RE: a few a-fib treatment questions

July 28, 2002

Your Drs. tests are correct. They are checking to see if your heart is

structuarlly sound. That it has no defects i.e bad valves, enlargement of

chambers and many other things. None of that is for blocked arteries.

Stress does cause A Fib. Your Doc's off on that one. It's already been

documented.

One of the top heart hospitals in the country is in Houston, at St. Luke's.

Get a through evaluation before you rush into anything. Don't do something

you may regret!

Rich O

July 28, 2002

In a message dated 7/28/2002 2:21:16 PM Pacific Daylight Time,

bruceboulanger@... writes:

<< plans to see

another cardio/EP this week â€“ should've been last week, but he was

tied up in surgery last week and had to cancel his office

appointments. Does anyone have relatives that are also in A-fib, and

are both of you being treated with the same medications?

>>

Bruce,

Others in this group are more expert in the area of ablation and other

non-pharmaceutical afib treatments, but I can respond knowledgeably to your

questions about the relation of stress and afib as well as family incidence

of afib. First, I believe your EP has given you misleading information in

saying that stress does not cause afib. To put it more strongly, he is just

plain wrong or misinformed. Stress doesn't always cause afib and it isn't

the only cause of afib but it definitely has been a cause for me, for my

mother, and for my older brother who is in permanent afib. In fact, my first

known incident of afib was caused by an extraordinarily stressful situation

in which I was bitten by a strange dog whose owner then appeared to be

planning to attack me. As I jumped on my bicycle to escape and peddled

frantically home, I was aware that my heart felt as if it were about to burst

from my chest, the now familiar sensation that many describe as being similar

to a mammal or fish flopping around in one's chest. That incident was

nineteen years ago, and the afib episode triggered by that wildly

melodramatic event lasted about 24 hours. Since then I have had numerous

other afib episodes triggered by stressful situations, although thankfully

none have been as threatening or dramatic as that first one. Obviously

stress does not trigger afib in everyone, but in one prone to afib it can

definitely be a trigger. Unfortunately the kind of intense athletic activity

in which you have engaged can also be a precursor of afib, which is extremely

common among runners and other athletes. The kind of afib triggered by

stress or physical exertion is called adrenergic afib.

Another type of afib is called vagal because it is triggered by increasing

tone of the vagus nerve, a large nerve which controls both digestion and

heart beat. The process of increasing tone of the vagus nerve is called

vasovagal stimulation. A vagal afib sufferer finds that afib is triggered by

eating the wrong foods, eating too much or too fast, drinking cold beverages

too fast, caffeine, alcohol, and various postures. I am afflicted with both

adrenergic and vagal afib, as many of us are, although some individuals

experience just vagal or just adrenergic.

To answer your question about genetic connections, I would say that my heart

frequently responds to stress by converting to afib because afib is genetic

in my family. Every member of my immediate family, except one of my brothers

who coincidentally is a physician, has suffered afib. My mother was in afib

when she died and probably was a paroxysmal afib sufferer most of her life.

My father also suffered afib among other more serious heart disease problems,

and had to be cardioverted to restore sinus rhythm. My other older brother,

not the doctor, has been in permanent afib for at least twenty to thirty

years but wasn't diagnosed until thirteen years ago. I was not diagnosed

until six years ago when I took myself to my doctor's office during an

episode and had an ECG. (I have never gone to an emergency room for afib

because I always felt that I would recover more effectively in the peace and

quiet of my own home.) Both my brother and I have been taking Atenolol for

the past thirteen years, and it has controlled our afib to the point that we

both live absolutely normal and probably unusually active, busy lives. My

brother also takes Digoxin, which is generally considered appropriate for one

in permanent afib but not for one like me who has paroxysmal (intermittent)

afib. I also take Verapamil, a calcium channel blocker, in addition to the

Atenolol.

I don't know your complete medical situation, of course, but on the surface

it would appear that your EP has jumped into a quite heavy duty medication

for your initial treatment. However, I know that some in this group are

doing very well with Tambocor. My EP told me that he will try Tambocor

(Flecainide) with me only if Atenolol and Verapamil fail in the future to

control afib. However, I am presently in a period of " remission, " having

experienced only 30 hours of afib in the past 115 days. This represents a

dramatic improvement over my afib incidence during last January and February

when I was in afib for 32 days of the two months. I attribute my current

long sinus run to elimination of dairy products from my diet. If you do not

have vagal afib, such a strategy would not make any difference for you, but

at this point you probably don't know if you also have vagal afib.

Atenolol has served me well over the past thirteen years. My brother thinks

and I am reasonably sure that I would be in permanent afib by now as my

brother was by my current age, if it were not for the Atenolol treatment.

Atenolol will not prevent afib episodes, but it does offer safe, thorough

control of symptoms to many people. As my EP said, all to the medications

are only 60-70 percent effective anyway, and the trick is to find the

medication that works for you. Everybody responds differently to each

medication because afib is very unpredictable. I think that you are very

wise to get a second opinion as you are planning to do. If the new doctor

tells you that stress doesn't cause afib, a third opinion is definitely in

order! Do your research and don't jump into anything. Afib is not a

killer, so you have time to consider your options. I don't remember whether

you are also taking Coumadin, but it would be a good idea to ask about that

if you are not because Coumadin will protect you from a stroke, the only real

possible danger from afib. If you don't understand about that, just ask and

we will be glad to explain. Good luck and feel free to ask questions because

this group is filled with experienced, knowledgeable, and helpful people.

in sinus in Seattle (67th day)

July 28, 2002

1) Purpose of the various tests and what kind of information do they

really provide?

The tests that you are given are given to rule out heart disease or

abnormalities. It is good you have none. If you had had any they wouldn't

have been able to put you on Tambacor.

2) Is stress (either mental or physical) a contributing factor for

causing A-fib?

I would say that both mental and physical stress are contributing factors.

Also, I notice that you are very atheletic. Oxidative Stress also plays a

part here. I don't know where, but someone may jump in and help, there are

articles written about this.

I hope that helps a bit.

Fran

July 28, 2002

Hi Bruce,

Firstly welcome to our boards and the band of brothers and Sisters. I am sorry

to hear about your troubles with AF.

A couple of Points if I may.

With the younger patients it does sometime affect the fittest one of us. Dr

the creator of the maze, once wrote that his office was crowded with fit young

people coming in with AF.

I believe somewhere there are some papers on Generics that it does run in the

family.

At this time nobody knows what causes AF that is for the exception of some

cardiac problems, the test you have had will rule out these problems and I

suspect you have been diagnosed with Lone AF.

You must think positive as notso many years ago the two in fact. There was only

one nasty drug and ablations were not available as they are now. It does take

some time to get use the drugs and finding one that will suit you is sometimes a

problems.

Best of luck

C

Hi,

I have several questions throughout this message. Sorry. I've

relisted them at the bottom of this message for the convenience of

any who might respond.

I was diagnosed with A-fib about a month ago. I was very physically

active before this thing hit me (38 y.o., weight training, aerobics,

other activities, 3-4 times/week, no alcohol/drugs/caffeine at all -

boring guy I know - but under a lot of stress at work.) In that

time, my cardiologist has started me on Tambocor. Although, I have

found that I still have weird heartbeat episodes, most of which I've

been told are premature atrial contractions (isn't that what pac

stands for?) (I'm using an event monitor for a few weeks currently.)

When my cardio started me on the tambocor, he checked me into the

hospital for a couple of days to monitor my response to the drug.

While there, they did X-rays, stress test, and an echo. The cardio

told me initially that he saw no evidence of Congestive Heart

Failure, Coronary Heart Disease, or any other structural

abnormalities. However, on a subsequent visit, I started questioning

him a little more about the tests that were run, and the message I

got was that these tests really give no definitive indication of

artery blockage. Is that accurate? What's the purpose of these

tests then - to make money off me and my insurance carrier?

Also, he told me that stress is not a factor in causing A-fib. In

his experience, he said that people with stress generally don't get A-

fib. Is that accurate as well? Seems to contradict a lot of what

I've read on the Internet about this thing.

There are arrhythmia's throughout my family. Mother and brother are

currently being treated as well, but using antentol <spelling?> and

have shown good response to it. (No arrhythmia.) However, my cardio

doesn't see that as significant in my case. I have plans to see

another cardio/EP this week - should've been last week, but he was

tied up in surgery last week and had to cancel his office

appointments. Does anyone have relatives that are also in A-fib, and

are both of you being treated with the same medications?

Lastly, I will be discussing the option of ablations with the EP I

will be seeing. Is " RF Focal Point Ablation " with

determining " Pulmonary Vein Potentials " the latest and greatest fix

for this? I've read elsewhere that traveling to LA or some other

places are best, but if that's not an option for me, then is there

someone in the Houston, Texas area that is up on the latest?

Many thanks to any whom respond to whatever questions you can, and

here are my questions again:

1) Purpose of the various tests and what kind of information do they

really provide?

2) Is stress (either mental or physical) a contributing factor for

causing A-fib?

3) Other family members with similar condition and whether all are

being treated with the same medications and results?

4) RF Focal Point Ablation using PV Potentials to identify A-fib

source, the latest and greatest?

5) Who in the Houston, Texas area is the most experienced the latest

and greatest ablation procedures?

**********************************************************************

This message may contain information which is confidential or privileged.

If you are not the intended recipient, please advise the sender immediately

by reply e-mail and delete this message and any attachments

without retaining a copy.

**********************************************************************

July 28, 2002

I'm pretty sure heavy duty Clogging brought my Afib on!

Ellen

69 NC

(NSR on Dofetilide)

*******************

Starfi6314@... wrote:

(snip) Stress doesn't always cause afib and it isn't the only cause of afib

(snip) Unfortunately the kind of intense athletic activity in which you have

engaged can also be a precursor of afib, which is extremely common among

runners and other athletes. The kind of afib triggered by stress or physical

exertion is called adrenergic afib.(snip) in sinus in Seattle (67th day)

********************

July 29, 2002

Hi, Bruce,

Like , I think your cardio jumped the gun in putting you on a

heavy duty med like Tambocor. The first cardio I saw wanted to put

me on a strong antiarrhythmic but my GP said wait. And I have done

reasonably well on just a beta blocker, which is much safer. I have

an episode of afib or multiple extra beats a minute lasting some

hours every few months or so. Antiarrhymic medications can have

significant side effects and even have a slight tendency to cause

arrhythmias.

is right, we do see a lot of exceptionally fit people in here.

My impression was that they mostly have vagal afib, though, not

adrenergic, although many people have mixed types. As a shorthand,

if you find your episodes starting when you're resting, they are

probably vagal, vs. starting while exercising, which is more likely

adrenergic. The meds most useful differ for the two types. Beta

blockers, for example, are not that great for vagal people. Probably

Vicky, who is a vagal expert, can chime in here about the meds for

that.

Yes, stress is a huge factor in afib, regardless of the type. Your

cardio is so wrong about this.

pacs are premature atrial contractions.

> While there, they did X-rays, stress test, and an echo. The cardio

> told me initially that he saw no evidence of Congestive Heart

> Failure, Coronary Heart Disease, or any other structural

> abnormalities. However, on a subsequent visit, I started

questioning

> him a little more about the tests that were run, and the message I

> got was that these tests really give no definitive indication of

> artery blockage. Is that accurate?

My cardio told me that the combination stress echo is a good

indicator about artery blockages as the test tells you indirectly

about the heart walls and the walls would be showing problems if

there were significant blockages.

> Lastly, I will be discussing the option of ablations with the EP I

> will be seeing. Is " RF Focal Point Ablation " with

> determining " Pulmonary Vein Potentials " the latest and greatest fix

> for this?

No, electrical isolation of the pulmonary veins from the heart is the

current procedure. I think you are way jumping the gun to consider

an ablation at this point, esp. as the techniques are rapidly

evolving currently. There is always the risk of pulmonary vein

stenosis, damage, etc. You may never have another episode of afib in

your life, even without medication. My own doc had two episodes of

afib about ten years ago after going thru a horrendous divorce, and

has not had it since, no meds either.

Glad to see you in here, sorry you have afib. But I would find a

more cautious doc, if I were you.

July 29, 2002

I don't see why anyone would consider Tambocor to a " heavy duty drug " .

It has minimal side effects and is quite effective for some people. It

is my doctor's first choice for anti-arrhythmics. He first tried

verapamil on me, but that is for rate control only, and had no effect.

I'm a little unclear about why we are referring to anti-arrhythmics as

weak and strong here, and why one would want to start with the weak

ones. These recent posts would imply that one might only want to use

Tambocor as a last resort, while I maintain that it should be among the

first tried.

Of course there is a problem with using Tambocor with underlying heart

disease. That is one good reason to undergo a full course of testing to

determine the condition of the heart. I received an echocardiogram and

thallium stress test in addition to chest x-rays. As far as being

monitored in a hospital after beginning treatment with Tambocor, one of

our polls back in December of 2000 indicated 8 out of 13 had no

observation at a hospital, and 5 had from 1 to 3 days.

Bobby

Atlanta

Re: a few a-fib treatment questions

Hi, Bruce,

Like , I think your cardio jumped the gun in putting you on a

heavy duty med like Tambocor. The first cardio I saw wanted to put

me on a strong antiarrhythmic but my GP said wait. And I have done

reasonably well on just a beta blocker, which is much safer. I have

an episode of afib or multiple extra beats a minute lasting some

hours every few months or so. Antiarrhymic medications can have

significant side effects and even have a slight tendency to cause

arrhythmias.

July 29, 2002

on Mon, 29 Jul 2002 at 07:25:57, Bobby

wrote :

>I don't see why anyone would consider Tambocor to a " heavy duty drug " .

>It has minimal side effects and is quite effective for some people. It

>is my doctor's first choice for anti-arrhythmics.

I thought so too. However, last week I got a small shock in that I

actually had an ECG while on 200 mg/day Flecainide (post ablation) and

was told that my QT elongation and QRS width were at the maximum I could

take, so I shouldn't take above 200 mg/day. The words " nearly at the

point where it is toxic " were used.

This is alarming since when I was first on it I had always been

self-regulating the dose between 50 mg/day and 300 mg/day max - usually

around 100-200, depending on ectopics etc. I found that things got

worse at the higher doses, but had taken 300 / day several times (it

being the maximum does).

Just shows.

I think all anti-arrhythmics need to be treated with care - they are all

on the list of QT-lengthening drugs and can interact with others.

But I'd also agree it is not a bad drug, if it works for you.

Best of health to all,

Vicky

July 29, 2002

bruceboulanger wrote:

> . . . then is there someone in the Houston, Texas area that is up on the

latest?

>

Bruce,

I live in Houston and have been researching this very question, as well as the

question where outside Houston are the best docs for a

pulmonary ablation. If it's OK, I'll email you directly and give you my phone

number so we can talk about actual names.

July 29, 2002

Of course everyone is different. I have been taking the max dose, 150 mg

twice a day for several years now, and showing a normal ECG. It used to

indicate an enlarged atrium, but that has subsided!

Re: Re: a few a-fib treatment questions

on Mon, 29 Jul 2002 at 07:25:57, Bobby

wrote :

>I don't see why anyone would consider Tambocor to a " heavy duty drug " .

>It has minimal side effects and is quite effective for some people. It

>is my doctor's first choice for anti-arrhythmics.

I thought so too. However, last week I got a small shock in that I

actually had an ECG while on 200 mg/day Flecainide (post ablation) and

was told that my QT elongation and QRS width were at the maximum I could

take, so I shouldn't take above 200 mg/day. The words " nearly at the

point where it is toxic " were used.

July 29, 2002

> I don't see why anyone would consider Tambocor to a " heavy duty

drug " .

Bobby,

My question was why use an antiarrhythmic at all, when this is

apparently his first experience of afib and the afib subsided

spontaneously. He may not need any medication,let alone being put on

an antiarrhytmic and shuttled off to see an EP about an ablation.

July 29, 2002

Did it subside spontaneously?

Re: a few a-fib treatment questions

> I don't see why anyone would consider Tambocor to a " heavy duty

drug " .

Bobby,

My question was why use an antiarrhythmic at all, when this is

apparently his first experience of afib and the afib subsided

spontaneously. He may not need any medication,let alone being put on

an antiarrhytmic and shuttled off to see an EP about an ablation.

July 29, 2002

In Texas check out Texas Cardiac Arrhythmia, P.A. in Austin.

. Web site http://www.austinheartbeat.com. Drs. Canby,

Gallinghouse, Horton and Zagrodzky.

Segmental Focal Point Ablation using Pulmonary Vein Potentials is

probably going to become the treatment of choice for curing most cases

of A-Fib.

bruceboulanger wrote:

> Hi,

>

> I have several questions throughout this message. Sorry. I've

> relisted them at the bottom of this message for the convenience of

> any who might respond.

>

> I was diagnosed with A-fib about a month ago. I was very physically

> active before this thing hit me (38 y.o., weight training, aerobics,

> other activities, 3-4 times/week, no alcohol/drugs/caffeine at all -

> boring guy I know - but under a lot of stress at work.) In that

> time, my cardiologist has started me on Tambocor. Although, I have

> found that I still have weird heartbeat episodes, most of which I've

> been told are premature atrial contractions (isn't that what pac

> stands for?) (I'm using an event monitor for a few weeks currently.)

>

> When my cardio started me on the tambocor, he checked me into the

> hospital for a couple of days to monitor my response to the drug.

> While there, they did X-rays, stress test, and an echo. The cardio

> told me initially that he saw no evidence of Congestive Heart

> Failure, Coronary Heart Disease, or any other structural

> abnormalities. However, on a subsequent visit, I started questioning

> him a little more about the tests that were run, and the message I

> got was that these tests really give no definitive indication of

> artery blockage. Is that accurate? What's the purpose of these

> tests then - to make money off me and my insurance carrier?

>

> Also, he told me that stress is not a factor in causing A-fib. In

> his experience, he said that people with stress generally don't get A-

> fib. Is that accurate as well? Seems to contradict a lot of what

> I've read on the Internet about this thing.

>

> There are arrhythmia's throughout my family. Mother and brother are

> currently being treated as well, but using antentol <spelling?> and

> have shown good response to it. (No arrhythmia.) However, my cardio

> doesn't see that as significant in my case. I have plans to see

> another cardio/EP this week - should've been last week, but he was

> tied up in surgery last week and had to cancel his office

> appointments. Does anyone have relatives that are also in A-fib, and

> are both of you being treated with the same medications?

>

> Lastly, I will be discussing the option of ablations with the EP I

> will be seeing. Is " RF Focal Point Ablation " with

> determining " Pulmonary Vein Potentials " the latest and greatest fix

> for this? I've read elsewhere that traveling to LA or some other

> places are best, but if that's not an option for me, then is there

> someone in the Houston, Texas area that is up on the latest?

>

> Many thanks to any whom respond to whatever questions you can, and

> here are my questions again:

>

> 1) Purpose of the various tests and what kind of information do they

> really provide?

> 2) Is stress (either mental or physical) a contributing factor for

> causing A-fib?

> 3) Other family members with similar condition and whether all are

> being treated with the same medications and results?

> 4) RF Focal Point Ablation using PV Potentials to identify A-fib

> source, the latest and greatest?

> 5) Who in the Houston, Texas area is the most experienced the latest

> and greatest ablation procedures?

>

July 29, 2002

" " Unfortunately the kind of intense athletic activity

in which you have engaged can also be a precursor of afib, which is

extremely

common among runners and other athletes. The kind of afib triggered by

stress or physical exertion is called adrenergic afib.

Another type of afib is called vagal because it is triggered by increasing

tone of the vagus nerve, a large nerve which controls both digestion and

heart beat. " " "

I may be wrong, but I was under the impression that most runners and highly

atheletic people got AF because of heightened vagal tone, rather than

adrenergic Afib when they were actually running. I attributed by my Af to

heightened vagal tone as I was very atheletic, but now not so sure as I have

eliminated AF through diet, but not the ectopics. Oh well.

Fran

July 29, 2002

RE: Re: a few a-fib treatment questions

> I don't see why anyone would consider Tambocor to a " heavy duty drug " .

> It has minimal side effects and is quite effective for some people.

For vagal AF this seems to be the first drug of choice when there are no

underlying heart disorders. I know when I tried it it was a million times

better than the betablockers or other antiarrhythmics. Only problem was that

I developed tachy and visual pulsating light with it. I hope they didn't

miss something with my ultrasound scan.

FRan

July 29, 2002

a few a-fib treatment questions

Bruce,

Most of us have had the tests you refer to. Yes they are necessary to give

a correct diagnoses and to rule out a number of cardiac conditions which

could cause your Afib. I've had the ECGs, the Cardiac Echo, the chest X-Rays

and Angiograms not to mention the Holter Monitors. All well worth having so

you can eliminate heart disease. You would appear to have Lone Atrial Fib.

I am taking Tambocor since last November and apart from a few brief episodes

I must say it does the job. If thats the drug for you then you will have

some respite from the Afib which afflicts us. Eight years ago I started

Afib.

I have to say that I too have relatives who are blessed with AF so there's

surely a genetic factor somewhere. I certainly do not agree with your

cardio re the stress causing the episodes. I am a stressful person and I

can lay the blame fairly and squarely on stress for most my episodes. Diet

also has a bearing in my case so I have to eliminate quite a number of

foodstuffs which I know act as triggers. In fact any type of tummy upset

sends me into Afib. Physical stress is yet another no-no for me.

Things are improving all of the time and ablations are definitely looking

more and more promising so good luck when and if you decide to go down that

road.

Bernie

Hi,

I have several questions throughout this message. Sorry. I've

relisted them at the bottom of this message for the convenience of

any who might respond.

I was diagnosed with A-fib about a month ago. I was very physically

active before this thing hit me (38 y.o., weight training, aerobics,

other activities, 3-4 times/week, no alcohol/drugs/caffeine at all –

boring guy I know – but under a lot of stress at work.) In that