AF Legacy Study (interview)

[journeyart]

Here is a related article and interview with Dr. Mandrola (who recently wrote the article on putting down the catheter and Rx pad) and Dr. Sanders who was the lead for the Legacy Study. I have begun the weight loss process and am already seeing the benefits. Enjoy....

medscape.com/viewarticle/84...

[jeanjeannie50]

Wow, that's an inspiring discussion! That's it I'm determined to lose some weight. When I think about it, my AF only started when I put on weight, before that I was quite slim. Thank you for posting the link. Everyone with AF needs to read this.

[Hardjuice]

Can't see info unless I become a member

[Dave1961 in reply to Hardjuice]

It takes about 15 seconds to join and is free.

[souljacs4]

Great article thank you.

[Hidden]

Thank you for this... I guess I am going to have to get serious about that diet, then. Has anyone done any work on whether exercise helps?

[bayfield in reply to Hidden]

It is all related - diet, exercise, wellness. Anything that causes strectch of the atria. Likely all of us have an atria that is enlarged and scarred. Dr. Sanders work with sheep shows that this remodleing can be reversed and you can achieve normal sinus rhythm with lifestyle changes.

[chris45558]

I have found as I got fitter through cycling I have not had any episodes that have hospitalized me. I am still overweight but having seen this article this is going to make me work harder to lose it.

This make loads of sense.

[MarkS]

The article doesn't mention who weight loss strategy is suitable for. What if you already have a BMI of less than 25? Presumably it's not going to work then. There's only so far you can take these lifestyle modifications and I am getting a little bored with Dr Mandrola constantly harping on about them

[Finvola in reply to MarkS]

Mark - my BMI was just over 22 but I decided to follow the diet recommended by CareAF and BHF in the hope that it would help my general health. BMI is now just under 21 and I have much more energy and generally feel better - walking and very mild exercise biking are very enjoyable too.

[PeterWh in reply to MarkS]

Don't forget that the average American weight is quite a lot higher than the average in the UK!!!

[AnneTS]

Very, very interesting article. Thank you so much for posting it. Anne

[CDreamer]

So good to hear of physicians researching none invasive and not pharmaceutical methods. People do need encouragement and the idea of meeting 1:1 to determine and maintain achievable goals is really the key,

Somehow I don't see it happening here for the foreseeable.

[Barry24]

Hi Journeyart,

Thanks for this, most interesting.

Regards

Barry

[PeterWh]

Loosing weight will certainly help us all but I can't see that it would have an effect on the AF itself for those with persistent or permanent AF.

[creschendo]

Based on this interview I called Professor Sanders' clinic in Adelaide (I live in Sydney) and made an appointment for an initial consultation. For those who are interested, here's a summary of that consultation earlier this week.

First of all please let me point out that I wasn't meeting Professor Sanders in an academic setting, more your standard specialist consultation, just as you would with any cardiologist or EP. Professor Sanders has his clinical practice at "The Cardiovascular Centre" in Adelaide, details on the Google.

Professor Sanders has given me permission to post here re the consultation and our conversation.

On arrival I filled out a questionnaire re my AF and general health status. e.g. am I currently in AF, how often am I in AF, how long does it last, how severe, weight, height, alcohol consumption etc.

Next step was an echocardiogram followed by a treadmill stress test. After recovering from the stress test I was taken through for a "baseline ECG" and then deposited in a comfy chair in the Professor's office.

Professor Sanders arrived a few minutes later with all my paperwork in front of him - the questionnaire & ECG were certainly there, presumably the echocardiogram and stress test results as well.

The consultation was fairly informal and certainly not rushed. The key points I noted are that Professor Sanders' treatment regime aims for/requires are:

A.BMI of 25 or less

B.Maximum 3 standard drinks per week - any more will harm the aorta

C.80% of BP reading to show systolic 130 or below and diastolic 80 or below

I was given a very concise and easy to understand explanation of the impact of high BP on AF onset - the blood under pressure enters the atrium, which stretches to compensate and to reduce pressure elsewhere in the heart. In stretching, the atrium becomes thinner and irritated, leading to AF.

Please excuse me if this is obvious and well understood by others, for me it is a revelation. I have always thought that my hypertension is a long term health issue that I can deal with later, now I realise that a high BP today can kick me into AF today.

Most patients consulting Professor Sanders would then be placed under the care of a physician to manage weight loss to hit criteria A, BMI of 25 or less. In my case I have fortunately got this under control - I've lost about 10 kg since diagnosis, mainly by getting off the grog, walking a lot and eating more sensibly. The Professor told me that he's had 3 different physicians running the weight loss program and all have achieved consistent reductions in "AF burden" for patients under care. As a physician-led program is costly, the Professor is now moving to a nurse-led model with a view to expanding the program within Australia and possibly overseas in future.

My challenge now is to meet criteria C, 80 % of BP readings below 130/80 - at present I'd be tracking to a run rate of precisely zero. To assist me the Professor has made minor changes to my anti-hypertensive prescriptions, different drugs but in the same families.

Because I don't need supervised weight loss, I won't need to venture back to Adelaide too soon. My GP can help me with BP and I've recently started following the guidelines of the "Dietary Approach to Stop Hypertension" (DASH) from the U.S. Dept of Health. With diet, exercise and meds I am hopeful I can soon get to 80% below 130/80.

Professor Sanders told me that 45% of his patients reduce AF burden without ablation and he predicts I will be in that category. We've agreed that if I can get a full year AF free we can discuss reducing or dropping my antiarhythmic. Professor Sanders also advised that if all goes well I can expect my left atrium to return to normal size over time.

The 2 key lessons I have learned from this forum are that we are all different and we all need to become our own experts. This is my story of my consultation with Professor Sanders and my understanding of his pioneering but very promising work. Thanks for reading, I hope you get something out of it and please let me know if there's any more info I can provide.

All the best

Ric

[creschendo in reply to creschendo]

PROGRESS REPORT, following initial appointment

BMI kept below 25 & alcohol kept below 3 std drinks per week throughout.

IN THE FIRST YEAR I only managed to keep Systolic below 130 on 51% of days measured (target 80%). Diastolic was below 80 on 91% of days measured.

In this time I had 60 Episodes of mild AF for a total of 351 hours.

[creschendo in reply to creschendo]

IN THE SECOND YEAR I kept Systolic below 130 on 52% of days measured and diastolic below 80 on 96% of days measured.

In this time I had 60 Episodes of mild AF for a total of 359 hours.

[creschendo in reply to creschendo]

IN THE THIRD YEAR I kept Systolic below 130 on 32% of days measured - diastolic below 80 on 97% of days measured.

In this time I had 105 Episodes of mild AF for a total of 369 hours.

[momist in reply to creschendo]

Thanks for posting these details Ric. Could you tell us the regime you use for measuring BP? Is this at the same time of day every day, or after a particular point (e.g. sat down for half an hour)? I know BP goes up and down with activity, so was wondering when is the best time to try to make these numbers.

[creschendo in reply to momist]

Hi Momist

Prash Sanders did actually ask that I not monitor BP at the same time everyday, he'd prefer that I mix it up a bit. i.e. some days after exercise, some days after work etc. However, as I don't want to spend the day thinking about BP I just get it done in the morning while I read the paper & wait for my tea to brew

If I ever get to 80% below 130 on the morning measurement regime I can think about following the good Professor's direction more closely but hopefully by then I will be AF-episode free

All the best

Ric

[creschendo in reply to creschendo]

HALF WAY THROUGH THE FOURTH YEAR I have found that my average amount time in AF is 50% more than in the previous 3 years, and not getting any better. I am not sure if there is a cause and effect relationship but this deterioration has conincided with 6 months of travelling with no permanent “home”. Extremely enjoyable but not conducive to maintaining a regular routine. I also let the alcohol guard down during this time - nothing extreme but more than the 3 drinks per week stipulated by Prof Sanders.

Bottom line is I am back to zero alcohol, establishing a new routine in a new home and yesterday had a Cryo Ablation which my (new) EP considers to have a good chance of successfully curtailing AF.

I am more determined than ever to give the lifestyle approach every opportunity to improve my life, now with the added assistance provided by the Ablation.

[creschendo in reply to creschendo]

ONE YEAR POST ABLATION

Zero bouts of AF, a few ectopics but nothing that lasted long enough to record on the Kardia. Flecainide ceased, Apixaban and anti-hypertensives continued. My BP is much better controlled since the ablation and quality of life is beyond compare.

I continue to be vigilant regarding weight, alcohol, fitness and stress.

[creschendo in reply to creschendo]

TWO YEARS POST ABLATION

One hour of AF in the past 12 months, associated with a dropping of the guard on the alcohol front. Lesson learned.

[creschendo in reply to creschendo]

THREE YEARS POST ABLATION

Zero bouts of AF in the past 3rd year following ablation. Low alcohol intake, keeping control of my weight and trying to keep my fitness up. Long may it continue!

[creschendo in reply to creschendo]

FOUR YEARS POST ABLATION

All ticking along nicely, no AF detected all year. Not complacent, still working on fitness and weight. Moderate alcohol intake.

[creschendo in reply to creschendo]

FIVE YEARS POST ABLATION

No AF detected all year. Not complacent, still working on fitness and weight. Moderate alcohol intake.

I recently had a stress echocardiogram and I was very pleased to discover that my left atrium is now normal size, no longer stretched (see my initial reply 7 years ago re discussion with A/Prof Prash Sanders). I would like to think this is a payoff for the lifestyle changes I have made & (fingers crossed) that it augers well for remaining AF free.

[journeyart]

Thanks Ric for taking the time to post your experience! I'm working, as well, on reducing BMI as my primary strategy. Now persistent in more ways than one.

All best,

Marcus

[MickN]

I have never had a weight issue and kept myself very fit for my age (55) but AF got me at 54

Yes I drank quite a bit in my early years but so have many many people who have not however been beset by AF, and I might add more than most overweight.

My EP has I have mentioned many times before actually thinks I may have overdone the fitness side of things which may have somehow contributed to AF.

So all interesting reading, but I put it down to pure bad luck.

Yes we can introduce things (magnesium) which defo helps, but AF as we know has no cure, we mange it in our own different ways.

[journeyart]

Thanks Mick. I agree with you that "we/I" introduce things that help...as there is no known cure. I share a similar history with regard to alcohol...and other things for me...sometimes I wonder how I am still alive. (I'll be 70 in September and still am told that I look like I'm in my late 50's. :-)) I jogged & lifted 3 to 6 times a week for the past 40 years.....through it all. Probably burning the candle at both ends! And then one day it all came to a crashing halt. Every now and then at first...and now persistent...24/7. But I hope there may still be a lot of candle remaining! So, for me, it's all about a number of approaches including reducing BMI. Also, meditation, yoga, diet, positive affirmations (prayer), magnesium (certainly) and other herbs and supplements....until I can get off of amiodarone.....and then continue with the above. For me, I have to give all I have to changing my lifestyle before considering ablation.

I'm not sure about the "bad luck." I look at it a little differently...as in...what is my heart telling me and where is my heart leading me at this stage of my life.

All best...Marcus