will also dictate what drug they are prescribed. As I mentioned in my post above, my doctor prescribed metoprolol instead of Bystolic because for my specific situation he felt Bystolic made more sense.
Travis
Thank you, Travis, for a very informative and well-written article. So glad you’re doing well!
Thanks Dora!
Travis…GREAT article.
I had my (first and hopefully only) ablation late July this year with good results so far. It’s so refreshing to feel great, or, compared to most people, normal.
I am still on a handful of meds, but hopefully at the next review with my EP, I can eliminate a few. More than likely I will need to keep the Eliquis, metoprolol, and a few others.
My question concerns diet: since your ablation, did you change your diet significantly? Must admit, still like a good burger now and then, and realize we are all different, but wondering if you found certain food types that didn’t treat you well?
Thanks in advance and congrats on the great checkup.
John
John:
Congrats on your successful ablation. I hope you’ll be able to go off some of your medications. Fingers crossed:)
My diet was pretty good the year following my ablation, but in 2017 my diet went off the rails. I probably had the worst diet known to man…lol. I literally only ate fast food and junk food and drank plenty as well (vodka to be specific) and lots of Coke and Pepsi too. You know what happened? My heart was the calmest it had ever been. No kidding. My PVCs and PACs disappeared and it was a year of total bliss – well aside from gaining a bunch of weight and having a liver scare as I mentioned in my last blog post.
I’ve moderated my diet now as I’m trying to lose weight but I definitely don’t shy away from the foods I love. I will regularly eat hamburgers, pizza, and all kinds of fried food. And I still enjoy my cocktails but only on the weekends.
In a nutshell, my diet has NEVER impacted my afib. Even during the 9 years that I battled afib I ate and drank whatever I wanted. It never made a difference. I’m a strong believer that afib is strictly genetic related. I don’t believe that diet or any specific food causes afib or makes it any worse. Sure, some foods may trigger episodes but the idea that if you eat some kind of special diet will prevent afib episodes is a belief I don’t subscribe to.
If there is a food or drink you enjoy and it doesn’t trigger your afib, go for it!
Travis
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