Hi there, I was diagnosed with PAF in March 2017 and until October 2019 was pretty much asymptomatic. Whilst exerting myself I was experiencing shortness of breath and after all the routine investigations (echo, angio and treadmill test) there is nothing obvious that has changed. However having bought an Apple Watch I can see that episodes of AF are now once a week lasting 3 days. Has anyone experienced this change and any recommendations? I am only on 1.25 mg bisoprolol and Apixaban as otherwise issue of low pulse. Although not sure I am always rate controlled when in AF.
Not sure whether I need to consider an alternative approach - drugs or ablation.
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Reena09
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As I am sure you must have read, AF begets AF so teh more you have the more you will get. Yes now may be a good time to seek an appointment with an electrophysiologist to discuss possible future treatements.
We are seeing the EP this Friday. As I’m predominantly asymptomatic it’s hard to know exactly what the right thing is to do. I’m not that keen on an ablation but equally the side effects of some the drugs are quite severe.
How long were your episodes and how frequent? Were you also a symptomatic? I presume you did not consider the rhythm control drugs in the first instance?
I can only say that when my episodes got to twice per week and they lasted at least 24 hours ,it was time to seriously consider ablation. Medication wasn't doing anything in solving the situation. Ablation 16 months ago. Still fingers crossed. Worked for me. So far. Hey ho.
What do you mean medication was not solving the problem? I can’t even tell when I am in AF but relying on the Apple Watch to tell me! Did you ever consider rhythm control drugs? Thanks
Yes ,some people can tell exactly when they are in AF and some have
no idea. I belonged to the former group. Flecainide twice daily for 3 years.100 mg. Didn't work for me. However,it works for many as PIP. I believe I would have ended up in PAF had I not had an ablation.
I was asymtomatic and had a TIA. It made sense to me to push for ablation instead of rhythm controlled drugs , and if successful , your heart is returned to rhythm. Fingers crossed. Its 5 years on now and the best decision I've ever made. Not a nice procedure. But no worse than an unpleasant trip to the dentist.
I have had a total of three ablations: two at 74 years old and one at 76. Age was not a problem at all; I had no complications and I recovered very well thanks to my excellent EPs. My tragedy was the Canadian system got me to 5 months persistent. It took me another month to set up the ablation in Pessac, France which meant I was 6 months persistent at first ablation.
Because you say, "... episodes of AF are now once a week lasting 3 days." , I would be most alarmed with your time frame going in and out of AF in 3 to 4 day cycles.
In your situation, I descended into AF more than rapidly , and I often wonder whether age contributed to my fast decent ( I did have some bad reactions to the beta blocker plus increased dosage of a calcium channel blocker that put me into AF). If you are going the route of ablation, get it done while you are still in paroxysmal , and have a chance of a good outcome. Otherwise, you will be facing 3 or more like me. Now I am nine months sinus, but no thanks to Canada. I really hope you do not follow my shoes. Do keep me informed.
Were you in paroxysmal AF during your first ablation? As i understand, if the AF is rate controlled it does not really matter whether you are in and out of AF frequently... unless I am missing something?
As above, I was 6 months persistent at the first ablation. The damage beyond the pulmonary veins is done when you go persistent whereby the EP has to ablate beyond the pulmonary veins up to four targeted areas in the first six months.
Frequently has a broad definition. I have read, and I don't have the article handy, that a certain percentage ( I don't remember whether it was 20% or 30%) will go persistent within the year when you are going out in 3 or 4 day cycles.
I would draw the conclusion that when one is about to go persistent, rate control can go out the window. I am one of those cases because I went persistent in about two months when my heart was acting like yours. You may be luckier and I hope so.
Personally, my conclusion, is that cardiologists should concentrate more on rhythm control than rate control to keep patients out of AF as opposed to living with AF. Rate control does not get you out of AF; it makes you live with AF. I disagree that it doesn't matter, and if that person were in AF, that person may evaluate from a patient's point of view.
I know when I am in AF but check with my Kardia and take flecainide (100mg) as a PIP which tends to get things back to normal in two hours or less often with added bisoprolol (1.25mg) - good luck with finding what works for you!
I think the decision to have an ablation is a personal one as no two people's afib experiences are the same. As with medication ablations are about improving your quality of life they are not a cure. I have had afib for 8 years, I don't have symptoms but can feel when I'm in afib. I currently don't take any medication. For me I don't seem to be following the afib begets afib statement my episodes vary in length and frequency at different times but in the whole have remained the same over the years if anything the last couple of years they've been on the whole shorter. My sister had less episodes than I do but was symptomatic and in the end decided on an ablation and I probably would have done in her shoes. So for me it's not about the number of episodes you have but how those episodes affect your quality of life.
Thanks Jan5. I presume you can tell when you are in AF? How often are your episodes and how long do they last? Also, how old are you? I agree that its a personal choice but with the increase in number of episodes, I dont want it to progress rapidly and then little chance of a successful ablation.
I'm 61 now and was diagnosed 4 years ago but had it 5 years before that when it was diagnosed as menopausal symptoms. It concerns me that there is a lot of misinformation about ablations and about progression with people being given a variety of prognosis dependent on which consultant they see and a lot of out based on their opinions (obviously they they're the experts and qualified to give those opinions better than I) but they're not backed up by research some of which contradicts those opinions. I have now seen 5 different experts and only a couple of those seen to be up to speed with latest studies. Some have been way off Every time my episodes go through a period of being more frequent I consider an ablation and research the current success rate. The last time was the earlier last year when a study have the average length of an ablation lasting at 3 years. Not good enough for me although my choice is also coloured by my sister's experience of ablation which wasn't as straight forward as the other 2 posts suggest here. Also not everybody progresses to permanent, I can't remember what the figures were the last time I looked. I have been 17-19 episodes a year which can last between less than 2 hours to 16 hours. I can tell immediately it starts, it even awakes me up, but harder to tell when it stops usually have to feel my pulse to check. Also I have lone afib or no other comorbidities. If the ablation cured it and also reduced the stroke risk I would maybe consider it but it doesn't. I would say do your research on the latest study based opinions (ignore studies funded by pharmaceutical companies) and work out your own personal risks versus benefits.
I was diagnosed with PAF back in September. I’m 55 and found just normal exercise and walking was making me out of breath and palpitations most evenings and waking me in the night. My gp put me on Bisoprolol which made me even more tired - sleeping in the afternoon by 2pm! Referred to a consultant who did an MRI scan which showed a healthy heart and blood supply and put me on Flecainide. Again I felt exhausted just doing the simplest of things and felt like I was just existing - the palpitations still continued pretty much as before.
Two weeks ago I had a catheter ablation, stopped the Flecainide and continue with Rivaroxiban for 6 weeks. So far so good - 1 short episode of AF and a higher than normal heart rate - but hopefully that will settle. I feel much better in myself and getting back to normal. My consultant is hopeful that it will be a success due to catching it early, although I think I probably have had it for a couple of years - just kept pushing it to the back of my mind and due to my age thought it was to do with menopause!
I had the ablation done under general - the build up to it was worse than the actual procedure - a little bit tender afterwards but that’s wearing off now. Fingers crossed that it has worked and doesn’t come back.
See if this helps you:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas, Thyroid (sends signals to the heart to increase speed or strength of beat), Adrenal Gland (sends signals to increase heart rate), Sympathetic Nerve (increases heart rate) or Vagus Nerve (decreases heart rate), Hypothalamus Gland or others - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
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