Arial Fib

[John G58]

I am a healthy and active 39 year old male.  I have had AFIB 4 times in 11 years.  The most recent as last week.   The first time was 1994 I went into AFIB I vomited after drinking and noticed I was in AFIB.  I converted with Procainamide.  Doc put me on 25mg of Tenormin once daily.  The second time was 1996 and a similar situation, I had 3 beers over 6 hours, vomitted and went into AFIB.  I again converted with Procainamide.  7 years passed before the 3rd time when I was laying in bed eating Ice Cream, and after the second bite, I felt the AFIB start.  Procainamide wasn't tried because Covert was a "better" drug. "It will convert you in 10 minutes".  Well it didn't convert me and I needed cardioverted.  The 4th time was last week.  My 8 year old son sliced his cheek while playing.  I picked him up ran him into the house, cleaned him up and rushed him to the ER.  When we arrived I noticed I was in AFIB.  ER tried a different drug this time, but it didn't work either.  Cardioverted the next day.  Been on Tenormin since the first bout. I should note I have not vomited since 1996.  HR runs at about 150 when in AFIB.
Clearly the first 3 bouts were Vagal AFIB, but what about the last one?  I drink maybe  3 or 4 beers on the weekends now with no problems.

I am now concerned that I can go into AFIB at anytime.  I would like to look at treatment alternatives.  What are my choices?

I know 4 times isn't a huge amount, but I live in fear of getting the flu, vomiting and having to go to the hospital to get cardioverted.  And now stress?  I need to get this worry out of my mind.

[CCF-M.D.-MJM]

Hi John,

You still have vagally mediated a fib.  Most likely seeing the blood increased your vagal tone and put you back in AF.

You aren't going into atrial fibrillation very often.  One option is to wait until you go into AF and get cardioverted.  A second option is to take a medication like flecainide to try to stay out of AF. A third option is to have an atrial fibrillation ablation.  Paroxysmal AF has a very high cure rate with ablation.

It is a tough balance bewteen the fear of complications from procedures, medications versus the AF itself.  There is no one right or wrong answer -- it depends on the individual.

I hope this helps.

[John G58]

What are the risk factors of ablation?  Will I need a Pace Maker with ablation, or is the procedure better now.  Is ablation a radical procedure for only 4 episodes of AFIB?

How do I go about getting evaluated for ablation?  Do I need to be in AFIB for ablation to work properly?

How risky is Cardioversion.  It seems simple enough, but I worry about stroke.  Is the stroke risk increased greatly with cardioversion compared to normal everyday living?

What about the medications?  Side effects?  Sudden Death risk?  Liver Failure?

One last question.  When I'm in AFIB how quick to I need to get to the ER?  Am I better off waiting untill my Cardio Doc is in and go see him and skip the ER?

Thanks for your help!

John

[relax15]

From what I have been told it is not good to be in A-fib for more than 24 hours.  I have been having afib for a year now since right before my 28th birthday.  The random bouts of a-fib are quite hard to deal with.  I think it is one of those conditions that can become debilitating if you allow it to.  Basically I think that medication or ablation are something you should look into.  I have been told by my EP that eventually lone a-fib will eventually turn into chronic a-fib without the proper treatment.  Who knows?  It may be a great way for him to make money, or he may be on the mark.  Given the frequency of your attacks I would say you are quite lucky as some people have much more frequent bouts of a-fib.  I know personally that I was having a bout every two weeks which would convert rather quickly, and one every two months that usually landed me in the hospital.  I have travelled to Cancun twice since then and tried to not live in fear of strokes, sudden death, etc....  Its hard at times since I think panic is the body's natural response to stimuli like this.  I did some reading and got my doc to put me on Norpace XR which is an antique in the drug world, and some people say its a really bad drug.  Since starting the Norpace I have had (knock on wood) NO afib what so ever.  I still have my millions (is seems) of pvc's/pac's ectopic whatever they may be, but I am thankful for the relief.  My advice which is worth exactly nothing would be for you to see a qualified E.P. who can help get some stability in your life again.  Take care of this soon before the anxiety and stress ruin relationships, or even your own health!

Sean

[relax15]

The medication I take is Norpace CR, not XR.

[dquenzer]

As a former sufferer this is what my cardiologist said, "Afib will eventually get worse if it isn't treated."

Having said that this depends upon the person.  How aggressive of a treatment do you want based upon your symptoms?

My cardiologist believed that it was better to be aggressive rather than passive.  He srongly believed that regular episodes were unacceptable.  So I started on anti-arrythmics soon after my first bout.  However the drugs would work for a period of time, and then I would start having frequent bouts (from 1 hour to 1 day) every week it seemed.  AFIB would always convert on its own, but I was symptomatic (meaning I felt miserable in AFIB).  I then had an ablation, and since then have been AFIB free (except for about two weeks immediately following).

This is how I would proceed:
1)  I would probably take an anti-arrythmic to make sure that I wouldn't go in AFIB again. I would at least take a full aspirin once a day to prevent blood clotting.
2)  If the anti-arrythmic kept the episodes to practically nill then I would proceed with that treatment.
3)  I would try at least another drug if one failed.
4)  If the episodes become frequent on the second drug (once or twice a month), then I would look at an ablation.

That's my opinion, and that's how my doctor proceeded.  It's reasonable.  I don't think one should have invasive procedures right away if other treatments are successful.  Drugs are not risk free, but that's why they generally put you in the hospital to monitor your progress while they put you on the drug.  But I also think that once AFIB starts it will generally progress if not treated in some way.

[bama jane]

Does anyone that has a fib have a mother or father that has or had it.  My father's problem began much like mine, svt and other arrhythmias, and then progressed into chronic afib.  He developed heart failure and died. He also developed lung disease later in life that could have caused the afib. I just wonder if it is an inherited condition since they can find no cause for my problem, and if so what the percentagae is that other atrial arrhythmias develop into afib.

[dquenzer]

The Mayo Clinic is doing research on this of which I am part of that study since my Mom had AFIB, my sister has it, and I had it.

But right now as I understand there is no conclusive evidence.

[Stelladallas]

When I read about people who are in their 20/30's having AF, I feel lucky.  Mine didn't start until I was 54 yrs. old and that year I had it 3 times.  Another run didn't occur until 5 yrs. later then once in 2002, twice in 2003, and by 2004, I had more episodes and 3 cardioversions. I've had a total of 15 episodes of AF.  In 2001, I had an ablation but 3 months later, I was at it again.  Frankly, I would not do an ablation again.  Too scary and too invasive.  I developed sick sinus syndrome because I was either too fast or way too slow.  In Dec. I had to have a dual chamber pacemaker for a pulse of 30.  During this time, I traveled all over the US, and once to Paris.  My plan always was that if I started up again to go to the ER if my rate gives me symptoms.  If not, I call the Dr. and follow his directions.  I am on Rythoml and I'm not so sure how this works, but I've been on many other drugs and they certainly did not prevent AF. My mother had AF but did not develop it until she was in her late 70's.  She was cardioverted a couple of times, otherwise, she would convert on her own.  That I never did no matter what I tried.  Continue to live your life to the fullest but just have a plan.  Good luck!

[dquenzer]

You are correct that ablations don't always work.  It really depends upon the cause of the AFIB as well as how well the ablation goes the first time. That's why a very good specialist is required.

Also since 2001 ablation procedures have improved due to greater experience.

But invasive procedures should only be done with great counsel and care.

[PikaPika88]

Hi Stelladallas,
After the dual chamber pacemaker implanted, do you take any blood thinner for your AF?  Do you get atrial tachycardia as well?  I've a two leads pacemaker and I've AF as well.  Appreciate for your answers.  Thanks.  Pika.

[Stelladallas]

Yes, I am on Coumadin.  No I do not get atrial tachy.  All my episodes have been either and/or both atrial fib. or flutter.  When I don't have an episode, I feel really well and one would never know that I've had such a time with my heart.  Because of my pacemaker, my pulse runs at 60 and I know that I am using it about 100% of the time.  I am also on blood pressure meds even though I did not have high blood pressure.  The Drs wanted to make sure I don't have any added pressure.  My heart is severly enlarged and personally I believe it's from the many years of horrible asthma which finally got under control with all the newer drugs they now have.  My other meds. are Lipitor and Tiazac.  Take care.

[PikaPika88]

Thanks Stelladallas.  I didn't take blood thinner. I thought with the help of pacemaker, AF is only activate at the short time then will convert back to normal.  I didn't use the pacemaker all the time.  I only use it when necessary.  I like that way so I don't have to replace the battery so quick.  You take care too.  Pika.

[heart5]

My husband was born with Tetralogy fallot and had a complete correction by the age of 6. He is now 34 and has an abillation for a-fib, it did not work. He also has a vavle leaking (more that likely it has been leaking they said for 20 years) that has to be repaired. The doctors said the right side of his heart is very badly damaged. He looks healthy which was very shocking to us. He is going to have the valve replaced. Has anyone ever had the maze procedure done? I am trying to educated myself on his condition. I do not know how much heart damage is to much and how long can you live with "very bad heart damage". He is on toprol, coumidan and cartizen. We see the doctors again next week and I am writing my questions down. Anyone have any advice?

[Stelladallas]

I too was told that I had a mitral valve leak which none of the Drs. told me was problematic.  It was not fixed but I also understood that's why they try to control my blood pressure even though I did not have a history of high blood pressure.  I guess one question I would ask is how bad is the leak and to explain to me exactly how bad my heart is and what their explanation for this is plus the prognosis.  Good luck!

[mongu]

A related discussion, stress myocardial perfusion study was started.