A-FIB Anyone? Well I have it! And I am pissed. A-Fib, A Definitive Guide

[Epoman]

Atrial Fibrillation

NORMAL

A-Fib

PLEASE READ AND REPLY IF YOU HAVE BEEN IN A-FIB. I don't mean have an irregular heart, I mean you have been told you were in A-Fib.

Well as you know I have had irregular heartbeats/rates in the past. If you had read this thread http://ihatedialysis.com/forum/index.php?topic=469.0 that I replied in. Well I can go weeks with no irregular heartbeats. Well since Wednesday (today is Saturday) I have been in A-Fib (Atrial Fibrillation) and it sucks. I have never had a episode last this long. So last night I went to the ER after my wife go off of work and sure enough I am in A-Fib. According to my past EKG's I have had irregular episodes but never been in A-Fib.  So I was at the ER and they gave me some meds to lower my pulse rate which was about 90-110 which is not too bad, but I still felt bad, no chest pain but the bad thing about being in A-Fib is that your blood can pool in the top chambers and form clots and then they can dislodge and go to the brain and cause a "stroke"  Here are some images of what A-fib is all about:

So as I said I went to ER and I got this one doctor who was very quick and VERY uncompassionate. And would even not talk to me about options, he said the first step is lets just give you meds to lower your rate and it may put you back into Sinus Rhythm, what is Sinus Rhythm you may ask? Well that is the normal method that your heart should be in. The meds didn't work after 3 doses via IV and he came back and told me they would be keeping me for an Echo and Cardioversion most likely. Cardioversion is:

Electrical Cardioversion

Electrical cardioversion is used to terminate atrial fibrillation but in and of itself has no long-term effect on the recurrence of AF. Patients are generally admitted as an outpatient to the hospital, placed on a heart monitor, an intravenous form of anesthetic is given and patches are placed on the chest.

Once the patient is completely anesthetized, a small electrical charge over the heart is delivered. This electrical charge causes a momentary electrical discharge of all the cardiac cells and allows the primary pacemaker, the SA node, to take control of the rhythm, thus stopping the atrial fibrillation and resetting the heart.

Sometimes, cardioversion is done in conjunction with antiarrhythmic medications to reduce the likelihood of recurrence of the AF.

Sounds fun huh? But it is an outpatient procedure and is supposed to get your heart back into Sinus Rhythm. So I was waiting while the doctor called a consult, and finally another doctor came in, not a cardiologist but an "Internal Medicine" doctor (the one the other doctor consulted with). He basically said I am in STABLE A-Fib my pulse rate is good now, I am still in A-Fib however but he thinks it is an isolated event and will go away on it's own and it may indeed be due to my Thyroid issue. And then he said I can go home if I want and talk to my doctor on Monday to see what she wants to do. I asked well what about blood thinners to reduce the risk of clots forming since I am in a-fib? He said I didn't need it. But I explained to him that I have had this problem for 3 days straight non-stop. He said it's fine not to worry he believes it is "Paroxysmal AF" which is:

Paroxysmal AF occurs intermittently and varies in frequency and duration from a few seconds to more protracted episodes lasting several hours or even days.

I hope he is right because I hope I don't have "Persistent AF" which is:

Persistent AF on the other hand, becomes the primary heart rhythm and it is usually unresponsive to medical therapy or other non-pharmacologic interventions such as electrical cardioversion. This form of AF is typically seen in an older population.

So I went home, I was tired and my arm was sore after them trying to draw blood and get an IV going, it took several tries and a few blown veins until I finally got someone who knew what they were doing. So my arm was in pain and I just wanted to go home, and I figured they wouldn't release me if they felt I was in danger. I hope.  But now I am worried that I am doing more damage to my heart being in A-fib for going 4 days now. My heart just won't go back into Sinus Rhythm.

Any advice? I am very worried that I have a major problem. I had an Angio done last year and it looked great (no blockages), I had an Echo done last year and it looked good but my heart is enlarged. So either this is Thyroid problems or I have something that the doctors have not discovered. I am really worried about being in A-fib for 4 days now and I hope someone out there can give me some encouraging advice.

More information will be added as this thread grows.

- Epoman

[Sara]

If it's not one thing, it's another, huh?  I wish I had some advice for you.  Hopefully someone on here does.   

[Fighter]

Hmm, I 'm not sure this will be very helpful but Dr Weil swears by his breathing exercises for heart arrhythmias(amongst other problems, actually he thinks everybody should be doing this):
http://www.drweil.com/drw/u/id/ART00521

Also this is a link to some info about atrial fibrillation and a number of therapies:
http://www.medical-library.net/sites/framer.html?/sites/_atrial_fibrillation.html

Sorry I don't know much about this problem because it doesn't concern me directly but if you want I can help you research it.

[Black]

Sorry I can't speak from experience, but I did find a couple of things you may or may not have seen. See below.

We have discussed your thyroid previously and I was, at the time, amazed that your TSH was so far above normal range -- you appeared to be grossly under-treated and hypothyroid.  A-Fib is sometimes related to hyperthyroid.  So, unless your thyroid condition has changed drastically in a few months,  it's probably not related to the A-Fib.

Sure am sorry you're having to deal with this and hope it is resolved quickly.

1) The Atrial Fibrillation Foundation has a web site with many links to information on common Q & A, medications, procedures, research, and other information.

http://www.affacts.org/index.html

2) And this recent study on defibrillators.

Can defibrillators prolong survival in dialysis patients?

October 2, 2006  Marlene Busko

From Medscape Medical News—a professional news service of WebMD

Chicago, IL - In a retrospective study, dialysis patients who had implantable cardiac defibrillator (ICD) therapy were more likely to receive appropriate shocks for ventricular tachycardia or ventricular fibrillation, but they also had worse survival compared with a nondialysis cohort [1].

Study author Dr Rod S Passman (Northwestern University Feinberg School of Medicine, Chicago, IL) said: "Being on dialysis was the greatest predictor of using the device for a particular tachyarrhythmia. However, even though these devices were in place and were being used [appropriately], dialysis patients still had a survival significantly less than patients without dialysis. In a sense, this is not terribly surprising, because we know that dialysis patients have a lot of competing comorbidities and that perhaps decreasing the risk of sudden death with a defibrillator still leaves them open to dying from other diseases."

He added that since this was a retrospective study with inherent study design biases, it could not answer the question of whether defibrillators can actually prolong life in dialysis patients.

The study will appear in the October 2006 issue of Heart Rhythm.

High risk of sudden cardiac death
Cardiac disease is the leading cause of death in dialysis patients, and 61% of all cardiac deaths in these patients are due to cardiac arrest and/or arrhythmia, the group, with first author Dr Jason Robin (Northwestern Memorial Hospital, Chicago, IL), writes. Current guidelines do not exclude dialysis patients from receiving ICD implants, yet ICD trials have either excluded these patients or not presented subgroup data for them, they note.

The investigators aimed to evaluate whether having end-stage renal disease (ESRD) was an independent risk factor for appropriate ICD therapy, which was defined as shock and/or antitachycardia pacing for ventricular tachyarrhythmias. Patients were considered to have ESRD if they were on dialysis before implantation of the device and did not receive a kidney transplant during the study follow-up period. The study's secondary objective was to compare long-term survival of ICD recipients with and without ESRD.

The team analyzed data from 585 patients (mean age 63±15 years; 79% male) who were implanted with an ICD and received follow-up care at Northwestern Memorial Hospital from May 1992 to December 2003. Of the entire cohort, 19 patients (3.2%) had ESRD. These 16 hemodialysis and three peritoneal dialysis patients had been on dialysis for a mean of 3.1±3.2 years before implantation of the ICD.

Appropriate shocks, shorter survival
During the average follow-up of 2.2±2.4 years, 156 patients (26%) received appropriate defibrillator shocks. Compared with patients without ESRD, those with ESRD were more likely to receive appropriate ICD therapy (47% vs 26%, p=0.05) and to receive the shocks sooner (1.8 vs 6.0 years; log-rank p=0.013).

On the other hand, the median survival after ICD implant was shorter for the ESRD patients than for the patients without ESRD (3.2 vs 7.4 years; log-rank p=0.009). The cause of death was available for six of the seven deceased dialysis patients; three died of sepsis, two died of heart failure, and one died of nonspecified cardiac arrest.

Impact of ESRD vs no ERSD on appropriate ICD therapy, survival

(You'll have to go to the site to see this -- formatting lost)

End point
 HR (95% CI)
 
Time to first appropriate ICD therapy
 2.30 (1.17-4.54)
 
All-cause mortality
 3.54 (1.60-7.82)
 
 
More study needed, potential for great impact
Study limitations include its small size, single-center population, and retrospective design. The authors note, however, that use of ICDs in this population is very low. For example, Dr Charles Herzog (Minneapolis Medical Research Foundation in Minneapolis, MN) and colleagues showed recently that only 460 of 6042 (7.6%) dialysis patients in the United States Renal Data System database who survived sudden cardiac death were implanted with a defibrillator; compared with the patients who did not receive an ICD, those who did had a 42% lower risk of death [2]. Robin and colleagues write that despite the reduced survival of dialysis patients who received an ICD in their study, the findings by Herzog and colleagues underscore the potential benefit of ICDs within the dialysis population.

"The good news from our study is that those [dialysis] patients who died did not die from sudden death," Passman said. "What I would want to emphasize is that perhaps in dialysis patients who are currently indicated to receive a defibrillator—patients who are on dialysis with low ejection fraction or who have survived sudden death—some may be too sick to benefit. . . . I believe that the risk of sudden death persists even in dialysis patients with more preserved ejection fractions, and perhaps those are the patients who may benefit most from having a defibrillator."

He added that this is a unique patient population that has been largely ignored in major cardiology trials, and their rates of sudden death are equal to that of the post-MI population to whom a great amount of resources are devoted. "I think that the cardiology community needs to consider specially designed trials in the dialysis population. It is a rapidly expanding patient population with great prevalence of cardiovascular risk factors, coronary disease, and heart failure, and yet we know very little about how to prolong the lives of these patients. . . . This shows more work needs to be done—there is no doubt—but I also think that there is the potential for great impact in this population," he concluded.

Coauthors Drs Alan Kadish and Jeffrey Goldberger receive research funding from Medtronic, Guidant, and St Jude; Passman receives research funding from Medtronic and St Jude and receives salary support from a National Institutes of Health K23 award.

The complete contents of Medscape Medical News, a professional news service of WebMD, can be found at www.medscape.com, a website for medical professionals.
 
 http://www.theheart.org/article/745359.do

[JerseyGirl]

Please while you are working this out and learning how to cope with it make sure your serum potassium levels remain WNL.  In other words, watch your potassium closely.  Keeping the potassium level between 4.0 -5.5 is optimal and essential at this point. Too low or too high potassium can adversely affect your cardiac muscle.  They may put you on digoxin as well.  Good luck our dear EPOMAN. We are here for you!

[jbeany]

No answers from me - just thinking positive thoughts for you. 

[kitkatz]

Oh man, I agree. If it is not one thing it is another with you!  I have no idea whay to tell you. other than I hope you feel better.

[Rerun]

It is exhausting isn't it?  I hate it when I can feel my heart doing weird things.  I would want to believe that doctor, but I also know they can be unreliable!

[Joe Paul]

Man, sorry to hear about this, hope it works out soon.

[Sluff]

Wish there was something I could do to help.    I knew something was up. All I can do is wish you well and pray things work out to the good.

[angela515]

I'm sorry I can't offer any advise or suggestions... but I can offer positive thoughts. Keep us posted hun. 

[Nan]

I am so very sorry, this is how we all learn about things that can happen to each and everyone of us, just sorry that it is "you" who is teaching us...I promise to keep you in my thoughts and prayers.

[MattyBoy100]

I have no helpful advice either Epoman, just want to say that I hope you get to the bottom of this. 

[AlasdairUK]

Hey Epoman,

I hope you manage to sort yourself out soon. 

PS. as Fighter stated: I'm happy to help research if you need, What don't you know that we do. Not a lot I think.

Best Wishes,

Alasdair

[nextnoel]

I'm so sorry for your new trouble (and for your old troubles, too)!  There should be a lifetime limit to how many problems one person can have.  I have no experience with this particular problem, but I am sending positive thoughts your way, and hoping the problem will be resolved satisfactorily very soon! 

[Epoman]

Well last night my "A-Fib" stopped on it's own after 5 days.  I am happy it stopped but now I am worried when it will come back and if it will last that long again. I am still going to go see my cardiologist (again) for advice. Thanks for all the warm thoughts. Just thought I would update everyone and let them know my heart is back to normal rhythm for now. 

- Epoman

[okarol]

Thanks for the update. I hope you stableize and it stays away, whatever caused it.
Best wishes,
Karol

[mallory]

Hey Epoman, sorry about this, you don't need something else to worry about.  I have a friend who has this.  He has had that electrical cardioversion to stop it, and they told him that if it worked, it probably wouldn't come back.  It did work but it did come back, twice.  So he had the electrical cardioversion again each time, and he hasn't had it again.

They told him to get a heart rate monitor watch and to monitor his heart rate with it, and to watch his potassium very carefully.  He has been fine for about six months, no more episodes.

Now keep in mind, I have no medical training, but could they try something like Coreg?  I take Coreg for my blood pressure and one of the benefits of Coreg is that it slows your heart rate down.  They keep telling me to watch my heart rate that it doesn't get too slow.  Just a thought.

Hope you're feeling better.

[Epoman]

Well last night my "A-Fib" stopped on it's own after 5 days.  I am happy it stopped but now I am worried when it will come back and if it will last that long again. I am still going to go see my cardiologist (again) for advice. Thanks for all the warm thoughts. Just thought I would update everyone and let them know my heart is back to normal rhythm for now. 

- Epoman

Just quoting myself, this whole a-fib situation has really got me depressed and worried more than I have ever been in my whole life. I can and have handled all the other bullshit, but now we are talking about my heart. That's the last straw, I feel like I don't have much time left with my son and it makes me so sad, but not sad for me, but sad knowing that my son will cry so much and feel such a loss, since him and I are so close. Why should such a small person have to feel such pain at such a young age? Why GOD?

Please GOD if you are watching while I type this (I know you are), please let my son become a man before you take his father, I know he won't be the first or the last to lose a father at such a young age. But please Lord I will do anything, I don't care about myself. I just beg you GOD, let me finish the job you let me start in the first place. Let me raise my son, then after he is an adult you can have me. Nick is yours GOD and I am just borrowing him on this earth, you made me his father to guide him and to show him your greatness. So let me live long enough to guide him to you. Keep this beaten heart pumping for a little while longer, if not for my sake, for a little innocent young mans sake. If something were to happen to me, it would alter his life for ever. If I have done things in this lifetime to warrant such a sickened body, then punish me until you see fit, but please do not punish YOUR "other" son Nick.

[JerseyGirl]

Dear EPOMAN - truth be told many people have a fib and live with it for years and years.  Follow up with your cardiologist as planned.  I know it is different when it is you but hang in there!  While I have no crystal ball  - noone does - you will probably overcome this!  My best to you today, and your very dear little one!

[nextnoel]

I'm SO sorry you're having such trials.  I pray your heart, which is so big, will remain in normal rhythm for many years to come; Epokid is indeed fortunate to have such a loving parent, and I hope he has you in person for a long, lonnnng time.      

[Ken Shelmerdine]

Epoman

Sorry to hear you are having this problem. I would have thought you should be on blood thinners at the very least to guard against clots forming.  I experienced this about 3 years ago when I had about 3 x 24 to 48 hour main episodes where I was in AF and several small ones of a few minutes to a couple of hours. It's probably temporary but I know only too well how it's difficult not to worry no matter what you are told. It's so difficult to get rid of that panicky feeling of not being in control and any minute it's going to be goodnight Vienna. I would insist on bloodthinners. I still take Warfarin now as a safeguard for if or when I go into AF again although touch wood it hasn't happened since. One things for sure, try not to panic about it as I did because I think it only exacerbates the problem, easier said than done I know, I've been there.

[*kana*]

Hello Epoman!

I would have posted to you yesterday, but had to wait for that darn moderator to manually activate me.  
 I know that you will tell me to go post an intro,  but I am a lurker and plan on staying that way for a while yet.  I'm pre-dialysis so I'm not ready to be here fully, but wanted to offer you some encouragement.  Your forum is preparing me for my future. This is my small way of saying thank you to you and your members.  If I can help you then I help them because it is obvious that they care so much for you.   

I'm a register Cardiac Ultrasound tech (echo) and see many people, young and old, in and out of A-fib that live with this condition just fine.  The reason that you probably have a problem with this is because of your enlarged heart caused by your other medical problems.   Do you happen to know the size of your atrium's?  This is key in knowing if you will stay in normal sinus rhythm with medication and/or cardioversion.   

The potential for clots to form are there, but if your heart function(ejection fraction) is still really good then your risk is a lot less.  We typically see elderly people with barely any function with clots, not in the chamber of the heart itself, but in the left atrial appendage.  The appendage is a small pouch in the left atrium that serves no purpose.  I see a lot of young dialysis patients BUT it isn't a common thing to see clots in their heart.  I know that you are terrified and it feels that your world is falling apart once again.  You seem like a very strong person and I know that you will do very well with this after you absorb it all. 

They normally start you out on medication and if that doesn't work then they would need to cardiovert you.

 This is exactly what our hospital does.
Most of our patients come in 1 1/2 hours prior to having a Transesphogeal Echo and Cardioversion and leave a couple hours after the  procedure.  We start an IV and make sure that you haven't had anything to eat or drink in the past 6 hours.  You will sign a consent.  They will sit you up and listen to your lungs and put a large patch on your chest and back.  They will then hook you up to the EKG monitor, Blood pressure cuff,  Pulse Oximetry and Oxygen.  They will normally have 1 nurse, Doctor and Echo tech in the room. 
They start by spraying your throat three times with cetacaine or other numbing agent.  My patients always tell me that that is the worst part of the entire test.  Rotten bananas is what it smells like, cheap whiskey is what it tastes like.   They then will give you something to make you sleepy or nothing at all if you want to be awake for it.  We do have a few patients that will go thru the TEE without sedation.  Me, I'd want the drugs if they are giving them! 

After you are sleepy they will give you a bite block to bite on and then put the TEE scope to the back of your throat and ask you to swallow.  The scope is about as big around as your little pinky finger and most patients have no problem swallowing it.  When they get the scope down they will look at your heart from the esophagus and briefly from the stomach.  You might feel a bit of pressure when they move the scope around, but many people don't and are surprised when we tell them we are finished.

We do TEE's vs Echo's because the appendage can NOT be seen on a surface(chest) Echocardiogram. 

After they pull out the scope they will give you more sedation for the cardioversion.  Many many many people go thru a cardioversion without remembering a thing when given more of the same drugs they gave for the TEE.  I do think there are people out there that are not given enough sedation and do remember, so that being said...I'd personally demand that someone from anesthesia be there to sedate me.  If they don't honor that wish then when they try to wake you up and you hear them, open your eyes or move. 

They will then shock you back into normal rhythm, get an EKG to confirm it and then take you back to your room. 

I hope that I didn't scare you more and some of the stuff helped you understand a bit more.  It is important to know what your heart size measures and how well it is squeezing.  Ask them to send you a copy of your Echo report and PM me if you want my opinion on what is viewed as normal, enlarged or severally enlarged.                     
     
Take care and know that there are many here that care about your well being....even the lurkers. 



 
             

[mallory]

*kana*, that was a great, caring, post!  You should post more, you'd be a welcome addition to the site.  I'm pre-dialysis too (I start tomorrow!), so you'd fit right in.  Looking forward to hearing more from you!

[Panda_9]

I have been having palpitations lately and some chest pain. Had an echo and a holter monitor on for 24hrs. Its been a few weeks now and havent heard anything back.
Have you had a holter monitor before EPO?