#013 How to Get Rid of Atrial Fibrillation Once and For All
Dr. John DayDr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark’s Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology. |
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Do you or someone you love suffer from atrial fibrillation (A-fib)? If so, you are not alone. One in four Americans will have at least one episode of A-fib in their lives. In this article, I share how to get rid of atrial fibrillation.
Many of my patients feel horrible when A-fib strikes. Their hearts race chaotically and they often feel short of breath, fatigued, dizzy, lightheaded, or may even have chest pain.
The effects of A-fib can be devastating. A-fib is one of the major causes of stroke. It can also put people on a number of different medications, all with serious side effects.
This is something you definitely want to avoid, if possible…
If you are like most patients with this condition, you have already been put on a heavy duty blood thinner for life. You may also be on a medicine to slow your heart down or hold you in rhythm.
Do you want to live this way for the rest of your life? There are other options.
If aggressive lifestyle changes are made soon enough, the A-fib may completely go away. I have seen many patients “beat” A-fib just by making significant lifestyle changes. For others, the A-fib attacks may significantly decrease. Sometimes, lifestyle changes alone may not be enough. If this is the case, all is not lost. These lifestyle changes will double your chances of successfully beating A-fib with a minimally invasive procedure called an A-fib ablation.
If we are going to beat A-fib, we need to know everything that may be contributing to this condition. If we can aggressively attack each of these 10 items early enough there is an excellent chance that you can get rid of A-fib once and for all!
1. Get Rid of High Blood Pressure
High blood pressure is one of the main causes of A-fib. It puts a big strain on the heart which can cause the lower chambers of the heart to thicken and the upper chambers of the heart to enlarge.
If you have high blood pressure you are not alone. Studies show that half of all Americans have a blood pressure above the goal of 120/80 mmHg as established by the American Heart Association. As with A-fib, if significant lifestyle changes are made early enough, high blood pressure is completely reversible.
I have seen this with many of my patients. In fact, after just a few weeks of making major lifestyle changes, under the direction of their physicians they can start getting off of their high blood pressure medications. I personally dropped my blood pressure which could go as high as 150/90 mmHg down to 110/70 mmHg without medications.
For more information on how to reverse high blood pressure, please read my article “How to Get Off Your Blood Pressure Medications: Lower Your Blood Pressure with These Eight Steps.”
Until you can reverse your high blood pressure with lifestyle modification, you may need to work with your physician on getting this under control. For my patients with A-fib, I tend to be aggressive on getting the blood pressure under control. I usually shoot for a target of less than 135/85 mmHg.
2. Reverse Your Biologic Age
Unfortunately, getting older is a big risk factor for developing A-fib. Even though you are getting older year-by-year (your chronological age), you can reverse your biologic age now! Your biologic age can be 10-20 years younger than how “old” you are. You can regain your youth, feel great, and reverse the effects of aging on your heart.
How do you reverse your biologic age? Please read my recent article “We Can Reverse the Aging Process“.
3. Keep Stress in Check
It seems like we are all stressed out. According to a study from Everest College, 83% of Americans are stressed out at work. One study showed that our chronic stress is the equivalent of smoking 5 cigarettes a day! Even if you just think you are stressed is enough to increase your risk of a heart attack by 27%!
When we are stressed our bodies release cortisol and adrenalin into the blood stream. These substances are toxic to the heart if it continues long enough.
What can we do to get our stress under control? Make it a priority to do something every day to get your stress levels under control. We will never be able to completely avoid stress. It is part of the human experience.
Even something as simple as yoga to calm your nerves has been shown to decrease your risk of A-fib by 50%! The key is to recognize your stress and do something actively every day to bring your stress levels down. For some people this could be exercising, spending time in nature, reading a good book, getting a good night of sleep, or just hanging out with your friends.
For more information on this, please read my article “Seven Ways to Manage Stress”. https://drjohnday.com/?p=779
4. Reduce Inflammation
Inflammation is like stress, it can be helpful to the body for short periods of time. However, when inflammation never turns off it can damage the heart and the rest of the body as well as result in premature aging.
It has been recognized for quite some time that inflammation is an important cause of A-fib. The good news is that if we can turn off the inflammation for our heart it will help the rest of our body to recover as well.
Did you know there is a simple blood test your doctor can order for you to check your inflammation level? This test is called C Reactive Protein or CRP for short. The goal is to have a CRP of less than 1 mg/L. If you can get your CRP to less than one you can dramatically reduce your risk of A-fib, heart attacks, cancer, and even Alzheimer’s Disease.
How can we reduce inflammation? Please read the article I wrote on this subject entitled “Six Strategies to Reduce Inflammation and Chronic Pain“.
5. Get Your Weight in Line
Did you know that being overweight is one of the biggest causes of A-fib today? A recent study published in the Journal of the American Medical Association by my good friend, Dr. Prash Sanders, showed how important weight loss is with reversing A-fib. In this study, if overweight people could lose just 32 pounds, they could reduce their A-fib attacks nearly three-fold.
This is something I have seen time and time again in my practice. Overweight people with A-fib who can lose the weight can often make their A-fib go away.
6. Eat the Right Foods
Did you know the rates of A-fib are several times higher in North America than anywhere else in the world? The Standard American Diet (SAD) is like pouring gasoline on the A-fib fire. The right foods can reverse most of the factors, discussed in this article, driving A-fib.
For my patients with A-fib I recommend the following:
-Nine servings of fruits or vegetables daily
-At least one serving of nuts or seeds daily
-At least one serving of legumes daily
-Two servings of a low mercury oily fish, like salmon, weekly
For many of my patients, they need to learn how to eat vegetables. Vegetables can be the most wonderful tasting food if prepared right. These foods can heal our hearts and our bodies.
To go along with these must eat healing foods, I recommend that my A-fib patients minimize or avoid the following three foods.
-Processed or prepared foods
-Animal meat, especially processed meats (hot dogs, sausage, bacon, deli meats) and red meat
-Sugar, including foods that are immediately turned to sugar like wheat flour, white rice, or potatoes
The goal is to eat real food. To get back to cooking and sharing meals with friends and families!
7. Rejuvenating Sleep
I cannot stress enough how important it is to get rejuvenating sleep if we are to beat A-fib. For most people this means at least seven hours of sleep. It also means sleep free from sleep apnea.
What is sleep apnea? That is where people stop breathing while sleeping. These big drops in oxygen levels when people are not breathing can lead not only to A-fib but also to heart attacks, sudden death, heart failure, or high blood pressure.
How do I know if I have sleep apnea? Generally I find that the spouse or sleeping partner can easily make this diagnosis. People with sleep apnea usually snore like a train and then will stop breathing for 20 or 30 seconds.
Fortunately, for most people, sleep apnea is totally reversible. It is a complication of being overweight. With weight loss the sleep apnea usually goes away.
Until the weight can be lost, I recommend that my patients with sleep apnea get treated. Studies show that you can cut the numbers of A-fib episodes by about 50% with getting the sleep apnea treated.
8. Get Moving
Did you know that people with the least amount of physical activity are at high risk of developing A-fib? The key is to get moving! The first thing I recommend for my patients is to get a pedometer.
Studies show that just the mere act of tracking your steps will increase the number of steps you take each day by 2,500. That is the equivalent of walking more than one extra mile each day just by tracking your steps!
The pedometer is so helpful because people overestimate their activity. In fact, based on pedometer data, less than 5% of Americans get enough physical activity.
I have found that in my practice, most of my A-fib patients only get 2,000 to 3,000 steps each day. The average American gets 5,000 steps each day. The average European, where A-fib is much less common, often gets about 10,000 steps each day. The goal is to get at least 10,000 steps a day.
While this may seem hard to achieve, most of my patients can easily get to this goal. You just have to be creative. Can you walk somewhere instead of driving? Can you add an evening walk to your day? The possibilities are endless.
In addition to 10,000 steps daily, I recommend at least 30 minutes of moderate intensity exercise each day. I am often asked, what exercises should I do. My answer is simple, do what you enjoy. Anything counts. Gardening, dancing, skiing, hiking, etc. are all great. The most important thing is that you are consistent and do something each day.
I do recommend varying your daily exercise to keep it fun, work different muscle groups, and to prevent overuse injuries. Depending on what you choose to do, you may also need to incorporate a couple days of strength training into your routine.
9. Get Rid of the Vices
Tobacco, alcohol, and any stimulants, including caffeine, can be a trigger for A-fib. Did you know there is even a condition called Holiday Heart? This is when someone drinks a lot of alcohol and then goes into A-fib.
For many of my patients, just getting rid of these vices can eliminate A-fib episodes. Other stimulant medications, including Sudafed, Ritalin, or other attention deficit hyperactivity disorder (ADHD) medications can also trigger A-fib.
To learn more about the effect of caffeine to heart arrhythmias, please read this article I wrote.
10. When All Else Fails Get it Ablated
For most of my patients, aggressive lifestyle modification can drive A-fib into remission. Unfortunately, there will always be some cases that just don’t seem to resolved with lifestyle modification. What should be done in these cases?
For these patients, blood thinners, medications to slow the heart, and rhythm controlling medications are often prescribed. Unfortunately, for most patients, rhythm drugs only work for a few years at most.
When medications are no longer effective in controlling the symptoms of atrial fibrillation, an ablation is the next step. This is also an excellent option for patients who have side effects from the medications or just do not want to be on life-long medications.
Fortunately, the lifestyle changes we have discussed in this article can double the chances of a successful procedure if an ablation is ultimately required to control the symptoms.
With an ablation, we go into the heart through an IV in the leg, map where the A-fib is coming from in the heart, and then ablate those areas. The entire procedure takes about three hours and patients will typically spend the night in the hospital following the procedure. The following day patients will go home with just a band aid.
I have personally done nearly 4,000 of these A-fib ablation procedures. In experienced hands, most patients can ultimately be free of atrial fibrillation. There are certainly risks associated with this procedure but these can largely be avoided by physicians with the most experience in performing these procedures. Please discuss the risks, benefits, and alternatives of A-fib ablations with your physician.
Here is a link to see more that I have written about atrial fibrillation. Also, be sure to sign up for my free weekly newsletter or subscribe to my podcast.
Feel free to leave your questions and comments below.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.
Dr Day, when you have successfully abated someone and they remain a fib free for over a year will you take them off blood thinners. What about if they are 66 and female with no other risk factors?
Hi Sandra,
Great questions. The guidelines as to who should take a blood thinner have nothing to do with being Afib free after an ablation. Rather it is all based on risk factors. To learn more, here is an article I wrote on who should be on blood thinners.
https://drjohnday.com/do-i-have-to-take-a-blood-thinner-for-a-fib/
Hope this helps!
John
Dear dr. John,
Thank you for the above article. I was supposed to get a double ablation for three problems with my heart: 2 arythmia’s that are getting worse and episodes of AFib on top of it since a year. at night my heart speeds up to 215 bpm or goes down to 45bpm. Most of your tips I already do and always have done.
I am allergic to the bloodthinners needed for the double ablation. ( My mom, aunt and nephew are all also allergic to bloodthinners) So now I cannot have the ablation.
What are my further options to get rid of my heart problems?
Thank you for your time and answer.
Great questions. Unfortunately, there are no simple answers. I would suggest meeting with a local cardiologist, ideally an electrophysiologist or a cardiologist who specializes in arrhythmias, for guidance on further options. If you don’t have one, here is a link to find one near you.
http://www.hrsonline.org/Find-a-Specialist
John
Dear Dr. Day,
Thank you for the extremely informative info. I appreciate your lay out of the sections for #1 – to #10. I rec’d this information from one of my daughters and I see now why she was so pleased to share it with me. I am
very motivated by this news. I did work out and loose 40 pounds 3 1/2 yrs.
ago. but the weight slowly crept up as I am waiting for a total knee replacement op and exercising is hard to do at this time. I will, however – re-approach my stationery bike as your article says it PLAIN AND SIMPLE!
I am sure I can navigate through this – in order to do the best for my wee
adventure with Afib 1 yr. ago. Thanks so very much – Mrs. McKinnon.
I’m wishing you all the best!
John
Dear Doctor,
I have had a-fib for 13 years twelve of these with no issues. Last year I stated having issues waking up and couldn’t breath. Resulting in many months of sleep issues. During this 12 years I was seeing Dr. Rolston East Jefferson Hospital in Metairie La. In 2016 he recommended I see Dr. McKinney and Dr. Brothers East Jefferson Hospital who do the convergent procedure for long standing a-fib. This was performed on June 7 2016. It appears to not have worked in that I am still in a-fib today and are still having sleep issues and fatigue but no breathing issues. Dr. Mckinney would like to performed cardio converting and if that doesn’t work an ablation. The cardio converting from what I have read is only a temporary fix. The convergent procedure was very hard on me I am 65 years of age am worried about the ablation and that it may not work and I will go through some more rough times. Dr. Rolston has stated that I should wait and see what happens in the next few months and see him in December 2017. If still in a-fib will regroup and try to figure out my best options. I am not feeling well now which I think is due to not sleeping well combined with the a-fib fatigue, However I am able to exercise an hour a day and get around pretty good so far which is interesting. It appears that I feel a lot better when I get a good night sleep of course. I don’t appear to have any sleep apena signs. No snoring etc. I have never been on medication because I don’t like their side effects. My chad score is 0 so I only take asprin. I have no vices except exercise. Your opinion is appreciated.
Hi Randy,
Unfortunately, my hospital doesn’t allow me to diagnose, treat, or make any recommendations over the Internet. Your case certainly sounds very complex and you will want to get all of your doctors on the same page to make sure you get the best treatment possible. You also bring up a good point–by optimizing your sleep you can increase your chances of holding and maintaining normal rhythm. If you had to pick a vice, exercise is definitely one of the better choices.
All the best,
John
How about vitamin K2-7? Or modified citrus pectin, etc?
Hi Jack,
No data yet on the impact of these substances on atrial fibrillation…So the effects are unknown…
John
I’ve been looking for information to know which direction my husband should go . He was diagnosed with flutter 9 years ago they did a car diversion with no success , then an ablation with no success , finally after seven days and being put on sotalol, he was back in normal sinus rhythm. Here we are 9 years later, and now he’s back in afib now, apparently he wasn’t aware of it and it caused cardiomyopathy. They tried conversion again, not successfully, did another abalation no success, put in a loop recorder and found he now has afib and flutter! He’s wearing a life vest now and they are going to do another cardio version in two days! Where do we go from here , what are his options? I feel at this point that his cardiologist really doesn’t know where to go! We’re desperate for answers ! Do you have any? Thank you , oh and his ejection fraction was at 24
Hi Connie,
I’m so sorry to hear about your struggles. It seems a bit odd that none of the therapies seems to work for him. It sounds to me like you need a new set of eyes to look at his case (second opinion).
Hope this helps!
John
Hi Dr. Day,
I found out that I have afib in September when I went in for a checkup. I was 34 weeks pregnant and my heart function had decreased quite a bit and I was in afib. I ended up needing an emergency c section because of the condition they termed as Peripardom Cardiomyopathy. They did try cardio versions on me but none of them have worked. Right now they just have me on a bunch of different medications to see if they will help me. My heart function has improved but I am still in afib, they have talked about an ablation but they say there is a 50:50 chance it would work. I heard about an essential oil that could help the afib called Aroma Life but I am not sure how safe that is to do on the meds I am taking I read that if you take blood thinners it could interfere and I am taking Pradaxa. Any advice you could give would be helpful.
Hi Shannon,
In a young person, such as yourself, the chances of a successful ablation at an experienced center should be much higher than 50%. I think you need a second opinion.
Unfortunately, there are no proof that essential oils treat atrial fibrillation. Yes, it is true, many things can interfere with blood thinners.
Talk with your doctor and pharmacist about whether this essential oil is right for you or not.
Hope this helps!
John
Hi, I have Af and recently had an ablation which wasn’t successful and on a waiting list for another in 4-6 months. I have been taking rivaroxaban (20mg) once a day. My question is when my heart goes back to normal can I stop taking the rivaroxaban (I have some side effects) and switch to aspirin 75mg? I was taking the aspirin before. I don’t take a betablocker because of the side effects. Thanks
Hi Deb,
Taking a blood thinner on an “as needed” basis is not something that is “officially sanctioned” as part of the AF treatment guidelines. However, there is a study wherein people monitor their rhythms with home EKG machines and then take a blood thinner, like Xarelto, for 30 days after each AF episode. Although it was a small study, it showed no increased stroke with a lower risk of bleeding. Make sure your physician is aware of how you are taking your Xarelto.
With regards to aspirin, the data on aspirin and AF stroke prevention just keeps getting worse. The most recent data suggests aspirin provides no benefit but yet has a bleeding risk that may be as high as a blood thinner like Eliquis.
Hope this helps!
John
Hi doctor
Just had eaten quite alot of cheese yesterday after a short while
Had massive palpatations in my neck chest
No chest pain no sob no dizzyness
I felt my heart rate and i had ectopics beats
One after another
I felt awful
When i laid down it resolved even when i
Moved to different positions it came back and stoped when i kept still
After one hour i stood up and wh again started
Went to sleep woke up at 4 everything was fine
So scary
I was disgnoised PAF last year with normal echo
Not sure what it was ? Af or ectopics so scary
Hi June,
Hard to say if it was another AF attack or something else going on. There are monitors you can get (Alivecor) for your phone to do an ECG during events like these. Work with your doctor in determining what is going on.
Best,
John
Dear Dr John,
I wonder if you have any up to date information of the low level transcutaneous electrical vagus nerve stimulation method for perverting afib.
I read that this can be achieved by tickling the tragus part of the ear.
Colin
Hi Colin,
While there are some exciting studies in this area, this therapy has not yet been proven to work. Stay tuned. It is possible that this could someday be a viable treatment option.
Best,
John
I had an Afib event that sent me to the ER, where I was given medication through an IV and my heart returned to a normal rhythm. Now I am asked to wear a heart monitor FOR A MONTH. I already told them I would not take the “rat poison” so they better think of something else. How will this heart monitor help get rid of another Afib event???
Hi Carol,
Unfortunately, heart monitors do not prevent Afib episodes. All they do is document Afib, or other arrhythmia, episodes. Thus, the information from this test can help your doctor to better treat your Afib.
Fortunately, there are many other blood thinner options other than warfarin (Coumadin)…
Hope this helps!
John
Hello Dr.John.
I am 45 years old and I have about 2 episodes of atrial fibrillation per year(since age 40),self terminating within 24 HRS. Last year pattern changed and I had first atrial fibrilation which had to be cardioverted after 10 days. After a month I had another a.fib episode which responded to PIP(flecainide). Presently I am on flecainide 50 mg twice a day and Atenolol. I had another atrial fibrillation(6 months in to taking flecainide) which responded to PIP again I just gave myself additional 200 mg dose of flecainide. My question is what is better, continue to use flecainide or go for ablation? My episodes are vagally mediated(they happen during sleep).
I do not have other medical problems. Thanks for your response. Oto
Thanks Dr.John for your response. Can patient have deterioration of their atrial fibrilation after procedure? Does flecainide do pretty good job to
avoid post procedure atrial fibrilation? Left sided atrial flutter is also mentioned as complication in some literature. Center I have chosen does cryoablations.
Thanks for your dedication to atrial fibrilation community.
Oto.
Hi Oto,
Yes, it is possible the arrhythmias get worse after the procedure. Sometimes it is just transient for the first month or two after the procedure and then it resolves. Other times it persists. If it persists, usually a second procedure corrects this.
left sided flutters occasionally occur and may require a second procedure to correct.
I wish you all the best with your upcoming procedure!
John
Hi Oto,
For a 45 year-old healthy individual, Afib ablations done at experiences centers are often curative. Whether or not it is time to do the ablation now or not really depends on how debilitating the condition is for you. Have an open conversation with your electrophysiologist about when is the right time for an ablation.
There are studies from our center, as well as other centers, showing that the earlier it is treated with ablation the better the outcome. While this finding has not yet been proven, it is worth consideration.
Hope this helps!
John
HV HAD ATRIAL FLUTTER/FIBRIALLATION AT THE SAME TIME SINCE EARLY 2013…MY DR PUT ME ON THAT HIGHLY TOXIC MED AMIODARONE FOR 21 MONTHS; IT’S A MED THAT ADVERSELY AFFECTS JUST ABOUT EVERY ORGAN IN THE BODY..IN MAY OF 2015 MY DR HEARD AN UNFAMILIAR NOISE IN MY LUNGS ALTHOUGH MY PULMONARY XRAYS SHOWED NO SIGNS OF ANYTHING WRONG…IT’S A HORRIBLE MED…EVERYTHING WAS FINE UNTIL FEB 15, ’16 WHEN I CAME DWN WITH ATRIAL FLUTTER. AFTER BEING EXAMINED BY THE HOSPITAL’S EKG, MY ELECTROPHYSIOLOGIST DETERMINED I HAD FLUTTER ONLY; SO HE ASKED IF I EXERCISED (I WALK 2 MILES A DAY) FELT OUT OF BREATH AND SO ON..I SAID “NO”… SO HE DECIDED I HAD ASYMPTOMATIC FLUTTER AND COULD LIVE WITH IT..SINCE FEB I HAD ONLY 4.5 WEEKS OF PERFECT RHYTHM BUT MY HEART KICKED BACK INTO ARRHYTHMIC FLUTTER ONCE AGAIN…SO I HAVE LIVED WITH IT FOR ALMOST 8 CONTINUOUS MONTHS AND SO FAR NO PROBLEM…MY CARDIOLOGIST GAVE ME METOPROLOL (50 GRAMS IN THE AM AND 50 IN THE PM) SO MY BLOOD PRESSURE IS ABOUT 100 T0 110 AND PULSE 60 ..24/7…BUT MY ATRIAL PULSE RATE WAS AT THE TIME OF MY EKG 300 (NEVER FEEL THAT RATE AT ALL BUT I DO THE ARRHYTHMIC PULSE RATE AT NITE WHN SLEEPING)
Hi Jim,
So sorry to hear about your struggles with arrhythmias and amiodarone. There are many different ways to treat bothersome arrhythmias. If you are not happy with your care, I would suggest getting a second opinion.
Hope this helps!
John
Dear John,
I had SVT from when I was eleven years old, had a successful ablation in 2005. I then had eleven glorious years being arrhythmia free.
Unfortunately I developed Afib in July 2015. I didn’t suffer too badly from the effects, although it often woke me up during the night, and the episodes became more frequent quite rapidly. Since my previous procedure was such a success, and I found it hard to tolerate the drugs, I was keen to have an ablation which was carried out on 23rd May this year. Apart from having fairly regular ectopics and some slightly scary post op complications, it seems to have been a success.
I had my follow up appointment yesterday and was basically told I can’t come off the drugs, ever!!! I’m on Apixiban, Flecainide and Bisoprolol. I’m extremely breathless, exhausted, have brain fog and weight gain. I was fairly fit before this and I am so disappointed. I had high hopes of skipping off into the distance leaving it all behind me – maybe I was being a bit unrealistic!
I’m very interested in lifestyle changes as I’ve noticed that the arrhythmias (before and after ablation) seem to get worse if I eat wheat or sugar. Is it possible that continuing along these lines I will be able to ditch the drugs?
Evie.
(Female – 59)
Hi Evie,
Interesting observations. I have had many patients share with me that sugar seems to be an Afib trigger as well. Lifestyle changes work for many people…hopefully they will allow your doctor to gradually stop the drugs.
Best,
John
I have afib and have had a couple spells.been cardioverted once.Im scared to death having this.is really scary.Im afraid to do things.what do i do to overcome this fear and get my life back
Hi Roland,
Yes, Afib can be scary indeed. A healthy lifestyle in combination with a competant and caring cardiologist can be very helpful!
John
Thank you Dr. Day, great information. In my case though I was recently diagnosed, I believe I have had a fib for at least 8 years now. Today I am 70 years old, and have been a competitive triathlete for about 25 years. In a race way back in 2008, during the swim I suddenly couldn’t lift my arms (not recommended in the water!!), and while I completed that race struggling for breath I never knew what caused the problem. I put it down as a “mystery” race. Years and many strong workouts and races later, this summer my cycling became a struggle ergo finally the diagnosis. I’ve had 2 cardioversions and am on blood thinners and beta blockers. My workouts have become walking now. My blood pressure is on the low side but I do have stress at work, and my share of restless sleeps. No alcohol, and a coffee plus decaf a couple times/day. I’d really like to get back to (non-competitive) working out but possibly that might be a remote possibility at this point.I believe that ablation is really the only route at this point?
Thanks Doc!!
Hi Paul,
Sorry to hear about your AF struggles. Current indications for an ablation are symptoms from AF that don’t resolve with an antiarrhythmic. Please discuss the risks versus benefits of this procedure with your cardiac electrophysiologist.
Hope this helps!
John
My husband was diagnosed with afib after having two minor strokes. He is 69 and his weight is under 160 and doesn’t smoke or drink. We are finding out tomorrow if he has sleep apnea. He has been on four different anti-arrhythmics and not tolerating any of them. He has been hospitalized 4 times in four months. He is now on Amiodarone and cardizem plus blood thinner and cholesteral meds He is now in afib (3 days, goes out of afib for a few hours) but doesn’t want to be hospitalized again unless his heart rate stays elevated. He is sheduled to have an ablation in December. Our EP said success rate in only 60%. Seems like that is pretty low odds. What is your success rate and are there other meds or options out there
Hi Valerie,
Sorry to hear about your husband’s Afib challenges. Yes, an ablation success rate of 60% sounds low. If people have been out of rhythm for a long time, or have other cardiac issues, the success rate can be significantly reduced. Hope the procedure goes well!
Best,
John
Dr Day:
I have intermittent, highly symptomatic a/fib with usually a high-ish heart rate~~from 120-150 per min 🙁
Episodes can last btw 6-24 hrs, avg is about 12 hrs~~varies. Diltiazem doesnt work, and am afraisd to take other anti-arrhythmics as they have bad safety profiles.
My question is:
lately Ive noticed that a 15-30 min fairly intense excercise, even while at a fairly high heart rate, will absolutely end the a/fib: its happened pften enough that I know its not a coincidence.
Is this a good, or a bad sign? Could it mean I have a narrowing or partial blockage thats causing the a/fib now (did not that that at my last stress echo 4 yrs ago, as a very normal echo tho Ive been having a/fib for 14 yrs off & on, tho noticed the episodes are getting longer:(….my concern is, is the dilation of vessels, arteries etc, caused by the exercise resolving the a/fib because I have narrowing or partial blockage? Or is it somehow a good sign…
My GP says seems to be a good sign, my cardiologist is out of town for awhile…
would so appreciate your take on this (new?) phenomenon w/ my a/fib.
Thanks, Anne
Hi Anne,
Sorry to hear about your Afib challenges. While it is possible your exercise-induced Afib indicates a blockage in one of the arteries of your heart, more often exercise-induced Afib is due to sympathetic stimulation (i.e. adrenalin release from exercise).
I have all my Afib patients undergo some sort of a stress test to rule out a blockage.
Whether or not your Afib is exercised induced doesn’t really indicate a good or bad prognosis. To me, it just means that it needs to be treated so that you can enjoy all the health benefits of exercise.
Hope this helps!
John
What is ablation
An ablation is a procedure where a catheter is inserted into the heart to “map and zap” atrial fibrillation. This “zapping” of heart tissues could be with either heat (radio frequency) or cold (cryo). Hope this helps! John
AT 71 I HAVE HAD TWO BY A VERY EXPERIENCED DR. BUT MY A-FIB STILL PERSIST ..
Hi George,
Sadly, not every case of Afib can be effectively treated with ablation. Sometimes, the ablation was performed too late in the disease process. Sometimes there are other things going on with the body that have to also be treated or reversed for the ablation to take hold such as diabetes, high blood pressure, obesity, etc. Sometimes, it may be coming from a source that technology does not yet allow us to see.
Don’t give up hope. There are always options to help with then symptoms. Keep working with your electrophysiologist and do everything in your power to live as healthy as possible.
Hope this helps!
John
I suffer with ibs and the diet my doctor has given me cuts out carbohydrates ie:potato. Wont that drastically alter my inr
Hi Ann,
The INR blood test with warfarin (Coumadin) is altered by foods with vitamin K in them. Your green leafy vegetables are highest in vitamin K so they would be expected to affect the INR blood test the most.
As potatoes are low in vitamin K, I would expect eating or not eating potatoes to significantly affect the INR levels.
Hope this helps!
John
I am 58 years old 6.2 170-175# with an impeckable livestyle always have and in extremely good health, fast walk 10 miles a day and weight lift, stair climbing ect. a bit of a freak for my age i have been told, small heart 0 under lying heart or health conditions and have had afib for 24 years, but very rare ep. up until about the last 24-30 months (diag. about 18 months ago). Since that time i ave. about 5-6 ep. a month almost always in bed in the 1st 4 hours of sleep (i do sleep pretty well overall considering) lasting from 2 to 36 hours before self terminating with no drugs. My card. doctor wants to put me on bisop. or other daily drugs that i refused so we settled on Propafenone PIP routine. It only takes 150-225 mg which is less than the 300-600 mg suggested to terminate an afib ep. so my ep. are pretty freq. but my conver. to NSR are quick and easy also (1-5 hours) with PIP. I take a 81 mg. asp. also although reading your fantastic info i know now that means little to nothing for afib patients. I have tried every heart and afib friendly supl. known to mankind (about 2k worth) with little to no affect in the last 18 months. Its unbel. frustrating doing everything right-life style, eating, exercise-never drugs-smoke-drink BP perfect chol. in normal range and still have this condition that does not even run in my family, its like there is NOOOOO reason for it. It comes out of the blue with a little stress maybe yes or when i am feeling 100% does not matter bang it hits normally like clockwork every 5 days or so. I will try 1 last thing before my Cryo Ablation at the Mayo clinic early next year and that is a doctor approved blood donation to lower my Ferritin (iron) level. Even though my level is not considered high-88 on a scale from 20-300 or so, much literature i have read says anything over 80 is higher than it should be and 40-50 is the ideal ferritin level and that reduction might make the diff. to my afib so it cannot hurt and can only make me healthier overall. Failing that the Question i have DR. is in the remaining 4 months or so i have before my Ablation if i decided to take the reg. daily dose of Propafanone 3×150 mg a day or even 2×150, would that make the likelyhood of a successful procedure LESS than if i entered the operating room with only the infreq. use of the drug in my heart, cause that is the main reason i have been balking at taking any drugs long term so my heart is not reliant on them to stay in NSR so to give the best chance at success at the procedure that i have been dreaming about for a year and cannot wait for. I hope my overall condition will factor in to the 70-80% success rate for normal afib patients cause i can confid. say other than my age 58 i am not your normal afib patient.
Ty love this site.
Hi Randy…Have you thought about you are over training over stressing your heart. I think you should back off try the “HITT” the high intensity interval training 3 days a week and weight lift two days a week on the same days you interval train try that for a while.
Hi Randy,
Good question. Whether or not you take an antiarrhythmic should have no impact on whether your ablation procedure is successful or not.
I wish you all the best with your procedure!
John
Is it normal to have fatigue and dizziness 7 weeks post ablation? I also have a lot of digestive issues since the procedure.
I am on no medication except a baby aspirin . I did have Afib on and off for the first three weeks after the procedure. Could it just be taking longer to recover?
Thank you.
Seven weeks is a little long to be having fatigue and dizziness after an ablation. It sounds like something else is going on. Make sure your physician knows that you still don’t feel well.
Digestive issues can occur after an ablation. If they are from the ablation, they usually resolve with time.
Hope you are feeling better soon!
John
I was told that some people bounce right back and others take months to get their energy back and feel better. Just seems way to long to me.
Thank you.
I just turned 75 and am female. I’ve had Afib for about 2 to 3 yrs. and seem to be experiencing it more. I have started to walk about a mile everyday, have always watched my eating habits, and play a lot of tennis. I try to stay away from stress . My concern is I have low thyroid and have been taking meds for about 20 years. I did get my Dr. To lower the strength because I felt that it made me feel nervious and wasn’t helping my Afib situation.
Living in the Midwest ,we had a very hot summer and I felt very heated and slowed down. I don’t feel good about taking 20 mm of Xareito and would like to change my Thyroid med. ( Thyroxine)) to a natural medicine. I do not sleep well and try to keep my weight down, but find it hard because the thyroid meds do not help a lot of people to loose weight..
I want to do as much as I can to avoid the next step, a (aviation) because I’ve heard that they are very expensive and they don’t always work.. Do you have any suggestions as to what I can do as my next more to get off of Xareito and feel better by getting of of Thyroxine and going to a natural replacement ?
NatureThroid by RLC Labs would be my choice for hypothyroidism. Took Armour Thyroid until the formula was changed when Forest Lab was sold.
Natural desiccated is the way to go!
If insurance doesn’t cover it, you can get it from HealthWarehouse
I am using the online order for the first time since it is so inexpensive.
Your doctor just has to call in the script
Most of the meds scare me to death! I hope you can get off Xarelto. Read there is a class action law suit against them Thinking of ablation but again drs want to script anticoagulants (blood thinners) By reading this blog, you may get some great advice!I’ve read most of them and learned plenty…seems to be RISK no matter what we choose
Hi Carol,
There are certainly different forms of thyroid hormone. Perhaps you might feel better with a different formulation. This would be something to discuss with your regular physician or even a specialist in hormones such as an endocrinologist.
Unfortunately, given your age and gender you are at increased risk of a stroke from atrial fibrillation. Thus, the only way to safely get off Xarelto would be to explore other options like the Watchman device. The Watchman was recently FDA approved and seals off the left atrial appendage which is the main source of strokes from Afib.
Hope this helps!
John
Dr john
Have you ever heard of mini maze that suppose to be a cure for people that has AFIB periodically.
Dr wolfe does it in Huston Texas. I was thinking about getting involved. What is your opinion?
Thank you in advance
Charlotte
Hi Charlotte,
Unfortunately, there is nothing “mini” about the mini maze procedure. This is major surgery and I have seen some patients go through very long and difficult recoveries.
If you look at the medical literature, the mini maze has never been shown to be better than the much less invasive catheter ablation procedure. If you choose either procedure, make sure your physician is very experienced at doing these procedures.
Hope this helps!
John
Hello Doctor John,
I have lone atrial fibrillation continuously for eight months so it is “permanent”. Apart from the disconcerting feeling of palpitations, I have no other symptoms. Obviously though I realize that the long term prognosis of the condition could mean structural, electrical and morbidity complications and therefore I have to try and deal with the situation sooner than later.
I am 53 years old and have no heart problems or other health issues. I am in good shape apart from from being overweight not obese. My CHADS score is zero so I just take a beta blocker.
Given the “permanent” nature of my condition, do you think the lifestyle measures you advocate could actually reverse or even cure my atrial fibrillation? If not, would an ablation or other surgical procedure be appropriate for me?
Hi Phil,
Given that you have been continuously out of rhythm for 8 months, it is unlikely that lifestyle changes alone will get you back into a normal rhythm. Certainly, the longer you are out of rhythm the harder it will ever be to restore normal rhythm again.
Given your young age it does make me nervous to commit yourself to a life of living with Afib. You never know what the future may hold.
I would recommend at least a consultation with a cardiac electrophysiologist near your. Here is a link to find one.http://www.hrsonline.org/Find-a-Specialist
Hope this helps!
John
I have had this now about 9 months it only comes on as I falling to sleep or as I wake up but my heart rate is normal about 58 to 62 as this is happening so I think it’s a fib I also have lbbb and mild inpairment of left ventrical this has lava come on in the last year a bit confusing because no heart probes in family I have never smoked don’t really drink and not overweight male age 61
Is it normal to have an increase in heart rate when standing and walking 5 weeks post ablation? Resting heart rate is fine, just no energy and goes to about 105 when I get up and walk around. I am on no medication at this point. BP is fine.
Thank you.
After an Afib ablation, there can be changed to the heart rate. Interestingly, there have been some studies which showed that an elevated sinus heart rate after an ablation predicted a better long-term success rate. In many patients, after a number of months the heart rate returns back to the pre-ablation heart rate. Make sure your physician is aware of these changes.
Hope this helps!
John
Cac I get an appointment auto dr. Daly.?
Hi Don,
Thanks for your interest. All consultations are scheduled through my office at 801-507-3513.
Best,
John
Hi Hamada,
Thanks for reading and sharing!
Great point…does anxiety trigger PVCs or do PVCs trigger anxiety. While it may vary from person to person, both are true.
Azithromycin does cause transient QT interval prolongation. In general, this is just a temporary phenomenon while the drug is in your system and while the QT interval is prolonged.
Best,
John
If someone has an ablation and was not n blood thinners before the procedure is it safe to stop them a month after ablation? I was given Eliquis and its side effects are awful. Paroxsymal AFib chads score of 1.
What is your protocol for this situation?
Thank you.
For a CHADS-VASc score of 1, the medical guidelines state that either blood thinners or no blood thinners are OK. Immediately after an ablation is a special case though…the consensus statement from the Heart Rhythm Society recommends 2 months of blood thinners following an ablation regardless of your CHADS-VASc score. However, there are no scientific data or studies to support this recommendation. As every case is different, this is something that is best determined by a discussion with your physician.
Hope this helps!
John
I just had cryo. Ablation. I dont understand why im still on meds
During the healing phase immediately following an ablation procedure, arrhythmia recurrences are very common. Thus, most physicians will keep patients on antiarrhythmics for 2 to 3 months.
Also, as there may be an increased risk of stroke immediately following an ablation as well, blood thinners are also used for a period of time.
Hope this helps!
John
Hi Dr Day,
I am 3 weeks post ablation. I have been in and out of AFib since but it is calming down.
I am so fatigued I have not been able to do anything. Still pretty much bed rest. Is this normal? I am guessing because of the AFib coming and going it has just set my recovery behind.
The only medication I am on is Xeralto 20 mg which my EP says I have to stay on fir another 3 mos. I do not like being on anything and thought it was only going to be for a month or two. I was not on any before the PVI. My CHADS score is 1. My heart is great and I am 58.
My EP says it’s all part of the healing process but I am disappointed to say the least. He makes it seem like it’s no big deal and perhaps it isn’t.
Any help is greatly appreciated. You have been so helpful with my other questions. Wish you were in NJ.
Cindy
Yes, immediately following an ablation procedure, arrhythmia recurrences are common. Fortunately, most of these resolve within a month. Some may require longer to resolve. If they have not resolved by 3 months, most EPs consider a second procedure.
Also, depending on your case, there may be an increased risk of stroke immediately after the procedure. Thus, blood thinners may be used immediately after the procedure. This may be the case for people with even a lower CHADS-VASc score.
Hope this helps!
John
Thank you for the quick response. Is the awful fatigue common this long after the procedure as well?
Cindy
Hard to say…fatigue can often be a difficult symptom to pin down since so many things can cause fatigue. Sounds like it is time to check in with your doctor about the fatigue.
John
Thank you John, I took you advice and went to my primary. I have gastritis and or an ulcer so that explains the fatigue and other issues. He has suggested I stop the Xeralto since I have been on it for one month since the ablation and if I do have an ulcer it may cause bleeding and there is no antidote for Xeralto. Hoping that is safe to do. My EP said the first month is the most important to be on the blood thinners, so stop it if I want to.
Cindy
Hi Cindy,
As with everything in medicine, you always have to weigh the risks versus benefits. In your case it is the possibility of gastrointestinal bleeding versus a stroke. Only your EP can tell you if it would be safe for you to stop Xarelto at this time. Sometimes we have to stop blood thinners due to bleeding risks.
Hope this helps!
John
I was diagnosed with Afib about a year ago. I have had ablation and after the surgery I was still in AF. I had inversion which put me in a normal heart rhythm for about 60 days. I am in AF again and my DR says he doesn’t know what else to try. I also have a moderate case of pectus excavatum which the DR says does not cause AF. However I have read online about cases of AF caused by pectus. What should i do now? I am more than tired of feeling lousy.
Pete
Hi Pete,
So sorry to hear about your struggles. Yes, precuts excavated is associated with atrial fibrillation. To read more about this, here is a link: http://www.ncbi.nlm.nih.gov/pubmed/23692892
As you are still suffering from Afib and your physician doesn’t know what else to try, it is time for a second opinion. Here is a link to find another cardiac electrophysiologist near you. http://www.hrsonline.org/Find-a-Specialist
Best,
John
I am a 56 year old male. The information I received from my doctor stated that corrective surgery for pectus excavatum is awful and that is why I think he says PE is not causing the issue. Since the ablation and cardio inversion didn’t work, i think PE is the problem. Thanks for the link. It did pull up a DR that I was thinking about seeing for a 2nd opinion. Thanks.
Hi, and thank you for you website. I had an a-fib episode and was given a pacemaker check. It should that I had had 42 episodes. My Dr. now wants me to go on xarelto, and I want to know if I go on this medication can I ever get off it through life style changes. I recently stopped drinking and have walking 3 miles a day for years. Thank you in advance for ant information.
Richard
Hi Richard,
Great question. The key to safely getting off a blood thinner is to get your CHADS-VASc score below 2. For example, if people are able to reverse their diabetes, high blood pressure, or heart failure then many can safely come off of blood thinners. To learn more about how to determine your risk of stroke and whether or not you qualify for blood thinners, please read this article I wrote: https://drjohnday.com/do-i-have-to-take-a-blood-thinner-for-a-fib/
Hope this helps!
John
Thank you Dr. Day for your quick response. I will review the information with my cardiologist and start on a program of diet and exercise to reduce my weight and blood pressure. Thank you for the information and for giving me some hope.
Richard
Hi Dr. Day, I am 65 and had a third ablation in 13 months ths past February. After a very difficult 3 month recovery I went into flutter and had a cardioversion. My Dr. Suggested a pacemaker but I went into remission and was Afib free for 3 months and I felt amazing. Last week Afib has returned. No longer than 2 hour events and some only last seconds. I am a nurse and know many of my episodes are vagal related. I have lost 65 pounds in 18 months. BP is low with no underlying heart issues. I started losing my hair after starting xarelto and naturally it got worse with flecainide. I am off the flecainide and will not go back on it because of side effects. I am fighting depression due largely to hair loss. I’ve lost more than half of my hair and there just seems to be no end to this. I don’t know where to go from here. Do you see a lot of depression with your patients? Any suggestions would be greatly appreciated. I subscribed to your news letter and find your articles helpful. Have you had patients suffer hair loss and do you know if any of the other blood thinners do not have this side effect. I’ve been thinking of changing to Eloquis!
Hi Sandra,
Glad to hear the AF is better and congratulations on the weight loss! I agree, hair loss is a very troubling side effect.
I most commonly see hair loss with warfarin (Coumadin). Hair loss isn’t something I commonly see with the newer blood thinners. I have occasionally seen it as well with amiodarone but much less commonly with other antiarrhythmics like flecainide.
In general, once the offending drug is removed, the hair slowly comes back. However, there could be other causes like a hormonal imbalance or a nutritional deficiency. Check with your physician for possible testing.
With regards to depression, I often see this when Afib is initially diagnosed. However, once people have found a treatment strategy that works for them, it generally resolves. I would suggest checking in with your physician about getting help with the depression as well.
Hope this helps!
John
Hi Dr Day,
I had a PVI ablation for AFib last Wed. I had Paroxsymal AFib. No other heart issues and CHADS score of 1.
I went into AFib yesterday for 13 hours. Dr put me on Metroprolol 50mg bid and a heart monitor. Today I am going in and out of AFib for the past 2 hours and had PAC’s before this started.
Is the common after an ablation?
Thank you,
Cindy
Hi Cindy,
Unfortunately, it is common to go out of rhythm right after an Afib ablation–especially the first month after the procedure. This is likely due to inflammation from the procedure or, possibly, reconnection of the pulmonary vein(s). Fortunately, most episodes resolve after a month or two. Just be sure to let your physician know this is happening.
Best,
John
Thank you. It’s upsetting and I feel awful but I’m relieved it’s common.
Thanks again.
Cindy
Hi Dr John
I would like to ask is PAF genetic
Many thanks
June sharp
Hi June,
Great question. Yes, atrial fibrillation can be genetic. For example, this helps to explain why atrial fibrillation is more common with Caucasians.
Like everything else, it is a combination of nature (genes) and nurture (lifestyle). The good news for atrial fibrillation is that studies show that lifestyle is far more important than genetics.
Hope this helps!
John
Hi Dr. Day,
After the ablation, how long do you have to lay flat? Or do you just not move your legs?
Thank you.
Great question. We typically have patients in bed for 3 to 4 hours after an Afib ablation. Usually, we elevate the head of the bed based on the comfort of the patient.
These 3-4 hours typically pass fast as the patient is still drowsy from anesthesia and is sleeping for a lot of this time.
Hope this helps!
John
That helps a lot. The entire idea is frightening. I am scheduled for next Wed and feeling very anxious. I have Paroxysamal AFib and no other issues with my heart. I just cannot tolerate any medication. I am only on a daily baby aspirin. My BP rises under stress, but is not consistently high. Although the fluctuation cannot be good I ams sure.
I wish I could try controlling stress and plant based diet after reading your blog. It makes perfect sense.
Your information has been much more helpful than any of my Dr visits.
Thank you.
If someone lowers their blood pressure with their AFib be cured if that is the only problem they have?
Yes, if high blood pressure is the cause of Afib, and it is corrected early enough before any scarring of the atria occurs, then it could reverse Afib.
If you want to learn more about how to reverse Afib, I have a number of articles and presentations I have given on this. Here is the link: https://drjohnday.com/cure-afib/
Hope this helps!
John
Thank you!
Dr.john,i have had a_fib for ten yrs or longer I have had a cardio aversion now the afib has came back I am overweight to the point of obesity’not good also have sleep apnoea I am always tired and stressed out under Doctors care for everything and nothing is working for me I feel so hopeless please can you help me I found you on internet while looking for an alternative for help ..please help just one word of hope
Hi Linda,
So glad to hear you found my site! Don’t give up hope!
Unfortunately, cardioversions are just temporary solutions at best. While drugs and procedures are available to treat Afib, these are often also just temporary solutions unless lifestyle challenges are addressed.
A great first step would be to call your physician today and ask for a nutritionist and cardia rehab referral. If you are in the U.S., most insurance companies will allow nutritionist/cardia rehab visits. If emotional or binge eating is a challenge for you, you could ask for a referral to a psychologist/therapist that is skilled in working with people who struggle with eating disorders.
Hope this helps!
John
Are you advising the Heart Ass. serving size or another serving size
Hi Monty,
Thanks for reading!
Yes, the current vegetable/fruit goal of the American Heart Association is 9 servings daily. Personally, I would consider this the minimum number to shoot for. When you consider that a serving size is defined as a half a cup, or a full cup in the case of lettuce or spinach, that really isn’t that much in the way of veggies/fruit.
Hope this helps!
John
please advize on new atrial fibrillation method used by actually targeting where the a/fib is comeing from, which i was advized is comeing from a certain small muscle attatched to the ends of the pulmonary veins, which has proved somewhere in the us.a. to be a successful way of getting rid of a/fib once and for all the only way to be rid of medicines , proved over at least five years to be sucessful. please advize on this and please advize on the correct name of this actual muscle which they ablate around to do so. thanking you. this procedure and invasive operation isnot only sucessful i was told, but overides the necessity for the convention method of pulmonary vein ablation which many have occurrance of a/fib with.
Hi Jill,
Great question. To back up, the only agreed upon ablation method for treating Afib is pulmonary vein isolation. After that, everything is hotly debated.
Pulmonary vein isolation alone works for about 80% of patients with paroxysmal Afib and only 50% of those with persistent Afib.
To help improve the success rate for those with the more advanced forms of Afib (persistent), researchers have looked at other technologies. In my mind, the best would be to identify the source of the Afib by mapping drivers/rotors. With this approach, people are looking for the specific area of the heart, or muscle, where the Afib is coming from.
The only commercially available technology to do this is the Topera rotor mapping system. Unfortunately, a recent study showed this technology doesn’t work. Here is the link to the OASIS Study to read more about this: http://www.ncbi.nlm.nih.gov/pubmed/27163758
Fortunately, mapping the source of Afib isn’t dead. There are many companies looking at new technologies. I actually share a patent with my colleague, Dr. Jared Bunch, to map the source of Afib. Currently, we are partnered with a medical device company to map the source of Afib.
To make a long story short, there is no proven way yet to map the source of Afib in an ablation procedure. Our hospital is working on this as well as many other hospitals. Stay tuned as new research is always coming out.
Best,
John
My name is Phillip I am 27 years old and I have been diagnosed with proimital a fib with one persistent episode of a fib lasting for 4 days which then I had to be cardio reinverted. I am currently going to the VA hospital, I want to know with your experience what is the best corse of action for a person so young should do. Are there any other steps besides mentioned above that I should take since I am so young to better my chances to help me preven an Afib attack.
Hi Phillip,
Sorry to hear you had an Afib episode at such a young age. At you age, often there is something that triggered this. Common triggers for someone in their 20s include energy drinks, alcohol, trauma, other illness, stress, or sleep deprivation.
If there is a trigger, the best step is to correct it. If there are no triggers, you really just have to focus on living as healthy as possible.
At your age it is unclear if or when there will be another episode.
If your heart is otherwise healthy (i.e. normal stress test, normal echo, etc.), your doctor could prescribe some flecainide to have on hand in the event this ever happens again. This is what we call the “pill-in-the-pocket” approach. You would only take the flecainide if your heart went out of rhythm. As long as your heart staid in rhythm, you wouldn’t take flecainide.
Hope this helps!
John
Very interesting reading, I had an ablation it worked well for 7 years.I now have about five episodes a year that are lasting longer each time.THE Doctor who did the ablation won’t do another. Atrial fib runs rampant in my family, so claims because of that an ablation won’t work,needless to say I’m confused why that would.I live Canada, will try Bordeaux in France
Hi Al,
So sorry to hear. Redo procedures are often needed.
Best,
John
What is your success rate, ie, afib-free, in your experience of doing nearly 4000 ablations? My physician suggests that while somewhat effective (over 50%), he is otherwise very conservative in his prognostication for success.
What is your opinion of afib heart appendage left atrial appendage closure (LAAC)?
For context, I am 68 and until I was diagnosed with paroxsymal afib 5 months ago my primary health issue was recurring IBS, albeit fairly well managed with probiotics, digestive enzymes and a vitamin/mineral supplement from time to time. It is pretty clear to me that my few afib episodes have been triggered when I was in IBS mode. I have worked out 5 days a week my entire adult life, I eat with discretion (albeit fall short of diet you recommend). My CRP score was less than 1 at my last physical last year.
Thank you for your responses.
Hi Patrick,
Congratulations on keeping your CRP below 1!
A great question on left atrial appendage closure. We have been doing the WATCHMAN procedure with excellent results for the last 7 or 8 years as part of the clinical trials. We have seen excellent results with regards to safety and stroke prevention. However, we haven’t seen much benefit from left atrial appendage closure in helping people to maintain normal rhythm.
Our Afib ablation success rates have been well published in the medical literature. Success rates really depend on the individual person. The healthy person with paroxysmal AF and an otherwise normal heart can expect a one year drug free success rate of greater than 80% at one year. In contrast, the person with multiple medical problems with persistent Afib will have a lower success rate.
People who are able to adopt a healthy lifestyle after their ablation typically have much better long-term success rates. We find that about 1 in 3 people may require a second procedure.
Hope this helps!
John
Dr Day:
I used to bike moderately for about 90 minutes per day but ceased now that I had an episode of AFIB that was successfully treated with a Cardioversion about 9 months ago.
To the best of my knowledge I am still in rhythm – I have a low resting heart rate around 50 or so. Taking rhythm control and blood thinning meds.
Problem is that I take an antidepressant, Remeron, that has a nasty side effect of weight gain. My depression is atypical and does not respond well to other anti-depressants – belief me – I have tried a lot of them. Without my exercise regimen, I am slowly gaining weight. I am up about 15 pounds which is not good.
So – back to the poster below which about slowing the rate of exercise down in hopes of lowering cortisol and inflammation. Does training at a much slower pace – say I keep my heart rate below 110 or so – mitigate the risk chronic inflammation in my system?
Thanks in advance for any response.
Hi Donley,
Great question. There are some data that suggest lower intensity exercise may help in controlling AF. While this works for some, I find that most of my athletes end up with ablation as they are unwilling to take meds or reduce exercise.
John
Dr. Day,
I am a 56 yo female and started flecainide (100 mg twice a day) with beta blocker 3 years ago which has completely kept my heart in rhythm (for paroxysmal afib). I would like to clean up my diet and try weaning off of flecainide (otherwise I’m in excellent health and exercise regularly but not excessively; normal to low BP; low cholesterol; and am not overweight but could stand to lose a few pounds). However every EP I’ve worked with believes once you have afib, you will always have afib until you get an ablation and I’ll be on flecainide until that point (which can stop working I’m told). Do I need to make an appointment to see you and fly out to Salt Lake City (I’m in Portland, OR)? Or do you know of an EP locally who can work with me on this? I don’t just want to stop flecainide or cut the dose on my own (I could try, but know I don’t have my EP’s support; and I think I have the best one in the Portland area). I would like to try to avoid an ablation and would like to clear up my afib by following your dietary advice.
Hi Diane,
Not all cases of AF can be reversed with “lifestyle medicine,” but many can. If you are already at an ideal weight, exercising at a moderate level, sleeping well without sleep apnea, have stress under control, eat healthy, drink little to no alcohol, don’t smoke, and have a low to normal blood pressure then your AF may not be reversible as your lifestyle is already ideal. If this is indeed the case, then the choices really are medications or the possibility of eliminating your AF with an ablation procedure.
Unfortunately, I am not aware of any EP’s in Oregon that believe in the results of the LEGACY Study. As you know, the LEGACY Study showed that approximately 50% of AF cases can be reversed, without drugs or procedures, by a healthy lifestyle (here is the link to the LEGACY Study: http://www.ncbi.nlm.nih.gov/pubmed/25792361).
If there are lifestyle aspects which could be improved, I’m sure there are other healthcare providers in your area that you could work with. If you can go 6 or 12 months without an AF recurrence, I’m sure your EP will be willing to work with you on weaning off of flecainide. It really doesn’t make a whole lot of sense to travel to Salt Lake City unless you were considering a procedure.
Hope this helps!
John
I see Dr. David Shroeder at the Providence Heart Clinic in the Portland area and have found him very open to Dr. Day’s ideas and info about the LEGACY study. Not sure what he would say about your specifics of course. Best wishes!
Dr. Day
I am a 55 year old female. I started high blood pressure medication for the first time in my life (Losartan) in January and less than two weeks later went to emergency with an erratic heartbeat which they diagnosed as atrial fibrillation. It stopped after two hours. Is it possible it was not actually AFib but just an erratic heartbeat side effect of starting the medicine? Since then an echocardiogram showed a leaky mitral valve and enlarged atrium. My blood pressure and heartbeat had been normal (118/75 and heartbeat 75) with just an occasional skipped beat on the losartan and aspirin and I was feeling great. My EP added metropolol and eliquis two weeks ago. I am very stressed out about this. It seems so rushed to be put on so much medication. After the high blood pressure diagnosis I had started a diet and exercise change and had already lost 15 pounds. I am disappointed because it now seems that I will never be able to find out if I could have lowered my blood pressure naturally. Is there any chance of getting off these blood pressure pills and blood thinner if I continue on my lifestyle change plan? My concern is that now that I have started on them there will be no chance of getting off. How do I suggest to my EP I would like to try this med-free for a while? I just have a feeling that now is the time I should be trying this rather than later.
Hi Erin,
So sorry to hear about your AF experience. Yes, unless the EKG was read wrong from your ER visit it sounds like you have AF.
A history of high blood pressure and an enlarged atrium are both significant risk factors for developing AF. However, studies show that about 50% of AF cases can be reversed with weight loss and a healthy lifestyle.
Congratulations on your 15 pound weight loss. You are well on your way to a much lower blood pressure and hopefully reversal of your AF!
Once you have reversed your high blood pressure then your stroke risk factors may have changed enough so that you no longer need Eliquis. This would require you to get your CHADS-VASc score down to a 1. To learn more about who should be on a blood thinner for life, here is an article I wrote on the topic: https://drjohnday.com/do-i-have-to-take-a-blood-thinner-for-a-fib/
Metoprolol doesn’t prevent AF. It does slow the AF if it recurs. Also, it helps with high blood pressure.
There is still an excellent chance that with a healthy lifestyle, weight loss, and reversal of your high blood pressure that you can get off of these medications. Of course, don’t stop your medications on your own. Work with your EP and let them know of your commitment to reversing everything naturally over time. Keeping a detailed blood pressure log at home may help to convince your EP that you may no longer need the blood pressure meds.
The sooner you can make these lifestyle changes the better of your chances of success. Keep me posted on your success.
John
Hi Dr John
I’m 31 have a-fib I was wondering I have slow a-fib and fast a-fib and take pills for when it’s in a-fib now when it’s in a-fib I feel absolutely terrible but my heart tends to skip beats and do extra beats and my doctor says thats not a-fib is that true and if so y is my heart skipping and doing extra beats with my a-fib is it bad to skip beats and have extra beats when it misses a beat it’s very scary and feels very Strang and make’s me panic a bit and I think I’m going to die I have had an altrasound of my heart to check blood flow and came back normal
Hi Kade,
You are not alone with your Afib. Many people feel horrible when their hearts are out of rhythm. The key is to live as healthy as possible and to work with your local cardiologist. For many people this can reverse the condition. For others, an extremely healthy lifestyle can maximize the chances that medication, or an ablation, will effectively treat their condition.
John
I have had 2 ablations for afib already within the past 3 years. It has come back yet again. Would a pacemaker totally fix this issue?
Hi Aurora,
Unfortunately, pacemakers won’t fix atrial fibrillation. Pacemakers just speed up a slow heart. For most people with Afib, the problem is not a slow heart beat but rather too fast of a heart rate. However, when nothing else has worked, an AV node ablation combined with a pacemaker may give you the relief you are looking for.
A few things about the AV node ablation with pacemaker approach.
1. Pacemakers only speed up a slow heart. So unless the heart beats slowly in Afib, a pacemaker offers little benefit. This is why the AV node is ablated with the pacemaker.
2. The AV node is the main electrical relay station of the heart. If this is ablated then your life is likely dependent on the pacemaker.
3. The benefits of an AV node ablation with pacemaker is that your heart should no longer race or beat chaotically if the pacemaker is programmed correctly. Also, most people can get off 1-3 meds as they no longer need medications to keep the heart in rhythm or slow the heart rate.
4. The patients who benefit most from an AV node ablation with pacemaker are those whose hearts beat incredibly fast with Afib and nothing else has worked.
5. With this approach, the heart can still go into Afib, the difference is that the Afib electrical signals are no longer conducted to the ventricles if the AV node is ablated. Thus, blood thinners are still needed.
Hope this helps!
John
Hello Dr. John,
Thank you for the great article.
I am a healthy 55 year old male. I eat right and exercise regularly but make sure to keep my adrenalin and cortisol in check. Is it ok if I run at or just below aerobic threshold? Will this help me build a strong aerobic base but not stretch my heart like running does to other runners?
In health,
Jim
Hi Jim,
Thanks for reading and for leaving your comments. This is a great question.
As you know, with exercise we see a “U” shipped curve when it comes to Afib. On one end of the spectrum, the couch potato is at high risk for Afib. On the other end of the spectrum, the ultra endurance athlete is also at increased risk of Afib. The sweet spot, or those with the lowest risk of Afib, seems to be the person who exercise at a moderate level each day.
However, for most of my ultra endurance athletes, cutting back on exercise or slowing down on their race times is not something they are willing to do. Thus, we often end up moving toward an ablation so that they can continue to compete.
When you look at the ultra endurance athletes and AFib risk studies, it appears that if these athletes slow down on their race times (a more aerobic pace) that the risk of Afib seems to decrease. The same findings are also true when you look at heart scarring with MRI studies of ultra endurance athletes.
Of course, every person and every heart is different. Make sure that you are doing your training under the supervision of your physician to make sure that you are safe and are not causing long term issues.
Hope this helps!
John
Dr John,
I am 59 have Bradycardia( resting HR in low 40’s) with PAF since 2011, my episodes vary, sometimes clusters in month, or every few months, i’m on PIP, 25mg metroplol+100mg flecanide, convert to nsr in 3 hours, my chadVasc is 0, 1) should I add a blood thinner to PIP , 2) can I remove Metroplol from PIP to avoid aggravating my bradycardia?3) If I decide to go on chronic medication can I just use flecanide W/O Metroplol as well. Appreciate your feedback.
Hi Sam,
Some good questions.
1. According to the atrial fibrillation treatment guidelines, for people with a CHADS-VASc score of 0, no blood thinners are needed unless you are cardioverted after a prolonged episode of atrial fibrillation (more than 48 hours).
2. There are no official recommendations on adding a blood thinner to the pill-in-pocket (PIP) approach. Some of my patients have requested a blood thinner with their PIP.
3. A rate controlling aging, like metoprolol, is recommended before the PIP approach. However, due to bradycardia issues, I have had patients where I only prescribe flecainide as the PIP medication.
4. While a rate controlling agent, like metoprolol, is recommended for people on daily flecainide therapy, I have had some patients that I have had to stop the rate controlling medication due to bradycardia.
Of course, please do not start or stop any medications without first discussing it with your cardiologist. Also, given your bradycardia challenges, your physician may want to try PIP first in a monitored setting to make sure there are no problems.
Hope this helps!
John
Hi, Dr. Day 🙂
I had my first attack November 2015, awoke in early morning hours with erratic heartbeat, was hospitalized, did not resolve with medication so had cardioversion which corrected it. All tests showed normal heart, no high blood pressure. I was dehydrated and low magnesium. Was on xarelto for one month, then told I could discontinue it.
I have a large hiatal hernia and have noticed when my stomach is out of sorts I get the flutter sensation, my heart does seem to skip, I belch and it stops it. Is there a correlation between hiatal hernia and afib?
I am overweight, have changed my eating habits and have been losing. No caffeine, no alcohol, eat organic as much as possible. The only medicine I take is hydroxyzine, one 25mg 1x a day for anxiety. Ever since being hospitalized I’ve been getting the ‘flutter’ on and off most every day. Had it previously to hospitalization occasionally but attributed it to the hernia and gerd. I don’t know if I’m just noticing it more now that I’m aware, or what?
Other than having hashimoto thyroiditis, no gallbladder, and being overweight, I am a healthy 64 year old female. Oh, and I do not handle stress well and constantly worry.
Is there hope for me?
Hi Martha,
There is always hope! I have seen countless miracles where many medical problems all went away over time by living a healthy lifestyle.
To answer your questions.
1. Yes, some people have “vagal” triggers for their atrial fibrillation. Gastrointestinal challenges, such as a hiatal hernia, can be one of many. Acid reflux is another.
2. It is possible that you are just noticing the palpitations more now or that the underlying condition has worsened. Either way, things should improve as the weight comes down and you get stress under control.
Sign up for my newsletter if you have not already done so. Every week we cover topics that will help you to improve the medical struggles you are currently facing.
Best,
John
Hi Dr John,
Is there any research in respect of natural blood thinners for example, omega3, garlic, ginger etc.
Surely a natural blood thinner product would be better than none, even if it’s half as effective as warfarin.
I read somewhere that taking 2 ginger capsules is just was effective as a baby aspirin.
Colin
Hi Colin,
Great question. This is something I am asked nearly every day by my patients.
You are absolutely correct, all of these agents somewhat “thin” the blood. There are also many other natural minor “blood thinners.”
The problem is that none of these agents have been specifically tested for atrial fibrillation. Even a well known blood thinner, aspirin, has only been shown to be helpful in preventing Afib strokes in just 1 study (all of the other studies, and there have been many, have not shown any benefit with aspirin).
Thus, there really are no reliable studies that we can base a clinical recommendation on–
Hope this helps!
John
thank you so much Dr John
you are a breathe of fresh air in a somewhat stale environment of afib treatment. when i was first diagnose in 2013 i was given all the heavy drugs and basically told to take them or you will have a stroke. well i can tell you i freaked out as i also suffer with anxiety. i am a keen cyclist and walker and i feared those days would be behind me and the fear of coming off my bike with a body full of warfarin is not good.i took the drugs for 8 months then stopped them and carried on with a pill in the pocket up to the present day i will certainly follow your program with fingers crossed,
cheers
Dave Jones
Hi Dave,
You touch on some good points–the risk of stroke versus bleeding with anticoagulants (blood thinners). As an avid cyclist, you are certainly at increased risk of bleeding. However, you also don’t want to put yourself at increased risk for stroke. The risk benefit trade off of these medications is something everyone should discuss with their physician.
As you know, The only safe way for people to get off their anticoagulants (blood thinners) for atrial fibrillation is to change their risk factors for stroke. For example, if someone can put their diabetes or high blood pressure into remission by changing their lifestyle then this would lower their CHADS-VASc score so that they would no longer qualify for anticoagulants. For people wishing to learn more about who should be on a blood thinner, here is an article I wrote on this subject: https://drjohnday.com/do-i-have-to-take-a-blood-thinner-for-a-fib/
Best,
John
Hi Dr. John,
I was diagnosed this May with AFib when I ended up in the hospital with Afib RVR. I have had two episodes since then lasting under 12 hours and converting on my own with Metroprolo and Xanax. All of my testing has been normal. No heart disease. My CHADs score is a 1.
I am under much stress and anxiety due to my husband battling Glioblastoma Grade 4 for the past three years.
My question is this, if the AFib is caused by stress and anxiety can it be “cured” by trying to control as much of the stress as possible. My Cardiologist has suggested it may be controlled, but if I have another episode he feels I should have the ablation in hopes that it does not happen again.
I eat a vegetarian diet and have stopped all alcohol. (only had a wine now and then) I also take daily supplements.
Thanks for your help.
Cynthia
Hi Cynthia,
Thanks for reading. Congratulations on living as healthy as possible to reduce Afib episodes!
Yes, stress is a powerful trigger for atrial fibrillation. Many studies have shown that meditation and yoga may decrease Afib episodes.
Hope this helps!
John
Thank you for the fast response Dr. John.
Does Cardiac Ablation cure the episodes so that I won’t have to worry about them happening again?
Thanks,
Cynthia
For many patients, catheter ablation can put Afib into remission. The ideal patients for ablation are younger, have not had Afib for very long, have the paroxysmal or intermittent form, and are healthy without any other medical conditions.
Hope this helps!
John
Well I guess that is me. I am 57, only had three episodes starting in May with no other health issues.
Thanks Dr. John, this may be the way for me to go.
I wish you were closer. Thanks for all you do to educate us.
Cynthia
Hi Cynthia,
Thank you so much for your kind comments. Make sure you select a doctor and a hospital that has extensive experience with Afib ablations. Ideally, they have even published their outcomes in a medical journal. Studies show that inexperienced physicians and low-volume hospitals have many life-threatening complications from these procedures.
Wishing you success!
John
I should have said that I am not on any medication only the Metroprolo when it happens and a daily baby aspirin.
Do you prescribe a “pill in the pocket” protocol for your afib patients to return to NSR after an event has started? If so what do you recommend?
Is there other things one can do to return to NSR quickly?
Hi Colin,
Yes, we frequently prescribe flecainide and propafenone to be used as a “pill in the pocket.” This works well for people who know the exact minute they go out of rhythm and their episodes of Afib are very infrequent. Of course, there are always precautions to make sure that it is as safe as possible. Talk with your doctor to see if this approach is right for you.
Best,
John
Should I worry if my Ldl levels are high (4.9) when my triglycerides are good 0.8, blood presume is below 120/70 and my fasting blood sugar is normal at 5.5.
Would this suggest my blood is flowing without restriction? Yes?
I don’t want to take statins because they depletes CoQ10 and I read that a high Ldl is linked to lower incidence of afib.
I am not on any blood thinners other than ginger capsules which I take once a day, I understand ginger is as effective as aspirin but not harmful.
I would be interested in your reply and comment.
Hi Colin,
Thanks for reading! Elevated LDL levels have been consistently linked to coronary artery disease in countless studies. Keeping triglycerides and fasting glucose low is also desirable.
Unfortunately, you cannot assess coronary blood flow from the above lab tests alone. However, people with an elevated LDL, triglyceride, or glucose are much more likely to have blockages in their coronary arteries.
It is true that statins deplete CoQ10.
The data on cholesterol and Afib is not clear. My guess is that this is likely because there is not much of a link. Cholesterol relates more to “plumbing” issues within the heart rather than “electrical.”
Unfortunately, aspirin has been falling out of favor as a blood thinner for Afib. Most studies show it doesn’t help much in preventing Afib strokes. In addition, there is no compelling evidence that the alternative blood thinners prevent Afib strokes either…
Hope this helps!
John
Hi all–
I just published an article you may find interesting on the latest research on caffeine and arrhythmias. Here is the link: https://drjohnday.com/is-caffeine-safe-for-the-heart/.
Best,
Dr. John Day
How do you feel about the drug amiodarone for afib?
Hi Becky,
Amiodarone is by far the most effective antiarrhythmic medication we have for any kind of arrhythmia. It is also very cheap, has been around forever, and can be started as an outpatient.
The problem is that amiodarone has significant toxicities. For example, I have seen cases where amiodarone has caused partial blindness, permanent lung injury requiring lifelong oxygen therapy, liver failure requiring transplantation, and thyroid failure.
Of course, please keep in mind that I have seen thousands and thousands of patients on this medication. Also, I tend to see the worst cases. In other words, my amiodarone experience is biased because I tend to see all of the amiodarone failures–if amiodarone is working well I may never be asked to consult on the patient’s Afib.
In general, amiodarone is best used in situations when no other medication would likely be effective. If amiodarone must be used then the goa; should be to get on the minimally effective dose (lowest dose possible to control the Afib). Also, anyone on this medication needs to religiously have their eyes checked at least every year. They also need to make sure they are getting at least annual pulmonary function tests, liver function tests, and thyroid function tests to monitor for possible amiodarone toxicity.
Hope this helps!
John
Thanks so much! I think I need to try some other drugs before I jump to this one.
I wish more doctors would stress a more wholistic approach to managing or maybe even reversing afib. Thank you for writing all of these articles!
Question…if you needed to be on a bloodthinner long term which one would you choose and why.
Hi Tim,
Thanks for your comments!
For my patients who meet the criteria for blood thinners my favorite is Eliquis. This is because the bleeding risk of this blood thinner seems to be the lowest. In fact, one study showed that the risk of bleeding on Eliquis was statistically the same as aspirin. Here is a link to that study: http://www.nejm.org/doi/full/10.1056/NEJMoa1007432
However, some of my patients just can’t remember to take a twice daily medication. For these people I like Xarelto because it has once daily dosing.
Lastly, for my patients who want an FDA approved antidote to their blood thinner I use Pradaxa. I should note that an antidote to Eliquis and Xarelto will soon be available.
My least favorite blood thinner is warfarin. This medication is hard to keep in a therapeutic range and it interacts with too many foods (green leafy vegetables) and other medications.
Hope this helps!
John
A million thanks for your reply..it’s great news that there are better and safer options now. Warmly, Tim
Hi doctor, many thanks for these articles. I’m happy to see some encouraging words about how to make my life better with afib. How can you get off of bloodthinners once you’re on them though..? If you hugely reduce your afib incidents aren’t you still at risk for stroke…? Would you have some way of proving you no longer had afib to get off the meds?
Hi Tim,
Great question. Blood thinners for Afib are determined by your risk of a stroke. The guidelines are pretty clear that the need for blood thinners is not determined by whether or not you are having Afib but by your risk factors for stroke. Thus, the only way to safely get off of blood thinners is to reduce your risk of a stroke.
Your stroke risk is determined by your CHADS-VASc score. To learn more about this scoring system and who should take blood thinners, please read this article I wrote: https://drjohnday.com/do-i-have-to-take-a-blood-thinner-for-a-fib/
As you can see, if you can reverse your high blood pressure, diabetes, etc. then you can drop your CHADS-VASc score. Once you get your CHADS-VASc score below 2 then blood thinners are no longer needed.
Hope this helps!
John
I understood that the CHADS-VASc point scored for high blood pressure was applicable to any history of HBP — as opposed to active HBP — and you get that point for life. Has it been your experience that “curing” HBP with lifestyle modifications (say, as opposed to medication) allows one to remove this point? Since being diagnosed with A-Fib last May, I have lost 75 pounds and now have normal blood pressure without medication. That is my only risk factor and it would be great if I could drop the anticoagulant.
Hi Jeff,
Congratulations on reversing your high blood pressure and losing 75 pounds! For my patients who can reverse their high blood pressure, I no longer count this as a “point” on the CHADS-VASc scoring system.
Best,
John
Dr. John, I was wondering whether you consider the size of the left atrium when making recommendations about anticoagulation. I read that many A-fib sufferers have an enlarged left atrium, but it doesn’t seem to be considered in the various risk stratification regimes. Thanks.
Hi Jeff,
Great question. There are some data linking left atrial size or left atrial appendage size to stroke risk (the bigger the size the higher the stroke risk). However, the data currently available aren’t strong enough yet to make it into the anticoagulation guidelines.
Hope this answers your question.
John
Hi Dr. John,
I was wondering what is your feeling about continuing or discontinuing anticoagulation if the lifestyle changes you discuss have caused afib to abate.
Your website is a great service to those of us dealing with this condition. Thanks!!
Hi Jeff,
Great question. Yes, if people can put their high blood pressure or diabetes into remission with a healthy lifestyle then their CHADS-VASc score would go down.
The CHADS-VASc score measures the stroke risk factors. This scoring system is what your doctor uses to decide if you need anticoagulation or not. If you can get your score below 2 then you don’t need long-term anticoagulation (short term use may be needed like for a month after a cardioversion).
Thanks for spending time on this website!
Best,
John
This is a very helpful and informative article, though discouraging to read how few people could get off or not go on blood thinners. Am I reading it correctly that all women 74 and older should be on them, with two points for age and one for being female? Cannot individual differences be taken into account in any way–i.e. some people are much ‘younger’ than their chronological age? This just seems intuitively wrong and like pharmaceutical overkill. What about the women in Longevity Village?
I also had never seen this article until you posted the link and wonder if I am missing others than are not listed under your Reverse Heart Disease Section. Is there another index of all the articles somewhere? Your pieces are invaluable, so incredibly helpful, motivating and educational!
Hi Jean,
Unfortunately, the anticoagulation guidelines are just “one size fits all.” The guidelines were developed based on population wide averages.
You are correct, a totally healthy 74 year old woman, even though she is say 60 years old biologically, would have a CHADS-VASc score of 2 and would be indicated for life long blood thinners according to the anticoagulation guidelines.
In my opinion, the anticoagulation guidelines are rather aggressive. At the end of the day, whether or not someone should go on blood thinners is really a decision between the doctor and the patient weighing all of the risks and benefits.
Thank you as well for your interest in my other articles. I need to make sure all of my previous articles can be easily found. If you go to the very beginning of my blogs (before blog #001), you will find 8 Afib articles I wrote.
Hope this helps!
John
What a treasure trove of information! I had not actually clicked on blog heading and did not realize all the wonderful content there. This site is phenomenal and so is your responsiveness in answering people’s questions and sharing so much exciting and helpful research that’s not widely publicized elsewhere. Thank you so much!
Hi Jean,
Thank you so much for your kind words!!!
John
I just realized this score is only for people with a fib, which makes the medicating recommendations considerably less sweeping than I initially thought! Still, no distinctions are made between those who have had just a handful of fib episodes that quickly resolve and those who have it all the time or often. If a person is knowingly in a fib only 4-6 hours in a year or less and the a fib improves from that or seems to go away, for example, does it make statistical sense for their risk be considered the same as for someone in a fib for weeks or months? Is there no way to take a blood thinner with the very occasional a fib episode and get some protection there?
Thank you very much for any info you can provide!
Hi Jean,
Correct again…the guidelines make no distinctions in risk based on how frequent or how long the episodes are. The guidelines were never meant to be a “law,” but rather suggestions on how to treat patients. This is why this decision is something that must be carefully discussed between the doctor and the patient.
Hope this helps!
John
Many thanks for your help! Wishing you and your family a wonderful new year!
Thanks!!!
John
I am very appreciative of this information. At 72 I almost fell over with the diagnosis of AFIB three weeks ago especially since I try to take good care of myself. BUT — what I let get away from me was the management of stress, which I let get too high in running my businesses.
In the long run I would like to suggest that we put more time into ourselves so that others can know that they can count on us for a long time to come.
Merry Christmas to everyone out there
Marty
Hilton Head Island, Sc
Great point…just like when they tell you on an airplane to put your own oxygen mask on first before helping someone else. If we are to be there to help others we have to care for our own health.
Best,
John
What is the most important factor to cure a fib? That article does not come up, and I really would love to know!
Hi Jean,
The “key domino” in reversing Afib seems to be weight loss. If the weight can be lost, then the high blood pressure, sleep apnea, diabetes, etc. often go away and the Afib may go into remission.
John
Your program is a life-saver, and I feel so happy and grateful to be following it! Thank you so much. In 10.5 weeks I’ve lost 24 pounds, which I could not seem to lose before, and I feel like I’ve found a sustainable, healthy way of eating for life. I intend to keep at this and hope to reverse my paroxysmal a fib, but have a few questions:
1. When or how that can be determined if a person has reversed their a fib if they apparently already have gone months and months between observed episodes? I read in the LEGACY study that the people were observed for seven days on Holter, but what if one goes longer than that between known occurrences? What does it take to declare reversal?
2. I feel as if I generally know when I’m having a fib, which usually occurs when I wake up in the night after having felt really stressed and revved up going to bed and late the day before. I routinely now avoid the over-exercise, caffeine or stress without relaxation that previously caused this to happen and check my pulse when I awaken during the night to see if all’s well. I also feel I can just tell from the unsettled feeling of my heart and that it is unlikely I would have this without knowing but am not sure I can be certain of this. How can an unmonitored person know if they are really free of a fib? Can there be very short, undetected episodes if one has never known that to happen before?
3. Can people who’ve had a fib go off blood thinners when their a fib ‘reverses’? What if they still need to be on blood pressure medication to be well controlled for periodic spikes in that and are 65 or older and female? When can people who have had a fib ever go off blood thinners and/or not start them?
Thank you so much for any light you can shed on these matters and for your wonderful site and teachings!
Hi Jean,
This is an amazing success! Congratulations!
To answer your questions:
1. You are correct, the follow up in the LEGACY Study was not long–about 2 years. It is certainly possible that some of these people will have their AF come back at some future date.
2. You are also correct, in that unless you a monitored 24/7 you never really know if you are truly Afib free or not. For example, even in people who feel every episode of Afib, they could have an episode in the middle of the night and never know it happened.
3. Blood thinners for Afib are given based on stroke risk factors. So if someone is able to reverse their stroke risk factors (high blood pressure, diabetes, etc.) then they could come off of their blood thinners. Of course this is something that should only be done under the direction of a physician.
Hope this helps!
John
Very helpful–thanks so much!
alkalizing diet, raw food, wild caught fish and grass fed beef OK but no dairy, goats milk OK, avoid all processed food, not too much coffee 2 to 3 cups max a day, use organic Stevia in place of sugar eat organic , no alcohol: alcohol can delete all progress made in healing in one night of drinking! , exercise: yoga daily and anaerobic exercise 2 to 3 times per week, have social activities, keep stress down. Take magnesium supplements, apple cider vinegar 2 to 3 tablespoons daily, blackstap molasses.
Avoid all prescribed medications if possible
Note: alkalizing diet can show immediate improvement to eliminating AFIB
My fiancé, age 74, just had a cryoballoon ablation for Atrial Fibrillation of 14 months duration. He is otherwise healthy and was on no medication. While waiting for the procedure date he went into permanent atrial fibrillation for 51 days. He previously had converted on his own. He converted during the procedure. He had refused medication treatment prior to surgery. He took nattokinase 100mg every 6 hours after going to permanent afib and had been taking it initially as twice daily, later 3 daily and finally up to 4 daily. The TEE done before showed no evidence of clots and fibrinogen activity of 271. He, also, ate very healthily and took other nutritional supplements. After surgery, he was in NSR. He was put on Eliquis 5 mg bid for 3 months and Frecainide 50 mg BID. The reason given for the medicines was because of considerable fibrosis detected during the procedure. He did have an MRA and standard Echo pre-op. He was, also, give Prilosec 20 mgm BID for some unknown reason. The doctor said that he procedure went extremely well and that my fiancé did extremely well during the procedure. The Flecainide and Eliquis are to be used for 3 months. We had expected that he would get Eliquis for one month only after the procedure. It is confusing as to why the two drugs for 3 months if the surgery was successful. My fiancé’s normal (athletic) pulse was 58-64. The pulse has been hanging at 54-62 since the procedure. Any help on understanding the “why” about the medications would be helpful. Those are not medications that should be used lightly! He wants to go back to his nutritional and supplement lifestyle.
Hi Helen,
Great questions. Let me try to answer.
1. Prilosec is generally used after Afib ablations to minimize the risk of an esophageal injury. The esophagus can be injured by too much heat or cold during the ablation procedure. There is no data that this helps but probably 99% of electrophysiologists do this because an esophageal injury can be a life threatening emergency.
2. Flecainide or other antiarrhythmics are also generally used by the vast majority of electrophysiologists for 1-3 months after an ablation procedure. The reason is that the heart is very prone to arrhythmias until everything heals after an ablation. Research shows that these medications help to hold the heart in rhythm during the healing phase after an ablation procedure.
3. Eliquis or other blood thinners. Most electrophysiologists require blood thinners for 1-3 months after an ablation. This one is tough to answer as there are so many variables as to how critical this is for an individual patient. You should definitely discuss this with your doctor.
Please don’t ever stop any medications without talking it over with your doctor. Hopefully, this helped!
John
Can u please tell me when the abalation procedure is done , is a patient under anesthesia ?
I am very nervous about this procedure and if I were knocked out I think my anxiety levels would go down.
Thank you for your help
Hi Betty,
Hard to say how your physician likes to approach these procedures. We have always used general anesthesia but some physicians like to just use a milder sedative. Talk with your physician to see how he or she manages the anesthesia/sedation component of the procedure.
Best,
John
I have been diagnosed with lone atrial fibrillation and thus assume ablation would not be an option – I seem to have attacks on a seasonal basis, primarily in the fall and spring, and have observed a definite association between attacks and my digestive system, notably an increase in the frequency of attacks after large meals. I am on low dose inderal (20 mg daily) and lorazepam (.5 mg twice daily) with instructions to take an extra dose of each drug if and when an attack begins. I have averaged a couple of attacks per year for the last 5 years, most of which have lasted between 30 minutes to 2 hours, all of which have spontaneously returned to a normal rhythm – on several occasions, the attacks stopped shortly after I took the extra medication. My weight is normal, my blood pressure is on the low side, I have no other health issues, drink red wine moderately and exercise daily but it seems that nothing I do has much of an impact on this condition
Hi Bruce,
It is common for many people to have the “vagal” triggered episodes of atrial fibrillation. Large meals and sleep will definitely bring out a vagal response. Ablation, when done at experienced centers by experienced electrophysiologists, can be helpful for these forms of atrial fibrillation.
John
Thanks very much for the response – I will check with my cardiologist to explore options
Am 63 year old health, Had a stroke in late May, and afib two days later. On warfarin and metoprolol er 100 daily. Could stop afib by walking up to four weeks ago. Now I afib for 2 or 3 days and than normal for 2-4 days. Started using a bipap for central sleep apnea 2 months ago and part of the fog is from the stroke. I,m exhausted and in a fog world of fitque. Can,t get anything done. Having an ablation in three weeks. But I,m getting mixed message if I should have it from cardiologist no -who recommended the cardiologist electrophysiologist yes who is doing it.
Hi Susan,
So sorry to hear that you have been struggling since your stroke. I sure hope things resolve over time.
Great questions. The medical guidelines state an ablation is indicated when nothing else has worked and the patient is still suffering from atrial fibrillation symptoms. While studies done from our hospital indicate that the stroke risk can be reduced with an ablation this has not yet been proven from other centers. Hope this helps! John
Great and inspiring article! This is all so motivating to me. A question about your dietary recommendations. You say two servings of Mercury-free oily fish a week. If a person likes fish, would is be healthy and permissible to eat more fish servings, provided the other guidelines are met? I’ve read that pescatarians can have better health statistics in some areas than vegans or vegetarians but also came across one study that said eating more fish was associated with more a. fib. Your thoughts?
Hi Jean,
Many of my patients love to eat fish and may do so 3 to 5 times a week. For these people I recommend that they definitely stick to the lower mercury fish.
Studies can be tricky. Regardless of the topic, it is common to see studies showing conflicting findings. I always try to look at both the quality of the studies and where the predominance of the data lies.
This is the same for atrial fibrillation, or heart disease in general, and fish consumption. If you look at the entire field of data, most studies report that there is either a benefit or no harm. Thus, my current feeling on fish and heart disease is that there is probably a benefit and when compared to other meats, fish seems to have the most benefit to the heart.
Hope this helps!
John
Thank you very much! This helps a lot!
That was me, Jean 🙂
I’m 70 years old and diagnosed with A-fib 4 yrs ago. Have been on several medications with the last being Amiodarone which stopped working in September 2014. Had an ablation in November 2014 and have been in NSR since then. As of last visit with EP I am on 60 mg of sotolol twice a day and 10mg of xarelto daily. I’m nervous about stopping meds as afraid of going back into A-fib. Can you please give me your thoughts on this.
Hi Eileen,
Glad to hear the ablation has been successful thus far. Sotalol certainly caries some risk–the main risk being that of a cardiac arrest. At your current dose of sotalol the chances of a cardiac arrest from this drug are quite low assuming that your kidney function is normal.
While stopping sotalol could trigger an Afib episode it is also the only way to determine if you still need medications or not. One other comment is that your 10 mg dose of Xarelto is lower than what is typically used for stroke prevention in Afib.
Hope this helps!
John
Hello Dr John,
I have been on Flecanide now for 2 yrs as my A Fib was coming every few weeks and lasting for 10-30hrs at a time. The Flecanide has my A Fib more or less under control which I know is good. I take 100mgs at night and 50mgs in the morning. I do feel strong side-effects from the Flecanide though. Fatigue, heavy tired eyes, depression and on….. I seem to be constantly fighting fatigue and I can’t stand it anymore. My quality of life has diminished so much in the last 2 yrs. Do you think I could ever get off Flecanide? I am also on Valsartan for high BP but only for the past 9 months. I also suffer from Fibromyalgia though it is mild compared to some people. but I do get inflamed joints and always have a pain somewhere. My EP told me I can tweak the amount of Flecanide I take to see if I can take the dose down but I did try and got some scarey chest sensations going on and upped the dose again. Just came down to 50mgs morning and evening.
I hope you can give me some hope.
Biddy
Hi Biddy,
Yes, flecainide can cause a lot of symptoms for some people. Hopefully your lower dose will control the Afib and also minimize the side effects.
Other options could be to switch medications or consider a catheter ablation procedure to try and eliminate the Afib.
Hope this helps!
John
PS I’m 59yrs old
Biddy
Hi Dr. Day,
I am a complex individual with a myriad of health problems. I have diastolic congestive heart failure, paroxsmal atrial fibrillation, I’m morbidly obese but am losing weight, going to be 60 in November, indigestion problems with gas and many times when I eat I feel sick and have gas pains, I have a pacemaker, hernia and my homelife is not always satisfying. My cat Elvis does help immensely in alleviating bad feelings. Oh and I don’t like mmy roommate Tom because he is verbally abusive sometimes. I really don’t have any way at this time for Elvis and I to leave. My roommate and I are only living together for financial reasons- both of us are on the lease. I want to move closer to my son who lives in Colorado but I have tovtry and save money but it’s really difficult when you get SSI because the payout is low . I am going to have to figure out how to cut some corners. Also, I never hardly get to see my son, my only child due to because he is so far away and he can’t afford travel expenses and neither can I . I was though able to see him Christmas 2014. I hadn’t seen him in 3 years and it just about broke my heart and he was upset about it also. We do call each other alot which helps. We are trying to figure things out tovfet me and Elvis to Colorado. I just can’t live where my son lives cause the elevator is too high for my condition. Sterling Colorado has an elevation just under 4,000 . Where my son is in Pagosa Springs Colorado, the elevation is 7,183 I believe. I keep telling myself everything will work out and I tell my son the same.
Hi Paula,
I wish you the best in your efforts to live a healthy lifestyle! It will help!
Best,
JOhn
Hi DrJohn.I have Afib from having Lyme Disease. Will it go away once I’m healed from Lyme? Thanks David
Hi David,
Great question. Hard to say on this one. Let’s hope it goes away with the Lyme Disease.
Hoping for the best!
John
Dr. John,
I appreciate this site very much, it is very informative. I am 31 and have had afib for three months. Mine always happens at night or right when I wake up. Once in a while it happens after a large meal or bending down. My EP has helped me realize that the afib only occurs when I am in a high vagal tone. The afib is unusual that it is very frequent (once a week) and is very mild (normal ventricle rate and I barely notice it). Strangely, vigorous exercise will return me to normal sinus rhythm. Is this type of afib unusual?
I don’t know why I have this as I am super health conscious with low blood pressure, normal atrial size, low resting heart rate, no sleep apnea, no thyroid issues or anything they could find. My EP thinks it may be from running too much. I consider a five mile run short and ran competitively all the way through college and still run a lot (40-50 miles a week).
What lifestyle changes would you recommend? Some research seems to suggest that “detraining” May help. Beta blockers lower my heart rate too much (below 50 bpm) so I only take them if I have an episode.
Hi Jon,
I am sorry to hear you are suffering from Afib. There is a growing body of data that suggests that extreme levels of exercise may be an important cause of Afib. I have certainly seen many young triathletes, ultra marathon runners, marathon runners, competitive cyclists in my Afib clinic over the years with otherwise unexplained Afib.
Some of these patients have backed off significantly with their training with varying degrees of improvement in their Afib. Most cannot back off on exercising and ultimately end up with an ablation so that they can continue to do what they love.
Hope this helps!
John
I have been in and out of aFib since 2002. Severe high blood pressure not well controlled. Dr Day performed my ablation last Feb, after a rough couple of months I have stayed in normal rhythm. Thanks Dr Day. I do have a question how do you fell about the Keto diet and aFib/ weight loss?
Hi George,
Glad to hear the Afib is under control now! The ketogenic diet can be very helpful for some people. To make sure it is the right approach for you, it should be done under the direction of your regular physician.
Yes, weight loss can be incredibly helpful for Afib. For example, in the LEGACY Study, of the people who could lose an average of just 36 pounds, 46% of them had their Afib go into remission without procedures or medications.
In general, I am not a big fan of diets. Too often these are things people go on and off of. Ideally, you can find a healthy eating approach that you enjoy and can sustain it for the rest of your life. This way the weight will always stay off and not come back.
Hope this helps!
John
I walk 3 miles per day, and workout at cardiac rehab 3 hours per week. I swim in season, and average 12,000 steps per day. I have a mechanical mitral valve since 2006. Have had 2 maze ablations with open heart surgery. Am currently wearing a monitor device to track my AFIB. My pacemaker is set to come on at 70 BPM.
I am taking 480mg of Verapamil and 450 mg of Propafenome daily.
My diet includes almonds, fruits, and healthy food.
Today my AFIB hit 113, and has been around 89 to 99 all day. This past week it was in the low 70’s. I was advised the next step is to have my 2 natural pacemakers severed and rely completely on my mechanical pacemaker. This sounds like it is non reversible and the end of the line. I keep thinking medical science has better answers. What do you think?
Hi Jim,
You are absolutely correct. An AV node ablation will make you 100% pacemaker dependent and it is not reversible. This procedure can be helpful for people who have a very fast heart rate with atrial fibrillation when everything else has failed (lifestyle changes, medications, atrial fibrillation ablation, etc.)
Atrial fibrillation ablations with a healthy lifestyle are generally very effective for this condition. Even if you have already had a MAZE surgery you may be a candidate for an atrial fibrillation ablation.
Hope this helps!
John
Hi Dr. John, thank you for your very informative website.
Regarding the post before me, I was surprised to know that some people with paroxysmal a-fib have MRIs to measure fibrosis in their left atrium, which patients with a-fib would you recommend it to ? and does an atrial MRI have false positives or negatives in detecting fibrosis?
Hi Adam,
Great question. MRIs to assess left atrial fibrosis is a new imaging technique. Early data suggests that the more fibrosis (scarring) of the left atrium the harder it is to treat. This makes sense.
There are other techniques to assess left atrial fibrosis. For example, a severely enlarged left atrium on echo is likely to have a lot of fibrosis whereas a normal sized left atrium is likely to have minimal scarring.
Also, the patient with paroxysmal atrial fibrillation is likely to have less fibrosis than the patient with persistent atrial fibrillation.
The MRI technology to detect fibrosis continues to get better with time. This test is ideal for the patient with persistent atrial fibrillation where you are not sure if there is even a fighting chance of a successful ablation procedure.
Hope this helps!
John
I am 59 with PAF, had it for 4 years, on pill-in-pocket, 100 Flecanide and 25 Metroplol, CHA2DVAS2c score 0, no other health issues except bradycardia, recently had a DE-MRI/MRA at UT hospital, all results were normal including left atrium size and function, except for mildly enlarged right atrium, however they gave me an LA fibrosis score of 22, my question is how accurate and reliable their results are? I heard they can fluctuate, and what is average LA fibrosis for my age barring other contributing factors ? And does this 22 fibrosis score preclude an ablation if it was correct?
Thank you, and looking forward to hear from you Dr Day.
Hi Sam,
The MRIs looking at left atrial fibrosis are becoming progressively more accurate with time. In general, the more the fibrosis the harder it is to treat atrial fibrillation.
The fact that you have paroxysmal atrial fibrillation, are relatively young, have a CHADSVASc score of 0, and have a normal sized left atrium are all factors which predict increased ablation success.
Hope this helps!
John
I am 73 years old and had a Quad By Pass 4 years ago and would like to know if my chances are better with an “Operation” than with a “Diet” as I like my greens and all Veggies and I have found out it is very hard to stop what I have had to eat all of my life.!**
I have survived Cancer 9 years ago and died twice ~~ once in the Ambulance and then again in the Emergency Room and had Stents put in but they closed and then I had the Quad done by a very good Dr. and my currant Dr. is Dr. Towne at Tennova Hospital West in Knoxville,Tn. but I don’t think he doe’s the Ablation and I don’t know who doe’s but you.! Any help would be appreciated on this matter.** Thank You.
JAG
Hi Jack,
Great question. The chances of a successful ablation procedure depend on a number of different things.
1. How many months/years you have had Afib (shorter period of time is better).
2. Whether your Afib is self-correcting (paroxysmal) or persistent (paroxysmal is much better).
3. Age (younger is better).
4. Other heart or medical problems (less is better).
5. Size of your left atrium (smaller is better).
6. Scarring of your left atrium (less is better).
7. Lifestyle factors (a healthy lifestyle can double the chances of a successful procedure).
Hope this helps as you make this important decision!
John
Hi I had suffered with Occasional AF for over 25 years it was finally diagnosed in 2005 at an age of 55 it had become very dibilitating and was happening 3 or more times each week, it had been treated with good results in the next few years with Metrolol and Flecanide but I still had some bad episodes sometimes it would last for days.
I decided to go for an oblate on in 2011 which was a great success and got rid of 90 percent and the remaining 10 was much milder.
It’s now 2015 and I suffered a mild heart attack nothing to do with the AF and was fitted with a stent to open up a restricted artery, I now unfortunately have my AF back although not as bad as before and have been offered another oblation, I have decided to see if the AF goes away as my heart gets stronger before making a decision.
Andrew
Hi Andrew,
Thank you for sharing your AF experience. Your experiences help the group to know they are not alone in dealing with AF.
Best,
John
Thank you for all you do! Thanks for looking me right in the eyes and telling me that losing weight would help! I am trying the Eat for your blood type and I am dedicated, for the first time to lose weight for my health! This comes from someone who has dieted and won many times, once out of grief ! It was usually for the wrong reasons. .. its gonna work and when i see you in the fall, I hope it will be noticeable! Love you dear Dr Day! Erma hugs to Hannah
Hi Erma,
I’m cheering for you! You will be successful!
John
At the emergency can they tell if it’s svt or Afib when your heart rate is 180?They did blood work, Ekg and chest xray and said I had SVt!
If it was Afib would they say Afib or svt !I’m confused if Afib is a svt
Hi Rayanne,
Yes, you can definitely tell from an EKG if the rhythm is SVT or Afib even if your heart rate is 180 beats per minute. Technically, “SVT” means any fast rhythm arising from above the ventricles.
However, in clinical practice SVT generally refers to a regular fast rhythm coming from above the ventricles. A-fib is an irregular rhythm.
Hope this helps!
John
Hi had a real different issue than most, got a really nasty shock 240Volts lying in water felt it go thru body burnt skull fingers elbow neck felt like sh-t didn’t go to E.R because I’m so stubborn, but went for procedure, several weeks later honestly didn’t feel too terrible before but “off” a lot a few weeks when had it done if you need the procedure do it! 1000 percent better shaved chest hair slept thru it went out drinking and eating an hour after leaving hospital don’t fear it best of luck to all, but do it!!!!!!!!!!!!!! Steve