Managing unavoidable triggers in adrenergic AF

I have an increasing daily burden of daytime AF. It doesn't bother me overmuch. I could, but don't, sit and read a book all day to minimise the AF.

Because I am a stay at home dad, dealing with 2 kids and their assorted friends on a weekdaily basis, do all the housework, laundry, cook etc. Plus walking to the shops, defusing the tensions of a stressful day at work, the norm for my wife who is a very senior psychiatrist and trust management board member....

That just isn't an option, particularly now that alcohol is not allowed by my "little nest of vipers" ☹️

I take Sotalol 120mgs twice a day, which is getting near the usual limit, as rhythm control. The beta blocking action is a bonus, in modulating anxiety with it's associated adrenaline rush. I take Sertraline long term, like for ever, a life saver for me, literally.

Had probs with Flecainide and AFlutter. Not tried Propafenone.

Done most of the lifestyle things, not able to exercise as much as I would like, that always starts off a long episode.

Not really got the time to meditate, do take the MagCitrate, BMI 18, no caffeine. Gut biome super healthy thank you. Pretty decent sleep for a 69 male. Not tried the deep breathing thing, not sure how that works.

Do you think there are many alternatives for me beyond the second ablation which seems increasingly inevitable.

Thank you

[Hidden]

Perhaps book yourself in while we think about this! Personally I'd prefer to opt for ablation rather than increased or altered medication.

[Hidden]

Just remembered that Basil also spoke fondly of Sybil as his " great sabre-toothed tart". Sounds about right ❤️

[BobD Volunteer]

No.Sorry.

[Peddling]

Well now, that’s a big ask. Not knowing which and what lifestyle/diet changes you have made, it’s difficult to offer an opinion. Gluten free? grain free? sugar free? Fodmap diet? It’s tough to make radical changes, made even tougher by your full on home life. It’s also costly. Finding a gluten free loaf that doesn’t taste of blotting paper can be done but it’s soooo expensive. Having got all that sorted it’s the stress that comes out of left field, when you are least expecting it that is the trigger for me. I mentioned in a previous post and to my EP that in extremis I would walk over hot coals for an ablation. But, for now, I think i’m managing my symptoms . Not easy, but for me, neither is ablation.

[Hidden in reply to Peddling]

Thanks Peddling

I read your old thread starters but couldn't find a reference to left field stress. I definitely identify with that, could you point me to it?

I follow Mark Sisson's Primal diet which I enjoy (Low carb, high fat). No to gluten free, not seen any credible evidence published in the absence of coeliac disease.

[Polski in reply to Hidden]

Going gluten-free seems to be worthwhile in the US where they use different wheat strains from the UK, and much of their wheat is GM. Here in the UK it is not so important, but some people do try it and some find it helpful.

[rosyG]

Sotolol isn't used as much now (NICE guidance) have you looked into alternatives?

Agree with what's been said about healthy eating- no processed foods and ensure enough potassium rich food.

[Hidden in reply to rosyG]

Thanks Rosy.

Been on Sotalol 8 years without problem, started as an outpatient against all the rules.

Sotalol is very widely used around the world, many UK cardios use it. NICE guidelines apparently lack credibility amongst many/ most medics.

Not sure there are many meds left given Buffaly's comments below, the non availability of Dofetilide and my certain refusal to be poisoned by Amiodarone.

It's really other lifestyle changes I'm looking for now, Failing that, it's another ablation I reckon.

[Buffafly]

If Flecainide induced Aflutter I fear Propafenone would as well. So no, this is to do with QOL previously mentioned. Best wishes.

[Hidden in reply to Buffafly]

Thanks Buffaly, I hadn't realised that.

[Buffafly in reply to Hidden]

Should clarify, Flecainide and Propafenone are in the same class, I was offered Flecainide with Diltiazem added to control rate when Aflutter became a problem with Propafenone (but changed back). Some people find it more effective but you would have to take it in conjunction with a betablocker or calcium channel blocker to prevent flutter/tachycardia.

I could not cope with what you are trying to do as well as frequent PAF so (please forgive the bluntness) I think your wife should reverse the stress defusing roles long enough to agree a plan to get you some kind of domestic help. You'll definitely need it if you have the ablation otherwise the two weeks rest up won't happen and the ablation may be wasted. If you don't have the ablation you should both be aware persistent AF leads to HF, much quicker if you 'drive' your heart, so taking CDreamers advice is crucial. Also I agree with Rellim2, timing is important if you won't take Amiodarone which is what I was (literally) threatened with if I didn't opt for a speedy ablation.

I am facing the same dilemma but my lifestyle is totally different so my decision may be. Best wishes.

[Hidden in reply to Buffafly]

Thanks again Buffafly, a lot to think about there.

We used to have aupairs with the older boys when I was also working. Not sure my wife would allow that now. She thinks I am lazy ☹

But I certainly have been wondering about the reciperation phase after ablation which I realise is fundamental to the chances of success

All the best to you too.

[CDreamer]

If it is adrenaline triggers then improving vagal tone - needs daily practice - lots of ways to do that. slow breathing requires you to simply reduce your breathing rate to about 6 breaths per minute and a daily practice of Mindfulness for 5 minutes a day will really help! I think everyone can find 5 minutes Badger. You don’t need to to meditate for hours.

[Hidden in reply to CDreamer]

Many thanks CDreamer

Yes it is about time I had a proper look at these breathing exercises that seem to have helped some folks. Also other ways to improve vagal tone. Strangely I was mainly vagal before my ablation 4 years ago. In the last 2 months, clearly adrenergic.

I know nothing about mindfulness but will need to overcome my prejudices and embrace it.

And meditation, well I haven't forgotten the mantra given me by a Maharishi I met in London, back in '67

Again, many thanks, I was hoping you would spot this thread 🙂

[songbird74]

you don't mention weight - there seems to be lots of evidence of a correlation between weight loss and reduced AFib even in those who are moderately overweight not obese.

[Hidden in reply to songbird74]

Thanks Songbird

I quite agree with you about weight and AF. I'm hoping my BMI of 18 covers that