My first pacemaker showed a very small amount of AFib, so my cardiologist put me on Amiodarone. Fast forward a couple of years and the Amiodarone puts my Thyroid into overdrive (hyper), which in turn put my heart into permanent AFib. Gotta love the irony. I've been in AFib 24/7 since April 4, 2018. Through adopting a proper human diet and exercise I have been able to live a normal life with the exception of less stamina than I would like to have, but I can still walk two miles every morning, mow my own yard, go up on the roof to remove leaves and limbs, etc. I'm 77.
The amount of time you are currently spending in AFib correlates with how progressed your AFib is and the stage. If you are going in and out of AFib and your episodes are less than 7 days at a time you are technically Paroxysmal AFib (early stage). If you are spending more than 7 days at at time in AFib you are Persistent AFib (mid stage). If you are in the Persistent stage spending more than a week at a time in AFib and you have been that way for more than a year then you are Longstanding Persistent AFib (late stage). And if you are spending 100% of the time in AFib and it doesn’t go to sleep at all by itself and it is too strong to get it to go back to sleep with an antiarrhythmic drug (AAD) or too much to get rid of it from the inside with an ablation then you are Permanent AFib (end-stage). (Staging is discussed in the “Ablation Techniques #1” video) Even if you ever reach Permanent AFib stage, as long as you don’t have a clot and stroke from your AFib (the decision as to whether you need to be on a blood thinner to prevent this depends on your exact risk which in turn is based on your age and comorbid medical problems-see the video “Can AFib Cause a Stroke?”) you won’t directly die from AFib because it is not life threatening and mostly treated for symptoms. And remember the symptoms are usually palpitations depending on how fast the Afib is making your heart speed up to, and even if your Afib is well rate controlled it can still cause fatigue. Even if you are permanently in AFib you will live just as long as everyone else, but symptom-wise we no longer have the ability to keep the AFib asleep with an AAD or can get rid of it from the inside with an ablation. The best we can do at that point is just to slow it down with a Rate controlling medication to level where you can tolerate it. Most people are on a blood thinner to prevent risk of stroke long term. There is a CHA2DS2VASc scoring system which determines your exact risk of stroke. Any risk over 2% it is recommended you be on a blood thinner longterm. Back when your pacemaker was just showing a small amount of Afib, since AFib is not directly life threatening and treated just for symptoms (assuming you don’t have a stroke from it which is a separate issue), you ideally should have been given options. Either to just tolerate the AFib, using rate controlling meds to keep the heart rate in AFib mostly controlled and just tolerate the symptoms (less risky), use a stronger Antiarrhythmic medication to temporarily keep the AFib asleep (more risky), or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Remember, AFib slowly grows and progresses as you get older (although this happens over years) and the more progressed it becomes the more it wakes up and the less it goes back to sleep resulting in you spending more and more time in AFib until it is eventually Permanent AFib which usually occurs after 10-15 years. The younger one is the more one might consider an ablation because the AFib could become permanent and one might still be fairly young and regret that. On the other hand, maybe a procedure scares you and a 1-2% or less risk of a complication is too much for you and you would never consider it. Everyone is different. Usually when pt’s are in their 80-90’s where the risk of procedures go up, most say just do the least risky thing which is to either slow the AFib down with a rate controlling med and have them tolerate it or if symptomatic to keep it asleep with an AAD. Usually patients who are younger say they don’t want to just tolerate it and are willing to accept a small risk of a procedure to try to get a better long lasting result. But after doing this for 20 years, sometimes I see older pt’s say they understand the risks and still feel an ablation is right for them and sometimes I come across a younger pt that says the procedure scares them and they would never want it unless they were very symptomatic and all meds failed. Everyone’s stage, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. For you they chose to temporarily suppress the AFib with the antiarrhythmic med Amiodarone. Remember this does not get rid of the AFib cells or keep them from progressing as you get older; it simply masks the existing AFib cells until they grow strong enough to override the medication. So you may be able to keep them asleep for several years depending on how fast your AFib cells are growing/progressing. There is however a strength level to the AADs. Amiodarone is the strongest but has the most long term side effects. If you are on it for more than 5-7 years there is a 30% chance it will damage your liver, lungs, eyes, or thyroid. And the thyroid issues can occur in as short as 6-12 months. That is why I personally never use it for long term suppression of AFib (short term suppression for less than 6 months is okay) for anyone less than age 75 y/o because you could be on it for 10 years with adequate suppression of your AFib because it is so strong, but then develop a side effect and have to stop it and can never use it again. I usually try to use an AAD closer to the level of the pt’s stage of progression and then work upwards to the next strongest drug every few years when the AAD fails. For example, for you when you were having just a small amount of Afib maybe you could’ve been tried on our weakest drug Flecainide and then in a few years when that eventually failed work your way to the third strongest drug Sotalol then to the second strongest drug Dofetilide then and only then go to Amiodarone when that eventually failed. I believe it was premature to place you on Amiodarone at such an early stage of your Afib and as you said, it caused hyperthyroidism which woke your Afib up even more. While the hyperthyroidism didn’t cause your Afib to grow and progress to permanent Afib, it did wake it up a lot making it seem like you were at a more advanced stage, and then over several years your Afib progressed quickly and became permanent in 2018. Now that you that you are permanently in Afib albeit rate controlled, as long as you stay on your blood thinner and don’t have a stroke you will live just as long as everyone else. However, we cannot get you out of Afib with an antiarrhythmic med or ablation and you will just have to tolerate the increased fatigue and decreased stamina from this point forwards. What they should have done is either tried you on a weaker antiarrhythmic medication without the long term side effects of Amiodarone and worked their way upwards in strength, and/or offered you an Afib ablation. In your 60’s and 70’s y/o your risk for the procedure would’ve been the standard 1-2% and if a competent Electrophysiologist did your procedure and “turned the clock” back enough, you would not be in permanent Afib currently and be in normal rhythm feeling completely normal. True even if you get rid of all of a pt’s Afib and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon. Nevertheless, I’m glad you learned to deal with your Afib and minimize it’s symptoms.
Dr. Lee…..I watched this video last night, and was so impressed by your clear, concise explanation. I’ve now shared it with all my friends who also have afib. That said, in thinking about your video today, I figured out why I find you to be such a compelling speaker and educator! When you speak, I am able to visualize everything you are describing. The commandeering of our hearts electrical system, the cells going to sleep and reawakening…..all of it!! I’m so impressed with this video, I watched it twice!! 🤣🤣
Thank you so much for such a wonderful compliment. I really appreciate it! When patients truly understand the facts and are empowered the way in which I hoped they would be, it makes all of the time and effort involved in doing this really worth it. Thanks again!!
Thank you very much for your presentation. It’s a eureka moment for me, succinct and clarity. I am bradycardic after being athletic for 50 years and now been diagnosed with paroxysmal vagal AFib. The Watchman was implanted in January ‘24 and currently on rate control and baby aspirin. Recent 30-day monitoring revealed 1.39% AFib burden. Awaiting hospitalization for titration of the antiarrhymic Tikosyn. I know my triggers such as alcohol, and avoid them. I walk at least 5 miles daily 5 times weekly without symptoms except for very infrequent palpitations; my blood pressures thereafter are normal (120s/70s). I am 72 years young and still being active. Your video as well as the comments of my EP cardiologist give me confidence to start and enjoy traveling. Thank again Dr Lee. It’s a good video to share with anyone.
AFib basically causes three problems. Problem #1: It wakes up and takes over control of your heart away from your normal source of electricity thereby causing your heart rate to speed up. While this is not directly life threatening because AFib will never make your heart speed up to a life threatening speed, it can cause symptoms depending on how fast your heart rates goes to and that is why there are multiple ways of treating symptoms: using a simple rate controlling medication to slow your heart rate down while in AFib (these meds are simple meds that don’t have any potential dangerous side effects but they aren’t doing much other than slowing the speed of your AFib down so that you can tolerate the symptoms a little better; versus using a stronger antiarrhythmic medication (AAD) that potentially has stronger side effects to actually keep the AFib cells asleep so that you don’t keep going in and out of AFib and stay in normal rhythm feeling completely normal (these drugs don’t get rid of the AFib cells and they don’t keep you from forming more AFib cells as you get older, they simply “mask” your AFib cells until they can’t “mask” them any longer; versus, doing an AFib ablation where we do a special procedure to map the electrical cells inside your heart and try to destroy them from the inside in order to get rid of your AFib directly because they won’t wake up and take over control of your heart if they are gone (this procedure is never a permanent cure because AFib cells can grow back in other walls of the heart given time and the results are not “all or nothing;” Your results will vary depending on how many AFib cells you start out with, your “stage of progression,” and the skill of the operator doing your ablation). The ablation potentially can get you the longest lasting results but involves the most risk upfront (the risks of doing a procedure) whereas the rate controlling meds don’t even get you out of AFib so get you the least results but are the least risky treatment option. See my videos “4 Basic Facts About AFib”, “How Do I Treat the Symptoms of AFib?”, and “Catheter Ablation in AFib Part 1 & 2.” Problem #2: AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). See my video “Can AFib Cause a Stroke?” However, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch structure called the Left Atrial Appendage. The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage. So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). See my video “Watchman in AFib Explained.” Problem #3: AFib is primarily caused by aging and getting older. Once you develop AFib cells in the walls of your heart that are starting to wake up, every year you get older these cells keep growing and spreading and the more of these you have, the more walls they’ve spread to, the stronger they become, the more they want to be awake, and the less they go to sleep. Eventually you can reach a stage where you have enough AFib cells/sources where they are awake 100% and at that point we can’t put them back to sleep or get rid of them and your AFib will be 100% permanently awake from that point forwards. But the good news is that even if you reach that point you will never die from AFib because it is not directly life threatening. As long as you don’t have a clot and stroke from it you will live just as long as everyone else. Please see my videos on “What Causes AFib?” and “Stages of AFib Explained.” Because Afib is not directly life threatening and mostly treated for symptoms, the decision whether to just live with Afib and control the rate (least risky), versus try to suppress it for a few years at a time with a strong antiarrhythmic drug then in 15 years accept when it is permanent (more risky), or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But again we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib.
Ideally an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. This is the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving patients the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication. It sounds like they are planning on placing you on the second strongest antiarrhythmic med, Tikosyn, to keep the Afib temporarily asleep. Since you are only in Afib 1.39%, that is a very early stage of Afib, probably 1 wall or less worth. Normally I would say using Tikosyn which is a very powerful med (as evidenced by the fact that it has to be loaded in the hospital because it can sometimes cause normal electrical cells to turn into dangerous cells that can wake up and make your heart speed up to 3-400bpm and cause sudden death) that can suppress up to 4 walls worth of Afib would be overkill in your situation, but since it sounds like your normal rhythm is slow, technically all of the weaker AAD drugs can cause more bradycardia. Remember, the AAD won’t suppress your Afib forever especially as you get older and your Afib progresses and gets stronger as it grows on more walls of your heart. Another alternative at your age is to eventually consider the AF ablation. The effectiveness of an ablation has a lot to do with how progressed one’s stage of Afib is. Are you early stage called Paroxysmal Afib where you don’t have a lot of Afib cells (maybe 1-2 walls worth out of the 6 walls) and your Afib is only waking up 1-30% of the time? Are you mid stage called Persistent Afib (3-4 walls worth of cells) where your Afib is waking up 30-60% of the time? Are you late stage called Longstanding Persistent Afib (5-6 walls worth of cells) where your Afib is waking up 60-90% of the time? Or are you end stage called Permanent Afib (all 6 walls are covered with AF cells) where your Afib is awake 100% of the time and has been like that for years and can’t be converted back to normal rhythm no matter how strong the medicine, or how complex the ablation, or even a cardioversion? Think of the stages of Afib as like the stages of a forest fire. A 10% forest fire is super easy to put out no matter who the forest ranger is even if they are very inexperienced or of limited skills, but the more progressed your forest fire (eg. 70-90%) the more skilled a forest ranger who is able to put out complex forest fires is needed. At later stages of Afib the energy source used for the ablation is much less important than the skill of the operator. This is why in the advanced stages ablation results vary widely depending on who did the procedure, everything from having 3-5 procedures and still having significant Afib leftover and needing an antiarrhythmic drug, to getting the result but with 3-4 procedures, to some of us able to do very advanced and complex ablations getting the result often in one procedure. Think of the ablation as “turning back the clock” to an earlier stage by getting rid of Afib cells/sources from the inside; the more one can get rid of from the inside (the more skilled the operator doing the procedure) the less AFib remains to wake up. True even if you get rid of all of a pt’s Afib and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon. Whether to just live with Afib and control the rate (least risky) versus try to suppress it over the years with stronger and stronger antiarrhythmic drugs as the AFib slowly outgrows each drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. It sounds like you are doing your best to avoid any “triggers” that can wake up your Afib. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. I hope this helps!
If you really have had AFib for the last 28 years then it is likely it has progressed to being there 100% of the time which is what we call "permanent AFib" stage. But as long as you stay on a blood thinner and don't have a clot and a stroke, AFib is not directly life threatening and mostly treated for symptoms. Thanks for watching!
Thanks Dr. Lee. Thank you for taking the time to explain AFIB. I wish my regular cardiologies would have explained it this way back in July 2024. Not knowing what I know now about AFIB caused me and my family many sleepless nights. My recommendation to my AFIB friends is to seek the best medical advise, not all EP and regular cardiologies are created equal. I am still almost two month post my ablation and my AFIB episodes are much less frequent (about 0.5% per week) but I am getting an extra or some times missing a beat here and there and some palpitations at night.
It can take some time to see the full results of an AF ablation. We usually give it up to 3-4 months because Afib cells/sources can still die up to this point but nothing more will die off past that point. Anything that is still waking up past that point is something that either survived the ablation or wasn’t targeted. Remember, getting rid of AFib with an ablation is not an “all or nothing” event. It is more like putting out a forest fire. The bigger and more spread the fire is, the more of the forest it covers, the harder it is to put it out completely although one can always make it smaller. I consider an ablation like “turning the clock back to an earlier stage.” Depending on the skill level of the operator and the stage of progression of the Afib (early, mid, late, permanent) will determine one’s chances of turning the clock all the way back to zero or just back a little bit. The stage of Afib is like the stage of a forest fire. A 10% forest fire (1 wall’s worth of AF) is super easy to put out no matter who the forest ranger is even if they are very inexperienced or of limited skills, but the more progressed your forest fire (eg. 70-90% or 4-5 walls worth) the more skilled a forest ranger who is able to put out complex forest fires is needed. At later stages of Afib the energy source used for the ablation is much less important than the skill of the operator. This is why in the advanced stages ablation results vary widely depending on who did the procedure, everything from having 3-5 procedures and still having significant Afib leftover and needing an antiarrhythmic drug to suppress the rest, to getting the result but with 3-4 procedures, to some of us able to do very advanced and complex ablations getting the result often in one procedure. But remember, whatever you get the forest fire to is where it will start growing back. If someone has 4 walls-worth of Afib cells (70% of cells waking up 70% of the time) and someone does a simple 1 wall ablation and gets it to 3 walls-worth (50% of cells waking up 50% of the time) then not only did they not get it all but as one ages the Afib cells will start to grow from 3 walls and 50%. But if one has the skill to get rid of all of the Afib cells and turn the clock back to zero, not only will the patient not have any Afib cells waking up possibly for years but their Afib will start to grow back from zero so they will get longer before Afib significantly reoccurs. If this is true, why don’t more EP’s try to do a better job and get rid of more AF in one sitting? Quite simply, it is because it is hard to do and not everyone can do it. It would be like hearing an expert, very experienced forest ranger describe how he/she approaches and puts out very complex forest fires, then listening to an average forest ranger talk about putting out a certain amount of a forest fire and leaving the rest saying almost defensively that that is the best that can be done. If you ask them why they don’t do the approach the other ranger described you will often get a variation of the ego driven, “Well I’m the best so if I can’t do it then it can’t be done.” But clearly there is a large variation in what people do and the results they obtain. In truth, it is extremely difficult to learn to perform an advanced lesion set for complex Afib cases and to do it safely and effectively, and most physicians these days won’t bother. Why? Because under the current system of reimbursement, you make more money to do less. For example, I might spend twenty years experimenting and learning advanced techniques in order to get rid of Afib even in the most advanced stages and as such I block out 3-4 hours for a pt’s procedure and end up ablating 5-6 out of 6 walls to successfully ablate their persistent or longstanding persistent Afib into normal sinus rhythm, and 3 months later after everything settles down they are off any antiarrhythmic medication spending zero or minimal time in Afib. Another EP, even those just a couple years out of training, could block out 1 hour because they are just planning on electrically isolating that first wall, the pulmonary veins, irregardless of whether that is enough to get rid of all of that pt’s Afib, and as a result they can put on 4 procedures instead of my 2, and get the 2nd, 3rd, or even 4th redo’s and make 3-6 times the money for getting a worse result. This is because we all use the same billing code from the health insurances which pays us for doing something not for getting a specific result. It is assumed that we all do the same thing and get the same results, which personally I don’t think is true for any profession on the planet. When I came out of training in 2004 it used to be better with more docs trying to do the right thing for pts, but as physician pay has been squeezed and insurances keep looking for reasons not to pay us, I see more and more docs doing as many procedures as possible without regard for results. This is currently being exacerbated by the new Pulsed Field ablation technology which doesn’t currently create better lesions than radiofrequency or cryoballoon technologies, and in some cases actually creates more superficial and worse lesions, but it is faster and overall a little safer. I’m now seeing some places doing up to 6 ablations a day. It’s taking a simplistic technique that was never enough for the more advanced cases, applying it to everyone, and now doing twice as many so as to make the most money possible. But because what we do is so specialized such that even general cardiologists don’t quite understand what we do let alone pts, people get away with it. It’s unfortunate, because it often feels like one is penalized for trying to do the ethical thing of only doing a procedure if after explaining things thoroughly to the pt it is decided that it is the right thing to do; and if doing a procedure is deemed needed, doing it in such a way where only one procedure is necessary most of the time. At these later stages, whether to just live with Afib and control the rate (least risky) versus try to suppress it for a few more years with a strong antiarrhythmic drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. And remember, skipping of your heart beat doesn't always mean that you are in AFib or have AFib recurrence. Your heart is controlled by a source of electricity because it is essentially a big dumb muscle. Usually your normal source of electricity, the sinus node that is located at the roof of your heart, is in control of your heart and it tells your heart to beat at whatever speed your brain wants it to go to based on what you are doing. When an abnormal rhythm like AFib forms and wakes up and temporarily takes over control of your heart away from the normal source of electricity, it can tell your heart to go at any speed it wants but always something faster than your normal rhythm source. True, AFib makes your heart go fast and irregular, but in truth you can't tell where the electricity is coming from that is controlling your heart. You can only tell if your heart seems faster than normal or irregular. Only an ECG or heart rhythm monitor can sense the electricity in your heart directly and identify who is in control. Your normal rhythm can be in control and sometimes be a little bit irregular. More commonly younger individuals develop a condition known as premature beats which are essentially single extra heart beats coming from a weak abnormal source of electricity that doesn't take over control of your heart but just adds a couple of extra beats. These are called PVCs (premature ventricular complexes) or PACs (premature atrial complexes). They are benign and often woken up with stimulants like coffee. If you have weird sensation of palpitations either irregular or racing, the best way to evaluate it to see if it is recurrent Afib versus these benign premature beats is to see your general cardiologist or a competent electrophysiologist (electrical cardiologist) where a heart rhythm monitor can be placed to catch your symptoms and verify exactly what is going on. Also feel free to watch my video “Does an Irregular Heart Rhythm Mean I'm in AFib?” I hope this helps.
@@afibeducation Thanks Dr. Lee. Yes, my EP wants to place a monitor to see what is going on but want to give it more time to see if the the ablation worked or not. It happened on October 29th, 2024. I need to be patient and hopeful. Can't thank you enough for taking the time to address my concerns.
@@afibeducation By the way my EP told me the exact same thing about Pulse Field ablation. He used cryoballoon in my case. and he does no more than 3 ablation in a given day. After reading your explanation about the Pulse field ablation, I am glad my EP used cryoballoon.
So enjoyed understanding my a-fib issue, I am 74 yr old woman, just got my second pace with blue tooth, take thinner also, I know my a-fib is low range but most time I am in it Had veins checked, all clear Had echo, 45 number so some low I have hbp but try to be careful I know issues make life shorter but praying God hears my prayers and have good dr's Ty
I appreciate your feedback. Some thoughts: Because Afib is caused by getting older and the aging of the heart walls, once you live long enough to develop Afib cells and they start waking up, every year you get older you keep forming more Afib cells and it keeps progressing. Remember, the more Afib cells you have and the more walls they develop on, the more progressed your Afib is, the stronger it becomes, the more it wants to wake up, and the less it wants to go to sleep resulting in you being in it for longer percentages of time. Also remember that Afib can wake up and take control of your heart but sometimes it makes your heart go really fast and other times less so. When it is really fast you feel it, but if not that fast you may think you aren’t in it but you are. You can’t tell where the electricity is coming from that is controlling your heart, only if your HR seems abnormally fast. Only an ECG or heart rhythm monitor can identify if you are really in Afib or not. So you could be spending more time in Afib than you realize. But to a certain extent that’s okay because as long as your Afib doesn’t cause a clot and stroke, it is not directly life threatening and treated mostly for symptoms. Also there are stages to AFib progression. When you only have AFib on 1-2 out of the 6 walls of the left upper chamber of your heart you don't have that many cells and they wake up less than 30% of the time. This is an early stage called "Paroxysmal AFib." When you have AFib cells on 3-4 walls they are strong enough to wake up 40-60% of the time. This is a mid stage called "Persistent AFib." When you have AFib cells on 5-6 walls and they are waking up 70-90% of the time this is a late stage called "Longstanding Persistent AFib." Once your Afib cells cover all the walls and are awake 100%,, within three years they could progress to being permanently there and awake (end stage called "Permanent AFib") where you will be in active Afib for the rest of your life and at that point no antiarrhythmic medication will be able to keep it asleep, and no ablation no matter how complex the lesion set or the energy source will be enough to get rid of it. At that point you would just stay on your blood thinner because as long as you don’t have a clot and stroke you will live just as long as everyone else, but symptom-wise we would just use rate controlling meds to slow your Afib to a speed that you tolerate and leave it at that. Currently if you want to stay in normal rhythm longer and aren’t willing to accept just being in Afib for the rest of your life your options are either to use an antiarrhythmic medication to suppress the Afib (which doesn’t get rid of the Afib cells or keep them from growing as you get older but just masks them until they can’t mask them any longer) or do an ablation to try to get rid of enough of them from the inside. If you use an antiarrhythmic medication to keep your AFib asleep, remember that your Afib cells are still there and growing and can still become permanent in a few years. If you wanted it not to become permanent in several years since you might be at a late stage, only an Afib ablation could “turn back the clock” to an earlier stage by getting rid of Afib cells/sources from the inside; true even if you get rid of all of a pt’s Afib and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon. And also remember, the stage of Afib is like the stage of a forest fire. A 10% forest fire is super easy to put out no matter who the forest ranger is even if they are very inexperienced or of limited skills, but the more progressed your forest fire (eg. 70-90%) the more skilled a forest ranger who is able to put out complex forest fires is needed. At later stages of Afib the energy source used for the ablation is much less important than the skill of the operator. This is why in the advanced stages ablation results vary widely depending on who did the procedure, everything from having 3-5 procedures and still having significant Afib leftover and needing an antiarrhythmic drug, to getting the result but with 3-4 procedures, to some of us able to do very advanced and complex ablations getting the result often in one procedure. At these later stages, whether to just live with Afib and control the rate (least risky) versus try to suppress it for a few more years with a strong antiarrhythmic drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. Hopefully an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. Fee free to watch my other videos including "4 Basic Facts About AFib" and "What is an Arrhythmia?" for more in depth information on any of these topics. I hope this helps.
@@afibeducation Appreciate the detailed information. That was very informative on Afib and what treatment plans should be considered based on risk/benefit analysis for each individuals.
Thank you! Unfortunately, I've noticed that lack of explanations has been worsening over the twenty years I've done this. I believe that as Medicare keeps cutting physician reimbursement and private insurances keep looking for ways not to pay us on technicalities, it is causing more and more docs to feel that they just have to see as many patients as possible and sometimes, unfortunately do as many procedures as possible even if not always necessary, in order to keep up their income. Their rationale is: if the government and insurances are going to screw me then I have to do what I have to do. Unfortunately, the patients get stuck in the middle. This is also the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving pt's the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication.
Yes, AFib can often times be minimally symptomatic because the rate it makes your heart go at isn't always super fast. But the worst thing that it can cause is a clot forming in your heart causing a stroke. Check your risk score with the CHA2DS2VASc scoring system and if it is 2% or greater then you should be on a blood thinner to prevent a clot and a stroke. Once you are protected from this, everything else we do is based on your symptoms, your stage of AFib, your age, your risk tolerance, and your long term goals. Thanks for the feedback!
What exactly do you mean by HRV over 170? What does HRV stand for? HR stands for heart rate. Not sure what HRV stands for. How do you know that you have been in AFib for one week? Have you had an ECG or wearable heart rhythm monitor done verifying this? Or do you have a smartwatch or Kardia Mobile device that says you are in AFib. ECGs and wearable heart rhythm monitors are the most accurate devices for telling you what rhythm you are in, normal or abnormal rhythm. Smartwatches and Kardia Mobile devices are pretty good but can be fooled into thinking you are in AFib when sometimes you are not. Again, as long as you don't have a clot and a stroke from your AFib it is not directly life threatening and treated mainly for symptoms. Whether to just slow down the speed of your AFib with a rate controlling medication and tolerate it (least risky), use a stronger antiarrhythmic med to keep your AFib temporarily asleep so you stay under the control of your normal rhythm feeling normal (more risky), or do an invasive AF ablation to try to get rid of AFib cells from inside the walls of your heart directly so you stay in normal rhythm (most risky), depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. Feel free to watch "How Do I Treat the Symptoms of AFib?"
Excellent information! I've been taking Xeralto for a long time. Even though my cardiologist seldom hears a- fib and my meter, at home, does not indicate it doctor won't take me off Xeralto. Not sure why but when my Medicare/ Medicare goes in to the gap period the cost goes sky high. I now know what to do. Thanks again!
Thank you for watching! Yes, besides the fact that AFib can take over control of your heart and temporarily increase your heart rate causing symptoms, and that it is caused by aging and increases over time, AFib can also lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
Thank you for this! I have been stressing about this because I went into Afib on Tuesday. I ended up in the hospital. However they told me it was showing aflutter on the EKG. I am currently on bisporol but the hospital added diltiazem that helped bring my heart rate back down to a normal sinus rhythm. My heart rate went up to 170. I am also going through menopause and having every symptom of menopause. Which means anxiety and the fight or flight feeling, like the adrenaline rushes. I kept getting weird feelings like a flutter feeling in my neck so I thought it was my thyroid. I do take medicine for it I have hypothyroidism. I had two ultrasounds of my thyroid and it came back normal. My endocrinologist said my blood levels are normal too. I saw my EP doctor and cardiologist last week and the EKG showed normal sinus rhythm. I had an echo and stress test done and both were normal. I have been hearing a lot of other menapauseal women say that they found out they have Afib. I recently found some info about the vagus nerve that I found very interesting in relating to Afib and menapause actually. There are a couple of times I felt like I was about to go into Afib and I tried one of the vagal nerve manurving techniques and it calmed me down. It was splashing cold water on my face or putting a cold pack on my neck and it helped. If it wasn't a cold pack it was a cold bottle of water. But on Tuesday neither of it worked. I went right into Afib. It was after I ate dinner so I'm wondering if it was the food. I am now seeing a gastroenterologist for my stomach issues so I wonder if my irritated intestines triggered it.
AFib is made up of abnormal cells/sources that form in the walls of the left upper chamber of your heart, the left atrium, and these cells wake up randomly and take over control of your heart electrically away from your normal source of electricity that you are born with that is located in the right upper chamber of your heart. When the AFib cells are in control they make your heart go at faster speeds that can be symptomatic. They also increase the chances of a blood clot forming in your heart that can break loose, go to your brain, and cause a stroke. As one gets older the AFib cells/triggers/sources keep developing, growing, and spreading to more and more walls of the left atrium. The more walls you have AFib cells on, the more AFib cells you have total, the stronger they become, the more they want to wake up, and the longer they stay awake before going back to sleep. When you have them on all 6 walls of that chamber they are strong enough to be awake 100% of the time and that is when your AFib is called "Permanent AFib" because no medication, no ablation no matter how advanced, and even a simple electrical shock (cardioversion) won't get the AFib gone or back to sleep. You will be in AFib 100% from that point forwards, but as long as one stays on their blood thinner and doesn't have a stroke, you will never directly die from AFib because it is not directly life threatening. However, symptom-wise the best we can do at that point is just use a simple “rate controlling medicine” to slow the AFib down to a point where the pt can tolerate the palpitations. See my videos on “What is an Arrhythmia?” And “4 Basic Facts About Afib.” Because Afib cells once they’ve formed can randomly wake up on their own, it isn’t always a specific trigger that wakes them up. True, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, alcohol because of its direct toxic effects on the heart, and even the stress of menopause. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. Understand, while the stress of menopause may be helping to wake up your existing Afib cells/sources, they didn’t cause them to be there in the first place. If you had no Afib cells in your heart then undergoing menopause wouldn’t wake up anything. The reason why so many of your friends undergoing menopause are developing Afib is that Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. Also, the amount of time you are currently spending in AFib correlates with how progressed your AFib is and the stage. If you are going in and out of AFib and your episodes are less than 7 days at a time you are technically Paroxysmal AFib (early stage). If you are spending more than 7 days at at time in AFib you are Persistent AFib (mid stage). If you are in the Persistent stage spending more than a week at a time in AFib and you have been that way for more than a year then you are Longstanding Persistent AFib (late stage). And if you are spending 100% of the time in AFib and it doesn’t go to sleep at all by itself and it is too strong to get it to go back to sleep with an antiarrhythmic drug (AAD) or too much to get rid of it from the inside with an ablation then you are Permanent AFib (end-stage). (Staging is discussed in the “Ablation Techniques #1” video) But again, even if you ever reach Permanent AFib stage, as long as you don’t have a clot and stroke from your AFib (the decision as to whether you need to be on a blood thinner to prevent this depends on your exact risk which in turn is based on your age and comorbid medical problems-see the video “Can AFib Cause a Stroke?”) you won’t directly die from AFib because it is not life threatening and mostly treated for symptoms. And remember the symptoms are usually palpitations depending on how fast the Afib is making your heart speed up to, and even if your Afib is well rate controlled it can still cause fatigue. Most people are on a blood thinner to prevent risk of stroke long term. There is a CHA2DS2VASc scoring system which determines your exact risk of stroke. Any risk over 2% it is recommended you be on a blood thinner longterm. According to your history you aren’t spending that much time in Afib which suggests you are still at an early stage of Afib “Paroxysmal Afib.” Since AFib is not directly life threatening and treated just for symptoms (assuming you don’t have a stroke from it which is a separate issue), the good news is that you have multiple treatment options! Either to just tolerate the AFib using rate controlling meds to keep the heart rate in AFib mostly controlled and just tolerate the symptoms (less risky); this seems to be the treatment options that your doctors currently have you on. Bisoprolol is a “rate controlling medication.” It doesn’t keep your Afib from waking up but simply slows it down hoping that you can tolerate it until it goes back to sleep and the individual episode is over. In fact, when you went to the ER and they gave you IV Diltiazem, this too is simply a “rate controlling” med designed to slow your Afib speed down for symptoms then hoping it goes to sleep on its own after a while. It is NOT one of the antiarrhythmic meds (AAD’s) that is designed to put your Afib back to sleep or keep it asleep. Your Afib just went back to sleep on it’s own in the ER, not because of the Diltiazem. Had you stayed at home it would’ve done the same thing. Please see my video on “Rate Controlling Medications in Afib Explained.” Or use a stronger Antiarrhythmic medication to temporarily keep the AFib asleep (more risky). Or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Remember, AFib slowly grows and progresses as you get older (although this happens over years) and the more progressed it becomes the more it wakes up and the less it goes back to sleep resulting in you spending more and more time in AFib until it is eventually Permanent AFib which usually occurs after 10-15 years. The younger one is the more one might consider an ablation because the AFib could become permanent and one might still be fairly young and regret that. On the other hand, maybe a procedure scares you and a 1-2% or less risk of a complication is too much for you and you would never consider it. Everyone is different. Usually when pt’s are in their 80-90’s where the risk of procedures go up, most say just do the least risky thing which is to either slow the AFib down with a rate controlling med and have them tolerate it or if symptomatic to keep it asleep with an AAD. Usually patients who are younger say they don’t want to just tolerate it and are willing to accept a small risk of a procedure to try to get a better long lasting result. But after doing this for 20 years, sometimes I see older pt’s say they understand the risks and still feel an ablation is right for them and sometimes I come across a younger pt that says the procedure scares them and they would never want it unless they were very symptomatic and all meds failed. Everyone’s stage, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. I hope this helps!
I had catheter ablation in 2010. The weeks after I felt as if it had been a worsening of the condition. Things leveled out and I've only had one or two bouts that I know of and it was companion to other serious bodily stresses. I took warfarin for 10 yrs and I've stopped taking all blood thinners. In fact, I don't take any meds now. I eat a plant based diet and no simple carbs. I walk regularly, ride a bike and do indoor stuff with a resistance band or just general exercise. I'm 76!
I’m glad that you got a good overall result after your Afib ablation and have had minimal episodes since, although remember that Afib can sometimes make your heart speed up just a little bit faster than your normal rhythm and so it is possible to have episodes that you don’t always feel. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time and so they can grow back in different walls of the heart and start again. This is why Afib is not felt to be completely cured even after a successful ablation. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. Also remember that besides symptoms, the most serious problem that Afib can cause is that it can lead to a clot and a stroke. Treatment to prevent stroke is totally separate from treatment of symptoms. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. So for your situation even if you are doing well post ablation and seemingly having no significant recurrent episodes, even if they are waking up a little bit you are still at risk of clots and strokes, and over time your Afib will progress and start waking up even more. AFib never just goes away and is never completely cured. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which long term treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
@@afibeducation I remember when my cardiologist suggested I was a second class patient who had to use warfarin rather than Xarelto because insurance didn't cover the 'good' stuff. (a guy named Reiders did my ablation)
I have an HMO for my health insurance. I have paroxysmal Afib it started in 2021. I have less episodes when I 21:44 stop eating processed sugar and caffeine. The cardiologist gave me the pill in pocket flecinide. I took 1 pill 1 time was nauseous for several hours, then vomited, so I do not want to try that again. He also gave me a beta bocker same information take for episodes then later said take twice daily. I don't want to take drugs. It is an expensive proceedure so I can see why he didn't offer the ablation option. Would it not be better to get it done now before the cells continue to grow? I am 62, and no other health problems besides arthritis.
31 with afib, i got diagnosed 2 months ago. It's consistent now, so im on several medications to control it and the symptoms, im going for an electrical cardioversion in a few days. If that dont work, I'll go in for the ablation. I had symptoms for over a year. Every time i made it to the hospital, the ekg was good, and they said it was just anxiety. Well, now im worried about it being a progressive thing, which i didn't know. How will i manage it in the future? Will i keep having procedures done? Your video was very informative. Thank you!
Ok. This is very interesting. My husband had his first a fib when he had Covid. So there goes the blood thinner. For life. What about exercise. Proper food . Like heart healthy. Do these make a difference. And can a normal healthy man ever get off this dangerous drug? Thank you for your great explanation. Exactly what I thought
It sounds like your husband was starting to develop early Afib (probably from aging which is the number one factor causing Afib to form and progress) that was then woken up by the stress of the Covid infection. From there he will always have Afib cells there that can wake up but remember Afib is not life threatening, we just have to treat symptoms of rapid HR and risk of clots forming during an episode of AF leading to a stroke. The person's long term strong risk is determined by his/her CHA2DS2VASc score where every point is essentially 1-1.5% risk. If your husband's score is 0-1 then he wouldn't need to be on a blood thinner because the risk of clot and stroke would be less than 2% per year. If it is 2% or higher the recommendation is that he be on a blood thinner from that point on to reduce his risk to less than 1% because no one wants to have a stroke. And unfortunately, Afib is never permanently cured or will go away. If he doesn't want to be on a blood thinner long term he can either choose to accept the small but not zero risk, or consider a Watchman implant which may not reduce a patient's risk of stroke quite as well as a blood thinner but close, without needing to take a blood thinner long term (see video on Watchman). Exercise, eating healthy, and losing weight absolutely can affect Afib. It won't necessarily make those Afib cells go away or leave your heart, but since Afib grows and progresses slowly over time (and the more of them you have spread on more walls of the left upper chamber of your heart the stronger they become, the more they want to be awake, and the less they want to go back to sleep) and therefore wakes up more causing more episodes and potentially more symptoms, things like exercise, maintaining a healthy weight, keeping your BP under good control will definitely help slow the progression (see video "Can I Prevent Afib?"). Also there are things that can trigger or wake up your existing AF cells causing you to have even more episodes than you would've otherwise: caffeine, alcohol, stimulants, stress. Avoiding these "triggers" definitely helps, although they don't "cure" you of Afib like many people think. I hope this helps!
Sir, what about vagal afib or afib episodes that occur but you don’t have a high heart rate. It’ll stay within the 70 bpm zone but will have irregular rthym
Thank you for watching! I think you need to be careful about terms like “vagal” AFib. Remember, the basic premise is that AFib is made up of abnormal cells/sources that form in the walls of the left upper chamber of your heart, the left atrium, and these cells wake up randomly and take over control of your heart electrically away from your normal source of electricity that you are born with that is located in the right upper chamber of your heart. When the AFib cells are in control they make your heart go at faster speeds that can be symptomatic. They also increase the chances of a blood clot forming in your heart that can break loose, go to your brain, and cause a stroke. As one gets older the AFib cells/triggers/sources keep developing, growing, and spreading to more and more walls of the left atrium. The more walls you have AFib cells on, the more AFib cells you have total, the stronger they become, the more they want to wake up, and the longer they stay awake before going back to sleep. When you have them on all 6 walls of that chamber they are strong enough to be awake 100% of the time and that is when your AFib is called "Permanent AFib" because no medication, no ablation no matter how advanced, and even a simple electrical shock (cardioversion) won't get the AFib gone or back to sleep. You will be in AFib 100% from that point forwards, but as long as one stays on their anticoagulation and doesn't have a stroke, you will never directly die from AFib because it is not directly life threatening. However, symptom-wise the best we can do at that point is just use a simple medicine to slow the AFib down to a point where the pt can tolerate the palpitations. This means that at any given Stage of AFib the AFib is waking up more or less based on how much of it you have in the walls of the left atrium. Now in the early stages when you don’t have that much AFib, maybe half a wall to 1-2 walls worth, your AFib isn’t waking up very much. That is the stage where “triggers” of AFib make the most difference. Things like stress, stimulants, caffeine, and alcohol can often wake up your AFib more than it would otherwise. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. It is true that there are “non-stress” triggers that sometimes wake up AFib. These would be the so-called “vagal” triggers. Remember, your brain controls everything in your body through your autonomic nervous system which is comprised of either sympathetic stimulation (the “Fight or Flight response” where you see a Tiger and your heart rate increases, pupils dilate to take in more light to see the Tiger better, and blood pressure increases to be ready for action) or parasympathetic or vagal stimulation (this is the rest response where your body gets you ready to sleep or eat by slowing your heart rate, decreasing your blood pressure, constricting your pupils to take in less light, and increasing digestive juices to breakdown food). While AFib is usually woken up by sympathetic stimulation that “revs” the body up, in some people it is woken up more by vagal/parasympathetic stimulation that “slows” the body down. Vagal AFib refers to the “triggers” that wake up your AFib, not the speed the AFib makes your heart speed up to when it is awake. Whether your heart rate is “slow” when your AFib is awake has more to do with whatever speed your AFib chooses to make your heart rate go to at that moment or whether you are on rate controlling meds to artificially slow your heart rate down in AFib. So if you are in an early stage of AFib and notice that your AFib seems to be triggered more by sympathetic stimulation triggers, then avoiding those could mean you have less AFib episodes overall. If you notice your AFib seems to be triggered more by vagal/parasympathetic stimulation triggers like resting, eating, etc. then avoiding those triggers could mean you have less AFib episodes overall. But remember, avoiding triggers is not the same as “reversing” your AFib or curing it. If you have AFib cells/sources in your heart even at an early stage, they can wake up on their own based on how much of them you have in your heart at that particular stage. By avoiding known triggers of AFib, you are simply not waking them up more than they would wake up otherwise. But this only helps in the early stages of AFib. In the later stages of AFib when they are waking up a lot on their own already, they avoiding the triggers may be less helpful. For example, if you are at an early stage of AFib and it is normally waking up 1-2% of the time on it’s own but you do certain triggers that wake it up 10-15% of the time, then obviously avoiding those triggers will markedly reduce how much AFib episodes you are having. But if you progress over time to a later stage where your AFib is waking up 50-60% of the time on its own then doing triggers and waking it up 70% of the time may make less of a symptomatic difference at that point because it is mostly awake already. I hope this helps.
While Afib can be exacerbated by the stress of menopause and can be woken up more, if you really have Afib and on HRT your symptoms are better that just means that you are at an early stage of Afib and without the stress of menopause waking your Afib cells they aren’t waking up much on their own. However, since Afib progresses and grows as one gets older, if you truly have the correct diagnosis of Afib then over time the Afib cells will grow and progress and it will start to wake up more. But if currently they aren’t waking up much then you don’t have to be aggressive in terms of treating your current symptoms since Afib doesn’t kill you just by taking over control of your heart and speeding it up. However, remember that Afib can also cause clots to form in your heart that can break loose, float up to your brain, cut off blood supply to your brain and cause a stroke. This can occur irrespective of the amount of Afib you are having and irregardless of whether or not you have a lot of symptoms from your Afib. Your risk of stroke is determined by a scoring system called the CHA2DS2VASc score. Every point on this scoring system increases your risk by about 1 to 1.5%. With a risk score of 2% or greater, standard of practice guidelines recommend that anticoagulation be used. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. If you truly had Afib correctly diagnosed and are 83 y/o then you have a CHA2DS2VASc score of at least 2 (age greater than 65 y/o and greater than 75 y/o) and so whether or not you have a lot of Afib or minimal symptom-wise, your risk for Afib causing a clot and stroke is at least 2% per year and guidelines would recommend you be on a specific blood thinner to protect you from risk of clots and stroke long term. Thanks for watching!
I experienced atrial fibrillation At age 78, I received an electrical shock to put my heart back into rhythm. My cardiologist put me on Eliquis, is it advisable to stay on this medication for the rest of my life.. At this point I have not experienced another event .
Thank you for watching! Yes, besides the fact that AFib can take over control of your heart and temporarily increase your heart rate causing symptoms, and that it is caused by aging and increases over time, AFib can also lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. Similarly, for your situation even if you are at an early stage of AFib where you don’t have a lot of AFib cells yet and they aren’t waking up much, even if they wake up a little bit you are still at risk of clots and strokes, and over time your Afib will progress and start waking up even more. AFib never just goes away. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which long term treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
I have had AFib for over 10 years ( am 93) with two pulmonary embolisms , nearly died, my heart rate 37 to 40 bpm, yet do not want a pace maker, have no symptoms apart from those of heart failure
A pacemaker treats slow heart rates not fast. AFib causes fast heart rates not slow. Therefore your AFib really has nothing to do with whether or not you need a pacemaker. It would depend on why your heart rate is 37 to 40 bpm. However, in general, the main indication for a pacemaker is someone having slow heart rates that are symptomatic. If it is true that your heart rates go down to 37-40 bpm but you feel fine, then a pacemaker may not be required. Ideally you would be seen by a competent, ethical Cardiac Electrophysiologist (those of us who are heart rhythm experts) who could evaluate you and determine if you really in fact need a pacemaker, although just from the little bit you've told me, you may not. Hopefully you aren't seen by a doctor just pushing you into a pacemaker implant not because it is truly needed, but because they just want to make more money.
Thanks I am 78 have had afib 7 yrs now. Cardioversion x 2 did not work. I do not like any of the side effects of amiodarone at all. Doing ok on bisporopol now 15 mg a day. Rather just stay on that. Internist did give me a rx for amidorone tho I said I didn't want it. Anyway its more pricy and I am low income. Solotol put me in chronic afib.
I have been dx'd with a-fib for about 5-6 years. I have tried to focus in on what brings it on. I no longer consume alcohol and avoid foods or drinks containing aspartame and MSG. I believe with positive results. What do you think about this?
I think this is a terrific start! Remember, AFib is made up of abnormal cells/sources that form in the walls of the left upper chamber of your heart, the left atrium, and these cells wake up randomly and take over control of your heart electrically away from your normal source of electricity that you are born with that is located in the right upper chamber of your heart. When the AFib cells are in control they make your heart go at faster speeds that can be symptomatic. They also increase the chances of a blood clot forming in your heart that can break loose, go to your brain, and cause a stroke. As one gets older the AFib cells/triggers/sources keep developing, growing, and spreading to more and more walls of the left atrium. The more walls you have AFib cells on, the more AFib cells you have total, the stronger they become, the more they want to wake up, and the longer they stay awake before going back to sleep. When you have them on all 6 walls of that chamber they are strong enough to be awake 100% of the time and that is when your AFib is called "Permanent AFib" because no medication, no ablation no matter how advanced, and even a simple electrical shock (cardioversion) won't get the AFib gone or back to sleep. You will be in AFib 100% from that point forwards, but as long as one stays on their anticoagulation and doesn't have a stroke, you will never directly die from AFib because it is not directly life threatening. However, symptom-wise the best we can do at that point is just use a simple medicine to slow the AFib down to a point where the pt can tolerate the palpitations. Up until your AFib is permanent we still have options of use a stronger antiarrhythmic medication to keep the AFib cells asleep so that you don’t keep going in and out of AFib and stay in normal rhythm feeling completely normal (these drugs don’t get rid of the AFib cells and they don’t keep you from forming more AFib cells as you get older, they simply “mask” your AFib cells until they can’t “mask” them any longer; versus, doing an AFib ablation where we do a special procedure to map the electrical cells inside your heart and try to destroy them from the inside in order to get rid of your AFib directly because they won’t wake up and take over control of your heart if they are gone (this procedure is never a permanent cure because AFib cells can grow back in other walls of the heart given time and the results are not “all or nothing;” Your results will vary depending on how many AFib cells you start out with, your “stage of progression,” and the skill of the operator doing your ablation). The ablation potentially can get you the longest lasting results but involves the most risk upfront (the risks of doing a procedure) whereas the rate controlling meds don’t even get you out of AFib so get you the least results but are the least risky treatment option. See my videos “4 Basic Facts About AFib”, “How Do I Treat the Symptoms of AFib?”, and “Catheter Ablation in AFib Part 1 & 2.” Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. I hope this helps!
I got mine when i was 25/26 years old now im almost 32 . I get it around once a year but it stays for 8-16 hours , i take concor 5mg thats all my cardiologist gave me and i asked if i could have an ablation and he said its not necessary for me right now but its up me . I wanted your opinion on having an ablation or not
AFib basically causes three problems. Problem #1: It wakes up and takes over control of your heart away from your normal source of electricity thereby causing your heart rate to speed up. While this is not directly life threatening because AFib will never make your heart speed up to a life threatening speed, it can cause symptoms depending on how fast your heart rates goes to and that is why there are multiple ways of treating symptoms: using a simple rate controlling medication to slow your heart rate down while in AFib (these meds are simple meds that don’t have any potential dangerous side effects but they aren’t doing much other than slowing the speed of your AFib down so that you can tolerate the symptoms a little better); versus using a stronger antiarrhythmic medication that potentially has stronger side effects to actually keep the AFib cells asleep so that you don’t keep going in and out of AFib and stay in normal rhythm feeling completely normal (these drugs don’t get rid of the AFib cells and they don’t keep you from forming more AFib cells as you get older, they simply “mask” your AFib cells until they can’t “mask” them any longer); versus, doing an AFib ablation where we do a special procedure to map the electrical cells inside your heart and try to destroy them from the inside in order to get rid of your AFib directly because they won’t wake up and take over control of your heart if they are gone (this procedure is never a permanent cure because AFib cells can grow back in other walls of the heart given time and the results are not “all or nothing;” your results will vary depending on how many AFib cells you start out with, your “stage of progression,” and the skill of the operator doing your ablation). The ablation potentially can get you the longest lasting results but involves the most risk upfront (the risks of doing a procedure) whereas the rate controlling meds don’t even get you out of AFib so get you the least results but are the least risky treatment option. See my videos “4 Basic Facts About AFib”, “How Do I Treat the Symptoms of AFib?”, and “Catheter Ablation in AFib Part 1 & 2.” Problem #2: AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). See my video “Can AFib Cause a Stroke?” Problem #3: AFib is primarily caused by aging and getting older. Once you develop AFib cells in the walls of your heart that are starting to wake up, every year you get older these cells keep growing and spreading and the more of these you have, the more walls they’ve spread to, the stronger they become, the more they want to be awake, and the less they go to sleep. Eventually you can reach a stage where you have enough AFib cells/sources where they are awake 100% and at that point we can’t put them back to sleep or get rid of them and your AFib will be 100% permanently awake from that point forwards. But the good news is that even if you reach that point you will never die from AFib because it is not directly life threatening. As long as you don’t have a clot and stroke from it you will live just as long as everyone else. Please see my videos on “What Causes AFib?” and “Stages of AFib Explained.” Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. Because Afib is not directly life threatening and mostly treated for symptoms, the decision whether to just live with Afib and control the rate (least risky), versus try to suppress it for a few years at a time with a strong antiarrhythmic drug then in 15 years accept when it is permanent (more risky), or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But again we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. Ideally an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. This is the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving patients the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication. So for your situation at 32 y/o, depending on your level of symptoms and personal preference, an AF ablation may or may not be the right decision for you at this moment, but since you are young and presumably wouldn’t want your Afib becoming permanently awake in the next 20 years when you still aren’t that old, as your Afib progresses and starts to wake up more and more, you may want to consider an ablation at some point. But the great news is that you always have a say in it since we are just treating symptoms! Assuming you are on a blood thinner to protect you against clots and strokes, you will never directly die from AFib. And everyone is in a different situation. While most 80 y/o tell me that given their age they would prefer to go from least risky to most risky in terms of symptom treatment (which would involve using a medication to treat your AFib instead of an ablation), occasionally I get an 80 y/o that is healthy and they tell me after the whole discussion that their philosophy has always been to take more risk up front to try to get an ideal result without meds if possible and they still want me to proceed with an ablation. On the other hand, while most patients 40-65 y/o opt for an AF ablation at some point given their younger age, occasionally one tells me that a 1-2% risk of a procedure scares them and they would never consider it. My job as a physician should not be to bully patients into a procedure or to apply my personal algorithm of symptom control to the pt but rather to give patients options and to give them the knowledge so they can decide what is best for their specific situation based on age, level of symptoms, and personal preference. So my recommendation is to take as long as you need to decide whether or not to proceed with an ablation. Don't feel pressured into it. Get a second opinion if you need to. Don't ever be bullied into a medical procedure. I hope this helps.
I believe that visceral fat is a trigger for AF. Alcohol and caffeine may indeed affect some sufferers of AF, but they never factored in my case (used little of either one). But indigestion, and holding one's breath when bending over to tie shoes, for example, raises internal pressure and this must affect the Vagal response or tone. I found myself belching frequently, sometimes setting off AF, and other times it would be bending over and holding my breath due to adiposity internally.
I had an ASD at birth and repaired as a child. At 40 I was diagnosed with AFib. The IV medicines caused my heart to pause for 7 seconds. The cardiologist stopped the meds immediately and performed an AV node ablation with pacemaker. I don’t take AFib meds I only take Eliquis. I’m 71 now and still have anxiety over all of this. Without the AV node, my heart is 100 % dependent on the pacemaker. Hence my anxiety. My question is this is correct right? Is there another node that can take over should pacemaker stop working?
Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. However, anything that causes stretching or dilation of the left upper chamber of the heart, the left atrium, where the Afib cells form will also cause Afib to progress or form earlier. This includes high blood pressure, untreated sleep apnea, valvular disease where the mitral valve either leaks (regurgitation) or doesn’t open (stenosis), or in your case an ASD (atrial septal defect) which is a hole in the middle wall of the heart allowing increased blood flow into that left upper chamber of the heart thereby increasing pressures and dilating the walls. Remember, Afib is not one of the directly life threatening abnormal heart rhythms meaning it won’t ever make your heart race at a directly life threatening speed that will cut off blood supply to your brain and make you pass out and die. Instead Afib just causes symptoms of rapid heart rates like you are exercising, can cause a small but real risk of clots and stroke which is why most people with Afib are placed on a specific and powerful blood thinner to reduce the risk of this to less than 1%, and is a disease process that progresses over time. Once you live long enough to develop Afib cells in the walls of your heart that start to randomly wake up, every year you get older the more Afib cells form on the walls of your heart. The more walls-worth of Afib you have the stronger it becomes, the more it wakes up, and the less it goes back to sleep resulting in you spending more and more time in AFib percentage-wise until it is eventually Permanent AFib which usually occurs after 10-15 years. Permanent Afib is when you have enough Afib cells that they are awake 100%, they don’t go back to sleep at all, and no medication such as an antiarrhythmic medication (AAD) is strong enough to put it to sleep, and even those of us who do very complex Afib ablation can get rid enough of it from the inside to get you back to normal rhythm. At that point we just use “rate controlling” meds to slow your Afib to a speed that you just tolerate and that is the best we can do. But as along as you don’t have a clot and stroke from your Afib, you will live just as long as everyone else because Afib is not directly life threatening. See my videos “What Causes Afib?” and “Stages of Afib Explained” In your situation it sounds like your ASD dilated the walls of your left atrium prematurely leading to early development of Afib and so they tried the simplest method to treat your symptoms which is to slow it down with a rate controlling medication. However, these meds don’t just slow your heart rate down while in Afib, they slow your normal rhythm speeds down when your Afib goes to sleep. And since your normal rhythm isn’t making your heart go super fast the way Afib does, sometimes the meds can make your normal rhythm speed go too slow which is what sounds like happened with you. At this point you had several options: you could have placed a simple pacemaker implant which kicks in and paces when the heart rate goes too slow (see my video “Will a Pacemaker Treat My Afib?”) then use the rate controlling medication to keep the heart rate controlled when you went into Afib and just tolerate it (less risky). Another option would’ve been to use a stronger Antiarrhythmic medication (AAD) to temporarily keep the AFib asleep (more risky), or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Some of the AAD meds don’t slow your heart rate down at all so if your Afib was suppressed and kept asleep completely (which depending on the strength of the AAD and your stage of AF progression can sometimes last for years at a time) maybe you wouldn’t have needed a pacemaker. And of course if you had an AF ablation done by a competent Electrophysiologist where all of your Afib was gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, then you wouldn’t be going in and out of Afib so you wouldn’t have needed a med to slow your heart rates down thereby avoiding slowing your normal rhythm speeds down too slow and needing a pacemaker. True even if you get rid of all of a pt’s Afib with the ablation and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon.
But it sounds like instead of using an AAD or doing an AF ablation, they put in a pacemaker and instead of using the rate controlling med to slow down the Afib, they chose to do an AV node ablation. This is a minor procedure that we usually only do when your Afib is 100% awake and permanent. Sometimes patients Afib progresses to Permanent status and we no longer have the option of keeping it asleep or getting rid of it from the inside because it is too progressed and strong. But if their rates in Afib are too fast and they are still too symptomatic despite using aggressive doses of a rate controlling medication, we can do a minor ablation where we spend 5 minutes and destroy the nerve that conducts electricity through the heart. There are four chambers in the heart, two upper and two lower. It is actually the two lower chambers that pump the blood out of your heart, not the upper chambers. When you feel your heart rate you are actually feeling the speed your lower chambers, the ventricles, are pumping at, not the upper chambers, the atria. The atria act as primer pumps to help push blood from the top of the heart to the lower chambers, but blood naturally flow through these chambers into the bottom chambers on its own. Yet the sources of Afib and also your normal rhythm source are located in the walls of the left upper chamber and in the roof of your right upper chamber, respectively. Both sources use the AtrioVentricular Node (AVN), which is a nerve that connects the top chambers of the heart to the lower chambers, to conduct electricity from the sources down to the bottom chambers of the heart to actually pump the blood out of the heart. If we purposely destroy this nerve, which is very easy to do but can’t be undone once it’s done, then the Afib cells can no longer control the bottom chambers of the heart and tell them to speed up causing symptoms. But neither can your normal rhythm which also uses that nerve to conduct signals to control the bottom chambers of the heart, be able to control the bottom chambers. So where do the bottom chambers get a signal telling it what speed to beat at? Without an electrical signal controlling it your heart won’t beat and you’d be dead. The pacemaker, which is a device that paces the heart when it goes to slow, is implanted first and this controls the bottom chambers of the heart from that point forwards. The analogy would be to say that the generator of electricity in your home is “infected” by weird Afib circuits that make the lights flicker horribly. You can either use a medication to suppress the abnormal circuits or a full-on ablation to destroy all of the abnormal circuits. But if all of that has failed, the next best thing would be to open a hole in the wall of the room and snip the electrical wiring transmitting electricity from the generator to the lights in the room. The lights will go out but they won’t flicker any more. Then you attach your own portable generator to the lights and power it that way. That would be the same as destroying/ablating the AV node nerve and then putting a simple pacemaker to take over control of the heart mechanically from that point forwards. The advantage is that this is a simpler, technically easy, less risky procedure than a full Afib ablation, has a 100% success rate, and will make it so you never have fast heart rates in Afib ever again because the pacemaker is now 100% controlling your heart rate. Plus you can get off of rate controlling meds or antiarrhythmic meds to suppress your Afib. The downside is that you really didn’t get rid of your Afib because the top part of your heart is still controlled by the Afib cells; they just can’t control the speed of the bottom chambers of your heart anymore. This is why you still need to be on blood thinners to protect against clots and strokes. And secondly you now have a pacemaker and are technically pacemaker dependent. If you ever let your battery run out on the pacemaker there won’t be any conducted heart rhythms and so you could pass out or even die. Now technically that would be rare. It is extremely rare for pacemakers to just stop working considering the technology has been around for 70 years. Also, as long as you get your pacemaker wireless checked every 6 months as recommended, we would detect a problem with your pacemaker long before it ever made it stop working. Please see my video “Will a Pacemaker Treat My Afib?” It is possible that if your pacemaker stopped pacing for whatever reason that an “escape rhythm” meaning a different source of electricity in your heart might wake up and take over control of your heart, but this isn’t guaranteed so I wouldn’t necessarily count on it. Just make sure your pacemaker is regularly checked and in good working order and you should be fine. The good news is that you will never have fast heart rates due to Afib ever again as you will just be paced 100% from this point forwards. But I agree, had they done one of the many other options that I mentioned, you maybe could’ve avoided being made pacemaker dependent. Then again, depending on how long ago this was done, up until about 10-15 years ago Afib ablation was a lot more primitive and so this type of treatment was done a lot more. Nowadays it is rarer to have this done unless one’s Afib really has progressed to permanent or one is going to a less scrupulous EP who is doing mediocre sham ablations just to bill you and then after doing this 3-5 times without getting rid of all your AFib ends up doing a pacemaker and AVN ablation (which unfortunately does happen). I hope this helps!
@@afibeducation Thank you so much for your thorough explanation. I do have my pacemaker checked every six months. Also I had the AV node ablation in 1995, so 29 years ago; so that is probably why they went with this type of remedy. (AV node ablation with pacemaker.) I don’t remember my cardiologist giving me a choice 😔I would like to ask one more question. I walk often and rebound on an exercise trampoline for good cardio health. Would this strengthen my heart enough to keep beating should pacemaker fail, until I can receive medical help? And do you know if the pacemakers today have a back up system?
Unfortunately, no amount of exercise and even having the strongest heart in the world would keep your heart beating should your pacemaker fail because the heart’s electrical conduction system is separate from the strength of the heart muscle and after your AV node ablation no electricity gets to your heart muscle to control it except the artificial signals from the pacemaker. It would be like saying the wiring in the walls of your home are cut and so your lights go out. It doesn’t matter if you had the strongest, newest, best lightbulb on the planet, it still wouldn’t turn on if the portable generator of electricity you were using to power it were to stop working. And no, pacemakers don’t have backup systems. They are so reliable that they really don’t need one. Once again, as long as you have yours checked every 6 months, it would be extremely rare for your pacemaker to ever stop working because most of the time we will be able to pick up a potential problem long before it made your pacemaker stop working. I hope this helps!
Hi! Thanks for watching. Leaving the TV on all night thereby disrupting your sleep pattern likely did not cause your Afib. Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. Unfortunately, once you live long enough to develop Afib cells in the walls of your heart that start to randomly wake up, every year you get older the more Afib cells form on the walls of your heart. The more walls-worth of Afib you have the stronger it becomes, the more it wakes up, and the less it goes back to sleep resulting in you spending more and more time in AFib percentage-wise until it is eventually Permanent AFib which usually occurs after 10-15 years. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. So in your situation it is likely that your Afib was slowly developing due mainly to you getting older, and after your husband died and you were under stress from that it probably helped trigger it awake even more. Then as you’ve continued to age it has continued to slowly progress. I hope this helps!
When I was much younger strong Coffee gave me some kinda skipping beat sensation of heart & past 40 just went away & alcohol doesn't have any effect so far....
Skipping of your heart beat doesn't always mean that you are in AFib. Remember, your heart is controlled by a source of electricity because it is essentially a big dumb muscle. Usually your normal source of electricity, the sinus node that is located at the roof of your heart, is in control of your heart and it tells your heart to beat at whatever speed your brain wants it to go to based on what you are doing. When an abnormal rhythm like AFib forms and wakes up and temporarily takes over control of your heart away from the normal source of electricity, it can tell your heart to go at any speed it wants but always something faster than your normal rhythm source. True, AFib makes your heart go fast and irregular, but in truth you can't tell where the electricity is coming from that is controlling your heart. You can only tell if your heart seems faster than normal or irregular. Only an ECG or heart rhythm monitor can sense the electricity in your heart directly and identify who is in control. Your normal rhythm can be in control and sometimes be a little bit irregular. More commonly younger individuals develop a condition known as premature beats which are essentially single extra heart beats coming from a weak abnormal source of electricity that doesn't take over control of your heart but just adds a couple of extra beats. These are called PVCs (premature ventricular complexes) or PACs (premature atrial complexes). They are benign and often woken up with stimulants like coffee. If you have weird sensation of palpitations either irregular or racing, the best way to evaluate it is to see either a general cardiologist or a competent electrophysiologist (electrical cardiologist) where a heart rhythm monitor can be placed to catch your symptoms and verify exactly what is going on. Also feel free to watch my video on Does an Irregular Heart Rhythm Mean I'm in AFib? I hope this helps.
I appreciate your feedback. No, I have never personally had a heart rate of 265bpm, but over the twenty plus years of practicing Cardiac Electrophysiology, I have seen and taken care of plenty of patients who have. I never said that it was no big deal. In fact having fast heart rates in Afib even not up 265bpm can be extremely symptomatic and instill a lot of fear and panic in patients. This is why took the time to create 40+ videos on Afib with over half of them discussing in detail the specific pros and cons of the various treatments currently available to treat the symptoms caused by Afib. Long term treatments (for symptoms because AFib is not directly life threatening unless it causes a clot and a stroke) include just slowing it down with a simple rate controlling medication (least risky), putting the AFib cells actively to sleep with a stronger antiarrhythmic medication (more risky), or doing a procedure to try to map and get rid of these cells from the walls of the heart directly (most risk). Whether to just live with Afib and control the rate (least risky) versus try to suppress it for a few more years with a strong antiarrhythmic drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. Please see my videos: “What are the Symptoms of Afib?” and “How Do I Treat the Symptoms of AFib?” One of the main reasons I took the time to create this channel and these videos is precisely because I’ve seen many regular cardiologists still practice 30 year old medicine and not offer all treatment options. They put patients on a blood thinner to protect them from the small but very real risk of clots and strokes, but for the patient’s symptoms they just give them a simple rate controlling medication to slow down the speed of their Afib and tell them they won’t die and to just live with the symptoms. They won’t discuss other treatment options to try to get the patient out of AFib and they won’t refer the patient to a Cardiac Electrophysiologist (EP’s) to discuss these other options. However, the point of the “8 Myths” video was not to talk about symptoms or imply that patients with Afib can’t have severe symptoms. It was to discuss the myth that Afib by virtue of the fact that it can speed up your heart rate means that it is directly life threatening. And that is false. Unless your Afib causes a clot to form in your heart that breaks loose, floats to your head, blocks off blood supply to your brain, and causes a stroke, Afib will not directly kill you just by speeding your heart rate up. Again, this is not to say that if it makes your heart rate go at very fast speeds that you won’t be severely symptomatic. But having a lot of symptoms isn’t the same as directly dying from it. AFib is the most common abnormal heart rhythm out of the 13-15 different abnormal heart rhythms people can develop in their lifetime. Out of these there are 4 that are considered directly dangerous life threatening abnormal heart rhythms and these originate in the ventricles, the bottom chambers of the heart. Examples of these rhythms are “Ventricular Tachycardia, Ventricular Flutter, and Ventricular Fibrillation.” These rhythms can take over control of your heart and and make your heart rate speed up to a life threatening speed of over 300bpm. At this speed your heart is beating too fast to effectively pump blood because there isn’t enough time to fill up in-between heart beats so the blood pressure drops below 60mmHg which isn’t enough to perfuse the brain and other organs of the body. This causes immediate loss of consciousness and death within 20-30 minutes without chest compressions and defibrillator shocks for resuscitation, and is called a cardiac arrest. Atrial Fibrillation and Atrial Flutter are not capable of making the heart rate go at life threatening speeds of over 300bpm and as such they are not abnormal heart rhythms that can cause a life threatening cardiac arrest event. Even in the cases where Afib or Aflutter speeds the heart rate up enough such that the blood pressure does drop enough to make the patient feel lightheaded, it is rare that the blood pressure gets low enough to cause full syncope/loss of consciousness. This is why we treat patients mainly for symptoms because as long as one is protected from having a clot and a stroke from their Afib, they will not directly die just by having their Afib speed their heart rate up. The faster and more symptomatic your Afib is, the more aggressive a treatment option you may choose; the slower and less symptomatic your Afib episodes are, the less aggressive a treatment option you might go with. But the belief that Afib will kill you even if it doesn’t cause a stroke or that Afib is more life threatening the more symptoms you have is a myth, and I believe it is important that people understand this.
Over my twenty plus years of practicing in this field, I can not tell you how many times I see patients who have minimal or no symptoms from their Afib but be terrified that they might have an episode while sleeping or an asymptomatic episode and not know it, and therefore just die. This is often exacerbated by non-Cardiologists who sometimes overreact. Often patients tell me their Afib was first diagnosed because they had mild palpitations and they went to an Urgent Care Clinic or their Primary Care Doctor and was found to be in new-onset Afib at 120bpm and were told to get to the hospital right away else they will die! Terrified they rush to the hospital only to have the ER docs give them IV Diltiazem (a rate controlling medication) to slow their heart rate but it doesn’t put the Afib back to sleep. Then they admit them overnight waiting for the Afib to go back to sleep on its own which in the early stages usually happens after an hour or two. And now the patient is terrified they could at any moment lose consciousness and just die. Similarly, I’ve seen plenty of less scrupulous Electrophysiologists in my field prey on this lack of information to bully patients into Afib ablation procedures because they make more money to do a procedure than to put the patient on meds. I’ve seen patients show up to the hospital with Afib, have it go back to sleep after a day on its own, then have an EP consulted. But instead of explaining that because the pt is on a blood thinner for their Afib they won’t have a clot and a stroke and die from their Afib, that Afib is mostly treated for symptoms, and then find out how much Afib episodes the patient is having, how symptomatic it is, and then based on the patient’s age, risk tolerance, and preferences, help the patient decide the best long term treatment for their symptoms: whether that be just slowing the Afib down with a simple rate controlling medication, keeping it asleep with a stronger antiarrhythmic medication (AAD), or considering an AF ablation to try to get rid of it temporarily from the inside; instead they spend less than 5 minutes with the patient and essentially tell them that they need an AF ablation and that they need to do it before the patient leaves the hospital implying that if they don’t they will die. This is just someone bullying a patient into a procedure to make money. And unfortunately I’ve seen it happen a lot. Then they end up doing the ablation but the EP doesn’t do a very good job (they rush through the procedure doing a mediocre job so they can put on as many procedures a day as possible in order to make more money) and they end up doing it 3-5 times over a period of time, and then they put them on an AAD to suppress the remaining Afib and they tell the patient that that is the best that can be done. I had a patient come to me for a second opinion after having 3 AF ablations by another EP who was currently planning a fourth. His question was should he undergo a fourth ablation? After taking an hour to explain that Afib was not directly life threatening as long as he stayed on his blood thinner and didn’t have a stroke, and after discussing the pros and cons of the various long term treatments for Afib, I asked him, “I assume you must have a lot of symptoms considering they did three ablations on you?” Surprised the patient replied, “I can’t even feel when I’m in Afib!” I then asked why then did he undergo three ablations. His response? “Well, they didn’t explain anything to me and they made me feel that if I didn’t have the ablations I would die.” This happens because this field is so specialized that even regular Cardiologists don’t really know what we do let alone patients, so docs get away with it. And also because under the current system of reimbursement we get paid for doing something, not for getting a specific result. For example, I might spend twenty years experimenting and learning advanced techniques in order to get rid of Afib even in the most advanced stages and as such I block out 3-4 hours for a pt’s procedure and end up ablating 5-6 out of 6 walls to successfully ablate their persistent or longstanding persistent Afib into normal sinus rhythm, and 3 months later after everything settles down they are off any antiarrhythmic medication spending zero or minimal time in Afib. Another EP, even those just a couple years out of training, could block out 1 hour because they are just planning on electrically isolating that first wall, the pulmonary veins, irregardless of whether that is enough to get rid of all of that pt’s Afib, and as a result they can put on 4 procedures instead of my 2, and get the 2nd, 3rd, or even 4th redo’s and make 3-6 times the money for getting a worse result. This is because we all use the same billing code from the health insurances which again pays us for doing something not for getting a specific result. It is assumed that we all do the same thing and get the same results, which personally I don’t think is true for any profession on the planet. It’s unfortunate, because it often feels like one is penalized for trying to do the ethical thing of only doing a procedure if after explaining things thoroughly to the pt it is decided that it is the right thing to do; and if doing a procedure is deemed needed, doing it in such a way where only one procedure is necessary most of the time. Again, this is one of the main reasons I created this channel and website so as to empower patients to hopefully not be bullied into unnecessary procedures and to know if their doc is practicing 30 year old medicine and not giving them all available treatment options. Thanks for watching!
@@afibeducation Thank you so much for the detailed reply. In my case I was extremely symptomatic and it destroyed my quality of life. This went on for 3 years until I met with an EP who completely understood my situation. The cardiologist diagnosed A Flutter and Tachycardia. When I then learned of electrophysiologist's I went for a second opinion. Two separate EPS said they could see nothing to suggest the original diagnosis and said I had A Fib. and went onto a waiting list for ablation which I had in June of this year and I have been in NSR ever since that day. One more point, before the ablation I went into A fib every night at around 2 am and would self convert in about 2 hours this went on for 6 or 7 months, some days I would go into afib 4 or 5 times and self convert in about an hour and a half but.....before I converted I would just about pass out or some times did pass out, I learned these were called pauses. When in ER and they caught the pauses on the EKG we saw the pauses were average 9 seconds long and 1 was 18 seconds! I ended up with a pace maker the next day and no pauses since. I often wonder if I had have had the successful ablation before the pace maker if the pace maker would have been needed? I will see this July at the annual pace maker appointment if it has been pacing since I had the successful ablation Once again thank you for the reply
Thank you for watching and for your feedback. Another option for you is to turn on the subtitles and then turn off the sound. That way you can just read what I am saying.
I was one of the first in Germany to get a Watchman implantation. All i take is a baby aspirin 80 mg and 5 mg of Bisoprolol. Up to now 17 years later..All is well thank the Almighty.
A Watchman certainly can help you not have to take blood thinners long term. However, remember that the premise of the Watchman is that AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). However, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). I'm glad you got a good result with your Watchman!
Magnesium supplements in Afib in my experience has been hit or miss. Unless your magnesium levels are low, I’ve never since a reliable effect of Magnesium to keep Afib from waking up, although studies show it may make your episodes of Afib a little bit slower. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. This is how eating more vegetables and having a healthier diet can help since it can help you lose weight. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” I hope this helps!
AFib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop AFib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have AFib. At 80’s y/o it is 20%, and by 90’s y/o 30% have AFib. So it is truly an age related disease. Unfortunately, once you live long enough to develop AFib cells in the walls of your heart that start to randomly wake up, every year you get older the more AFib cells form on the walls of your heart. The more walls-worth of AFib you have the stronger it becomes, the more it wakes up, and the less it goes back to sleep resulting in you spending more and more time in AFib percentage-wise until it is eventually Permanent AFib which usually occurs after 10-15 years. So AFib is a progressive rhythm problem that wakes up more and more over time. See my video on “What Causes Atrial Fibrillation?” Therefore, it is possible that the daily palpitations you are feeling is your AFib progressing. You can’t tell where the electricity is coming from that is controlling your heart, only if your heart rate seems abnormally fast. Only an ECG or heart rhythm monitor can identify if you are really in Afib or not. Sometimes people think their AFib is progressing but it turns out they are just under the control of their normal rhythm but it’s just irregular. Wearing an external heart rhythm monitor for a week should be able to identify which rhythm is in control of your heart when you feel your daily palpitations. See my video “Does an Irregular Rhythm Mean I’m in AFib?” If it is true that your AFib is progressing such that it is causing symptoms daily, then a discussion as to how to treat your AFib symptoms long term is needed. Remember, AFib really causes only two problems: risk of blood clots forming in your heart that can break loose and go to your head to cut off blood supply and cause a stroke, and the ability to take over control of the heart to speed it up to a faster rate thereby causing symptoms. Both of these need to be treated separately, but as long as you don’t have a clot and stroke from your AFib, it is not life threatening and mainly treated for symptoms. For long term symptoms treatment, your options are to either just tolerate the AFib (no risk), use rate controlling meds to keep your heart rate in AFib mostly controlled and just tolerate the symptoms (less risky), use a stronger Antiarrhythmic drugs (AAD) to temporarily keep the AFib asleep (more risky), or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Remember, AFib slowly grows and progresses as you get older (although this happens over years) and the more progressed it becomes the more it wakes up and the less it goes back to sleep resulting in you spending more and more time in AFib until it is eventually Permanent AFib at which point no medication will be strong enough to keep it asleep and no ablation even by those of us who do very advanced, complex ablations will be able to get rid of enough of it to return back to normal rhythm. Up until your Afib is permanent it is possible to keep you in normal rhythm feeling completely normal using either an AAD or ablation, but it gets progressively harder to do so the more progressed your AFib becomes. This is why younger patients often consider an ablation because if their AFib became permanent after 15 years they might only be in their 60’s and regret that. On the other hand, maybe a procedure scares you and a 1-2% or less risk of a complication is too much for you and you would never consider it. Everyone is different. Usually when pt’s are in their 80-90’s where the risk of procedures go up, most say just do the least risky thing which is to either slow the AFib down with a rate controlling med and have them tolerate it or if symptomatic to keep it asleep with an AAD. Usually pt’s in their 40-50’s say they don’t want to just tolerate it and are willing to accept a small risk of a procedure to try to get a better long lasting result. But after doing this for 20 years, sometimes I see older pt’s say they understand the risks and still feel an ablation is right for them and sometimes I come across a younger pt that says the procedure scares them and they would never want it unless they were very symptomatic and all meds failed. Everyone’s stage, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. If you chose to temporarily suppress the AFib with an AAD remember this does not get rid of the AFib cells or keep them from progressing as you get older; it simply masks the existing AFib cells until they grow strong enough to override the medication. So you may be able to keep them asleep for several years depending on how fast your AFib cells are growing/progressing. I hope this helps!
Thank you for the feedback. I've received comments from people who enjoy the background music and wished it was more aggressive, so it is hard to decide what to do. Another option is to turn off the sound and turn on the subtitles. That way you can just read what I'm saying.
Unfortunately, yes. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. So controlling these factors can greatly slow down the progression of your AFib. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. And then of course there is an AF ablation. By mapping and get rid of AFib cells from directly within the walls of your heart you can "turn the clock" back on the level of AFib progression either to an early stage or even to zero depending on how much AFib you have at present and the skill of the operator doing your procedure. But even if you get your amount of AFib down to zero it is not a permanent cure because it can slowly grow back in other walls, and it will grow back from whatever level the doc doing your ablation reduces your AFib amount to so the more we can get rid of on the inside the more time it will take for your AFib to grow back to that level. But even if your AFib ever progresses to the end stage where you are in it 100% and we can't get you out of it any longer, it is never life threatening as long as you don't have a clot and a stroke from it; we are always mainly treating symptoms. I hope this helps!
When treating Afib, everyone’s stage of progression of Afib, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. If you choose to temporarily suppress the AFib with an antiarrhythmic medication (AAD) remember this does not get rid of the AFib cells or keep them from progressing as you get older; it simply masks the existing AFib cells until they grow strong enough to override the medication. So you may be able to keep them asleep for several years depending on how fast your AFib cells are growing/progressing. There is however a strength level to the AADs. Amiodarone is the strongest but has the most long term side effects. If you are on it for more than 5-7 years there is a 30% chance it will damage your liver, lungs, eyes, or thyroid. That is why I personally never use it for long term suppression of AFib (short term suppression for less than a year is okay) for anyone less than age 75 y/o because you could be on it for 10 years with adequate suppression of your AFib because it is so strong, but then develop a side effect and have to stop it and still be a fairly young age. And because your Afib continues to progress and grow stronger even if it is being kept asleep by the AAD you are on, if one uses Amiodarone for a very early stage of Afib before it is really needed, after 7-10 years one might develop a long term side effect from the Amiodarone so have to stop it but then one’s Afib might be too strong to be able to be suppressed by the other AADs that aren’t as strong. But if one is over 80 y/o then Amiodarone could be very appropriate. I usually try to use an AAD closer to the level of the pt’s stage of progression and then work upwards to the next strongest drug every few years when the AAD fails. Thanks for watching!
If that is really true, the question becomes: Who is controlling my heart when it speeds up from 40-175bpm? Is it my normal rhythm source in the roof of my heart that is supposed to be in control? Or is it an abnormal source of electricity that isn’t supposed to be there and is located in another wall of my heart and is making my heart go faster every time it wakes up? And if it is an abnormal heart rhythm, which one out of the possible 15 of them is it? Remember, AFib is not the only abnormal heart rhythm. There are 13-15 different abnormal heart rhythms you could possible develop and it is possible to have more than one abnormal rhythm (arrhythmia). The way to diagnose all of this is to catch your heart rhythm during a typical episode of fast heart rates by wearing an external heart rhythm monitor. They are called Event Monitors and can be worn for a day, a week, two weeks, or up to a month. For symptoms that are more infrequent than that and difficult to catch, there is a small device without wires called a Loop Recorder than can be surgically placed underneath your skin on your chest and it can record your heart rhythm for up to 3-4 years to make sure you catch the episode. This can all be evaluated by an ethical cardiac electrophysiologist. I hope this helps! Please see my videos "What is an Arrhythmia?" and "What is AFib?"
I met my cardiologist today, with a new Ecg test taken today. I'm scheduled for a session of shocking my heart , in early January. He also modified my medication. Thanks for you feedback@afibeducation
Remember, cardioversion or shocking your heart for AFib is not a long term treatment. Any shock will get any abnormal heart rhythm to temporarily go back to sleep so your normal heart rhythm takes back over control. It is not a cure, it will not get rid of the abnormal cells, and it won't make them not wake up. It just gets them to go back to sleep for the moment, but they can still wake up again in the future. That is why electrical cardioversion is usually used in conjunction with Antiarrhythmic Medications that work to keep the AFib asleep so it doesn't wake right back up. See my videos on "Cardioversion in AFib Explained" and "Antiarrhythmic Medications in AFib Explained." Good luck!
I got an electric cardioversion 2 days ago. My afib came back late in the evening. I went to see my cardiologist yesterday. He is going to scedule another cardiogram. With the holidays coming up it will go to the first week of January. Thanks for your replu .@afibeducation
A Watchman certainly can help you not have to take blood thinners long term. However, remember that the premise of the Watchman is that AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). However, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
You're welcome! Please feel free to watch "What is an Arrhythmia?" and "4 Basic Facts About AFib" and "How Do I Treat The Symptoms of AFib?" to learn more in depth about AFib, what you need to worry about, what you don't need to worry about, and what are the pros and cons of the different long term treatment options available for Symptom treatment.
Thank you for explaining AFIB in such a clear manner. This is the best information I have ever gotten.
My first pacemaker showed a very small amount of AFib, so my cardiologist put me on Amiodarone. Fast forward a couple of years and the Amiodarone puts my Thyroid into overdrive (hyper), which in turn put my heart into permanent AFib. Gotta love the irony. I've been in AFib 24/7 since April 4, 2018. Through adopting a proper human diet and exercise I have been able to live a normal life with the exception of less stamina than I would like to have, but I can still walk two miles every morning, mow my own yard, go up on the roof to remove leaves and limbs, etc. I'm 77.
The amount of time you are currently spending in AFib correlates with how progressed your AFib is and the stage. If you are going in and out of AFib and your episodes are less than 7 days at a time you are technically Paroxysmal AFib (early stage). If you are spending more than 7 days at at time in AFib you are Persistent AFib (mid stage). If you are in the Persistent stage spending more than a week at a time in AFib and you have been that way for more than a year then you are Longstanding Persistent AFib (late stage). And if you are spending 100% of the time in AFib and it doesn’t go to sleep at all by itself and it is too strong to get it to go back to sleep with an antiarrhythmic drug (AAD) or too much to get rid of it from the inside with an ablation then you are Permanent AFib (end-stage). (Staging is discussed in the “Ablation Techniques #1” video) Even if you ever reach Permanent AFib stage, as long as you don’t have a clot and stroke from your AFib (the decision as to whether you need to be on a blood thinner to prevent this depends on your exact risk which in turn is based on your age and comorbid medical problems-see the video “Can AFib Cause a Stroke?”) you won’t directly die from AFib because it is not life threatening and mostly treated for symptoms. And remember the symptoms are usually palpitations depending on how fast the Afib is making your heart speed up to, and even if your Afib is well rate controlled it can still cause fatigue. Even if you are permanently in AFib you will live just as long as everyone else, but symptom-wise we no longer have the ability to keep the AFib asleep with an AAD or can get rid of it from the inside with an ablation. The best we can do at that point is just to slow it down with a Rate controlling medication to level where you can tolerate it. Most people are on a blood thinner to prevent risk of stroke long term. There is a CHA2DS2VASc scoring system which determines your exact risk of stroke. Any risk over 2% it is recommended you be on a blood thinner longterm. Back when your pacemaker was just showing a small amount of Afib, since AFib is not directly life threatening and treated just for symptoms (assuming you don’t have a stroke from it which is a separate issue), you ideally should have been given options. Either to just tolerate the AFib, using rate controlling meds to keep the heart rate in AFib mostly controlled and just tolerate the symptoms (less risky), use a stronger Antiarrhythmic medication to temporarily keep the AFib asleep (more risky), or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Remember, AFib slowly grows and progresses as you get older (although this happens over years) and the more progressed it becomes the more it wakes up and the less it goes back to sleep resulting in you spending more and more time in AFib until it is eventually Permanent AFib which usually occurs after 10-15 years. The younger one is the more one might consider an ablation because the AFib could become permanent and one might still be fairly young and regret that. On the other hand, maybe a procedure scares you and a 1-2% or less risk of a complication is too much for you and you would never consider it. Everyone is different. Usually when pt’s are in their 80-90’s where the risk of procedures go up, most say just do the least risky thing which is to either slow the AFib down with a rate controlling med and have them tolerate it or if symptomatic to keep it asleep with an AAD. Usually patients who are younger say they don’t want to just tolerate it and are willing to accept a small risk of a procedure to try to get a better long lasting result. But after doing this for 20 years, sometimes I see older pt’s say they understand the risks and still feel an ablation is right for them and sometimes I come across a younger pt that says the procedure scares them and they would never want it unless they were very symptomatic and all meds failed. Everyone’s stage, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. For you they chose to temporarily suppress the AFib with the antiarrhythmic med Amiodarone. Remember this does not get rid of the AFib cells or keep them from progressing as you get older; it simply masks the existing AFib cells until they grow strong enough to override the medication. So you may be able to keep them asleep for several years depending on how fast your AFib cells are growing/progressing. There is however a strength level to the AADs. Amiodarone is the strongest but has the most long term side effects. If you are on it for more than 5-7 years there is a 30% chance it will damage your liver, lungs, eyes, or thyroid. And the thyroid issues can occur in as short as 6-12 months. That is why I personally never use it for long term suppression of AFib (short term suppression for less than 6 months is okay) for anyone less than age 75 y/o because you could be on it for 10 years with adequate suppression of your AFib because it is so strong, but then develop a side effect and have to stop it and can never use it again. I usually try to use an AAD closer to the level of the pt’s stage of progression and then work upwards to the next strongest drug every few years when the AAD fails. For example, for you when you were having just a small amount of Afib maybe you could’ve been tried on our weakest drug Flecainide and then in a few years when that eventually failed work your way to the third strongest drug Sotalol then to the second strongest drug Dofetilide then and only then go to Amiodarone when that eventually failed. I believe it was premature to place you on Amiodarone at such an early stage of your Afib and as you said, it caused hyperthyroidism which woke your Afib up even more. While the hyperthyroidism didn’t cause your Afib to grow and progress to permanent Afib, it did wake it up a lot making it seem like you were at a more advanced stage, and then over several years your Afib progressed quickly and became permanent in 2018. Now that you that you are permanently in Afib albeit rate controlled, as long as you stay on your blood thinner and don’t have a stroke you will live just as long as everyone else. However, we cannot get you out of Afib with an antiarrhythmic med or ablation and you will just have to tolerate the increased fatigue and decreased stamina from this point forwards. What they should have done is either tried you on a weaker antiarrhythmic medication without the long term side effects of Amiodarone and worked their way upwards in strength, and/or offered you an Afib ablation. In your 60’s and 70’s y/o your risk for the procedure would’ve been the standard 1-2% and if a competent Electrophysiologist did your procedure and “turned the clock” back enough, you would not be in permanent Afib currently and be in normal rhythm feeling completely normal. True even if you get rid of all of a pt’s Afib and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon. Nevertheless, I’m glad you learned to deal with your Afib and minimize it’s symptoms.
Dr. Lee…..I watched this video last night, and was so impressed by your clear, concise explanation. I’ve now shared it with all my friends who also have afib. That said, in thinking about your video today, I figured out why I find you to be such a compelling speaker and educator! When you speak, I am able to visualize everything you are describing. The commandeering of our hearts electrical system, the cells going to sleep and reawakening…..all of it!! I’m so impressed with this video, I watched it twice!! 🤣🤣
Thank you so much for such a wonderful compliment. I really appreciate it! When patients truly understand the facts and are empowered the way in which I hoped they would be, it makes all of the time and effort involved in doing this really worth it. Thanks again!!
Thanks Doc. This information is comforting.
Thank you very much for your presentation. It’s a eureka moment for me, succinct and clarity. I am bradycardic after being athletic for 50 years and now been diagnosed with paroxysmal vagal AFib. The Watchman was implanted in January ‘24 and currently on rate control and baby aspirin. Recent 30-day monitoring revealed 1.39% AFib burden. Awaiting hospitalization for titration of the antiarrhymic Tikosyn.
I know my triggers such as alcohol, and avoid them. I walk at least 5 miles daily 5 times weekly without symptoms except for very infrequent palpitations; my blood pressures thereafter are normal (120s/70s). I am 72 years young and still being active. Your video as well as the comments of my EP cardiologist give me confidence to start and enjoy traveling. Thank again Dr Lee. It’s a good video to share with anyone.
AFib basically causes three problems. Problem #1: It wakes up and takes over control of your heart away from your normal source of electricity thereby causing your heart rate to speed up. While this is not directly life threatening because AFib will never make your heart speed up to a life threatening speed, it can cause symptoms depending on how fast your heart rates goes to and that is why there are multiple ways of treating symptoms: using a simple rate controlling medication to slow your heart rate down while in AFib (these meds are simple meds that don’t have any potential dangerous side effects but they aren’t doing much other than slowing the speed of your AFib down so that you can tolerate the symptoms a little better; versus using a stronger antiarrhythmic medication (AAD) that potentially has stronger side effects to actually keep the AFib cells asleep so that you don’t keep going in and out of AFib and stay in normal rhythm feeling completely normal (these drugs don’t get rid of the AFib cells and they don’t keep you from forming more AFib cells as you get older, they simply “mask” your AFib cells until they can’t “mask” them any longer; versus, doing an AFib ablation where we do a special procedure to map the electrical cells inside your heart and try to destroy them from the inside in order to get rid of your AFib directly because they won’t wake up and take over control of your heart if they are gone (this procedure is never a permanent cure because AFib cells can grow back in other walls of the heart given time and the results are not “all or nothing;” Your results will vary depending on how many AFib cells you start out with, your “stage of progression,” and the skill of the operator doing your ablation). The ablation potentially can get you the longest lasting results but involves the most risk upfront (the risks of doing a procedure) whereas the rate controlling meds don’t even get you out of AFib so get you the least results but are the least risky treatment option. See my videos “4 Basic Facts About AFib”, “How Do I Treat the Symptoms of AFib?”, and “Catheter Ablation in AFib Part 1 & 2.” Problem #2: AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). See my video “Can AFib Cause a Stroke?” However, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch structure called the Left Atrial Appendage. The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage. So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). See my video “Watchman in AFib Explained.” Problem #3: AFib is primarily caused by aging and getting older. Once you develop AFib cells in the walls of your heart that are starting to wake up, every year you get older these cells keep growing and spreading and the more of these you have, the more walls they’ve spread to, the stronger they become, the more they want to be awake, and the less they go to sleep. Eventually you can reach a stage where you have enough AFib cells/sources where they are awake 100% and at that point we can’t put them back to sleep or get rid of them and your AFib will be 100% permanently awake from that point forwards. But the good news is that even if you reach that point you will never die from AFib because it is not directly life threatening. As long as you don’t have a clot and stroke from it you will live just as long as everyone else. Please see my videos on “What Causes AFib?” and “Stages of AFib Explained.” Because Afib is not directly life threatening and mostly treated for symptoms, the decision whether to just live with Afib and control the rate (least risky), versus try to suppress it for a few years at a time with a strong antiarrhythmic drug then in 15 years accept when it is permanent (more risky), or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But again we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib.
Ideally an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. This is the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving patients the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication. It sounds like they are planning on placing you on the second strongest antiarrhythmic med, Tikosyn, to keep the Afib temporarily asleep. Since you are only in Afib 1.39%, that is a very early stage of Afib, probably 1 wall or less worth. Normally I would say using Tikosyn which is a very powerful med (as evidenced by the fact that it has to be loaded in the hospital because it can sometimes cause normal electrical cells to turn into dangerous cells that can wake up and make your heart speed up to 3-400bpm and cause sudden death) that can suppress up to 4 walls worth of Afib would be overkill in your situation, but since it sounds like your normal rhythm is slow, technically all of the weaker AAD drugs can cause more bradycardia. Remember, the AAD won’t suppress your Afib forever especially as you get older and your Afib progresses and gets stronger as it grows on more walls of your heart. Another alternative at your age is to eventually consider the AF ablation. The effectiveness of an ablation has a lot to do with how progressed one’s stage of Afib is. Are you early stage called Paroxysmal Afib where you don’t have a lot of Afib cells (maybe 1-2 walls worth out of the 6 walls) and your Afib is only waking up 1-30% of the time? Are you mid stage called Persistent Afib (3-4 walls worth of cells) where your Afib is waking up 30-60% of the time? Are you late stage called Longstanding Persistent Afib (5-6 walls worth of cells) where your Afib is waking up 60-90% of the time? Or are you end stage called Permanent Afib (all 6 walls are covered with AF cells) where your Afib is awake 100% of the time and has been like that for years and can’t be converted back to normal rhythm no matter how strong the medicine, or how complex the ablation, or even a cardioversion? Think of the stages of Afib as like the stages of a forest fire. A 10% forest fire is super easy to put out no matter who the forest ranger is even if they are very inexperienced or of limited skills, but the more progressed your forest fire (eg. 70-90%) the more skilled a forest ranger who is able to put out complex forest fires is needed. At later stages of Afib the energy source used for the ablation is much less important than the skill of the operator. This is why in the advanced stages ablation results vary widely depending on who did the procedure, everything from having 3-5 procedures and still having significant Afib leftover and needing an antiarrhythmic drug, to getting the result but with 3-4 procedures, to some of us able to do very advanced and complex ablations getting the result often in one procedure. Think of the ablation as “turning back the clock” to an earlier stage by getting rid of Afib cells/sources from the inside; the more one can get rid of from the inside (the more skilled the operator doing the procedure) the less AFib remains to wake up. True even if you get rid of all of a pt’s Afib and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon. Whether to just live with Afib and control the rate (least risky) versus try to suppress it over the years with stronger and stronger antiarrhythmic drugs as the AFib slowly outgrows each drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. It sounds like you are doing your best to avoid any “triggers” that can wake up your Afib. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. I hope this helps!
Very good info.. I am 81 and I have atrial fibrillation since 28 years ago.
If you really have had AFib for the last 28 years then it is likely it has progressed to being there 100% of the time which is what we call "permanent AFib" stage. But as long as you stay on a blood thinner and don't have a clot and a stroke, AFib is not directly life threatening and mostly treated for symptoms. Thanks for watching!
Thanks Dr. Lee. Thank you for taking the time to explain AFIB. I wish my regular cardiologies would have explained it this way back in July 2024. Not knowing what I know now about AFIB caused me and my family many sleepless nights. My recommendation to my AFIB friends is to seek the best medical advise, not all EP and regular cardiologies are created equal. I am still almost two month post my ablation and my AFIB episodes are much less frequent (about 0.5% per week) but I am getting an extra or some times missing a beat here and there and some palpitations at night.
It can take some time to see the full results of an AF ablation. We usually give it up to 3-4 months because Afib cells/sources can still die up to this point but nothing more will die off past that point. Anything that is still waking up past that point is something that either survived the ablation or wasn’t targeted. Remember, getting rid of AFib with an ablation is not an “all or nothing” event. It is more like putting out a forest fire. The bigger and more spread the fire is, the more of the forest it covers, the harder it is to put it out completely although one can always make it smaller. I consider an ablation like “turning the clock back to an earlier stage.” Depending on the skill level of the operator and the stage of progression of the Afib (early, mid, late, permanent) will determine one’s chances of turning the clock all the way back to zero or just back a little bit. The stage of Afib is like the stage of a forest fire. A 10% forest fire (1 wall’s worth of AF) is super easy to put out no matter who the forest ranger is even if they are very inexperienced or of limited skills, but the more progressed your forest fire (eg. 70-90% or 4-5 walls worth) the more skilled a forest ranger who is able to put out complex forest fires is needed. At later stages of Afib the energy source used for the ablation is much less important than the skill of the operator. This is why in the advanced stages ablation results vary widely depending on who did the procedure, everything from having 3-5 procedures and still having significant Afib leftover and needing an antiarrhythmic drug to suppress the rest, to getting the result but with 3-4 procedures, to some of us able to do very advanced and complex ablations getting the result often in one procedure. But remember, whatever you get the forest fire to is where it will start growing back. If someone has 4 walls-worth of Afib cells (70% of cells waking up 70% of the time) and someone does a simple 1 wall ablation and gets it to 3 walls-worth (50% of cells waking up 50% of the time) then not only did they not get it all but as one ages the Afib cells will start to grow from 3 walls and 50%. But if one has the skill to get rid of all of the Afib cells and turn the clock back to zero, not only will the patient not have any Afib cells waking up possibly for years but their Afib will start to grow back from zero so they will get longer before Afib significantly reoccurs. If this is true, why don’t more EP’s try to do a better job and get rid of more AF in one sitting? Quite simply, it is because it is hard to do and not everyone can do it. It would be like hearing an expert, very experienced forest ranger describe how he/she approaches and puts out very complex forest fires, then listening to an average forest ranger talk about putting out a certain amount of a forest fire and leaving the rest saying almost defensively that that is the best that can be done. If you ask them why they don’t do the approach the other ranger described you will often get a variation of the ego driven, “Well I’m the best so if I can’t do it then it can’t be done.” But clearly there is a large variation in what people do and the results they obtain. In truth, it is extremely difficult to learn to perform an advanced lesion set for complex Afib cases and to do it safely and effectively, and most physicians these days won’t bother. Why? Because under the current system of reimbursement, you make more money to do less. For example, I might spend twenty years experimenting and learning advanced techniques in order to get rid of Afib even in the most advanced stages and as such I block out 3-4 hours for a pt’s procedure and end up ablating 5-6 out of 6 walls to successfully ablate their persistent or longstanding persistent Afib into normal sinus rhythm, and 3 months later after everything settles down they are off any antiarrhythmic medication spending zero or minimal time in Afib. Another EP, even those just a couple years out of training, could block out 1 hour because they are just planning on electrically isolating that first wall, the pulmonary veins, irregardless of whether that is enough to get rid of all of that pt’s Afib, and as a result they can put on 4 procedures instead of my 2, and get the 2nd, 3rd, or even 4th redo’s and make 3-6 times the money for getting a worse result. This is because we all use the same billing code from the health insurances which pays us for doing something not for getting a specific result. It is assumed that we all do the same thing and get the same results, which personally I don’t think is true for any profession on the planet. When I came out of training in 2004 it used to be better with more docs trying to do the right thing for pts, but as physician pay has been squeezed and insurances keep looking for reasons not to pay us, I see more and more docs doing as many procedures as possible without regard for results. This is currently being exacerbated by the new Pulsed Field ablation technology which doesn’t currently create better lesions than radiofrequency or cryoballoon technologies, and in some cases actually creates more superficial and worse lesions, but it is faster and overall a little safer. I’m now seeing some places doing up to 6 ablations a day. It’s taking a simplistic technique that was never enough for the more advanced cases, applying it to everyone, and now doing twice as many so as to make the most money possible. But because what we do is so specialized such that even general cardiologists don’t quite understand what we do let alone pts, people get away with it. It’s unfortunate, because it often feels like one is penalized for trying to do the ethical thing of only doing a procedure if after explaining things thoroughly to the pt it is decided that it is the right thing to do; and if doing a procedure is deemed needed, doing it in such a way where only one procedure is necessary most of the time. At these later stages, whether to just live with Afib and control the rate (least risky) versus try to suppress it for a few more years with a strong antiarrhythmic drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. And remember, skipping of your heart beat doesn't always mean that you are in AFib or have AFib recurrence. Your heart is controlled by a source of electricity because it is essentially a big dumb muscle. Usually your normal source of electricity, the sinus node that is located at the roof of your heart, is in control of your heart and it tells your heart to beat at whatever speed your brain wants it to go to based on what you are doing. When an abnormal rhythm like AFib forms and wakes up and temporarily takes over control of your heart away from the normal source of electricity, it can tell your heart to go at any speed it wants but always something faster than your normal rhythm source. True, AFib makes your heart go fast and irregular, but in truth you can't tell where the electricity is coming from that is controlling your heart. You can only tell if your heart seems faster than normal or irregular. Only an ECG or heart rhythm monitor can sense the electricity in your heart directly and identify who is in control. Your normal rhythm can be in control and sometimes be a little bit irregular. More commonly younger individuals develop a condition known as premature beats which are essentially single extra heart beats coming from a weak abnormal source of electricity that doesn't take over control of your heart but just adds a couple of extra beats. These are called PVCs (premature ventricular complexes) or PACs (premature atrial complexes). They are benign and often woken up with stimulants like coffee. If you have weird sensation of palpitations either irregular or racing, the best way to evaluate it to see if it is recurrent Afib versus these benign premature beats is to see your general cardiologist or a competent electrophysiologist (electrical cardiologist) where a heart rhythm monitor can be placed to catch your symptoms and verify exactly what is going on. Also feel free to watch my video “Does an Irregular Heart Rhythm Mean I'm in AFib?” I hope this helps.
@@afibeducation Thanks Dr. Lee. Yes, my EP wants to place a monitor to see what is going on but want to give it more time to see if the the ablation worked or not. It happened on October 29th, 2024. I need to be patient and hopeful. Can't thank you enough for taking the time to address my concerns.
@@afibeducation By the way my EP told me the exact same thing about Pulse Field ablation. He used cryoballoon in my case. and he does no more than 3 ablation in a given day. After reading your explanation about the Pulse field ablation, I am glad my EP used cryoballoon.
So enjoyed understanding my a-fib issue, I am 74 yr old woman, just got my second pace with blue tooth, take thinner also, I know my a-fib is low range but most time I am in it
Had veins checked, all clear
Had echo, 45 number so some low
I have hbp but try to be careful
I know issues make life shorter but praying God hears my prayers and have good dr's
Ty
I appreciate your feedback. Some thoughts: Because Afib is caused by getting older and the aging of the heart walls, once you live long enough to develop Afib cells and they start waking up, every year you get older you keep forming more Afib cells and it keeps progressing. Remember, the more Afib cells you have and the more walls they develop on, the more progressed your Afib is, the stronger it becomes, the more it wants to wake up, and the less it wants to go to sleep resulting in you being in it for longer percentages of time. Also remember that Afib can wake up and take control of your heart but sometimes it makes your heart go really fast and other times less so. When it is really fast you feel it, but if not that fast you may think you aren’t in it but you are. You can’t tell where the electricity is coming from that is controlling your heart, only if your HR seems abnormally fast. Only an ECG or heart rhythm monitor can identify if you are really in Afib or not. So you could be spending more time in Afib than you realize. But to a certain extent that’s okay because as long as your Afib doesn’t cause a clot and stroke, it is not directly life threatening and treated mostly for symptoms. Also there are stages to AFib progression. When you only have AFib on 1-2 out of the 6 walls of the left upper chamber of your heart you don't have that many cells and they wake up less than 30% of the time. This is an early stage called "Paroxysmal AFib." When you have AFib cells on 3-4 walls they are strong enough to wake up 40-60% of the time. This is a mid stage called "Persistent AFib." When you have AFib cells on 5-6 walls and they are waking up 70-90% of the time this is a late stage called "Longstanding Persistent AFib." Once your Afib cells cover all the walls and are awake 100%,, within three years they could progress to being permanently there and awake (end stage called "Permanent AFib") where you will be in active Afib for the rest of your life and at that point no antiarrhythmic medication will be able to keep it asleep, and no ablation no matter how complex the lesion set or the energy source will be enough to get rid of it. At that point you would just stay on your blood thinner because as long as you don’t have a clot and stroke you will live just as long as everyone else, but symptom-wise we would just use rate controlling meds to slow your Afib to a speed that you tolerate and leave it at that. Currently if you want to stay in normal rhythm longer and aren’t willing to accept just being in Afib for the rest of your life your options are either to use an antiarrhythmic medication to suppress the Afib (which doesn’t get rid of the Afib cells or keep them from growing as you get older but just masks them until they can’t mask them any longer) or do an ablation to try to get rid of enough of them from the inside. If you use an antiarrhythmic medication to keep your AFib asleep, remember that your Afib cells are still there and growing and can still become permanent in a few years. If you wanted it not to become permanent in several years since you might be at a late stage, only an Afib ablation could “turn back the clock” to an earlier stage by getting rid of Afib cells/sources from the inside; true even if you get rid of all of a pt’s Afib and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon. And also remember, the stage of Afib is like the stage of a forest fire. A 10% forest fire is super easy to put out no matter who the forest ranger is even if they are very inexperienced or of limited skills, but the more progressed your forest fire (eg. 70-90%) the more skilled a forest ranger who is able to put out complex forest fires is needed. At later stages of Afib the energy source used for the ablation is much less important than the skill of the operator. This is why in the advanced stages ablation results vary widely depending on who did the procedure, everything from having 3-5 procedures and still having significant Afib leftover and needing an antiarrhythmic drug, to getting the result but with 3-4 procedures, to some of us able to do very advanced and complex ablations getting the result often in one procedure. At these later stages, whether to just live with Afib and control the rate (least risky) versus try to suppress it for a few more years with a strong antiarrhythmic drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. Hopefully an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. Fee free to watch my other videos including "4 Basic Facts About AFib" and "What is an Arrhythmia?" for more in depth information on any of these topics. I hope this helps.
@@afibeducation Appreciate the detailed information. That was very informative on Afib and what treatment plans should be considered based on risk/benefit analysis for each individuals.
Thank you DR . Not many doctors explain this way , they don't explain anything at all
Thank you! Unfortunately, I've noticed that lack of explanations has been worsening over the twenty years I've done this. I believe that as Medicare keeps cutting physician reimbursement and private insurances keep looking for ways not to pay us on technicalities, it is causing more and more docs to feel that they just have to see as many patients as possible and sometimes, unfortunately do as many procedures as possible even if not always necessary, in order to keep up their income. Their rationale is: if the government and insurances are going to screw me then I have to do what I have to do. Unfortunately, the patients get stuck in the middle. This is also the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving pt's the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication.
Impressive explanation with lots of information regarding this condition... Thank you Doc.....
My pleasure! Thanks!
You are very good at explaining everything and have given me a lot to think about. Thank you.
You are so welcome!
I was just recently diagnosed. I never had a symptom but the EKG revealed I had AFib. Thanks so much for this information - it is excellent!
Yes, AFib can often times be minimally symptomatic because the rate it makes your heart go at isn't always super fast. But the worst thing that it can cause is a clot forming in your heart causing a stroke. Check your risk score with the CHA2DS2VASc scoring system and if it is 2% or greater then you should be on a blood thinner to prevent a clot and a stroke. Once you are protected from this, everything else we do is based on your symptoms, your stage of AFib, your age, your risk tolerance, and your long term goals. Thanks for the feedback!
My HRV is great, over 170
However, I’m in AFib for over one week now, with a BP around 140/90
What exactly do you mean by HRV over 170? What does HRV stand for? HR stands for heart rate. Not sure what HRV stands for. How do you know that you have been in AFib for one week? Have you had an ECG or wearable heart rhythm monitor done verifying this? Or do you have a smartwatch or Kardia Mobile device that says you are in AFib. ECGs and wearable heart rhythm monitors are the most accurate devices for telling you what rhythm you are in, normal or abnormal rhythm. Smartwatches and Kardia Mobile devices are pretty good but can be fooled into thinking you are in AFib when sometimes you are not. Again, as long as you don't have a clot and a stroke from your AFib it is not directly life threatening and treated mainly for symptoms. Whether to just slow down the speed of your AFib with a rate controlling medication and tolerate it (least risky), use a stronger antiarrhythmic med to keep your AFib temporarily asleep so you stay under the control of your normal rhythm feeling normal (more risky), or do an invasive AF ablation to try to get rid of AFib cells from inside the walls of your heart directly so you stay in normal rhythm (most risky), depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. Feel free to watch "How Do I Treat the Symptoms of AFib?"
Excellent information! I've been taking Xeralto for a long time. Even though my cardiologist seldom hears a- fib and my meter, at home, does not indicate it doctor won't take me off Xeralto. Not sure why but when my Medicare/ Medicare goes in to the gap period the cost goes sky high. I now know what to do. Thanks again!
Thank you for watching! Yes, besides the fact that AFib can take over control of your heart and temporarily increase your heart rate causing symptoms, and that it is caused by aging and increases over time, AFib can also lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
Thank you for this! I have been stressing about this because I went into Afib on Tuesday. I ended up in the hospital. However they told me it was showing aflutter on the EKG. I am currently on bisporol but the hospital added diltiazem that helped bring my heart rate back down to a normal sinus rhythm. My heart rate went up to 170. I am also going through menopause and having every symptom of menopause. Which means anxiety and the fight or flight feeling, like the adrenaline rushes. I kept getting weird feelings like a flutter feeling in my neck so I thought it was my thyroid. I do take medicine for it I have hypothyroidism. I had two ultrasounds of my thyroid and it came back normal. My endocrinologist said my blood levels are normal too. I saw my EP doctor and cardiologist last week and the EKG showed normal sinus rhythm. I had an echo and stress test done and both were normal. I have been hearing a lot of other menapauseal women say that they found out they have Afib. I recently found some info about the vagus nerve that I found very interesting in relating to Afib and menapause actually. There are a couple of times I felt like I was about to go into Afib and I tried one of the vagal nerve manurving techniques and it calmed me down. It was splashing cold water on my face or putting a cold pack on my neck and it helped. If it wasn't a cold pack it was a cold bottle of water. But on Tuesday neither of it worked. I went right into Afib. It was after I ate dinner so I'm wondering if it was the food. I am now seeing a gastroenterologist for my stomach issues so I wonder if my irritated intestines triggered it.
My last AFB attack was last year in June. My first one was in June of 2021.
AFib is made up of abnormal cells/sources that form in the walls of the left upper chamber of your heart, the left atrium, and these cells wake up randomly and take over control of your heart electrically away from your normal source of electricity that you are born with that is located in the right upper chamber of your heart. When the AFib cells are in control they make your heart go at faster speeds that can be symptomatic. They also increase the chances of a blood clot forming in your heart that can break loose, go to your brain, and cause a stroke. As one gets older the AFib cells/triggers/sources keep developing, growing, and spreading to more and more walls of the left atrium. The more walls you have AFib cells on, the more AFib cells you have total, the stronger they become, the more they want to wake up, and the longer they stay awake before going back to sleep. When you have them on all 6 walls of that chamber they are strong enough to be awake 100% of the time and that is when your AFib is called "Permanent AFib" because no medication, no ablation no matter how advanced, and even a simple electrical shock (cardioversion) won't get the AFib gone or back to sleep. You will be in AFib 100% from that point forwards, but as long as one stays on their blood thinner and doesn't have a stroke, you will never directly die from AFib because it is not directly life threatening. However, symptom-wise the best we can do at that point is just use a simple “rate controlling medicine” to slow the AFib down to a point where the pt can tolerate the palpitations. See my videos on “What is an Arrhythmia?” And “4 Basic Facts About Afib.” Because Afib cells once they’ve formed can randomly wake up on their own, it isn’t always a specific trigger that wakes them up. True, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, alcohol because of its direct toxic effects on the heart, and even the stress of menopause. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. Understand, while the stress of menopause may be helping to wake up your existing Afib cells/sources, they didn’t cause them to be there in the first place. If you had no Afib cells in your heart then undergoing menopause wouldn’t wake up anything. The reason why so many of your friends undergoing menopause are developing Afib is that Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. Also, the amount of time you are currently spending in AFib correlates with how progressed your AFib is and the stage. If you are going in and out of AFib and your episodes are less than 7 days at a time you are technically Paroxysmal AFib (early stage). If you are spending more than 7 days at at time in AFib you are Persistent AFib (mid stage). If you are in the Persistent stage spending more than a week at a time in AFib and you have been that way for more than a year then you are Longstanding Persistent AFib (late stage). And if you are spending 100% of the time in AFib and it doesn’t go to sleep at all by itself and it is too strong to get it to go back to sleep with an antiarrhythmic drug (AAD) or too much to get rid of it from the inside with an ablation then you are Permanent AFib (end-stage). (Staging is discussed in the “Ablation Techniques #1” video) But again, even if you ever reach Permanent AFib stage, as long as you don’t have a clot and stroke from your AFib (the decision as to whether you need to be on a blood thinner to prevent this depends on your exact risk which in turn is based on your age and comorbid medical problems-see the video “Can AFib Cause a Stroke?”) you won’t directly die from AFib because it is not life threatening and mostly treated for symptoms. And remember the symptoms are usually palpitations depending on how fast the Afib is making your heart speed up to, and even if your Afib is well rate controlled it can still cause fatigue. Most people are on a blood thinner to prevent risk of stroke long term. There is a CHA2DS2VASc scoring system which determines your exact risk of stroke. Any risk over 2% it is recommended you be on a blood thinner longterm. According to your history you aren’t spending that much time in Afib which suggests you are still at an early stage of Afib “Paroxysmal Afib.” Since AFib is not directly life threatening and treated just for symptoms (assuming you don’t have a stroke from it which is a separate issue), the good news is that you have multiple treatment options! Either to just tolerate the AFib using rate controlling meds to keep the heart rate in AFib mostly controlled and just tolerate the symptoms (less risky); this seems to be the treatment options that your doctors currently have you on. Bisoprolol is a “rate controlling medication.” It doesn’t keep your Afib from waking up but simply slows it down hoping that you can tolerate it until it goes back to sleep and the individual episode is over. In fact, when you went to the ER and they gave you IV Diltiazem, this too is simply a “rate controlling” med designed to slow your Afib speed down for symptoms then hoping it goes to sleep on its own after a while. It is NOT one of the antiarrhythmic meds (AAD’s) that is designed to put your Afib back to sleep or keep it asleep. Your Afib just went back to sleep on it’s own in the ER, not because of the Diltiazem. Had you stayed at home it would’ve done the same thing. Please see my video on “Rate Controlling Medications in Afib Explained.” Or use a stronger Antiarrhythmic medication to temporarily keep the AFib asleep (more risky). Or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Remember, AFib slowly grows and progresses as you get older (although this happens over years) and the more progressed it becomes the more it wakes up and the less it goes back to sleep resulting in you spending more and more time in AFib until it is eventually Permanent AFib which usually occurs after 10-15 years. The younger one is the more one might consider an ablation because the AFib could become permanent and one might still be fairly young and regret that. On the other hand, maybe a procedure scares you and a 1-2% or less risk of a complication is too much for you and you would never consider it. Everyone is different. Usually when pt’s are in their 80-90’s where the risk of procedures go up, most say just do the least risky thing which is to either slow the AFib down with a rate controlling med and have them tolerate it or if symptomatic to keep it asleep with an AAD. Usually patients who are younger say they don’t want to just tolerate it and are willing to accept a small risk of a procedure to try to get a better long lasting result. But after doing this for 20 years, sometimes I see older pt’s say they understand the risks and still feel an ablation is right for them and sometimes I come across a younger pt that says the procedure scares them and they would never want it unless they were very symptomatic and all meds failed. Everyone’s stage, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. I hope this helps!
😮for all good info.thank you doctor
I had catheter ablation in 2010. The weeks after I felt as if it had been a worsening of the condition. Things leveled out and I've only had one or two bouts that I know of and it was companion to other serious bodily stresses. I took warfarin for 10 yrs and I've stopped taking all blood thinners. In fact, I don't take any meds now. I eat a plant based diet and no simple carbs. I walk regularly, ride a bike and do indoor stuff with a resistance band or just general exercise. I'm 76!
I’m glad that you got a good overall result after your Afib ablation and have had minimal episodes since, although remember that Afib can sometimes make your heart speed up just a little bit faster than your normal rhythm and so it is possible to have episodes that you don’t always feel. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time and so they can grow back in different walls of the heart and start again. This is why Afib is not felt to be completely cured even after a successful ablation. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. Also remember that besides symptoms, the most serious problem that Afib can cause is that it can lead to a clot and a stroke. Treatment to prevent stroke is totally separate from treatment of symptoms. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. So for your situation even if you are doing well post ablation and seemingly having no significant recurrent episodes, even if they are waking up a little bit you are still at risk of clots and strokes, and over time your Afib will progress and start waking up even more. AFib never just goes away and is never completely cured. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which long term treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
@@afibeducation I remember when my cardiologist suggested I was a second class patient who had to use warfarin rather than Xarelto because insurance didn't cover the 'good' stuff. (a guy named Reiders did my ablation)
Thanks a million Doc.❤
This is very informative, thank you.
Glad it was helpful!
Thank you for the great education Dr Lee 💖
Thanks for watching!
Great explanation of what's going on inside.
Glad it was helpful!
I have an HMO for my health insurance. I have paroxysmal Afib it started in 2021. I have less episodes when I 21:44 stop eating processed sugar and caffeine. The cardiologist gave me the pill in pocket flecinide. I took 1 pill 1 time was nauseous for several hours, then vomited, so I do not want to try that again. He also gave me a beta bocker same information take for episodes then later said take twice daily. I don't want to take drugs. It is an expensive proceedure so I can see why he didn't offer the ablation option. Would it not be better to get it done now before the cells continue to grow? I am 62, and no other health problems besides arthritis.
31 with afib, i got diagnosed 2 months ago. It's consistent now, so im on several medications to control it and the symptoms, im going for an electrical cardioversion in a few days. If that dont work, I'll go in for the ablation. I had symptoms for over a year. Every time i made it to the hospital, the ekg was good, and they said it was just anxiety. Well, now im worried about it being a progressive thing, which i didn't know. How will i manage it in the future? Will i keep having procedures done? Your video was very informative. Thank you!
Great and very helpful, thanks
You are most welcome!
Excellent information. Thank you!
You bet!
Ok. This is very interesting. My husband had his first a fib when he had Covid. So there goes the blood thinner. For life. What about exercise. Proper food . Like heart healthy. Do these make a difference. And can a normal healthy man ever get off this dangerous drug?
Thank you for your great explanation. Exactly what I thought
It sounds like your husband was starting to develop early Afib (probably from aging which is the number one factor causing Afib to form and progress) that was then woken up by the stress of the Covid infection. From there he will always have Afib cells there that can wake up but remember Afib is not life threatening, we just have to treat symptoms of rapid HR and risk of clots forming during an episode of AF leading to a stroke. The person's long term strong risk is determined by his/her CHA2DS2VASc score where every point is essentially 1-1.5% risk. If your husband's score is 0-1 then he wouldn't need to be on a blood thinner because the risk of clot and stroke would be less than 2% per year. If it is 2% or higher the recommendation is that he be on a blood thinner from that point on to reduce his risk to less than 1% because no one wants to have a stroke. And unfortunately, Afib is never permanently cured or will go away. If he doesn't want to be on a blood thinner long term he can either choose to accept the small but not zero risk, or consider a Watchman implant which may not reduce a patient's risk of stroke quite as well as a blood thinner but close, without needing to take a blood thinner long term (see video on Watchman). Exercise, eating healthy, and losing weight absolutely can affect Afib. It won't necessarily make those Afib cells go away or leave your heart, but since Afib grows and progresses slowly over time (and the more of them you have spread on more walls of the left upper chamber of your heart the stronger they become, the more they want to be awake, and the less they want to go back to sleep) and therefore wakes up more causing more episodes and potentially more symptoms, things like exercise, maintaining a healthy weight, keeping your BP under good control will definitely help slow the progression (see video "Can I Prevent Afib?"). Also there are things that can trigger or wake up your existing AF cells causing you to have even more episodes than you would've otherwise: caffeine, alcohol, stimulants, stress. Avoiding these "triggers" definitely helps, although they don't "cure" you of Afib like many people think. I hope this helps!
P
I have had afib for 10 years on eliquis. I have never had a symptom or episode. The only way of knowing i have Afib is because it is shown on my EKG.
Sir, what about vagal afib or afib episodes that occur but you don’t have a high heart rate. It’ll stay within the 70 bpm zone but will have irregular rthym
Thank you for watching! I think you need to be careful about terms like “vagal” AFib. Remember, the basic premise is that AFib is made up of abnormal cells/sources that form in the walls of the left upper chamber of your heart, the left atrium, and these cells wake up randomly and take over control of your heart electrically away from your normal source of electricity that you are born with that is located in the right upper chamber of your heart. When the AFib cells are in control they make your heart go at faster speeds that can be symptomatic. They also increase the chances of a blood clot forming in your heart that can break loose, go to your brain, and cause a stroke. As one gets older the AFib cells/triggers/sources keep developing, growing, and spreading to more and more walls of the left atrium. The more walls you have AFib cells on, the more AFib cells you have total, the stronger they become, the more they want to wake up, and the longer they stay awake before going back to sleep. When you have them on all 6 walls of that chamber they are strong enough to be awake 100% of the time and that is when your AFib is called "Permanent AFib" because no medication, no ablation no matter how advanced, and even a simple electrical shock (cardioversion) won't get the AFib gone or back to sleep. You will be in AFib 100% from that point forwards, but as long as one stays on their anticoagulation and doesn't have a stroke, you will never directly die from AFib because it is not directly life threatening. However, symptom-wise the best we can do at that point is just use a simple medicine to slow the AFib down to a point where the pt can tolerate the palpitations. This means that at any given Stage of AFib the AFib is waking up more or less based on how much of it you have in the walls of the left atrium. Now in the early stages when you don’t have that much AFib, maybe half a wall to 1-2 walls worth, your AFib isn’t waking up very much. That is the stage where “triggers” of AFib make the most difference. Things like stress, stimulants, caffeine, and alcohol can often wake up your AFib more than it would otherwise. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. It is true that there are “non-stress” triggers that sometimes wake up AFib. These would be the so-called “vagal” triggers. Remember, your brain controls everything in your body through your autonomic nervous system which is comprised of either sympathetic stimulation (the “Fight or Flight response” where you see a Tiger and your heart rate increases, pupils dilate to take in more light to see the Tiger better, and blood pressure increases to be ready for action) or parasympathetic or vagal stimulation (this is the rest response where your body gets you ready to sleep or eat by slowing your heart rate, decreasing your blood pressure, constricting your pupils to take in less light, and increasing digestive juices to breakdown food). While AFib is usually woken up by sympathetic stimulation that “revs” the body up, in some people it is woken up more by vagal/parasympathetic stimulation that “slows” the body down. Vagal AFib refers to the “triggers” that wake up your AFib, not the speed the AFib makes your heart speed up to when it is awake. Whether your heart rate is “slow” when your AFib is awake has more to do with whatever speed your AFib chooses to make your heart rate go to at that moment or whether you are on rate controlling meds to artificially slow your heart rate down in AFib. So if you are in an early stage of AFib and notice that your AFib seems to be triggered more by sympathetic stimulation triggers, then avoiding those could mean you have less AFib episodes overall. If you notice your AFib seems to be triggered more by vagal/parasympathetic stimulation triggers like resting, eating, etc. then avoiding those triggers could mean you have less AFib episodes overall. But remember, avoiding triggers is not the same as “reversing” your AFib or curing it. If you have AFib cells/sources in your heart even at an early stage, they can wake up on their own based on how much of them you have in your heart at that particular stage. By avoiding known triggers of AFib, you are simply not waking them up more than they would wake up otherwise. But this only helps in the early stages of AFib. In the later stages of AFib when they are waking up a lot on their own already, they avoiding the triggers may be less helpful. For example, if you are at an early stage of AFib and it is normally waking up 1-2% of the time on it’s own but you do certain triggers that wake it up 10-15% of the time, then obviously avoiding those triggers will markedly reduce how much AFib episodes you are having. But if you progress over time to a later stage where your AFib is waking up 50-60% of the time on its own then doing triggers and waking it up 70% of the time may make less of a symptomatic difference at that point because it is mostly awake already. I hope this helps.
As soon as I knew I was in menopause, I started HRT and all symptoms of it went.
Kept me young looking and at 83, have no wrinkles.
While Afib can be exacerbated by the stress of menopause and can be woken up more, if you really have Afib and on HRT your symptoms are better that just means that you are at an early stage of Afib and without the stress of menopause waking your Afib cells they aren’t waking up much on their own. However, since Afib progresses and grows as one gets older, if you truly have the correct diagnosis of Afib then over time the Afib cells will grow and progress and it will start to wake up more. But if currently they aren’t waking up much then you don’t have to be aggressive in terms of treating your current symptoms since Afib doesn’t kill you just by taking over control of your heart and speeding it up. However, remember that Afib can also cause clots to form in your heart that can break loose, float up to your brain, cut off blood supply to your brain and cause a stroke. This can occur irrespective of the amount of Afib you are having and irregardless of whether or not you have a lot of symptoms from your Afib. Your risk of stroke is determined by a scoring system called the CHA2DS2VASc score. Every point on this scoring system increases your risk by about 1 to 1.5%. With a risk score of 2% or greater, standard of practice guidelines recommend that anticoagulation be used. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. If you truly had Afib correctly diagnosed and are 83 y/o then you have a CHA2DS2VASc score of at least 2 (age greater than 65 y/o and greater than 75 y/o) and so whether or not you have a lot of Afib or minimal symptom-wise, your risk for Afib causing a clot and stroke is at least 2% per year and guidelines would recommend you be on a specific blood thinner to protect you from risk of clots and stroke long term. Thanks for watching!
@ My dear, thank you for the explanation. I have been on blood thinners since I got the Pacemaker.
I experienced atrial fibrillation At age 78, I received an electrical shock to put my heart back into rhythm. My cardiologist put me on Eliquis, is it advisable to stay on this medication for the rest of my life.. At this point I have not experienced another event .
Thank you for watching! Yes, besides the fact that AFib can take over control of your heart and temporarily increase your heart rate causing symptoms, and that it is caused by aging and increases over time, AFib can also lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. Similarly, for your situation even if you are at an early stage of AFib where you don’t have a lot of AFib cells yet and they aren’t waking up much, even if they wake up a little bit you are still at risk of clots and strokes, and over time your Afib will progress and start waking up even more. AFib never just goes away. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which long term treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
I have had AFib for over 10 years ( am 93) with two pulmonary embolisms , nearly died, my heart rate 37 to 40 bpm, yet do not want a pace maker, have no symptoms apart from those of heart failure
A pacemaker treats slow heart rates not fast. AFib causes fast heart rates not slow. Therefore your AFib really has nothing to do with whether or not you need a pacemaker. It would depend on why your heart rate is 37 to 40 bpm. However, in general, the main indication for a pacemaker is someone having slow heart rates that are symptomatic. If it is true that your heart rates go down to 37-40 bpm but you feel fine, then a pacemaker may not be required. Ideally you would be seen by a competent, ethical Cardiac Electrophysiologist (those of us who are heart rhythm experts) who could evaluate you and determine if you really in fact need a pacemaker, although just from the little bit you've told me, you may not. Hopefully you aren't seen by a doctor just pushing you into a pacemaker implant not because it is truly needed, but because they just want to make more money.
Thanks I am 78 have had afib 7 yrs now. Cardioversion x 2 did not work. I do not like any of the side effects of amiodarone at all. Doing ok on bisporopol now 15 mg a day. Rather just stay on that. Internist did give me a rx for amidorone tho I said I didn't want it. Anyway its more pricy and I am low income. Solotol put me in chronic afib.
I have afib and factor 5 ,so my doctor put me on blood thinners. Do you think need to be on blood thinners? Im 62 years old.
I have been dx'd with a-fib for about 5-6 years. I have tried to focus in on what brings it on. I no longer consume alcohol and avoid foods or drinks containing aspartame and MSG. I believe with positive results. What do you think about this?
I think this is a terrific start! Remember, AFib is made up of abnormal cells/sources that form in the walls of the left upper chamber of your heart, the left atrium, and these cells wake up randomly and take over control of your heart electrically away from your normal source of electricity that you are born with that is located in the right upper chamber of your heart. When the AFib cells are in control they make your heart go at faster speeds that can be symptomatic. They also increase the chances of a blood clot forming in your heart that can break loose, go to your brain, and cause a stroke. As one gets older the AFib cells/triggers/sources keep developing, growing, and spreading to more and more walls of the left atrium. The more walls you have AFib cells on, the more AFib cells you have total, the stronger they become, the more they want to wake up, and the longer they stay awake before going back to sleep. When you have them on all 6 walls of that chamber they are strong enough to be awake 100% of the time and that is when your AFib is called "Permanent AFib" because no medication, no ablation no matter how advanced, and even a simple electrical shock (cardioversion) won't get the AFib gone or back to sleep. You will be in AFib 100% from that point forwards, but as long as one stays on their anticoagulation and doesn't have a stroke, you will never directly die from AFib because it is not directly life threatening. However, symptom-wise the best we can do at that point is just use a simple medicine to slow the AFib down to a point where the pt can tolerate the palpitations. Up until your AFib is permanent we still have options of use a stronger antiarrhythmic medication to keep the AFib cells asleep so that you don’t keep going in and out of AFib and stay in normal rhythm feeling completely normal (these drugs don’t get rid of the AFib cells and they don’t keep you from forming more AFib cells as you get older, they simply “mask” your AFib cells until they can’t “mask” them any longer; versus, doing an AFib ablation where we do a special procedure to map the electrical cells inside your heart and try to destroy them from the inside in order to get rid of your AFib directly because they won’t wake up and take over control of your heart if they are gone (this procedure is never a permanent cure because AFib cells can grow back in other walls of the heart given time and the results are not “all or nothing;” Your results will vary depending on how many AFib cells you start out with, your “stage of progression,” and the skill of the operator doing your ablation). The ablation potentially can get you the longest lasting results but involves the most risk upfront (the risks of doing a procedure) whereas the rate controlling meds don’t even get you out of AFib so get you the least results but are the least risky treatment option. See my videos “4 Basic Facts About AFib”, “How Do I Treat the Symptoms of AFib?”, and “Catheter Ablation in AFib Part 1 & 2.” Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. I hope this helps!
Great information. Recommendation -- please lower the level of the background music which is distracting and annoying.
I appreciate your feedback. Thank you!
I got mine when i was 25/26 years old now im almost 32 . I get it around once a year but it stays for 8-16 hours , i take concor 5mg thats all my cardiologist gave me and i asked if i could have an ablation and he said its not necessary for me right now but its up me . I wanted your opinion on having an ablation or not
AFib basically causes three problems. Problem #1: It wakes up and takes over control of your heart away from your normal source of electricity thereby causing your heart rate to speed up. While this is not directly life threatening because AFib will never make your heart speed up to a life threatening speed, it can cause symptoms depending on how fast your heart rates goes to and that is why there are multiple ways of treating symptoms: using a simple rate controlling medication to slow your heart rate down while in AFib (these meds are simple meds that don’t have any potential dangerous side effects but they aren’t doing much other than slowing the speed of your AFib down so that you can tolerate the symptoms a little better); versus using a stronger antiarrhythmic medication that potentially has stronger side effects to actually keep the AFib cells asleep so that you don’t keep going in and out of AFib and stay in normal rhythm feeling completely normal (these drugs don’t get rid of the AFib cells and they don’t keep you from forming more AFib cells as you get older, they simply “mask” your AFib cells until they can’t “mask” them any longer); versus, doing an AFib ablation where we do a special procedure to map the electrical cells inside your heart and try to destroy them from the inside in order to get rid of your AFib directly because they won’t wake up and take over control of your heart if they are gone (this procedure is never a permanent cure because AFib cells can grow back in other walls of the heart given time and the results are not “all or nothing;” your results will vary depending on how many AFib cells you start out with, your “stage of progression,” and the skill of the operator doing your ablation). The ablation potentially can get you the longest lasting results but involves the most risk upfront (the risks of doing a procedure) whereas the rate controlling meds don’t even get you out of AFib so get you the least results but are the least risky treatment option. See my videos “4 Basic Facts About AFib”, “How Do I Treat the Symptoms of AFib?”, and “Catheter Ablation in AFib Part 1 & 2.” Problem #2: AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). See my video “Can AFib Cause a Stroke?” Problem #3: AFib is primarily caused by aging and getting older. Once you develop AFib cells in the walls of your heart that are starting to wake up, every year you get older these cells keep growing and spreading and the more of these you have, the more walls they’ve spread to, the stronger they become, the more they want to be awake, and the less they go to sleep. Eventually you can reach a stage where you have enough AFib cells/sources where they are awake 100% and at that point we can’t put them back to sleep or get rid of them and your AFib will be 100% permanently awake from that point forwards. But the good news is that even if you reach that point you will never die from AFib because it is not directly life threatening. As long as you don’t have a clot and stroke from it you will live just as long as everyone else. Please see my videos on “What Causes AFib?” and “Stages of AFib Explained.” Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. Because Afib is not directly life threatening and mostly treated for symptoms, the decision whether to just live with Afib and control the rate (least risky), versus try to suppress it for a few years at a time with a strong antiarrhythmic drug then in 15 years accept when it is permanent (more risky), or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But again we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. Ideally an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. This is the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving patients the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication. So for your situation at 32 y/o, depending on your level of symptoms and personal preference, an AF ablation may or may not be the right decision for you at this moment, but since you are young and presumably wouldn’t want your Afib becoming permanently awake in the next 20 years when you still aren’t that old, as your Afib progresses and starts to wake up more and more, you may want to consider an ablation at some point. But the great news is that you always have a say in it since we are just treating symptoms! Assuming you are on a blood thinner to protect you against clots and strokes, you will never directly die from AFib. And everyone is in a different situation. While most 80 y/o tell me that given their age they would prefer to go from least risky to most risky in terms of symptom treatment (which would involve using a medication to treat your AFib instead of an ablation), occasionally I get an 80 y/o that is healthy and they tell me after the whole discussion that their philosophy has always been to take more risk up front to try to get an ideal result without meds if possible and they still want me to proceed with an ablation. On the other hand, while most patients 40-65 y/o opt for an AF ablation at some point given their younger age, occasionally one tells me that a 1-2% risk of a procedure scares them and they would never consider it. My job as a physician should not be to bully patients into a procedure or to apply my personal algorithm of symptom control to the pt but rather to give patients options and to give them the knowledge so they can decide what is best for their specific situation based on age, level of symptoms, and personal preference. So my recommendation is to take as long as you need to decide whether or not to proceed with an ablation. Don't feel pressured into it. Get a second opinion if you need to. Don't ever be bullied into a medical procedure. I hope this helps.
@@afibeducation thank you so much for taking the time to answer me , this really helped me alot . I appreciate you so much doctor
I believe that visceral fat is a trigger for AF. Alcohol and caffeine may indeed affect some sufferers of AF, but they never factored in my case (used little of either one). But indigestion, and holding one's breath when bending over to tie shoes, for example, raises internal pressure and this must affect the Vagal response or tone. I found myself belching frequently, sometimes setting off AF, and other times it would be bending over and holding my breath due to adiposity internally.
I had an ASD at birth and repaired as a child. At 40 I was diagnosed with AFib. The IV medicines caused my heart to pause for 7 seconds. The cardiologist stopped the meds immediately and performed an AV node ablation with pacemaker. I don’t take AFib meds I only take Eliquis. I’m 71 now and still have anxiety over all of this. Without the AV node, my heart is 100 % dependent on the pacemaker. Hence my anxiety. My question is this is correct right? Is there another node that can take over should pacemaker stop working?
Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. However, anything that causes stretching or dilation of the left upper chamber of the heart, the left atrium, where the Afib cells form will also cause Afib to progress or form earlier. This includes high blood pressure, untreated sleep apnea, valvular disease where the mitral valve either leaks (regurgitation) or doesn’t open (stenosis), or in your case an ASD (atrial septal defect) which is a hole in the middle wall of the heart allowing increased blood flow into that left upper chamber of the heart thereby increasing pressures and dilating the walls. Remember, Afib is not one of the directly life threatening abnormal heart rhythms meaning it won’t ever make your heart race at a directly life threatening speed that will cut off blood supply to your brain and make you pass out and die. Instead Afib just causes symptoms of rapid heart rates like you are exercising, can cause a small but real risk of clots and stroke which is why most people with Afib are placed on a specific and powerful blood thinner to reduce the risk of this to less than 1%, and is a disease process that progresses over time. Once you live long enough to develop Afib cells in the walls of your heart that start to randomly wake up, every year you get older the more Afib cells form on the walls of your heart. The more walls-worth of Afib you have the stronger it becomes, the more it wakes up, and the less it goes back to sleep resulting in you spending more and more time in AFib percentage-wise until it is eventually Permanent AFib which usually occurs after 10-15 years. Permanent Afib is when you have enough Afib cells that they are awake 100%, they don’t go back to sleep at all, and no medication such as an antiarrhythmic medication (AAD) is strong enough to put it to sleep, and even those of us who do very complex Afib ablation can get rid enough of it from the inside to get you back to normal rhythm. At that point we just use “rate controlling” meds to slow your Afib to a speed that you just tolerate and that is the best we can do. But as along as you don’t have a clot and stroke from your Afib, you will live just as long as everyone else because Afib is not directly life threatening. See my videos “What Causes Afib?” and “Stages of Afib Explained” In your situation it sounds like your ASD dilated the walls of your left atrium prematurely leading to early development of Afib and so they tried the simplest method to treat your symptoms which is to slow it down with a rate controlling medication. However, these meds don’t just slow your heart rate down while in Afib, they slow your normal rhythm speeds down when your Afib goes to sleep. And since your normal rhythm isn’t making your heart go super fast the way Afib does, sometimes the meds can make your normal rhythm speed go too slow which is what sounds like happened with you. At this point you had several options: you could have placed a simple pacemaker implant which kicks in and paces when the heart rate goes too slow (see my video “Will a Pacemaker Treat My Afib?”) then use the rate controlling medication to keep the heart rate controlled when you went into Afib and just tolerate it (less risky). Another option would’ve been to use a stronger Antiarrhythmic medication (AAD) to temporarily keep the AFib asleep (more risky), or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Some of the AAD meds don’t slow your heart rate down at all so if your Afib was suppressed and kept asleep completely (which depending on the strength of the AAD and your stage of AF progression can sometimes last for years at a time) maybe you wouldn’t have needed a pacemaker. And of course if you had an AF ablation done by a competent Electrophysiologist where all of your Afib was gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, then you wouldn’t be going in and out of Afib so you wouldn’t have needed a med to slow your heart rates down thereby avoiding slowing your normal rhythm speeds down too slow and needing a pacemaker. True even if you get rid of all of a pt’s Afib with the ablation and turn the clock back to zero it is not a permanent cure because the Afib will slowly grow back in other areas as the pt ages, but it can keep it from becoming permanent anytime soon.
But it sounds like instead of using an AAD or doing an AF ablation, they put in a pacemaker and instead of using the rate controlling med to slow down the Afib, they chose to do an AV node ablation. This is a minor procedure that we usually only do when your Afib is 100% awake and permanent. Sometimes patients Afib progresses to Permanent status and we no longer have the option of keeping it asleep or getting rid of it from the inside because it is too progressed and strong. But if their rates in Afib are too fast and they are still too symptomatic despite using aggressive doses of a rate controlling medication, we can do a minor ablation where we spend 5 minutes and destroy the nerve that conducts electricity through the heart. There are four chambers in the heart, two upper and two lower. It is actually the two lower chambers that pump the blood out of your heart, not the upper chambers. When you feel your heart rate you are actually feeling the speed your lower chambers, the ventricles, are pumping at, not the upper chambers, the atria. The atria act as primer pumps to help push blood from the top of the heart to the lower chambers, but blood naturally flow through these chambers into the bottom chambers on its own. Yet the sources of Afib and also your normal rhythm source are located in the walls of the left upper chamber and in the roof of your right upper chamber, respectively. Both sources use the AtrioVentricular Node (AVN), which is a nerve that connects the top chambers of the heart to the lower chambers, to conduct electricity from the sources down to the bottom chambers of the heart to actually pump the blood out of the heart. If we purposely destroy this nerve, which is very easy to do but can’t be undone once it’s done, then the Afib cells can no longer control the bottom chambers of the heart and tell them to speed up causing symptoms. But neither can your normal rhythm which also uses that nerve to conduct signals to control the bottom chambers of the heart, be able to control the bottom chambers. So where do the bottom chambers get a signal telling it what speed to beat at? Without an electrical signal controlling it your heart won’t beat and you’d be dead. The pacemaker, which is a device that paces the heart when it goes to slow, is implanted first and this controls the bottom chambers of the heart from that point forwards. The analogy would be to say that the generator of electricity in your home is “infected” by weird Afib circuits that make the lights flicker horribly. You can either use a medication to suppress the abnormal circuits or a full-on ablation to destroy all of the abnormal circuits. But if all of that has failed, the next best thing would be to open a hole in the wall of the room and snip the electrical wiring transmitting electricity from the generator to the lights in the room. The lights will go out but they won’t flicker any more. Then you attach your own portable generator to the lights and power it that way. That would be the same as destroying/ablating the AV node nerve and then putting a simple pacemaker to take over control of the heart mechanically from that point forwards. The advantage is that this is a simpler, technically easy, less risky procedure than a full Afib ablation, has a 100% success rate, and will make it so you never have fast heart rates in Afib ever again because the pacemaker is now 100% controlling your heart rate. Plus you can get off of rate controlling meds or antiarrhythmic meds to suppress your Afib. The downside is that you really didn’t get rid of your Afib because the top part of your heart is still controlled by the Afib cells; they just can’t control the speed of the bottom chambers of your heart anymore. This is why you still need to be on blood thinners to protect against clots and strokes. And secondly you now have a pacemaker and are technically pacemaker dependent. If you ever let your battery run out on the pacemaker there won’t be any conducted heart rhythms and so you could pass out or even die. Now technically that would be rare. It is extremely rare for pacemakers to just stop working considering the technology has been around for 70 years. Also, as long as you get your pacemaker wireless checked every 6 months as recommended, we would detect a problem with your pacemaker long before it ever made it stop working. Please see my video “Will a Pacemaker Treat My Afib?” It is possible that if your pacemaker stopped pacing for whatever reason that an “escape rhythm” meaning a different source of electricity in your heart might wake up and take over control of your heart, but this isn’t guaranteed so I wouldn’t necessarily count on it. Just make sure your pacemaker is regularly checked and in good working order and you should be fine. The good news is that you will never have fast heart rates due to Afib ever again as you will just be paced 100% from this point forwards. But I agree, had they done one of the many other options that I mentioned, you maybe could’ve avoided being made pacemaker dependent. Then again, depending on how long ago this was done, up until about 10-15 years ago Afib ablation was a lot more primitive and so this type of treatment was done a lot more. Nowadays it is rarer to have this done unless one’s Afib really has progressed to permanent or one is going to a less scrupulous EP who is doing mediocre sham ablations just to bill you and then after doing this 3-5 times without getting rid of all your AFib ends up doing a pacemaker and AVN ablation (which unfortunately does happen). I hope this helps!
@@afibeducation Thank you so much for your thorough explanation. I do have my pacemaker checked every six months. Also I had the AV node ablation in 1995, so 29 years ago; so that is probably why they went with this type of remedy. (AV node ablation with pacemaker.) I don’t remember my cardiologist giving me a choice 😔I would like to ask one more question. I walk often and rebound on an exercise trampoline for good cardio health. Would this strengthen my heart enough to keep beating should pacemaker fail, until I can receive medical help? And do you know if the pacemakers today have a back up system?
Unfortunately, no amount of exercise and even having the strongest heart in the world would keep your heart beating should your pacemaker fail because the heart’s electrical conduction system is separate from the strength of the heart muscle and after your AV node ablation no electricity gets to your heart muscle to control it except the artificial signals from the pacemaker. It would be like saying the wiring in the walls of your home are cut and so your lights go out. It doesn’t matter if you had the strongest, newest, best lightbulb on the planet, it still wouldn’t turn on if the portable generator of electricity you were using to power it were to stop working. And no, pacemakers don’t have backup systems. They are so reliable that they really don’t need one. Once again, as long as you have yours checked every 6 months, it would be extremely rare for your pacemaker to ever stop working because most of the time we will be able to pick up a potential problem long before it made your pacemaker stop working. I hope this helps!
@@afibeducation Thank you 🙏 I so appreciate your reply and detailed explanation. And yes! Your answer has helped me tremendously. 😊
After my husband died, i started to leave tv on all night. Could this have caused disruptions in sleep patterns and caused Afib?
Hi! Thanks for watching. Leaving the TV on all night thereby disrupting your sleep pattern likely did not cause your Afib. Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. Unfortunately, once you live long enough to develop Afib cells in the walls of your heart that start to randomly wake up, every year you get older the more Afib cells form on the walls of your heart. The more walls-worth of Afib you have the stronger it becomes, the more it wakes up, and the less it goes back to sleep resulting in you spending more and more time in AFib percentage-wise until it is eventually Permanent AFib which usually occurs after 10-15 years. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. So in your situation it is likely that your Afib was slowly developing due mainly to you getting older, and after your husband died and you were under stress from that it probably helped trigger it awake even more. Then as you’ve continued to age it has continued to slowly progress. I hope this helps!
@afibeducation thank you.
When I was much younger strong Coffee gave me some kinda skipping beat sensation of heart & past 40 just went away & alcohol doesn't have any effect so far....
Skipping of your heart beat doesn't always mean that you are in AFib. Remember, your heart is controlled by a source of electricity because it is essentially a big dumb muscle. Usually your normal source of electricity, the sinus node that is located at the roof of your heart, is in control of your heart and it tells your heart to beat at whatever speed your brain wants it to go to based on what you are doing. When an abnormal rhythm like AFib forms and wakes up and temporarily takes over control of your heart away from the normal source of electricity, it can tell your heart to go at any speed it wants but always something faster than your normal rhythm source. True, AFib makes your heart go fast and irregular, but in truth you can't tell where the electricity is coming from that is controlling your heart. You can only tell if your heart seems faster than normal or irregular. Only an ECG or heart rhythm monitor can sense the electricity in your heart directly and identify who is in control. Your normal rhythm can be in control and sometimes be a little bit irregular. More commonly younger individuals develop a condition known as premature beats which are essentially single extra heart beats coming from a weak abnormal source of electricity that doesn't take over control of your heart but just adds a couple of extra beats. These are called PVCs (premature ventricular complexes) or PACs (premature atrial complexes). They are benign and often woken up with stimulants like coffee. If you have weird sensation of palpitations either irregular or racing, the best way to evaluate it is to see either a general cardiologist or a competent electrophysiologist (electrical cardiologist) where a heart rhythm monitor can be placed to catch your symptoms and verify exactly what is going on. Also feel free to watch my video on Does an Irregular Heart Rhythm Mean I'm in AFib? I hope this helps.
Has the good Doctor ever had a heart rate of 265bpm? He stands there like its no big deal
I appreciate your feedback. No, I have never personally had a heart rate of 265bpm, but over the twenty plus years of practicing Cardiac Electrophysiology, I have seen and taken care of plenty of patients who have. I never said that it was no big deal. In fact having fast heart rates in Afib even not up 265bpm can be extremely symptomatic and instill a lot of fear and panic in patients. This is why took the time to create 40+ videos on Afib with over half of them discussing in detail the specific pros and cons of the various treatments currently available to treat the symptoms caused by Afib. Long term treatments (for symptoms because AFib is not directly life threatening unless it causes a clot and a stroke) include just slowing it down with a simple rate controlling medication (least risky), putting the AFib cells actively to sleep with a stronger antiarrhythmic medication (more risky), or doing a procedure to try to map and get rid of these cells from the walls of the heart directly (most risk). Whether to just live with Afib and control the rate (least risky) versus try to suppress it for a few more years with a strong antiarrhythmic drug then accept when it is permanent (more risky) or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. Please see my videos: “What are the Symptoms of Afib?” and “How Do I Treat the Symptoms of AFib?” One of the main reasons I took the time to create this channel and these videos is precisely because I’ve seen many regular cardiologists still practice 30 year old medicine and not offer all treatment options. They put patients on a blood thinner to protect them from the small but very real risk of clots and strokes, but for the patient’s symptoms they just give them a simple rate controlling medication to slow down the speed of their Afib and tell them they won’t die and to just live with the symptoms. They won’t discuss other treatment options to try to get the patient out of AFib and they won’t refer the patient to a Cardiac Electrophysiologist (EP’s) to discuss these other options. However, the point of the “8 Myths” video was not to talk about symptoms or imply that patients with Afib can’t have severe symptoms. It was to discuss the myth that Afib by virtue of the fact that it can speed up your heart rate means that it is directly life threatening. And that is false. Unless your Afib causes a clot to form in your heart that breaks loose, floats to your head, blocks off blood supply to your brain, and causes a stroke, Afib will not directly kill you just by speeding your heart rate up. Again, this is not to say that if it makes your heart rate go at very fast speeds that you won’t be severely symptomatic. But having a lot of symptoms isn’t the same as directly dying from it. AFib is the most common abnormal heart rhythm out of the 13-15 different abnormal heart rhythms people can develop in their lifetime. Out of these there are 4 that are considered directly dangerous life threatening abnormal heart rhythms and these originate in the ventricles, the bottom chambers of the heart. Examples of these rhythms are “Ventricular Tachycardia, Ventricular Flutter, and Ventricular Fibrillation.” These rhythms can take over control of your heart and and make your heart rate speed up to a life threatening speed of over 300bpm. At this speed your heart is beating too fast to effectively pump blood because there isn’t enough time to fill up in-between heart beats so the blood pressure drops below 60mmHg which isn’t enough to perfuse the brain and other organs of the body. This causes immediate loss of consciousness and death within 20-30 minutes without chest compressions and defibrillator shocks for resuscitation, and is called a cardiac arrest. Atrial Fibrillation and Atrial Flutter are not capable of making the heart rate go at life threatening speeds of over 300bpm and as such they are not abnormal heart rhythms that can cause a life threatening cardiac arrest event. Even in the cases where Afib or Aflutter speeds the heart rate up enough such that the blood pressure does drop enough to make the patient feel lightheaded, it is rare that the blood pressure gets low enough to cause full syncope/loss of consciousness. This is why we treat patients mainly for symptoms because as long as one is protected from having a clot and a stroke from their Afib, they will not directly die just by having their Afib speed their heart rate up. The faster and more symptomatic your Afib is, the more aggressive a treatment option you may choose; the slower and less symptomatic your Afib episodes are, the less aggressive a treatment option you might go with. But the belief that Afib will kill you even if it doesn’t cause a stroke or that Afib is more life threatening the more symptoms you have is a myth, and I believe it is important that people understand this.
Over my twenty plus years of practicing in this field, I can not tell you how many times I see patients who have minimal or no symptoms from their Afib but be terrified that they might have an episode while sleeping or an asymptomatic episode and not know it, and therefore just die. This is often exacerbated by non-Cardiologists who sometimes overreact. Often patients tell me their Afib was first diagnosed because they had mild palpitations and they went to an Urgent Care Clinic or their Primary Care Doctor and was found to be in new-onset Afib at 120bpm and were told to get to the hospital right away else they will die! Terrified they rush to the hospital only to have the ER docs give them IV Diltiazem (a rate controlling medication) to slow their heart rate but it doesn’t put the Afib back to sleep. Then they admit them overnight waiting for the Afib to go back to sleep on its own which in the early stages usually happens after an hour or two. And now the patient is terrified they could at any moment lose consciousness and just die. Similarly, I’ve seen plenty of less scrupulous Electrophysiologists in my field prey on this lack of information to bully patients into Afib ablation procedures because they make more money to do a procedure than to put the patient on meds. I’ve seen patients show up to the hospital with Afib, have it go back to sleep after a day on its own, then have an EP consulted. But instead of explaining that because the pt is on a blood thinner for their Afib they won’t have a clot and a stroke and die from their Afib, that Afib is mostly treated for symptoms, and then find out how much Afib episodes the patient is having, how symptomatic it is, and then based on the patient’s age, risk tolerance, and preferences, help the patient decide the best long term treatment for their symptoms: whether that be just slowing the Afib down with a simple rate controlling medication, keeping it asleep with a stronger antiarrhythmic medication (AAD), or considering an AF ablation to try to get rid of it temporarily from the inside; instead they spend less than 5 minutes with the patient and essentially tell them that they need an AF ablation and that they need to do it before the patient leaves the hospital implying that if they don’t they will die. This is just someone bullying a patient into a procedure to make money. And unfortunately I’ve seen it happen a lot. Then they end up doing the ablation but the EP doesn’t do a very good job (they rush through the procedure doing a mediocre job so they can put on as many procedures a day as possible in order to make more money) and they end up doing it 3-5 times over a period of time, and then they put them on an AAD to suppress the remaining Afib and they tell the patient that that is the best that can be done. I had a patient come to me for a second opinion after having 3 AF ablations by another EP who was currently planning a fourth. His question was should he undergo a fourth ablation? After taking an hour to explain that Afib was not directly life threatening as long as he stayed on his blood thinner and didn’t have a stroke, and after discussing the pros and cons of the various long term treatments for Afib, I asked him, “I assume you must have a lot of symptoms considering they did three ablations on you?” Surprised the patient replied, “I can’t even feel when I’m in Afib!” I then asked why then did he undergo three ablations. His response? “Well, they didn’t explain anything to me and they made me feel that if I didn’t have the ablations I would die.” This happens because this field is so specialized that even regular Cardiologists don’t really know what we do let alone patients, so docs get away with it. And also because under the current system of reimbursement we get paid for doing something, not for getting a specific result. For example, I might spend twenty years experimenting and learning advanced techniques in order to get rid of Afib even in the most advanced stages and as such I block out 3-4 hours for a pt’s procedure and end up ablating 5-6 out of 6 walls to successfully ablate their persistent or longstanding persistent Afib into normal sinus rhythm, and 3 months later after everything settles down they are off any antiarrhythmic medication spending zero or minimal time in Afib. Another EP, even those just a couple years out of training, could block out 1 hour because they are just planning on electrically isolating that first wall, the pulmonary veins, irregardless of whether that is enough to get rid of all of that pt’s Afib, and as a result they can put on 4 procedures instead of my 2, and get the 2nd, 3rd, or even 4th redo’s and make 3-6 times the money for getting a worse result. This is because we all use the same billing code from the health insurances which again pays us for doing something not for getting a specific result. It is assumed that we all do the same thing and get the same results, which personally I don’t think is true for any profession on the planet. It’s unfortunate, because it often feels like one is penalized for trying to do the ethical thing of only doing a procedure if after explaining things thoroughly to the pt it is decided that it is the right thing to do; and if doing a procedure is deemed needed, doing it in such a way where only one procedure is necessary most of the time. Again, this is one of the main reasons I created this channel and website so as to empower patients to hopefully not be bullied into unnecessary procedures and to know if their doc is practicing 30 year old medicine and not giving them all available treatment options. Thanks for watching!
@@afibeducation Thank you so much for the detailed reply. In my case I was extremely symptomatic and it destroyed my quality of life. This went on for 3 years until I met with an EP who completely understood my situation. The cardiologist diagnosed A Flutter and Tachycardia. When I then learned of electrophysiologist's I went for a second opinion. Two separate EPS said they could see nothing to suggest the original diagnosis and said I had A Fib. and went onto a waiting list for ablation which I had in June of this year and I have been in NSR ever since that day. One more point, before the ablation I went into A fib every night at around 2 am and would self convert in about 2 hours this went on for 6 or 7 months, some days I would go into afib 4 or 5 times and self convert in about an hour and a half but.....before I converted I would just about pass out or some times did pass out, I learned these were called pauses. When in ER and they caught the pauses on the EKG we saw the pauses were average 9 seconds long and 1 was 18 seconds! I ended up with a pace maker the next day and no pauses since. I often wonder if I had have had the successful ablation before the pace maker if the pace maker would have been needed? I will see this July at the annual pace maker appointment if it has been pacing since I had the successful ablation Once again thank you for the reply
Please remove that background music.
It is very annoying and competes with your presentation cause you are speaking so fast. Slow down!
I love the background music, I wish it was more aggressive. 😅
Thank you for watching and for your feedback. Another option for you is to turn on the subtitles and then turn off the sound. That way you can just read what I am saying.
Thank you!
Ok Karen 😂😂😂😅😅😮😢
I was one of the first in Germany to get a Watchman implantation. All i take is a baby aspirin 80 mg and 5 mg of Bisoprolol.
Up to now 17 years later..All is well thank the Almighty.
I'm glad you got a good result!
@afibeducation Thank you.👍👍
The Watchman really helped me to, after having a nosebleed and needing a transfusion.
A Watchman certainly can help you not have to take blood thinners long term. However, remember that the premise of the Watchman is that AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). However, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). I'm glad you got a good result with your Watchman!
Research magnesiium supplements. Eating more vegetables is tonbe considered too. Best thoughts
Magnesium supplements in Afib in my experience has been hit or miss. Unless your magnesium levels are low, I’ve never since a reliable effect of Magnesium to keep Afib from waking up, although studies show it may make your episodes of Afib a little bit slower.
Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. This is how eating more vegetables and having a healthier diet can help since it can help you lose weight. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” I hope this helps!
A lot of young people on Reddit with AFib
I have atrial fibrillation and I got it once a week , but I have heart palpitations every day to the point that keep the me awake at night 😢
AFib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop AFib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have AFib. At 80’s y/o it is 20%, and by 90’s y/o 30% have AFib. So it is truly an age related disease. Unfortunately, once you live long enough to develop AFib cells in the walls of your heart that start to randomly wake up, every year you get older the more AFib cells form on the walls of your heart. The more walls-worth of AFib you have the stronger it becomes, the more it wakes up, and the less it goes back to sleep resulting in you spending more and more time in AFib percentage-wise until it is eventually Permanent AFib which usually occurs after 10-15 years. So AFib is a progressive rhythm problem that wakes up more and more over time. See my video on “What Causes Atrial Fibrillation?” Therefore, it is possible that the daily palpitations you are feeling is your AFib progressing. You can’t tell where the electricity is coming from that is controlling your heart, only if your heart rate seems abnormally fast. Only an ECG or heart rhythm monitor can identify if you are really in Afib or not. Sometimes people think their AFib is progressing but it turns out they are just under the control of their normal rhythm but it’s just irregular. Wearing an external heart rhythm monitor for a week should be able to identify which rhythm is in control of your heart when you feel your daily palpitations. See my video “Does an Irregular Rhythm Mean I’m in AFib?” If it is true that your AFib is progressing such that it is causing symptoms daily, then a discussion as to how to treat your AFib symptoms long term is needed. Remember, AFib really causes only two problems: risk of blood clots forming in your heart that can break loose and go to your head to cut off blood supply and cause a stroke, and the ability to take over control of the heart to speed it up to a faster rate thereby causing symptoms. Both of these need to be treated separately, but as long as you don’t have a clot and stroke from your AFib, it is not life threatening and mainly treated for symptoms. For long term symptoms treatment, your options are to either just tolerate the AFib (no risk), use rate controlling meds to keep your heart rate in AFib mostly controlled and just tolerate the symptoms (less risky), use a stronger Antiarrhythmic drugs (AAD) to temporarily keep the AFib asleep (more risky), or try to “turn back the clock” on your AFib to an earlier stage with an ablation (most risky). Remember, AFib slowly grows and progresses as you get older (although this happens over years) and the more progressed it becomes the more it wakes up and the less it goes back to sleep resulting in you spending more and more time in AFib until it is eventually Permanent AFib at which point no medication will be strong enough to keep it asleep and no ablation even by those of us who do very advanced, complex ablations will be able to get rid of enough of it to return back to normal rhythm. Up until your Afib is permanent it is possible to keep you in normal rhythm feeling completely normal using either an AAD or ablation, but it gets progressively harder to do so the more progressed your AFib becomes. This is why younger patients often consider an ablation because if their AFib became permanent after 15 years they might only be in their 60’s and regret that. On the other hand, maybe a procedure scares you and a 1-2% or less risk of a complication is too much for you and you would never consider it. Everyone is different. Usually when pt’s are in their 80-90’s where the risk of procedures go up, most say just do the least risky thing which is to either slow the AFib down with a rate controlling med and have them tolerate it or if symptomatic to keep it asleep with an AAD. Usually pt’s in their 40-50’s say they don’t want to just tolerate it and are willing to accept a small risk of a procedure to try to get a better long lasting result. But after doing this for 20 years, sometimes I see older pt’s say they understand the risks and still feel an ablation is right for them and sometimes I come across a younger pt that says the procedure scares them and they would never want it unless they were very symptomatic and all meds failed. Everyone’s stage, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. If you chose to temporarily suppress the AFib with an AAD remember this does not get rid of the AFib cells or keep them from progressing as you get older; it simply masks the existing AFib cells until they grow strong enough to override the medication. So you may be able to keep them asleep for several years depending on how fast your AFib cells are growing/progressing. I hope this helps!
Background music annoying.
Thank you for the feedback. I've received comments from people who enjoy the background music and wished it was more aggressive, so it is hard to decide what to do. Another option is to turn off the sound and turn on the subtitles. That way you can just read what I'm saying.
Are you telling us there is no cure for a fib
Unfortunately, yes. Since AFib cells grow and develop just by getting older, they tend to naturally progress over time. However, there are things that can cause the AFib cells to grow and spread faster on top of just aging. These would be things like poorly controlled high blood pressure, untreated sleep apnea, poorly controlled diabetes, being overweight, and being too sedentary. So controlling these factors can greatly slow down the progression of your AFib. Losing weight, even 10% of your current body weight, has been proven to not only slow the rate of progression of AFib, but can sometimes cause some remodeling of your heart walls such that your AFib may even regress to an earlier stage. Although trying to “reverse” your AFib back to zero is unlikely and the amount of regression is likely dependent on what stage of AFib you are currently at. Please see my videos on “Can I Prevent Afib?” and “Stages of AFib Explained.” Then there are the things that don't cause AFib cells to grow or progress directly but can wake them up more at any given stage of progression. This would include things like stimulants, stress, caffeine, and alcohol because of its direct toxic effects on the heart. Avoiding these agents will definitely decrease the amount of "triggered" AFib episodes, but remember based on whatever stage of progression of AFib you are currently at (early, mid, late) will determine how many AFib cells you have inside your heart presently and they can wake up randomly on their own even without a "trigger" with the more AFib cells you have on the more walls of that left upper chamber of the heart (the more advanced stage of AFib progression) leading to you having more AFib episodes and a greater percentage of time spent in AFib overall. And then of course there is an AF ablation. By mapping and get rid of AFib cells from directly within the walls of your heart you can "turn the clock" back on the level of AFib progression either to an early stage or even to zero depending on how much AFib you have at present and the skill of the operator doing your procedure. But even if you get your amount of AFib down to zero it is not a permanent cure because it can slowly grow back in other walls, and it will grow back from whatever level the doc doing your ablation reduces your AFib amount to so the more we can get rid of on the inside the more time it will take for your AFib to grow back to that level. But even if your AFib ever progresses to the end stage where you are in it 100% and we can't get you out of it any longer, it is never life threatening as long as you don't have a clot and a stroke from it; we are always mainly treating symptoms. I hope this helps!
Great info,but way to long winded.
Stress lack of sleep
Yes, these can "trigger" episodes of AFib!
Lucky I was allergic to Amiodarone.
When treating Afib, everyone’s stage of progression of Afib, symptoms, age, risk tolerance, and personal preference are different which is why an ethical Electrophysiologist should explain the pros and cons of all options and help the pt come to the right decision for their situation. If you choose to temporarily suppress the AFib with an antiarrhythmic medication (AAD) remember this does not get rid of the AFib cells or keep them from progressing as you get older; it simply masks the existing AFib cells until they grow strong enough to override the medication. So you may be able to keep them asleep for several years depending on how fast your AFib cells are growing/progressing. There is however a strength level to the AADs. Amiodarone is the strongest but has the most long term side effects. If you are on it for more than 5-7 years there is a 30% chance it will damage your liver, lungs, eyes, or thyroid. That is why I personally never use it for long term suppression of AFib (short term suppression for less than a year is okay) for anyone less than age 75 y/o because you could be on it for 10 years with adequate suppression of your AFib because it is so strong, but then develop a side effect and have to stop it and still be a fairly young age. And because your Afib continues to progress and grow stronger even if it is being kept asleep by the AAD you are on, if one uses Amiodarone for a very early stage of Afib before it is really needed, after 7-10 years one might develop a long term side effect from the Amiodarone so have to stop it but then one’s Afib might be too strong to be able to be suppressed by the other AADs that aren’t as strong. But if one is over 80 y/o then Amiodarone could be very appropriate. I usually try to use an AAD closer to the level of the pt’s stage of progression and then work upwards to the next strongest drug every few years when the AAD fails. Thanks for watching!
My heart rate goes from 40 to 175
If that is really true, the question becomes: Who is controlling my heart when it speeds up from 40-175bpm? Is it my normal rhythm source in the roof of my heart that is supposed to be in control? Or is it an abnormal source of electricity that isn’t supposed to be there and is located in another wall of my heart and is making my heart go faster every time it wakes up? And if it is an abnormal heart rhythm, which one out of the possible 15 of them is it? Remember, AFib is not the only abnormal heart rhythm. There are 13-15 different abnormal heart rhythms you could possible develop and it is possible to have more than one abnormal rhythm (arrhythmia). The way to diagnose all of this is to catch your heart rhythm during a typical episode of fast heart rates by wearing an external heart rhythm monitor. They are called Event Monitors and can be worn for a day, a week, two weeks, or up to a month. For symptoms that are more infrequent than that and difficult to catch, there is a small device without wires called a Loop Recorder than can be surgically placed underneath your skin on your chest and it can record your heart rhythm for up to 3-4 years to make sure you catch the episode. This can all be evaluated by an ethical cardiac electrophysiologist. I hope this helps! Please see my videos "What is an Arrhythmia?" and "What is AFib?"
I met my cardiologist today, with a new Ecg test taken today. I'm scheduled for a session of shocking my heart , in early January. He also modified my medication.
Thanks for you feedback@afibeducation
Remember, cardioversion or shocking your heart for AFib is not a long term treatment. Any shock will get any abnormal heart rhythm to temporarily go back to sleep so your normal heart rhythm takes back over control. It is not a cure, it will not get rid of the abnormal cells, and it won't make them not wake up. It just gets them to go back to sleep for the moment, but they can still wake up again in the future. That is why electrical cardioversion is usually used in conjunction with Antiarrhythmic Medications that work to keep the AFib asleep so it doesn't wake right back up. See my videos on "Cardioversion in AFib Explained" and "Antiarrhythmic Medications in AFib Explained." Good luck!
I got an electric cardioversion 2 days ago. My afib came back late in the evening. I went to see my cardiologist yesterday. He is going to scedule another cardiogram. With the holidays coming up it will go to the first week of January.
Thanks for your replu
.@afibeducation
❤
Thanks!
Want get watchman get off blood thinners
A Watchman certainly can help you not have to take blood thinners long term. However, remember that the premise of the Watchman is that AFib can lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). However, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
Very informative. Thanks. Really helps my understanding on AFib. I’m from Malaysia. Had an episode and diagnosed with AFib a few months ago.
You're welcome! Please feel free to watch "What is an Arrhythmia?" and "4 Basic Facts About AFib" and "How Do I Treat The Symptoms of AFib?" to learn more in depth about AFib, what you need to worry about, what you don't need to worry about, and what are the pros and cons of the different long term treatment options available for Symptom treatment.