Guest guest Posted July 28, 2002 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2002 Report Share Posted 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 – 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) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2002 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2002 Report Share Posted 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. ********************************************************************** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2002 Report Share Posted 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) ******************** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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? > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted 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 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? Web Page - http://groups.yahoo.com/group/AFIBsupport FAQ - http://groups.yahoo.com/group/AFIBsupport/files/Administrative/faq.htm For more information: http://www.dialsolutions.com/af Unsubscribe: AFIBsupport-unsubscribe List owner: AFIBsupport-owner For help on how to use the group, including how to drive it via email, send a blank email to AFIBsupport-help Nothing in this message should be considered as medical advice, or should be acted upon without consultation with one's physician. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted July 29, 2002 Hi Bernie, Any news yet on an ablation. best regards C ********************************************************************** 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. ********************************************************************** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted July 29, 2002 Hi Bernie, Any news yet on an ablation. best regards C ********************************************************************** 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. ********************************************************************** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted July 29, 2002 Hi Steve, now you have your mails sorted out a very big welcome to the group. I think we have something in common that we have both had ablations and I believe you had your in France as I did . there are three of us in this club at the moment. I would be very happy if you would post you history and how you came to France from the USA. Best regards john C Sunny and hot Hornchurch. its 30+c at the moment. ********************************************************************** 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. ********************************************************************** Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted July 29, 2002 In a message dated 7/29/2002 4:26:40 AM Pacific Daylight Time, bobbyrgroups@... writes: << 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. >> I'm sorry if my opinion regarding use of Flecainide (Tamobocor) for a beginning afibber was upsetting to anyone who is taking Flecainide. My goal was not to cause anger or anxiety among successful users of Flecainide, but to give helpful advice to a beginning afibber based on my nonprofessional experience and opinion. I think I mentioned in my post that some in this group are finding Flecainide to be a successful drug. Obviously for some Flecainide is the answer, and as my cardiologist would say, " If it works, don't change it. " We all know by now that reactions to drugs are very individual, and that one man's " rat poison " is another man's salvation. If Flecainide is successful for you, that's all that counts. I apologize if I caused anyone distress, but I was not intending to be critical of Flecainide per se, only of prescribing Flecainide for a person who has had two afib episodes and now only experiences occasional " strange beats, " probably PVC's. For what it's worth, and it may not be worth much since I'm not a medical professional, my opinion is that rate control is a better option for a person who has had one or two afib episodes and converts spontaneously than rhythm control. It was this distinction between rhythm and rate control that I had in mind when I used the term " heavy duty. " I wasn't implying strength or weakness in general, but rather strong effectiveness in controlling rhythm as opposed to Atenolol which is not as effective in controlling rhythm but controls rate well. In my nonprofessional opinion, it seems more practical to work for rate control with a beginning afibber while assessing the situation and deciding on an appropriate rhythm control drug or a nonpharmaceutical solution. Since it's the fast heart rate that causes the distressing symptoms, it seems that control of that rate will spare the person the agonies that we all went through in the beginning when the pulse was racing and the " mammal " was wildly flopping. For example, my brother in permanent afib has just as erratic a pulse as ever, but since the rate is controlled he doesn't notice his afib. When a person has only had two episodes, it's probably impossible to determine if afib will become a major problem or never return, as is the case with some people, and it seems to me that rate control is the first priority. Starting a person who is not known to be a " committed, " long term afibber on Flecainide, a strongly effective rhythm control drug, seems more than a bit premature to me. I suspect that my electrophysiologist would agree because he wants to keep an experienced, nineteen year afibber like me on Atenolol and Verapamil because it's doing the job. He said that if Atenolol and Verapamil fail, his next drug of choice for me will be Flecainide, and I will accept the switch from rate control to rhythm control strategy. I won't regard the change as one of weakness to strength, but rather as a change of strategy from rate control to rhythm control. However, I think the results of the AFFIRM study show that the rate control approach may be better for many people. The bottom line, though, I think, is quality of life. If your quality of life is poor as a result of afib, you do what you must do to change that. If, as in the case of my brother and me, rate control offers you the possibility of a full, active, normal, rewarding life, there is no reason to strive for rhythm control, considering the results of the study regarding mortality in relation to rhythm vs. rate control. If rate control doesn't work and life isn't worth living, then rhythm control is the only practical option whether it's achieved by ablation, surgery, or proarrhythmic drugs. That's my philosophy of afib, and it may lead me to join the world of Tambocor users one of these days. I am very grateful that Tambocor and Dofetilide are out there waiting for me if I need them. Again I am sorry if I upset anyone by my unfortunate choice of the words " heavy duty, " which apparently have a connotative meaning that I did not intend. Because someone on another board once upset me by telling me early in my Atenolol/Verapamil career that the combination of the two drugs could cause heart block, I know how it feels to have someone offer disturbing information about a drug one is using. However, again I say that we have to remember that we are individuals in this afib experience, and if a drug is working for me, that's the only important consideration. in sinus in Seattle (68th, almost 69th day) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2002 Report Share Posted July 29, 2002 In a message dated 7/29/2002 4:26:40 AM Pacific Daylight Time, bobbyrgroups@... writes: << 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. >> I'm sorry if my opinion regarding use of Flecainide (Tamobocor) for a beginning afibber was upsetting to anyone who is taking Flecainide. My goal was not to cause anger or anxiety among successful users of Flecainide, but to give helpful advice to a beginning afibber based on my nonprofessional experience and opinion. I think I mentioned in my post that some in this group are finding Flecainide to be a successful drug. Obviously for some Flecainide is the answer, and as my cardiologist would say, " If it works, don't change it. " We all know by now that reactions to drugs are very individual, and that one man's " rat poison " is another man's salvation. If Flecainide is successful for you, that's all that counts. I apologize if I caused anyone distress, but I was not intending to be critical of Flecainide per se, only of prescribing Flecainide for a person who has had two afib episodes and now only experiences occasional " strange beats, " probably PVC's. For what it's worth, and it may not be worth much since I'm not a medical professional, my opinion is that rate control is a better option for a person who has had one or two afib episodes and converts spontaneously than rhythm control. It was this distinction between rhythm and rate control that I had in mind when I used the term " heavy duty. " I wasn't implying strength or weakness in general, but rather strong effectiveness in controlling rhythm as opposed to Atenolol which is not as effective in controlling rhythm but controls rate well. In my nonprofessional opinion, it seems more practical to work for rate control with a beginning afibber while assessing the situation and deciding on an appropriate rhythm control drug or a nonpharmaceutical solution. Since it's the fast heart rate that causes the distressing symptoms, it seems that control of that rate will spare the person the agonies that we all went through in the beginning when the pulse was racing and the " mammal " was wildly flopping. For example, my brother in permanent afib has just as erratic a pulse as ever, but since the rate is controlled he doesn't notice his afib. When a person has only had two episodes, it's probably impossible to determine if afib will become a major problem or never return, as is the case with some people, and it seems to me that rate control is the first priority. Starting a person who is not known to be a " committed, " long term afibber on Flecainide, a strongly effective rhythm control drug, seems more than a bit premature to me. I suspect that my electrophysiologist would agree because he wants to keep an experienced, nineteen year afibber like me on Atenolol and Verapamil because it's doing the job. He said that if Atenolol and Verapamil fail, his next drug of choice for me will be Flecainide, and I will accept the switch from rate control to rhythm control strategy. I won't regard the change as one of weakness to strength, but rather as a change of strategy from rate control to rhythm control. However, I think the results of the AFFIRM study show that the rate control approach may be better for many people. The bottom line, though, I think, is quality of life. If your quality of life is poor as a result of afib, you do what you must do to change that. If, as in the case of my brother and me, rate control offers you the possibility of a full, active, normal, rewarding life, there is no reason to strive for rhythm control, considering the results of the study regarding mortality in relation to rhythm vs. rate control. If rate control doesn't work and life isn't worth living, then rhythm control is the only practical option whether it's achieved by ablation, surgery, or proarrhythmic drugs. That's my philosophy of afib, and it may lead me to join the world of Tambocor users one of these days. I am very grateful that Tambocor and Dofetilide are out there waiting for me if I need them. Again I am sorry if I upset anyone by my unfortunate choice of the words " heavy duty, " which apparently have a connotative meaning that I did not intend. Because someone on another board once upset me by telling me early in my Atenolol/Verapamil career that the combination of the two drugs could cause heart block, I know how it feels to have someone offer disturbing information about a drug one is using. However, again I say that we have to remember that we are individuals in this afib experience, and if a drug is working for me, that's the only important consideration. in sinus in Seattle (68th, almost 69th day) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2002 Report Share Posted July 30, 2002 In a message dated 7/30/2002 7:50:02 AM Pacific Daylight Time, james@... writes: << I hate to disagree - but I'm going to Again - I'm no professional and 's opinion is as valid as mine - it's just that we don't agree - so take your pick. >> Hi, , An agreeable disagreement is always welcome since it stimulates thinking. :-) I think you make a very valid point. Your opinion is probably be more informed than mine because I must admit that I have not diligently studied the results of the AFFIRM study. When my first cardiologist told me about three years ago about the study, I was influenced by his attitude which seemed to be that the results of the study would be conclusive and definitive. At the time he was pushing rhythm control with Sotalol over rate control with Atenolol/Verapamil and was trying to clarify the difference between the two approaches. I'm not sure he was aware of the composition of the AFFIRM study group, or maybe he didn't emphasize it to me because he knew that my brother and I both developed afib at young ages and, therefore, would not fit the profile of the study group. One of his arguments for rhythm control was my age. Anyway, I chose rate control over rhythm control with Sotalol, and the rest is history. My present cardiologist/E.P. thinks that I made the right decision because he said statistically women do not do as well on Sotalol as do men. Because my decision was made primarily on the grounds of my basic " chicken " nature, I think it's an example of a most important element in the choice between rhythm and rate control: the subjective element. At the time I was so afraid of what I had read about Sotalol that if I had taken it, probably my own psychological fear of the drug would have exacerbated my afib and counteracted the beneficial effects of the drug. In part the reason that afib strikes everyone so differently and drugs have such varying effects arises from the differences in individual perception and psychological reaction to the symptoms of afib or effects of a drug. Some people just have a higher threshold of tolerance for afib, I think, just as some have a higher threshold of tolerance for pain. Although most of us " freaked out " during our beginning episodes, some reacted by taking up all night vigils in the emergency room whereas some like me just worried it out at home. Some people have very little tolerance for the frightening symptoms and discomfort that go with afib, or they just simply don't want any part of it. For those people aggressive pursuit of rhythm control is probably the most likely course. For those who don't experience such a strong psychological aversion to afib, rate control may be enough. Many factors can influence psychological acceptance of afib. In my case, the example of my brother, who is eleven years older and has lived most of his busy, active life in afib with rate control, was a strong consideration in my decision to go with rate control. As I said before, my decision could change in favor of trying rhythm control with Flecainide or even ablation if my future circumstances change. We may disagree on some points, but I am sure that all would agree that it's better to be in sinus! One can learn as I have done to tolerate the symptoms of afib, but being in sinus is infinitely better! in sinus in Seattle (69th day) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2002 Report Share Posted July 30, 2002 Hi - I hate to disagree - but I'm going to Again - I'm no professional and 's opinion is as valid as mine - it's just that we don't agree - so take your pick. I've posted this here before but I think it is worth posting again.... from the bottom of http://www.naspe.org/library/naspe_on_clinical_trials/affirm/ " This trial presents how important new information that will aid physicians in the treatment of patients with atrial fibrillation. It is very important to remember the type of patient enrolled, since the results pertain to that patient and cannot be readily extrapolated to all others. Most important is the criterion that the treating physicians concluded that their patients could be adequately managed by either strategy-thus, patients who have intolerable symptoms of AF even with good rate control, which is a sizeable group, especially in younger patients, were excluded from this trial. The data from AFFIRM does NOT pertain to such individuals. Further, AFFIRM studied older patients, and whether these results would be the same in younger individuals is not known. " ( N. Prystowsky, M.D.) Since Bruce is only 38 I'd be very wary about thinking the AFFIRM results apply to him. Flecainide was the second drug that was tried on me. (as I understand it, felcainide or sotalol is the first choice drug in the UK for AF depending on what doctor you happen to see). It wasn't until I got to my 5th drug that I tried a rate control only. I have since tried another rhythm control unsuccessfully and have gone back to rate control. I would dearly like to try another rhythm control drug. Rate control is the best of a bad world for me but is nowhere near good enough it slows my heart down unnecessarily when I'm in NSR and just keeps me out of hospital when I'm in AF (but keeps me in bed). As you say - we are all different - I strongly suspect that young athletic types have an entirely different problem to people who are more sedentary - it's just that they share the same symptom. All the best - stay sinus -- D (33, Leeds, UK) Paroxysmal AF for 24 hours every 16 days Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2002 Report Share Posted July 30, 2002 Hi - I hate to disagree - but I'm going to Again - I'm no professional and 's opinion is as valid as mine - it's just that we don't agree - so take your pick. I've posted this here before but I think it is worth posting again.... from the bottom of http://www.naspe.org/library/naspe_on_clinical_trials/affirm/ " This trial presents how important new information that will aid physicians in the treatment of patients with atrial fibrillation. It is very important to remember the type of patient enrolled, since the results pertain to that patient and cannot be readily extrapolated to all others. Most important is the criterion that the treating physicians concluded that their patients could be adequately managed by either strategy-thus, patients who have intolerable symptoms of AF even with good rate control, which is a sizeable group, especially in younger patients, were excluded from this trial. The data from AFFIRM does NOT pertain to such individuals. Further, AFFIRM studied older patients, and whether these results would be the same in younger individuals is not known. " ( N. Prystowsky, M.D.) Since Bruce is only 38 I'd be very wary about thinking the AFFIRM results apply to him. Flecainide was the second drug that was tried on me. (as I understand it, felcainide or sotalol is the first choice drug in the UK for AF depending on what doctor you happen to see). It wasn't until I got to my 5th drug that I tried a rate control only. I have since tried another rhythm control unsuccessfully and have gone back to rate control. I would dearly like to try another rhythm control drug. Rate control is the best of a bad world for me but is nowhere near good enough it slows my heart down unnecessarily when I'm in NSR and just keeps me out of hospital when I'm in AF (but keeps me in bed). As you say - we are all different - I strongly suspect that young athletic types have an entirely different problem to people who are more sedentary - it's just that they share the same symptom. All the best - stay sinus -- D (33, Leeds, UK) Paroxysmal AF for 24 hours every 16 days Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2002 Report Share Posted July 30, 2002 Hi - I hate to disagree - but I'm going to Again - I'm no professional and 's opinion is as valid as mine - it's just that we don't agree - so take your pick. I've posted this here before but I think it is worth posting again.... from the bottom of http://www.naspe.org/library/naspe_on_clinical_trials/affirm/ " This trial presents how important new information that will aid physicians in the treatment of patients with atrial fibrillation. It is very important to remember the type of patient enrolled, since the results pertain to that patient and cannot be readily extrapolated to all others. Most important is the criterion that the treating physicians concluded that their patients could be adequately managed by either strategy-thus, patients who have intolerable symptoms of AF even with good rate control, which is a sizeable group, especially in younger patients, were excluded from this trial. The data from AFFIRM does NOT pertain to such individuals. Further, AFFIRM studied older patients, and whether these results would be the same in younger individuals is not known. " ( N. Prystowsky, M.D.) Since Bruce is only 38 I'd be very wary about thinking the AFFIRM results apply to him. Flecainide was the second drug that was tried on me. (as I understand it, felcainide or sotalol is the first choice drug in the UK for AF depending on what doctor you happen to see). It wasn't until I got to my 5th drug that I tried a rate control only. I have since tried another rhythm control unsuccessfully and have gone back to rate control. I would dearly like to try another rhythm control drug. Rate control is the best of a bad world for me but is nowhere near good enough it slows my heart down unnecessarily when I'm in NSR and just keeps me out of hospital when I'm in AF (but keeps me in bed). As you say - we are all different - I strongly suspect that young athletic types have an entirely different problem to people who are more sedentary - it's just that they share the same symptom. All the best - stay sinus -- D (33, Leeds, UK) Paroxysmal AF for 24 hours every 16 days Quote Link to comment Share on other sites More sharing options...
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