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Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 2:28pm
by Bonefishblues
Jdsk wrote:
Audax67 wrote:The interesting thing about that is that the heart is made of so-called smooth muscle, which does not tire. Skeletal muscles are striated muscle, which does.

Muscle is traditionally divided into three types: smooth, skeletal and cardiac. Cardiac muscle is striated.

https://en.wikipedia.org/wiki/Smooth_muscle
https://en.wikipedia.org/wiki/Skeletal_muscle
https://en.wikipedia.org/wiki/Cardiac_muscle

Jonathan

Bugger beats on its own, doesn't it? Just loves beating - thank god.

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 2:29pm
by Psamathe
Bonefishblues wrote:There is no downside and much upside to taking a low dose aspirin daily, as I have been doing for years, long before I started to have AF's cousin, arrhythmia, in earnest.

I think it depends on what issues you might have. Certainly under some conditions you'r advised not to take aspirin.

Ian

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 2:35pm
by Bonefishblues
I read the research many years ago and decided it was the best insurance I could take, iyswim.

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 2:44pm
by Psamathe
Bonefishblues wrote:I read the research many years ago and decided it was the best insurance I could take, iyswim.

e.g. to quote NICE
https://www.nice.org.uk/guidance/qs93/chapter/quality-statement-2-use-of-aspirin wrote:The risks of taking aspirin outweigh any benefits of taking it as monotherapy for stroke prevention in adults with atrial fibrillation.

My Mum has AF (and I was live-in 24/7 care through her diagnosis and all the consultants and whilst she was not on aspirin, she was on NSAIDs (for arthritis pain control) and she had to stop all water retention tablets and start on diuretics.

I'm not a medic and not disputing whoever told you to take aspirin, just suggesting people don't take it as a universal "good thing" (like people regard vitamin pills) and check with medics aware of their personal situation.

Ian

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 3:13pm
by Bonefishblues
Psamathe wrote:
Bonefishblues wrote:I read the research many years ago and decided it was the best insurance I could take, iyswim.

e.g. to quote NICE
https://www.nice.org.uk/guidance/qs93/chapter/quality-statement-2-use-of-aspirin wrote:The risks of taking aspirin outweigh any benefits of taking it as monotherapy for stroke prevention in adults with atrial fibrillation.

My Mum has AF (and I was live-in 24/7 care through her diagnosis and all the consultants and whilst she was not on aspirin, she was on NSAIDs (for arthritis pain control) and she had to stop all water retention tablets and start on diuretics.

I'm not a medic and not disputing whoever told you to take aspirin, just suggesting people don't take it as a universal "good thing" (like people regard vitamin pills) and check with medics aware of their personal situation.

Ian

I didn't have it (AF) when I started taking it, I read the research and made the call for me.

Now I do, I am prescribed it.

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 4:52pm
by gerry84
I had an attack of atrial fibrillation last December, which resulted in a day at the CDU unit at hospital. After all sorts of tests, they fed me an Atrixaban tablet, and made sure it didn't kill me, then sent me home with a new prescription for Apixaban after breakfast and after evening meal. It is designed to stop the blood clotting in the top chambers of the heart, thus preventing strokes. Also, they removed aspirin from my prescription.
So far as I can tell it has not happened again, but they told me that if it did, I should dial 999 and tell the crew to take me straight to the cdu.

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 5:07pm
by Audax67
Jdsk wrote:
Audax67 wrote:The interesting thing about that is that the heart is made of so-called smooth muscle, which does not tire. Skeletal muscles are striated muscle, which does.

Muscle is traditionally divided into three types: smooth, skeletal and cardiac. Cardiac muscle is striated.

https://en.wikipedia.org/wiki/Smooth_muscle
https://en.wikipedia.org/wiki/Skeletal_muscle
https://en.wikipedia.org/wiki/Cardiac_muscle

Jonathan


Oops - bad memory. I did this stuff around 60 years ago.

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 5:16pm
by Bonefishblues
Whilst we're wandering about the subject, has anyone had ablation as a fix for AF?

Interested in people's experiences, if any - I've been offered it.

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 6:02pm
by simonineaston
smooth muscle, which does not tire. Skeletal muscles are striated muscle, which does.
Well, that's a bit rubbish, innit? Whoever did the original design should surely have specified 'smooth muscle' for legs, too, obviously...

Re: Atrial Fibrillation...Should We Worry

Posted: 18 Nov 2020, 6:35pm
by NATURAL ANKLING
Hi,
I'm sorry if the link didn't work I posted for some some of you.
I have no knowledge of such and are not particularly worried about it either, unless of course I develop a problem later.
I did have a raised heart rate once, felt terrible, admitted to A&E , Probable it was a virus which dehydrated me and sent my heart rate up.
My mother suffered some minor heart problems later in life I think it was just erratic, I think she was 93 when she died.
I used to work in a firm where we produced early pacemaking devices, one of my dogs was diagnosed with AV block, cost us the best part of two grand and an overnight stay might of been two nights, they use a redundant human pacemaker, after that the professor and his team couldn't keep up with him on the treadmill :lol:

Kept him going for another year anyway till the old man's problems got him again.

Re: Atrial Fibrillation...Should We Worry

Posted: 19 Nov 2020, 8:56am
by Audax67
Bonefishblues wrote:Whilst we're wandering about the subject, has anyone had ablation as a fix for AF?

Interested in people's experiences, if any - I've been offered it.


I know one long-distance rider - PBP/LEL level - for whom it fixed the AF without affecting his performance, and two strong riders who had to change to eBikes afterwards. One of them was around 50 years old and had still been racing. He's not very happy these days. OTOH he is alive. Our old club treasurer was in his mid-60s and had very bad AF. He had three ablations over a period of around two years, to no avail: he died in his sleep some months ago.

Re: Atrial Fibrillation...Should We Worry

Posted: 19 Nov 2020, 9:06am
by Audax67
NATURAL ANKLING wrote:Hi,
I used to work in a firm where we produced early pacemaking devices, one of my dogs was diagnosed with AV block, cost us the best part of two grand and an overnight stay might of been two nights, they use a redundant human pacemaker, after that the professor and his team couldn't keep up with him on the treadmill :lol:

Kept him going for another year anyway till the old man's problems got him again.


We have a couple of chocolate Labs that are getting into that territory. They're insured but that runs us a couple of grand a year. :(

In the 90s I did a software-production system for a bunch of defib research engineers. Back then they were the size of a meaty palm and had to be implanted in the abdomen. Last time I visited them, in 2008 I think, the things had shrunk to the size of a large wristwatch.

The engineers, BTW, had a somewhat raw sense of humour. Any time they saw a dog it was "let's cut him open and do a test run". Great guys.

Re: Atrial Fibrillation...Should We Worry

Posted: 19 Nov 2020, 2:03pm
by axel_knutt
NATURAL ANKLING wrote:Men are considerably more prone to arrhythmia than women — exactly why is unclear — and tall men are the most susceptible of all.

There are numerous risk factors documented by the European Society of Cardiology:
Age
Male gender
Genetic inheritance
Obesity
Blood pressure
Height
Sleep apnoea
Hyperthyroidism
Alcohol
Kidney disease
Endurance training
COPD
Smoking
Coffee
PR Interval
Murmur
Biomarkers of haemodynamic stress
Biomarkers of inflammation
Birth weight
Biomarkers of cardiac damage
Atherosclerosis
Psychological

Bonefishblues wrote:There is no downside and much upside to taking a low dose aspirin daily, as I have been doing for years, long before I started to have AF's cousin, arrhythmia, in earnest.

The downside of aspirin is that the bleeding risk is as high as that for Warfarin, and there’s no upside, because it doesn’t reduce the stroke risk. Furthermore, before taking anticoagulants those with AF first need to tot up their CHA2DS2-VASc score in order to find out whether they will benefit from anticoagulation at all. It’s also not a bad idea to tot up your HASBLED score as well whilst you’re about it, in order to assess the risk of a haemorrhage.

mikeymo wrote:I had a 12 lead ECG a couple of years ago, and was pronounced top notch.

I had two Bruce tests, two 24 hour Holters, a 7 day Holter, and more ECGs than you can poke a stick at, but the only times the NHS have ever seen my AF were the occasions when I fetched up at A&E in an ambulance. AF is commonly paroxysmal, one minute it’s there, next minute it’s not. Even if you manage get to the hospital with arrhythmia, you have to get past the doctors who can’t recognise it when they see it. I was once sent home with atrial flutter by doctors who thought I was just having a panic attack, and that was after I had already been diagnosed, medicated, and put on the waiting list for an ablation.

Jdsk wrote:The possibility of AF being caused by intense exercise is fascinating.

Possibility? Since 2016 the European Society of Cardiology have acknowledged chronic endurance training as an arrhythmogen, and advise that “athletes should be counselled that long-lasting intense sports participation can promote AF”. This is categorised as Class 1: “Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective”, and Level A: “Data derived from multiple randomized clinical trials or meta-analyses”. The degree of risk remains an open question, there are numerous studies finding an increase in the incidence of AF ranging from 20% to 20 fold.

Bonefishblues wrote:has anyone had ablation as a fix for AF?

No, but I’ve had an ablation for atrial flutter. It was fine, but then, flutter ablations are quicker, simpler, and have a higher success rate than those for AF. Flutter is ablated on the cavo-tricuspid isthmus in the right atrium, which is where the catheter emerges when it’s threaded up from the groin, but fibrillation ablations isolate the pulmonary veins which are in the left atrium, so they have to pierce the atrial septum to gain access, which makes a much bigger job. My ablation took about 40 mins, whereas pulmonary vein isolation typically takes 4 to 6 hours.

AF ablation is around 70% effective, so it’s common to need more than just one. Complication rate is low (around 6%), but they are quite serious: heart attack, stroke, tamponade, phrenic palsy, oesophageal fistula etc. Mortality rate is 0.1%. Atrial septal defects are strongly linked to migraine, so that’s also a more common but less serious side effect. The best way to reduce your risk is to find a hospital that does a lot of them, because the ones with the lowest complication rate are the ones with the most experience.

John Mandrola is an interesting guy to read, he's not only an Electrophysiologist (a cardiologist who specialises in treating arrhythmia), but also an AF patient and a keen cyclist. We's written a book on exercise as an arrhythmogen, and also has a weblog.

Re: Atrial Fibrillation...Should We Worry

Posted: 19 Nov 2020, 2:56pm
by Bonefishblues
I take it you are medically qualified AK?

Re: Atrial Fibrillation...Should We Worry

Posted: 19 Nov 2020, 3:52pm
by Jdsk
axel_knutt wrote:
Jdsk wrote:The possibility of AF being caused by intense exercise is fascinating.

Possibility? Since 2016 the European Society of Cardiology have acknowledged chronic endurance training as an arrhythmogen, and advise that “athletes should be counselled that long-lasting intense sports participation can promote AF”. This is categorised as Class 1: “Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective”, and Level A: “Data derived from multiple randomized clinical trials or meta-analyses”. The degree of risk remains an open question, there are numerous studies finding an increase in the incidence of AF ranging from 20% to 20 fold.

Thanks. I've read a fair number of original studies but I wasn't aware of that. I've got:

"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS"
https://academic.oup.com/eurheartj/arti ... 93/2334964

but I can't find that bit. Where should I be looking?

Jonathan