I'm fairly new to this forum and I already feel at home. It's very refreshing to find an online community whose members are so kind, understanding and generous.
By way of introduction, I'm a 69-year-old male living in Connecticut. My Afib history is as follows:
Diagnosed with Afib by PCP - 8/9/2023 Note: asymptomatic and persistent since then; annual Afib-free ECGs between 1/3/2011 and 6/14/2022
Initial consultation with cardiologist - 9/14/2023
Started Xarelto, 20mg - 9/24/2023 Note: insurance denied Eliquis
First cardioversion - "successful DC cardioversion of atrial fibrillation to sinus rhythm -after a few minutes the patient reverted back to atrial fibrillation with controlled ventricular response" - 11/16/2023
Consultation with electrophysiologist - 2/28/2024
My current medications are: Eliquis; Diltiazem; Doxazosin; Telmisartan and Rosuvastatin
Diagnosed with severe obstructive sleep apnea 12/5/2023; started CPAP sleep therapy 12/19/2023
I'm 6'1" and weigh 258 pounds
As noted above, my Afib is asymptomatic and my average resting heart rate is 70 - 75 bpm. Given my failed cardioversion my cardiologist discussed the option of an elective admission for either sotalol or amiodarone loading and a repeat cardioversion. My electrophysiologist discussed the possibility of starting flecainide on an outpatient basis but I have mixed feelings about doing that now. After considerable research and various consultations my sense is that it may be best for me to lose weight now rather than having another cardioversion or an ablation. My sense is that most Afib interventions are about hopefully improving one's quality of life and since mine is fine I don't sense a need for any medical interventions at this time; however, I am concerned about the progressive nature of Afib and if doing something now would be wise I'm certainly open to that. Any feedback would be welcomed and greatly appreciated. Thank you.
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DrBook
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As you mention, losing weight would help in so many ways. But it will take time.
How is the sleep apnea therapy going ? Sleep apnea can be a key contributor to afib. Did the EP discuss this with you ?
When first diagnosed with afib, particularly if asymptomatic, it is sometimes difficult to recognize we have afib. But as you mention, it can progress.
It would be best to take action early for best results, whether that be with a repeat cardioversion and follow up with antiarrythmic drug or an ablation/minimaze procedure.
Discuss with your EP. May want to purchase a Kardia device or Apple Watch to monitor and also monitor your blood pressure. Best to You !
Hello, mav7. Thanks very much for your response to my post.
My sleep apnea therapy is going remarkably well. I adjusted well to wearing a mask and I went from 47 events per hour to 3-5 events per hour. I've been 100% compliant since starting sleep therapy December 19, 2023. When I was diagnosed with Afib I immediately sought out a sleep medicine doctor as my research (I've spent countless hours researching Afib since being diagnosed) showed the significant relationship between sleep apnea and Afib.
My blood pressure has been well controlled with medication for many years. I have used a Kardia device since my diagnosis and I also use a Fitbit to monitor my heart rate. I should also mention that my labs are consistently very good.
I'll keep your recommendation for early treatment in mind as I continue my research. Thank you for your kind wishes.
A friend of a friend, maybe a decade older than you, also found out he had afib by screening. Like yourself, he was asymptomatic and played tennis daily.
Saw an electrophysiogist (ep) who checked out his heart structure via echo and a treadmill and everything was ok. Ep gave him some eliquis and sent him on his way. The ep's opinion, based on lack of symptoms and a structurally sound heart, was that there was no need for cardioversion, anti-arrythmic medications or an abation.
So he went home, took the eliquis and continued playing tennis daily. Six months later he naturally converted into sinus rhythm and has stayed that way for the last couple of years.
Unless there is proven damage to your heart from afib via echo or stress test, I see no reason why you shouldn't just continue on with your life as well. Cardioversion doesn't always hold and is not without risk. Anti-arrythmic drugs are toxic and should be reserved only for those that need them. And ablation is no walk in the park and no guarantee you will come out better than you went in. As to afib being progressive, that doesn't really fit your profile because you're in persistent afib already.
Regarding losing weight, always a good idea if you need to and that alone may put you back in normal rhythm, but again, really no need to force normal rhythm unless there's structural damage which may be unlikely because of your low afib heart rate.
Men with hammers like to hit nails and doctors like to treat, but not all doctors. You might want to get another opinion on this, preferably from an ep (electrophysiologist) who is a cardiologist who specializes in arrythmia's like afib. Hopefully, they will leave you alone like they did to my friend's friend.\
Hi, Jim. Thank you for welcoming me to the forum and for sharing the story about your friend's friend. I understand that everyone is different but it's still encouraging to hear positive stories about individuals who share one's condition. My echocardiogram showed some slight structural changes to my heart but nothing of concern to my cardiologist. I haven't had a recent treadmill stress but my previous stress tests (2) were fine. My electrophysiologist feels it would be in my best interest to have one now.
You mentioned that there may be "no need to force normal rhythm" in my case. What I don't know for certain is whether or not my being in Afib for possibly years to come may eventually cause structural damage to my heart. I also don't know if there's a possibility that my heretofore asymptomatic Afib may become symptomatic in time. Of course, I'm going to reseach these issues and talk with my doctors about them but do you have any thoughts about either of these issues? My sense is that there may not be a definitive answer in either case due to individual differences.
You last paragraph put a smile on my face which is always nice! Thanks again for taking the time to respond to my post.
You mentioned that there may be "no need to force normal rhythm" in my case. What I don't know for certain is whether or not my being in Afib for possibly years to come may eventually cause structural damage to my heart. I also don't know if there's a possibility that my heretofore asymptomatic Afib may become symptomatic in time.
For someone new here, you have a very good understanding of afib principles. All points above are valid and therefore if you decide to take a non-treatment, watchful waiting course, and remain in afib, you would want to be monitored more than someone treating afib.
You mention you live in CT which may not be too far from many major medical centers. If you have Medicare, you can self refer to as many ep's as you like. In my case, I spoke to at least five ep's -- either in person or via zoom -- before I came to a treatment decision. I learned more from each meeting which made subsequent meetings more fruitful.
Hi, Jim. I appreciate your highlighting the need for careful monitoring if I choose to "take a non-treatment, watchful waiting course" while remaining in Afib. I'm indeed blessed to live near some exceptional medical centers. The first electrophysiologist (EP) I met with is at Yale and has been practicing over 40 years and I'm also seriously considering consulting with another EP at NYU Langone Health who's the Director of the Heart Rhythm Center who has also been practicing over 40 years. The team there does over 2,000 ablations a year with higher than average success rates due to their extensive experience and their use of high frequency jet ventilation (rather than conventional ventilation) during ablations.
Thank you for your kind wishes, Jim. I wish you all the best.
Hi Dr Book and welcome to the forum. I had persistent AF. Like you I was offered amiodorone prior to a repeat cardioversion. I didn’t have any dire side effects from the amiodorone, but was fortunately only taking it for a few months. They monitor it quite closely.
First CV kept me in NSR for 3 days or so, second CV for seven days - so much for amiodorone! My persistent but low level AF was quite symptomatic so was glad to be offered an ablation. I found an EP (payed for privately) who was very informed on all latest developments in treatment for arrhythmias and pro ablation. I understand that even short-lived success with cv is an indicator of potential success for ablation.
I’m now six months post ablation (given on NHS), am in NSR, and will have another ablation if this becomes necessary. From a completely non scientific standpoint I don’t think arrhythmia was good for me and it wasn’t getting any better. I feel hugely lucky to live in a time where such procedures are possible. Another option my EP considered due to the persistent nature of my AF was a mini maze. You can research Wolfe Mini Maze too which forum members here have found successful (and expensive) for stubborn cases of AF.
Good luck and don’t feel you have to rush into anything. It’s great you’re getting the sleep apnea under control and wish you luck with weight loss. Lifestyle changes are key, as I’m sure you’ve researched well.
Hello, Rainfern. Thank you for welcoming me to the forum and sharing your story with me. I appreciate your encouraging me not to rush into anything. Sometimes I feel as if I may overdo my research but I feel it's essential not only in making informed decisions but it also helps me better understand the learned doctors with whom I consult.
I found your thoughts about your cardioversions (and amiodarone) and ablation very helpful. And your comment about thinking how your continuing arrhythmia wasn't good for you really hit home. I researched Dr. Wolf's Mini Maze procedure at length in anticipation of a virtual consultation with him in February but unfortunately he no showed which was very disappointing after having waited several months for the consultation. The good that came out of this was it made me turn my attention to options closer to home which I now believe will be in my best interest.
Thank you for your kind and encouraging words, Rainfern. With you I, too, feel blessed to live in a time when their are interventions that can make a significant difference in the lives of those of us who have Afib.
Hi, am in a similar boat, except younger (53) and no weight or OSA issues. Asymptomatic PAF with failed cardioversion despite Sotalol. Next suggested step is ablation but I have no symptoms, cycle and gym daily. Cardiac echo pressures good. Really struggling to accept an invasive procedure at this point.
I was symptomatic with AF episodes although these were few and far between. The decision to have an ablation was agreed between me and a very well respected EP in the UK. The biggest fear is that AF increases the risk of stroke five fold and can cause heart failure even if you are asymptomatic. Ablation gives the opportunity to control these risks but understand is not so successful for persistent cases
I have not had an afib event since November, am 57 exercise like you etc. I am having an ablation next week following protocol where my EPs have advised it is in my best interests to stop progression when it will be harder to ablate. It is now the first line of treatment offered in cases like mine in the US as success rates are much higher the sooner it is ablated. I don't want to take meds for the rest of my life as the beta blockers muffle my heart and make it hard to exercise- I actually don't take them anyway but if it progressed I may have to. I also want to travel and not have to worry about being near a hospital etc. I have agreed to it because my EP is very experienced, I am not sure I would have it done otherwise...
Hi, Hootsmon, I understand your struggling to accept an invasive procedure given your situation. Here's to your finding resources and doctors that will help you make a decision that is right for you. Thankfully, you've already discovered this forum which is certainly helping me. I wish you all the best.
I have paroxysmal AF, which is managed with medication and I consider it to be low burden. For me the risk/reward equation doesn't favour ablation at this stage. For me, ablation would need to result in a significant improvement in my quality of life given what you potentially need to go through and the associated risks, although low. I already have a good quality of life and if/when that changes I will seriously consider ablation.Your situation is different but you may wish to consider it from my perspective. How much will successful ablation improve your quality of life? Is that enough to want ablation(s)? Only you know the answer
Hello, bean_counter27. Thank you for sharing your situation with me. I appreciate your encouraging me to consider my situation from your perspective. As you stated, our situations are different but I believe it can be helpful to consider my situation from any number of perspectives as I seek to make a decision that's best for me. I appreciate your input.
I think you've worked things out well. An elderly friend and my son's colleague both have persistent AF, with the first being essentially with no symptoms, like you. He has never been offered an ablation and had one failed cardioversion. He wouldn't entertain anything being done.
With regard to your overall health and OSA, you have about 40lbs or so to lose, I guess. Best of luck with that. My wife's late aunt ran a highly successful diet club locally and her mantra was simply to eat somewhat less of what you enjoy and the weight will reduce slowly but permanently. She had so much success in her day that the local national club called "Weight Watchers" couldn't attract enough members to run, I recall! She also told her members that exercise was good for health but not for weight loss.
Hi, Steve. Thank you for sharing your elderly friend's story. I also appreciated hearing about your wife's late aunt's diet club. I'll keep her mantra in mind as I seek to lose weight. I've lost considerable weight in the past so I know I can do it. Now I must discipline myself to do what would certainly be in my best interest to do now. Many thanks for wishing me good luck with that endeavor.
I forgot to mention that another friend has sleep apnoea and has used a C-PAP machine for many years, now. He doesn't always sleep well but he has stuck with using the machine, which, I gather many don't. I have read that the drop-out rate is over 50%.
From all my reading, I would say it is worth trying hard to get OSA under control, but, more than anything else and for all of us, it seems that the key parameter to keep controlled is blood pressure.
Hi, Steve. I'm happy to report that my sleep apnea has been under control since I started using a CPAP device December 2023. I've been 100% compliant and my intention is to continue to be compliant. Yes, the drop-out rate is approximately 50% at one year which is unfortunate as sleep therapy is incredibly effective.
Thankfully, my blood pressure has been been well controlled with medication for many years. Next I must l lose weight and exercise!
Don't I wish! Let's put it this way, when I truly set my mind to do something self-discipline seems to follow. The key is setting my mind to do whatever needs to be done which can be challenging.
I can only imagine being married to a wonderful woman with such resolve! I'm 69 and I've yet to find a wonderful woman! I'm content living as a bachelor but there are times when I think it would be nice to have the company of a dear woman. My parents were married 67 years!
It won't be long now and you and your wonderful wife will be celebrating 50 years! It may be a bit early but congratulations nonetheless!
Or did you mean "need for further procedures". Re cardioversion.
I lost 6 kg 93 down to 87 and although Diltiazem 120mg controlled my Day H/Rate to 89-96, losing the weight I settled further down to 60s Day and Night Avge Rate stays at 47bpm.
Being controlled by CCB Diltiazem I was able to have 2 further operations. Not heart. As Anaesthetists will not undertake an operation until you are under 100bph at rest.
My list of meds are
Synthroid for Ca Thyroidectomy
Diltiazem 120mg AM
PRADAXA 110 AM
Bisoprolol 2.5 controlling BP PM
PRADAXA 110 PM
Keeps vitals: 123/69. 60s bpm avg DAY at rest 47 bpm avg NIGHT.
Hi, Cheri. Thank you for responding to my post. I believe the statement you're referring to is: " . . . I don't sense a need for any medical interventions at this time . . . " To clarify, I was referring to another cardioversion or an ablation.
Reading that your weight loss decreased your daytime heart rate was very encouraging to me. Thank you for sharing this with me. Best wishes, Cheri.
Hi Doc. My story is similar to yours. Excluding the sleep apnea. I was diagnosed with paf in 2011 and was difficult to live with. In May 2016 I went into persistent af but had no real symptoms. I met with the Electrophysiologist and was offered an Ablation I went to the appointment and during our discussions the Dr and myself came to the conclusion that the risks associated with an Ablation far outweighed the benefits to me so I got of the operating table and went home. That was eight years ago and I don't regret our decision. I am 77 years old now and take just 2.5mg of Bisoporol and Apixaban daily. I still walk good distances, swim and cycle but most importantly I can still chase my grandchildren around. Good luck what ever you decide to do. Cheers Roy
I have considered ablation, as my first cardiologist who treated me after my heart attack mentioned it immediately.
After that massive attack, I did every possible thing in my power to limit the damage to and remodeling of my heaert muscle, by cardio-training and medication. The damage therefore is surprisingly limited and I’m still exercising vigouresly every day to keep it hat way.
That is one of the reasons I have decided not to go the ablation route: I would feel very uncomfortable having my heart damaged on purpose, to treat a non-mortal condition.
Moreover, one of my best friends is a retired cardiologist, who also has Afib, and he agrees with me wholeheartedly. I know that ablation can be succesful, but the succes rate of 60 to 70 % for the first ons is not very attractive to me, and the risk of approx. 1 chance in 500 to suffer serious side effects and unforseen damage to heart and oesophagus is too high for my standards, not to mention the high dose of radiation involved.
So I’ll stick with Flecainide and Bisoprolol for the time being.
Hi, Roy. How incredible that you were on the operating table ready for the ablation and it was decided that the risks outweighed the benefits and home you went! And how wonderful that you can still walk, swim, cycle and, above all, chase your grandchildren around! What a terrific story! Thanks very much for sharing and for wishing me good luck on my journey. Best wishes to you and yours, Roy.
It is always good to make lifestyle changes so lose the weight, eat healthily and exercise well. As for whether you want further interventions that is totally up to you and no one can make that decision for you. I felt so much better after my first cardioversion (but that could have had something to do with the fact that up until then they were still trying to keep me on a beta blocker/ calcium channel blocker or some form of rate/rhythm control medication which I never got on with anyway and made me feel worse than the AF. After the successful cardioversion was able to stop them right away and stay on just anticoagulants - so would feel better because of that. This first cardioversion lasted for 11 months and I felt great. When I went back into AF I asked not to be put back on any rate or rhythm control medication and had another cardioversion which lasted about 5/6 months. After going back into AF Just before lockdown I was given another cardioversion and was on the list for an ablation and would have had it the April after the start of the first lockdown. This cardioversion lasted a little over 15 months and I was about to have the ablation when the EP realised I had had no tests or scans for over 2 years so sent me for all of them all over again when it was found that my heart had remodelled itself and he decided that any further interventions would not have the desired long lasting effects so no ablation or further cardioversions. In between all these scans I went back into AF which is now classed as permanent and to be honest seems so much calmer than it did before. My resting heart rate is around the mid 50's and i have got used to exercising alittle more moderately and rarely let my heart rate go over 120 during exercise. I go to the gym every day and take long walks twice a week with a neighbours dog we look after. So permanent AF doesn't stop me from doing anything I want to do and I am hoping this year to get back to skiing if I can get insurance. We go to Lake Tahoe to meet up with my youngest son and some of his friends and I really have missed it. Had a knee replacement in 2019 so couldn't go then. After that were all the lockdowns and now I feel I could do it all again at age 80 - even if it may be for the last time in the US as cost of travel insurance and medical insurance for travelling to the US is so prohibitive at my age.
Hello, Desanthony. Thank you for your thoughtful and encouraging response to my post. I appreciate your taking the time to share so many details with me as in doing so you've spoken to a number of my concerns. Your words have also sparked a desire in me to get back to exercising, something I haven't done in many years so thank you for that. If I may, I'd like to ask you what motivates you to go to the gym every day? I wish you all the best, Desanthony.
It has been my life and I just got used to being as fit as I can. I also enjoy talking to all the guys at the gym too, especially the instructors as we can compare notes with how it was when I started out as a PTI and what it's like now. I joined the Royal Air Force many years ago as a Physical Training Instructor (PTI). I already played football semi professionally and Rugby as an amateur - basically any sport going I loved. I was an accredited swimming coach, Tennis Association Coach, Fencing Coach. FA coach and referee and referree's coach and a life saving coach. I also had to learn as many sports as I could to a level where I could advise and referee inter flight competitions - including boxing which I hate and don't even like to watch. After all that I then became a Parachute Jumping Instructor for 30 years in the Royal Air Force. I hate it when I can't get to the gym - like during this last week when I have been away and have pretty much had to stay in doors because of bad weather - unfortunately yesterday was a good day but it was my wife's birthday so had to take her out for lunch and do what she wanted - walking slowly around a garden centre is not my idea of heaven. I just love being out and doing something once you get hooked on going and enjoy doing the activity and the company you will find you miss the days when you don't or can't go. Those endorphins love running around your active body and you will enjoy it too - it will make you feel so good.
You are quite right in that any and all treatment for AF is mainly for quality of life (QOL). You are also correct in thinking that weight loss is important. The LEGACY trails in Australia a few years ago showed that weight loss leading to a BMI of 26 or better often reduced AF burden to the level that treatment was unecessary.
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I'm 6'3" and at 230lbs do look slim enough but I'm not really and could do with shedding a stone.
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