First episode of AF

Hi Jim, your information is very encouraging for me. I had my first afib last year when I was 36. Then I had another three episodes in the following three months. But since then, I haven't had any episode for 90 days, and I'm not on any daily med. I hope can follow your luck to have very limited episodes in my up coming years.

My cardiologist said even after a successful ablation and no visible AF he would still keep me on blood thinners for life as AF is very unpredictable and you can develop irregular beats and not notice them. The cause of your AF never goes away.

different opinions from different EPs,you just have to make your own mind up in the end,whatever suits you best.

Hi li,

Afib presents in many different ways. Hopefully you will be able to identify your triggers (not always easy) and have few if any more episodes. My trigger had always been drinking very cold beverage or ice cream. If you can't identify your triggers, more general advice is to stop smoking, no binge drinking and get to an ideal weight. Many here have given up or cut down on caffeine. For some there may also be a food/afib connection and suggestions range from doing a food diary to limiting the size of meals. Stress management with mindful meditation/breathing or otherwise never can hurt. Exercise is a plus but overdoing it can cause afib for some.

How did they get you out of afib each of the four times?

Jim

Hi Sarah,

A new study came out suggesting OK to go off thinners after successful ablation. Also, some suggest that very brief episodes of afib or subclinical (not caught on a regular ekg) may not warrant thinners as much as clinical afib. In my case, I always know when I'm in afib since my heart starts racing over 170bph, but I realize everyone is different and I agree with you that it comes down to a personal decision based both on your unique situation, Chad Score, and how much risk you are willing to to take. Profession and lifestyle may also be a consideration as the bleeding risk of thinners versus their benefits. FWIW what I've found is that EPs are very bullish on thinners and ablation, while cardiologists are less so.

Jim

Hi Jim,

All my episodes happened when I was sleeping and ended by itself exactly at 8am. I tested for sleep apnea, it came out as mild apnea but EP said mild apnea doesn’t cause afib. I also noticed before all four episodes I read in bed with my neck/upper back against the headboard. Also during these episodes I was taking metoprolol. These are the only common things shared by all the episodes. Since then I started taking magnesium, not reading in bed and weaned off metoprolol, then I haven’t got an episode. Not sure if I have corrected what was wrong. I hope I won’t get another episode by doing these. Also I am not over weight (BMI 25), don’t drink alcohol. Oh, one more thing, 12 days before the first episode, I started a vegan diet which made me very tired and I had diarrhea for few days, and had heavy sweating few nights before first episode. Maybe the vegan diet messed up my electrolyte balance. Now I had resumed my normal diet. Wondering if my afib was caused by electrolyte imbalance, would I have it again if that’s corrected.

Don't hold me to it, but I think I read recently that Metoprolol can instigate certain types of afib, so hope that helps. VERY interesting what you said regarding your vegan diet. All my episodes of afib were precipitated by cold drinks or ice cream except the last. No ice drinks or ice cream that day but potential triggers were too much caffeine that day and stress. But coincidentally I also had been on a very low fat (under 10% of total calories) diet and while not vegan was mostly vegetarian. Like yourself, I went back to a higher fat, higher protein diet in case the diet was the cause. I hope your new regimen works.

Jim

Jim,

Yes, I've also read that beta blocker makes vagal type of afib worse. I think mine is vagal. It is sad that cardiologists and EP in the US don't seem to care different types of afib but just throw out the same treatment. I kept telling them metoprolol makes me misarable but they ignore me. I then decided to wean off and felt much better. I felt like my afib was started by improper vegan diet, and the follow three episodes were brought on by metoprolol. I can't proof though.

That's right, metroprolol somewhat contraindicated for vegal types of afib. Sometimes you have to make your own decisions and/or get second opinions. Lately, eating a lot of fatty fish like salmon plus I started magnesium supplementation.

Jim

Hi Jim, After reading on this forum that magnesium and potassium were beneficial for A-Fib folks, today I got some and will start taking it after getting the ok from my cardiologist. 

However, not sure exactly how these supplements help us. What do they do? I tried magnesium to help with my tinnitus but stopped as I didn’t feel a difference.How will it help my A-Fib? How about potassium? How does the salmon help?

Also, I read here that Taurine was beneficial. Would appreciate any feedback regarding these supplements and how they help us.

Thanks.

 

Magnesium and potassium have a preventative effect for arrhythmia's according to multiple sources. Salmon is high in Omega 3 fatty acids that also may help arrthymia's as well as general cardiac health. Keep in mind that nutrition/diet is one of the most confusing topics out there because you can almost always find one reputable source contradicting another! Not that familiar with Taurine but I'm sure others will chime in.

Jim

Thanks for the reply. Speaking of omega-3’s  and cardiac health,  my cardiologist recently advised me to stop taking fish oil which I had been taking for many years for cardiac health. Both he and a doctor of pharmacy I spoke with said fish oil will increase the bleeding risk. I was also advised to stop taking saw palmetto which I had been taking for many years for prostate health. Confusing and ironic, yes!

Hi Patrick,

Are you on blood thinners (I'm not) or have any other unusual bleeding risk? Even if on thinners, I don't think fish oils are necessarily contraindicated but of course you have to lean on your doctor's input but second opinions could be in order if you are not convinced. Saw Palmetto hasn't done well in some studies but other than spending potentially unnecessary dollars (or pounds) not sure what harm it would do. Did they give you a reason?

Jim

Hi Jim,

Yes, I was put on Pradaxa even before my electro cardioversion. I was contacted by a pharmacist from Florida Blue, my insurance company, and she counseled me about all the meds and supplements I was taking and strongly suggested I talk with my cardiologist about the bleed risk presented by fish oil and saw palmetto, which I did. He agreed about the fish oil but couldn’t find anything about saw palmetto and advised to take her recommendation if I wanted to be on the safe side.

The pharmacist also recommended to speak with the cardiologist about switching from Pradaxa to their “preferred” drug Eliquis as the copay is less than a third of the cost of Pradaxa. However, when I spoke to the cardiologist, he said he recommended Pradaxa because it is the only blood thinner that is reversible and he was concerned about a possible fall during my daily 30 mile bike rides.

Having said that, he admitted that it has never been an issue with any of his patients with the other blood thinners and he would be happy to switch to Eliquis if I wanted to. I told him I will stay with Pradaxa at least until my followup with the pharmacist in 30 days.

Any input regarding this issue would be appreciated!

How long do they want you on Pradaxa? Given your history, hopefully not more than a month. If this is the case, then no harm holding off on Omega 3 supplements and Saw Palmetto. FWIW I don't take fish oil supplements but just eat fatty fish (salmon, sardines) several times a week as well as walnuts daily.

While hopefully it's academic for you, which blood thinner to take can be almost as confusing as supplements! The best reversible thinner is the old standard Coumadin (Warafin) but they tend to steer you away from that because of blood monitoring. If you happen to be the type of person who eats the same thing every day, then it might be the best choice because your INR would be constant and easy to keep optimal dosage.

Among the others, Pradaxa did recently get a reversal agent but not sure if it's as effecttive as Vit K for Coumadin. I went over this with my ep who likes Xerelto for various reasons and he said that they can stop bleeding now with all of the thinners but I haven't seen that yet in studies. I assume he was talking about the reversal agent for Pradaxa but not sure if it was trialed with Xarelto. His second choice was Eliquis which also has good reviews. I'm sure there is a case for (and against) all of them.

I was prescribed Xerelto six years ago before there was a reversal agent for Pradaxa so I just took Xerelto with the onset of my last afib episode. I stopped taking it after 30 days. My Chad score is 2, and arguably I could be on thinners for life but my cardiologist is OK with me not taking them. If I felt that I was going in and out of afib frequently, I'd reconsider the thinner strategy, but I seem to have distinct events many years apart.

Jim

Jim

My cardiologist says I will likely be on thinners for life. I asked if I went the ablation route if I could get off thinners (I had read here where someone had done that) but he doesn’t think I am a candidate for ablation at this point. I think he is looking at my family history as my mother had a stroke at age 66 and died at 73 (I am now 68) as well as my hypertension and high cholesterol which gives me a CHAD score of at least 2 (I think?).

So I will take a wait and see perspective until I see the cardiologist in 6 months. I have had a couple episodes of palps since my cardioversion, both after eating, so if that continues he will put a holter monitor on me to see what’s happening there.

Jim, I appreciate your continued responses which have been helpful and enlightening. Here’s to better health for us all going forward!

Pat

 

Sorry, I was mixing you up with the original poster of this thread who is 40 and has a Chad score of 0. Your chad score is "2", the same as mine, and one could argue either way regarding thinners. Is this your only case of afib or do you have a history? If it's your only case, then you could arguably get off thinners if if it doesn't return, but running a halter first might be prudent. Whether or not to take thinners is a very individual situation and depends on Chad score, your afib history, lifestyle, as well as risk tolerance. As to ablation, I personally see ablation as a down the road procedure if afib keeps repeating and cannot be managed to your liking with rate and/or rhythm drugs. While some eps, may disagree, studies suggest no different in longevity for a successful ablation versus drug control. There is one study that suggests one could get off of thinners after a successful ablation, but I really see no difference between that ablation situation (situation A)  and the situation like myself where someone only has either a single episode of afib, or very infrequent episodes (situation B). A cynic might argue that the ep's either are overstating the use of thinners in situation B and understating in situation B. Profession bias? A way to market their bread and butter ablations

Jim

As far as I know, this was my first A-Fib event as I was admitted to the hospital with “new onset A-Fib”.

That being said, I was diagnosed many years ago with an irregular heartbeat and completed several tests, including a stress test and fared well with no further procedures or medications prescribed.

So my first A-Fib event was discovered 2 weeks ago when I had my first new patient appointment with a new doctor. After interviewing me to collect family history, etc., she checked my heartbeat and pulse and said “your pulse is all over the place.” I felt fine and had no symptoms so was quite surprised when, after a quick EKG, she put me in a wheelchair and had me rolled next door to a hospital ER where I was admitted with “new onset A-Fib” 😱

I had recently been having sporadic dizzy spells but attributed it to side effects of my blood pressure meds which had been changed several times looking for the right combination. I had been monitoring my BP which became a challenge about a year ago. Looking back at the history of my BP readings, I see several that indicated an irregular heartbeat which I attributed to my long history of arrhythmia.

So is it possible that I had had prior A-Fib events without knowing it? I have read that this is quite possible. As I said, I was feeling fine at the doctor appointment and looking forward to my daily 30 mile bike ride and was shocked when I was being wheeled to the ER. Yikes.

And then 3 days later came the REAL shock when the electro cardioversion jolted my heart back to normal rhythm. ??????

Sorry for for the length of this post but perhaps it sheds some light on why my cardiologist thinks I will be on thinners for the long haul.😟