I was first diagnosed with lone atrial fibrillation back in 2006. Over the years as I learned more and more about afib, the one thing that always frustrated me was that it was a guarantee that it was going to get worse. It was especially frustrating because in the beginning I rarely had episodes.
I was crossing my fingers I would get lucky somehow and it wouldn’t get worse. I was different I would tell myself. At the very least, I was hoping the progression wouldn’t kick in for a long long time.
Well, you can throw that wishful thinking out the door. As you can see by this simple graph I put together, the afib progression has officially begun for yours truly:
And in case you’re curious, here are the highlights of my episodes over the years:
June 18, 2006 (age 33)
First official episode (started at 6 p.m.); was cardioverted in the ER within a few hours
May 26, 2008 (age 35)
Afib at 11:35 a.m.; self-converted one hour later
October 14, 2011 (age39)
Afib at 3:15 p.m.; was cardioverted in the ER within a couple hours of episode
February 3, 2013 (age 40)
Afib at 11:00 a.m.; was cardioverted in the ER four hours later
January 19, 2014 (age 41)
Afib at 8:00 p.m.; was cardioverted in the ER within three hours of episode
June 17, 2014 (age 41)
Afib at 8:40 a.m.; converted with 300mg of Flecainide about 2 hours later
August 28, 2014 (age 41)
Afib at 11:10 p.m.; converted with 300mg of Flecainide about 2 hours later
September 29, 2014 (age 42)
Afib at 2:10 p.m.; converted with 300mg of Flecainide about 2 hours later
October 13, 2014 (age 42)
Afib at 9:30 p.m.; converted with 300mg of Flecainide about 3 hours later
October 20, 2014 (age 42)
Afib at 9:45 p.m.; converted with 300mg of Flecainide about 4 hours later
November 4, 2014 (age 42)
Afib at 9:45 p.m.; converted with 300mg of Flecainide about 75 minutes later
November 20, 2014 (age 42)
Afib at 7:50 p.m.; converted with 300mg of Flecainide 3 1/2 hours later
December 1, 2014 (age 42)
Afib at 4:35 a.m.; converted with 300mg of Flecainide about 2 hours later
December 7, 2014 (age 42)
Afib at 12:55 a.m.; converted with 300mg of Flecainide about 2 hours later
December 9, 2014 (age 42)
Afib at 1:56 a.m.; converted with 300mg of Flecainide within 1 hour
December 22, 2014 (age 42)
Afib at 12:19 a.m.; converted with 300mg of Flecainide about 6 hours later
January 18, 2015 (age 42)
Afib at 1:30 a.m.; converted with 300mg of Flecainide about 6 hours later
February 2, 2015 (age 42)
Afib at 11:45 p.m.; converted with 300mg of Flecainide about 3 hours later
I guess I should consider myself lucky that I went 8 years before my atrial fibrillation got progressively worse, but it still pisses me off. Now as I publish this post, I’m just waiting for the next episode. Will it be tonight, tomorrow, Monday night again…it just sucks. Nothing worse than walking around with a ticking time bomb in your chest.
My EP is recommending I go on daily Flecainide and diltiazem. I hate drugs more than anything so I’m holding off on his recommendation for now. If I do in fact have another episode within the next week I may take the plunge. Otherwise if I can go a couple weeks in between episodes then I’ll continue my current pill-in-pocket (PIP) program of 300mg of Flecainide whenever I have an episode.
I just need to keep these episodes in check until I can get my catheter ablation schedule – which will hopefully be no later than February. You might be asking, “Why not just go on the daily drugs then until you get the ablation? It would only be temporary.”
Good question. The reason is simple. I am scared to death of the side effects. I have a low resting heart rate (about 52 beats per minute) and generally low blood pressure. From what I’ve read Diltiazem lowers your blood pressure and slows your heart rate.
I’ve read in numerous forums that people on these drugs often experience extreme exhaustion – and they don’t have low resting heart rates to begin with! I’m fearful I’ll never be able to leave my bed if I’m on these drugs. I’ve got two young kids to keep up with and a life to live. I don’t want to be essentially bed-ridden even if it is “only” for 3-4 months.
I realize I might not have a choice but for now I’m fighting it and crossing my fingers I won’t have to go that route. Please, dear God, help me make it to the ablation without daily drugs…
Hey so I was wondering how the ablation went. How are you feeling. I was diagnosed with a-fib around August 2014. I am 38 and think I have had it since I was a teenager off and on. Haven’t really had any episodes until the past week, but just a slight loss of breath and fatigue, and then today I couldn’t get up out of bed with out feeling like passing out. Was prescribed metoprolol last year and it seemed to work because I have felt great.
Durand:
The ablation went great. You can read about it here: https://www.livingwithatrialfibrillation.com/1434/catheter-ablation-experience/
My advice to you or anyone is to get this afib treated sooner than later with an ablation being your first course of action. Even if drugs are working for you they are not the best long-term option.
I wish you well and keep us posted.
Travis
I have read that with that procedure it can re set itself? And they have to repeat the procedure again. Is that due to just a bad ablation, or the heart doing that on its own? Or am I misinformed. I’m kind of wondering what the percentages are
Durand:
I don’t have the statistics in front of me but I believe the success rates with just one procedure is 70-80%. However, that statistic is based on every ablation that is done so that includes procedures being done by world experts like Dr. Natale as well as EPs doing their first ever ablation! The success rates for guys like Dr. Natale are usually much higher, like 80-90%.
When a second procedure is needed after being ablated by an expert like Natale, it’s usually because afib is being fired from a new area in the heart.
For more inexperienced EPs, the need for a second procedure is usually due to the fact that they didn’t get an area fully ablated, or sealed properly. This can happen even with guys like Natale so it’s not restricted to just inexperienced EPs.
So to answer your questions, a second procedure is usually required because the first ablation wasn’t done 100% correctly (i.e. they didn’t get a full seal) and/or a new area of the heart is triggering afib (that wasn’t previously triggering afib).
Travis
But the ablation procedure is not free of serious risk. At best there is a 1% (reported at OSU) chance of complication and nationally in the US, the complication rate is even much higher (between 5 to 6%). So understandingly if I can keep my AFIB under control by medications then I don’t wish to take chances with the above risky procedure.
I am new to AFIB. I was diagnosed last month with AFIB (I had SVT before since childhood which is not life-threatening and had episodes once every decade). The latest attack was irregular beatings unlike previous childhood attacks (and it happened during a sexual encounter so I am avoiding a most pleasurable natural act of life likely for a long time or forever as I am nervous and this alone may cause AFIB).
I am given a blood thinner and beta blocker and BP medications. I am hoping by eliminating all risk factors (like maintaining normal BP, normal blood sugar, normal weight, low stress, avoiding alcohol and never smoked) I may stay in paroxysmal AFIB forever. I am hoping this may have been my only attack (yet to meet a cardiologist as a meeting will be scheduled soon. So I was told last month by my emergency doctor).
Also, the day before I had medication for my chest infection having heart stimulants. I am hoping that the stimulants in those stupid pills may have caused it. If that is the case then more likely it may be only one episode. Though, since the attack lasted 56 hours being it goes away by itself, then maybe the attack was long enough to cause scarring of my heart as I can feel it that my heart is not the same stable heart it used to be before the September 30th attack as I keep having extra pounding every few hours.
Keyvan:
Sorry to hear about your recent struggles with afib. You may very well be able to keep your episodes at bay with lifestyle changes and avoiding various triggers. I hope that is the case for you.
If, however, your episodes become more frequent and/or you experience bad side effects from the drugs you are on, I wouldn’t hesitate to consider having an ablation. The risks of this procedure today are minimal. I’ve been running this blog for well over 4 years now and I have yet to hear from anyone that was seriously hurt or killed by an ablation. Obviously, if someone died from an ablation I would not hear from them but what I’m saying is I’ve never heard from friends or family that they know someone who died from an ablation. The point is, the risks of ablations today are very minimal. They are virtually nonexistent if you go to an experienced elite-level EP (i.e. someone that has well over 2,500 afib ablations under their belt).
I hope your lifestyle changes and trigger avoidances work for a long time – for life hopefully – but if the drugs start to fail, don’t settle. Seek out an experienced EP and have an ablation!
Travis
Hey I had an episode of afib when I was 22. Then I just had one last month – and it went away after 6 hours. The emergency doc said nothing was wrong, but I feel like somethings off. How did your ablation work out? I feel like I might have to get one one day :( Is there a section here on foods? My doc says foods don’t affect it but I’ve a whole list of items that cause palpitations. Maybe you could put together a list of specific foods people have palpitations with or maybe you have one already? Canned salmon, fishermens friends coughdrops, drinking a big sweet drink…I could write a book. Thanks for this website. I’m going through a lot of the stuff you all are going through.
Mat:
Sorry to hear you had an attack recently. I haven’t had my ablation yet so I can’t share anything with you. My ablation is scheduled for March 5th. I’ll definitely be posting all about it! I don’t agree with your doctor. There are scores of people who will tell you specific foods trigger their episodes. The foods, however, vary from person to person. I can’t eat and drink just about anything without any issues. For a lot of people, alcohol is a trigger but for me I can drink liquor, beer, or wine without any issues (in moderation). That’s why it’s hard to put a list of foods together. People respond differently to different foods. Everything on your list wouldn’t affect me at all. I used to drink “big sweet drinks” all the time and I wouldn’t even have a palpitation.
Good luck to you! I hope you are able to keep your afib in check so you can avoid having an ablation. If it gets worse, don’t hesitate to consider one, however. They are a much better option than a life of prescription drugs.
Travis
Travis, I used to visit a site Stopafib.org, run by a lady who had a successful ablation a few years back. That site is definitely the biggest promoter of ablations. It seems that the younger ablated patients fare much better than the older. One thing that was amazing to me was , most were still bound to Meds for life, even with ablation. The stroke fear doesnt end with ablation, because quite frankly, the risk is not greater while in AF then out. With your age and taking a PIP with success, that would be a tough decision. Taking meds that way and even once a night, is most likely non intrusive. The good news is ablation surgery seems to be improving. Like I said, if I was you, it would be a tough decision.
James:
You’re speaking of Melanie Truehills who runs the site, StopAfib.org. The specific procedure she had was the mini-maze, which is a slightly more complicated procedure than a “simple” ablation. Like Melanie, a lot of us in this industry are advocates of ablations as it’s the best hope we have right now for a true cure. Drugs are not the answer long-term. Even if they work, they won’t work forever. And in many cases, they cause more harm than good over the long-term. If drugs work well for some people in the short-term, that’s awesome. And if they can have success with those drugs over the long-term, that’s icing on the cake. Unfortunately, that rarely happens.
As for my PIP approach, it works great for me now but as you can see by the progression of my afib, the PIP approach will become unrealistic if I start having daily or every other day episodes. When that happens, I’ll be forced to take daily meds…which I’m trying to avoid at all costs, thus my decision to have an ablation.
Travis
Travis, your chart looks like I should have invested stock in your AF!
So have you had testing done to see which one they are going to do, left/right etc? Im quite ignorant to most of those procedures. My PCP advised me not to have it, and Cardio agreed, possibly because my average is twice a year. Agreed on the daily meds, not a fan at all. I may see an EP in Jan just so I at least know my options and have his opinion.
No kidding! I wish my stock portfolio looked like that chart. I’d be rich:) I have not had any testing done and will not be having any testing done either. When they do an ablation, they are working on the pulmonary veins in the left atrium. If you’re only having two episodes per year, then you probably wouldn’t need to consider an ablation at this point. However, I know a guy who had one done after he had just two episodes!
Travis
Travis,
Don’t know if you follow Steve Ryan’s website, http://www.a-fib.com, on a regular basis? Several months ago, he posted comments by a cardiologist who spoke at the 2014 A-fib convention held annually in Boston.
This cardiologist recommended that patients be selective when choosing an electrophysiologist for an ablation procedure. His specific criterion was that an electrophysiologist “should perform at least 50 ablations per month”. Another comment was that the most successful electrophysiologists usually “had a waiting list” for ablation procedures.
I live in a university town in GA, and there is a cardiology practice here that does ablations. Unfortunately, an acquaintance of mine with A-fib had two ablations done here and both were unsuccessful. Eventually, she decided to get a second opinion in Atlanta and they tried a third ablation, also unsuccessful. Now they are telling her that she has “too much scar tissue” for additional ablations.
So — please choose the electrophysiologist for your ablation procedure carefully.
Fran
Fran:
Yes, I am very familiar with Steve’s website. In fact, I just met Steve at an afib conference I attended with him this past weekend. The experience of the electrophysiologist is crucial in determining your potential success rate. I spoke with Steve about this over the weekend and he said the bare minimum is 25 per month but ideally you’d want someone that does more than that. I spoke with another person at the conference and he said you want to pick someone that has done at least 1,500 ablations in their career. The bottom line is, experience is everything when it comes to these ablations. Of course, the other factor is the complexity of your afib. Sometimes even the best EPs can’t fix afib with ablations.
Travis
Steve Ryan, the author of Beat Your A-fib, recently sent out a monthly email newsletter which contained a short video interview with Carolyn Dean, MD. Dean is the author of The Magnesium Miracle, a book which I highly recommend.
Dean explains the difference between a Serum Magnesium test which tests for extracellular magnesium levels found in blood and a Magnesium RBC test which tests for intracellular magnesium found in body tissues (especially bone, skeletal muscle, and heart muscle). Only 1% of the body’s magnesium is found in blood; the remaining 99% is found in body tissues. Also, you can have a normal Serum Magnesium level and still be deficient in intracellular magnesium.
The recommendation for individuals with A-fib is to supplement with 600-800 mg of magnesium per day. However, the chelated magnesium supplements can produce loose bowel movements even when the dosage is slowly increased over time. Most magnesium supplements average about 50% absorption (or less) with the rest lost via the bowel.
You should check out ReMag, a liquid picometer magnesium supplement that is 100% absorbed without any bowel sensitivity. One teaspoon per day (divided in 3-4 doses) of this supplement results in 300 mg of magnesium per day. Since picometer magnesium is 100% absorbed, this is equivalent to 600 mg of chelated magnesium tablets. ReMag is available for purchase on Dr. Dean’s website. The cost is $29.99 + $10.00 shipping for a bottle which lasts 48 days when using one teaspoon per day.
My Serum Magnesium level is normal and I have just had a Magnesium RBC Test drawn last week. No results as yet, but I predict that I am most likely deficient in intracellular magnesium.
My A-fib is asymptomatic and was found on an ECG during a pre-op examination for hip replacement surgery last March. I am on a beta blocker + a blood thinner (Eliquis). Next step with cardiologist will be to wear a Holter monitor to see how often I am actually in A-fib. Then will discuss electrocardioversion to return my heart to normal sinus rhythm.
However, since intracellular magnesium is an important electrolyte in heart muscle, I want to be sure my Magnesium RBC level is within normal range before agreeing to electrocardioversion.
Frances:
Thanks for your terrific comments! Everything you’ve mentioned is spot on. The chelate magnesium didn’t work for me at all – despite trying it for several months. It seemed no mater what dose I used, I would get loose stools. A reader of this blog turned me on to magnesium glycinate and it’s been working really well in the sense that I no longer have loose stools. As for preventing afib episodes, I don’t think it has helped much but I’ve only been on it for a month.
I’m going to look into the product you recommend. It sounds even better than glycinate. Thanks for the tip!
Please do me (and my readers) a favor. Please comment here once you get your test results. It will be interesting to find out if you are indeed magnesium deficient.
I’m crossing my fingers that your electrocardioversion gets you back to normal sinus rhythm!
Travis
Travis, I guess the paradox is with Meds and surgery, (ablation) are more successful and compatible with youth, but the elderly usually need it more. . Im not fully educated on ablation so I have very little to offer on that subject, but just from posters, that has as many diverse results as Meds it seems. I dont blame you for choosing that over Meds, and believe they have that procedure dialed in pretty well. Of course Im always wondering if something else is compromised in the process? It comes down to give and take, and with this beast, Afib, theres alot I could think about giving up already in the way of lifestyle/diet, so why not ablate? My fear, and I m not saying it for you, would be that at my age, they may still keep me on Meds.
James:
Thanks for the comments! I personally think ALL afib patients are better off at least considering an ablation. I’m just not a big fan of these drugs when used long-term. If they work, they are usually only effective for a period of time. You might get 10 “good” years with drugs but then the wheels start falling off. I know this first hand watching my father go through his afib. He’s been on drugs to control his afib for that past 10 years and now he’s having issues because the drugs just aren’t as effective anymore.
I believe the reason the elderly are prescribed drugs is because the theory is if you’re 75 and you afib, the drugs are “good enough” to carry you to death. I know that’s morbid but I’m sure that’s the rationale. In addition, the elderly aren’t likely to recover as well even for a minimally invasive procedure as an ablation. And I’m sure they have stats that show the success rates of ablations overall for the elderly aren’t that great.
To me, “the elderly,” is 75 years or older so if you’re under 75 I would push for an ablation over drugs all day long. I see you’re only 60. That’s still pretty young in the scheme of things. I’d encourage you to at least talk to your doctor about it. I’m not saying it’s right for you but it might be:)
Travis
Hi, Travis,
Thanks again for sharing your AFIB experience. I just wanted to share that I have been on diltiazem for several months now, as well as metropolol, and the side effects of these drugs are significant for me. I have fatigue and sleepiness which I combat with coffee, take naps a couple times a week, and daily just sit down a while. Also, I’ve gained about 10 lbs since I was diagnosed 4 years ago. The fatigue and w eight gain caused me to seek out a dr. who will do cardiac ablation, and mine is now scheduled for Nov 20th (!). I understand your determination to do without the drugs, but I hope you’re on a blood thinner. I have also realized that anxiety can trigger AFIB episodes, so I have really tried to stay out of stressful situations. (Easier said than done!) I feel like I’m in a viscous cycle sometimes: Meds–coffee- work–stress–fatigue–nap– meds—coffee… another donut, another pound… Anyway, hang in there, and thanks again. Kay
Kay:
Thanks for reading my blog and leaving a comment! I’m sorry to hear about your side effects. Your experience is exactly why I’m trying to avoid these drugs like the plague. I’m glad to hear you’re having an ablation. I wish mine was scheduled in November! I have a few months to wait for mine. Be sure to stop by after your ablation and let us know how it’s going. I wish you the best of luck!!
Travis
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