ABSTRACTS

BOSTON, MASSACHUSETTS. Hypertension, diabetes, smoking, cardiovascular disease, and elevated cholesterol levels are among the major risk factors for ischemic stroke. Researchers at Boston University now report that a decline in cognitive function is also associated with an increased risk of experiencing a stroke within 10 years of assessment. The researchers tested the cognitive performance level of 2175 members of the Framingham Offspring Study. The tests included visual-spatial memory, attention, organization, scanning, abstract reasoning, and verbal learning and memory. After adjusting for other known stroke risk factors the researchers conclude that a significant decline in cognitive function is associated with an increased 10-year risk of stroke. They speculate that the mechanism underlying cognitive decline is related to the mechanism causing an increased risk of stroke.
Elias, MF, et al. Framingham stroke risk profile and lowered cognitive performance. Stroke, Vol. 35, February 2004, pp. 404-09

CLEVELAND, OHIO. As the limited efficacy of pharmacological drugs in arrhythmia prevention becomes increasingly apparent more and more patients are turning to vitamins, supplements and herbal medicine for relief. This has now been recognized by Dr. Mina Chung, MD at the Cleveland Clinic. Dr. Chung has just released a very impressive and comprehensive study of the use of natural remedies in arrhythmia prevention. Although the study addresses both atrial and ventricular arrhythmias many of its conclusions are directly applicable to atrial fibrillation. Some of the highlights are:

Potassium – Hypokalemia or a low blood serum level of potassium (less than 3.5 mmol/L) has been associated with both PACs (premature atrial complexes) and PVCs (premature ventricular complexes). Licorice consumption increases the risk of hypokalemia, as does the use of diuretics. Supplementation in potassium- deficient patients with arrhythmias is advised to maintain a potassium concentration of at least 4.0 mmol/L. NOTE: 5.0 mmol/L is the upper normal limit.

Magnesium – Hypomagnesemia or a low blood serum level of magnesium (less than 0.70 mmol/L) has been associated with an increased risk of arrhythmias and can be caused by the use of certain diuretics. Other research (not mentioned by Dr. Chung) has shown that magnesium supplementation is effective in reducing PACs and PVCs.

Vitamin C – A clinical trial concluded that vitamin C is effective in alleviating the oxidative and inflammatory stress resulting from bypass surgery. Patients given vitamin C (2000 mg prior to surgery and 2 x 500 mg/day thereafter) had half the incidence (16.3%) of atrial fibrillation than did controls given a placebo (34.9%). A larger, randomized, controlled trial is currently underway.

Coenzyme Q10 – This antioxidant and free radical scavenger is also an effective membrane stabilizer. It has been found to markedly reduce reperfusion arrhythmias and angina and improve ventricular function. Heart failure patients given 50-150 mg/day of coenzyme Q10 reduced their incidence of arrhythmia by 63%. Coenzyme Q10 has also been reported to markedly reduce PVCs.

Carnitine – L-carnitine has been reported to decrease the frequency of both atrial and ventricular arrhythmias and one study reported a marked reduction in PVCs in hypertensive patients given 2 grams/day of oral L-carnitine.

Fish oil – Fish oil (eicosapentaenoic acid and docosahexaenoic acid) has a potent membrane- stabilizing effect and has been found highly effective in preventing ventricular fibrillation and sudden cardiac death. A clinical trial involving 79 patients with frequent PVCs concluded that fish oil supplementation reduced PVCs by over 70% in 44% of patients compared with only 15% in the placebo group.

Chinese herbs

• Tetrandrine is an extract from the herb Stephania tetrandra, which has calcium channel blocking activity similar to that of verapamil and has been found to decrease aldosterone production. It can, unfortunately, also cause renal failure.
• Mai Dong has been found highly effective in preventing PVCs with no observed side effects and Xin bao is reputedly effective in improving symptoms of sick sinus syndrome such as palpitations, dizziness, and chest pressure.

Other herbal medicines

• Hawthorn (Crataegus) has been found to reduce PVCs in heart failure patients and also diminished fatigue, arrhythmias, and breathlessness brought on by exercise.
• Garlic and Ginkgo biloba have been reported to suppress PVCs and ventricular tachycardia.
• Licorice root may have antiarrhythmic effects in some patients and is particularly effective in preventing arrhythmias induced by chloroform, adrenaline, aconitine and barium chloride. However, it can also provoke arrhythmias by inducing hypokalemia.

Many other herbs may induce arrhythmias and should be avoided by sensitive AF patients. These include ma huang (ephedra), Agnus castus, black cohosh, cola, mate, St. John's wort, aconite, broom, and herbs with diuretic properties such as corn silk, dandelion, and uva ursi (especially if hypokalemia is suspected). Many herbs and supplements interact with digoxin and especially with warfarin so should be avoided if these drugs are taken.
Chung, MK. Vitamins, supplements, herbal medicines, and arrhythmias. Cardiology in Review, Vol. 12, No. 2, March/April 2004, pp. 73-84 (145 references)

VANDOEUVRE LES NANCY, FRANCE. The atrial refractory period (ARP) is the length of time (in milliseconds) during which the cells of the atria are incapable of responding to a stimulus. In other words, an ectopic beat or an afib episode cannot be initiated during the ARP. Thus it follows that the longer the ARP the less the chance of initiating an episode. It has generally been assumed that the main reason why the incidence of afib increases with age is that the ARP is shorter in older people. French cardiologists now report that this assumption is wrong.

Their study involved 734 patients between the ages of 18 and 85 years (average age of 61 years) who had been admitted for an electrophysiological (EP) study. None of the participants had previously been diagnosed with atrial fibrillation (AF). During the EP study extra stimuli were delivered in order to induce experimental afib. Much to their surprise, the researchers found that, while they could induce an episode (lasting longer than 1 minute) in 40% of patients younger than 40 years, they could only induce it in 28% of patients older than 70 years. The difference in afib vulnerability could not be explained by differences in sex, the presence of underlying heart disease or dizziness, low left ventricular ejection fraction or the presence of runs of PACs on the 24-hour Holter monitoring. The only significant correlation observed was between afib vulnerability and the ARP with older patients having a longer atrial effective refractory period (226 msec) than younger patients (208 msec).

The researchers conclude that a shortening of the ARP cannot explain the higher incidence of afib among older people. They speculate that an increased prevalence of heart disease and the fact that premature (ectopic) beats become more common with age may be the main contributing factors. They point out that afib episodes lasting several hours result in a shortening of the ARP, which in turn further lengthens the episode. They also observed that the vagal (parasympathetic) predominance often found in younger people, particularly heavy exercisers, tends to shorten the ARP thus increasing afib vulnerability.
Brembilla-Perrot, B, et al. Influence of age on atrial fibrillation inducibility. PACE, Vol. 27, March 2004, pp. 287-92

DUNDEE, UNITED KINGDOM. Human beings evolved on a potassium-rich, sodium-poor diet and as a consequence developed mechanisms, primarily the RAAS (renin-angiotensin-aldosterone system), for retaining sodium and excreting potassium. Unfortunately, the modern diet tends to be high in sodium and comparatively low in potassium. This creates serious problems, particularly in the cardiovascular system. The human body contains about 3500 mmol (137 grams) of potassium of which 98% is found inside the cells (intracellular). Total potassium level is maintained by matching renal excretion to dietary intake (about 2-6 grams/day). Serum (extracellular) potassium is maintained between 3.5 and 5.3 mmol/L by shifting potassium between the intracellular and extracellular compartments and by excreting any excess through the kidneys.

A deficiency of potassium (hypokalemia) increases the "irritability" of the heart and helps set the stage for atrial fibrillation. Increasing daily potassium intake has been found to reduce endothelial dysfunction, atherosclerosis, hypertension, adrenaline (epinephrine) levels, and the incidence of ventricular fibrillation. Of particular interest to afibbers is the finding that long-term (6-10 months) supplementation with potassium reduces the incidence of PVCs (premature ventricular complexes) and helps prevent ischemic stroke. An added intake of just 400 mg/day has been found to decrease stroke risk by 40%.

Remedying hypokalemia requires an adequate intake and absorption of magnesium. A low magnesium level is associated with hyperaldosteronism, which also causes low potassium levels. Magnesium is also required to run the sodium-potassium-ATPase pump, which keeps intracellular levels of potassium "topped up". In short, hypokalemia and hypomagnesemia (low magnesium levels) are very close cousins and both magnesium and potassium replenishment is necessary in order to normalize levels. Although supplementation with highly absorbable potassium and magnesium can, in the long term, reverse hypokalemia and hypomagnesemia, the normalization of levels can be achieved much quicker with drugs designed to block aldosterone, especially the newly developed drug eplerenone (Inspra). Drs. Allan Struthers and John Macdonald who co-authored this paper on potassium recommend that people who have suffered a heart attack or have developed heart failure should maintain a serum potassium level of at least 4.5 mmol/L in order to avoid ventricular fibrillation and sudden cardiac death. Other research has shown that afibbers should maintain a level of at least 4.0 mmol/L.
Macdonald, JE and Struthers, AD. What is the optimal serum potassium level in cardiovascular patients? Journal of the American College of Cardiology, Vol. 43, No. 2, January 21, 2004, pp. 155-61

Editor's comment: I, along with PC and many other researchers and contributors to the Conference Room and Bulletin Board, am becoming increasingly convinced that a potassium (K) and magnesium (Mg) deficiency is the root of the afib problem for many of us. I also believe that an excess of cortisol and/or aldosterone (hyperaldosteronism) is intimately involved. It should be kept in mind that, as far as maintaining appropriate K and Mg levels, the body does not distinguish between high cortisol and high aldosterone levels. Aldosterone and cortisol can dock with equal ease at the metallocorticoid (MC) receptors controlling K excretion and sodium retention and elicit the same end result.

I firmly believe that the next step in our "path to victory" has to be for afibbers, with a regular time interval between episodes, to have blood renin and urine (24-hour sample), cortisol and aldosterone levels measured to see how widespread the problem of high aldosterone and cortisol levels – and a low renin level are. The tests should be done as close to an expected episode as possible. I have had my tests done and they showed a low to non-existent renin level combined with off-the-scale aldosterone and cortisol levels. This could be indicative of an adrenal tumour or adrenal enlargement and I am having a CT scan to check this out. The aldosterone blocker, eplerenone, is unfortunately not yet available in Canada. If it were I would definitely try it.

Pulmonary vein isolation (PVI) is becoming increasingly accepted as the cure of choice for atrial fibrillation. Major centers like the Cleveland Clinic, the University of Michigan, the Mayo Clinic, the Bordeaux Clinic and several other European centers are now performing the procedure routinely. As a result, reliable data are becoming available regarding the rates of success (no afib, no antiarrhythmic drugs) and complications for the procedure. These may be summarized as follows:

* Cleveland Clinic data

It should be noted that a smaller study carried out at the University of Michigan found that the overall success rate after 2 years of follow-up was 70% for paroxysmal afibbers and only 25% for persistent afibbers. Overall though, it would appear that the success rate for a first PVI is 70-75% for paroxysmal afibbers and somewhat lower for persistent and permanent afibbers. A touch-up operation improves the overall success rate to over 90%. The incidence of stenosis is low with the now widely used ostial procedure as is the risk of stroke.
Journal of the American College of Cardiology, Vol. 43, Suppl A, No. 5, March 3, 2004, pp. 124A-134A (abstracts)

CLEVELAND, OHIO. Pulmonary vein isolation (PVI) has become an accepted therapy for patients with lone atrial fibrillation (LAF), that is atrial fibrillation (AF) without underlying heart disease. Until now it has generally been believed that the mechanisms of LAF and AF with underlying heart disease were somehow different and that PVI was therefore unlikely to work in AF patients with underlying heart disease. Researchers at the Cleveland Clinic have now dispelled this notion.

Their study involved 377 patients who underwent PVI using intracardiac echocardiography (ICE) guided circular mapping of the pulmonary vein ostia. A subgroup of 183 patients had underlying heart disease as indicated by a left ventricular ejection fraction of less than 40%, a history of cardiac surgery or significant aortic or mitral valve disease. All patients were followed for an average of 15 months. The success rate (no afib, no drugs) of the first PVI procedure was 69% in the LAF patients and 73% in the AF patients with underlying heart disease. A second PVI increased the overall success rate to 98% in the LAF group and 95% in the heart disease group. The total procedure time was 4 hours in both groups with a fluoroscopy time of 83 and 87 minutes respectively. There was 1 cerebrovascular event (stroke or TIA) in the LAF group and 3 (1.6%) in the heart disease group and the rate of severe pulmonary vein stenosis was 1% in both groups. The researchers conclude that PVI is just as effective in AF with underlying heart disease as it is in LAF.
Journal of the American College of Cardiology, Vol. 43, Suppl A, No. 5, March 3, 2004, pp. 133A-134A (abstract)

Editor's comment: It is interesting that the overall success rate for the initial PVI was only 71% and that a touch-up was required to bring it to 95%. Also of interest is the finding that a large left atrial size (49-52 mm) was not associated with a lower success rate.

MAGDEBURG, GERMANY. German researchers have just completed a study aimed at determining if physical exercise affects platelet aggregation and blood coagulation in people with persistent lone atrial fibrillation (LAF). An increase in either parameter could translate into an increased risk of ischemic stroke. The study involved 13 persistent afibbers and 13 matched controls in normal sinus rhythm. The LAF patients were all effectively anticoagulated with warfarin. All participants underwent bicycle ergometry using a respiratory gas exchange technique for 20 minutes at one-third of their age adjusted maximal workload (moderate exercise). The workload was then increased until maximum exercise capacity was achieved (heavy exercise). The following markers were determined in all participants throughout the study:

• Von Willebrand factor (a marker of endothelial dysfunction)
• Platelet factor-4 (a marker of platelet activation)
• Beta-thromboglobulin (a marker of platelet activation)
• Prothrombin fragments 1 and 2 (a coagulation marker)
• Fibrinogen levels.

The researchers found that levels of platelet factor-4 and beta-thromboglobulin increased significantly in LAF patients during heavy exercise, but not during moderate exercise. Exercise, whether moderate or heavy, had no significant effect on platelet activation in participants in normal sinus rhythm. The level of von Willebrand factor increased by about 24% in all participants during maximal exercise while the level of prothrombin fragments 1 and 2 only increased in the patients in sinus rhythm, thus indicating that warfarin does effectively interfere in the final step of the coagulation pathway.

The researchers conclude that heavy exercise increases platelet activity and von Willebrand factor levels during atrial fibrillation, but that moderate exercise has no detrimental effect on platelet activation or coagulation. They recommend further studies to determine whether heavy physical exercise is a risk factor for stroke in patients with AF.
Goette, A, et al. Effect of physical exercise on platelet activity and the von-Willebrand-factor in patients with persistent lone atrial fibrillation. J Interv Card Electrophysiol, Vol. 10, No. 2, April 2004, pp. 139-46

Editor's comment: The finding that vigorous physical exercise increases platelet activation and thus possibly the risk of stroke in patients with persistent LAF points to the advisability of going easy on the exercise when in afib. Heavy physical exercise also increases cortisol levels and vagal tone, so moderation is also important in avoiding afib episodes, especially among vagal afibbers.

American College of Cardiology Conference

PVIs and atrial flutter
About 2-8% of patients undergoing a successful pulmonary vein ablation (PVI) later develop atrial flutter in the left atrium. Electrophysiologists at the Cleveland Clinic report that 15 out of 613 patients (2.4%) developed left atrial flutter within a year or two of the PVI. Most of the flutter circuits originated from posterior atrial wall scars and recovery of ostial conduction around an average of 2 pulmonary veins (PVs) was observed in all 15 patients. Re-isolation of the affected PVs resolved the flutter problem in 14 patients.
Abstract #1052-207, p. 114A

Scar tissue affects PVI success
Cleveland Clinic researchers have found that the presence of scar tissue in the left atrium prior to a pulmonary vein isolation (PVI) procedure reduces the success rate for the procedure. In a recent study of 613 patients undergoing PVI they observed that 31 of the patients had scarring in the left atrial wall. The afib recurrence rate among these patients was 46% as compared to 14% among those with no scarring prior to the PVI.
Abstract #1052-224, p. 115A

Single vein isolation and atrial tachycardia
Atrial tachycardia (AT) is characterized by episodes of extremely high heart rates (150-250 beats/minute). The heart rate is usually regular in contrast to the highly irregular rate observed in atrial fibrillation. AT is usually initiated by premature atrial complexes (PACs) originating from a pulmonary vein. Cleveland Clinic researchers posed the question, "Is it enough to isolate the offending vein with a PVI procedure or should all 4 veins be isolated in order to prevent future atrial fibrillation?" They followed 13 patients who had undergone single vein PVI for AT for an average of 21 months. All the patients were cured of their AT and none developed new onset atrial fibrillation during the follow-up period. Two patients who had experienced afib prior to the PVI continued to do so after the procedure. The researchers conclude that AT can be successfully treated with single PV isolation thus reducing procedure time and radiation exposure significantly.
Abstract #1090-220, p. 124A

Magnesium prevents afib after heart surgery
Postoperative atrial fibrillation is one of the major complications of open-heart surgery. Researchers at McMaster University in Hamilton, Canada recently reviewed the results of 18 randomized trials aimed at determining the benefit of administering magnesium prior to surgery. The trials included a total of 2040 patients. The researchers found that magnesium administration decreased the incidence of postoperative afib from 28% to 17% for a relative improvement of 39%. Magnesium administration did not shorten the length of stay in hospital nor did it affect surgery-related mortality, which was quite low at 0.7%.
Abstract #1166-211, p. 144A

This is my story..... How I calmed my heart prior to ablation…and after. Three distinct components blended into one harmonious remedy worked for me… Mind, Body and Spirit.

I was already tuned into holistic healing from research on my other conditions, fibromyalgia, chronic fatigue, candidiasis, hypoadrenalism and hypothyroidism, so I just added atrial fibrillation to my list of search topics and added more targeted nutrients directed by my doctor, but other healing modalities are also involved.

To summarize in a few words what I think helped me the most, I'd say magnesium, taurine, potassium, energy work and acceptance of a higher power and my own spirituality. Almost a year after I began this calming quest, I know I am not the same person who set out on the journey.

Background
My first afib event occurred at age 59 and lasted for about an hour and a half. Over the next eight years, the events increased in frequency until January 2003 when I began experiencing daily or every other day events that were lasting over 20 hours.

At that time and after two trips to the ER, six weeks apart with 3 and 4-day stays in the hospital for breakthrough arrhythmia while on Flecainide, and involving a TEE (trans esophageal echocardiography) and cardioversion at one visit, it was suggested that I give serious thought to ablation. I refused the attempt to reintroduce a beta- blocker since I had taken myself off Toprol XL six months prior and felt much better without it although the event frequency remained the same. Clearly, drugs were not the answer for me in controlling afib.

"Ablation"! What I had never, ever wanted to do and wouldn't even consider previously. Yet, I knew I couldn't go on with this pattern every six weeks. I was on 200 mg a day of Flecainide and was feeling the effects of the double dose - fatigue and lethargy. I had instructions to take an additional 100 mg every time afib began…so I was taking the extra dose every day or every other day. I was very nervous about the high dosage.

During my consultation appointment at the Cleveland Clinic with EP, Andrea Natale, MD, the EP nurse told me that the more calm my heart at the time of ablation, the better my chances would be for a successful and calm heart after the ablation. I thought at the time, "Well, good luck. If I could keep my heart calm, I wouldn't have just had two 3-day sessions in the ER with runaway afib."

Nevertheless, I took the comment "to heart" and collaborated with my functional medicine MD (Dr. Sprecher) about the best approach to do just that…calm my heart and hopefully cure this condition so an ablation wouldn't be necessary. That was my ultimate goal. This was in early April 2003. I was assigned an ablation date of November 12. Six months of waiting and six months to affect a "cure."

The Calming Plan
Dr. Sprecher suggested I work on each facet of healing mind, body and spirit. I pulled out all the stops.

In addition to the already lengthy list of targeted nutrients she directed, I consulted with a homeopath, a psychologist who does mind, body, spirit work, an MD who does acupuncture and has a Doctor of Chinese Medicine degree, several massage therapists, and a chiropractic physician who does energy work based on Applied Kinesiology (AK). And, I had the support of fellow afibbers on the forum offering suggestions and current ablation research. Erling Waller, Jim W., Stan B., Lorraine, Hans…everyone helped me sort out ablation facts. This was invaluable support.

The homeopathic approach was a bust. I quickly fired him. The psychologist was viewing me as long-term income; my gut instinct rejected this approach; I fired him. I had about 20 acupuncture treatments that were calming, but didn't seem to help, although I learned a lot about Chinese Medicine and energy between sympathetic and parasympathetic nervous systems. I can't say it didn't help, but it didn't stop the breakthrough arrhythmia.

It was kismet that I found the chiropractor who does energy work. A friend was seeing him for neck pain which he traced to blocked emotions and negative energy. The bells went off and I made an appointment. I knew I had a lot of stuffed emotions and stress and knew instinctively that issue was part of my problem. I was drawn to that connection the minute she started describing his work.

I began NET treatments (Neuro Emotional Technique) which includes Applied Kinesiology, with Dr. Jordan the first of July (having wasted far too much valuable time with the other approaches) and saw him twice a week for about six weeks.

Various conditions were discovered and addressed through NET wherein locked emotional responses called Neuro Emotional Complexes (emotional reality) are detected with reflex responses or patterns…much like the Pavlov-dog response. Negative emotional responses (either conscious or unconscious) can manifest as symptoms and the result is ill health and imbalance. Neuropeptides carry emotions throughout the body. NET seeks to normalize neurological imbalances using physical corrections and removes the blockages to the body's natural healing process.

One very significant finding was a displaced diaphragm that was causing hiccoughs that set off afib immediately. Once the diaphragm was repositioned and it held in that position (about five treatments), I no longer triggered afib in that manner. Hiccoughs are a spasm of the diaphragm and attributed to magnesium deficiency.

Concomitant with that, Erling Waller, who had previously attempted to get me to understand the importance of magnesium deficiency by sending me very convincing evidence on the subject, began again to hammer away at intractable magnesium deficiency. All the while I thought I was taking enough magnesium…400 mg a day plus that from my food. I continued to read the data.

Finally, I had a revelation based on a posting from Carol on the BB saying she increased her magnesium up to 800 or 1,000 mg daily and had stopped her afib. I tried increasing gradually while I was getting the emotional energy work from Dr. Jordan. After the first session, I went 5 days without an event. This was a record. Then I went a week, then 13 days and by the end of August…breakthrough arrhythmia was not a common occurrence. If it happened, it was short…sometimes 2 hours or less. Previously, I was always afibbing for around or over 20 hours. The record was 39 hours before converting on my own.

In my case, Erling was right about magnesium deficiency. My magnesium glycinate dosage was at 800 mg daily. I also made a conscious effort to use only unsoftened water for drinking and cooking. While I have a well with hard water and a separate spigot in another area for unsoftened water, I admit to frequently being lazy and just using what was handy. After reading that water softened with sodium (either well water or municipal water) removes magnesium and calcium, I resolved not to use the water produced from our in-house softening system and to take 100% advantage of our naturally occurring spring water.

Additionally, Dr. Jordan found my thyroid was low by AK testing, even though my labs indicated normal, and added an additional support supplement for thyroid along with homeopathics for heart and emotions…. anger, repression, fear, fear of abandonment, disappointment, sadness - all of these blocked emotions he uncovered and released while doing the energy work. This was the mind/body part of the triad. It served to force me to acknowledge emotional stresses I had been suppressing for years and to deal with the reality of eliminating the causes of the stress. This is an ongoing project.

Negative energy is very damaging. One can't attain or maintain health in its presence. I began to play constantly audio tapes given to me by friends who knew of my journey. They were the smart ones who understood better than I about the mind/body/spirit connection. The tapes by Carolyn Myss - "Why People Don't Heal and How they Can" along with Wayne Dyer's "A Spiritual Solution for Every Problem," became my favorites because they spoke to me the most in terms of what I needed to address. Books that helped shape my thoughts were, The Art of Effortless Living, Full Catastrophe Living, and Power versus Force.

I had always stayed away from the spiritual aspect because I lumped spiritualism and religion together. Having had a very traumatic experience with religion early on in my life, I shied away from anything religious, but suddenly these tapes (and again, Erling- my mentor) opened my mind to spiritual healing and awareness. I got comfortable with the thought that I was a spiritual being and recognized that I had denied myself this privilege most all of my adult life. This was quite a revelation because I had always prided myself in being open minded; yet I was totally closed to spirituality. But once I let the thought develop and I became comfortable, my life and condition began to change and all for the better.

By mid-September, the "new me" was afib free, but still on Flecainide and I decided to wean off. Time was running out… I hoped to cancel the ablation, but in less than a week, I went into a nasty afib event. I chickened out. Went back on the Flecainide and focused on getting a calm heart (again) by the time of ablation.

Both Dr. Sprecher and Dr. Jordan worked to honor my ablation commitment and to help me become comfortable with it. They both insisted that if I had doubts or fears that ablation wouldn't work or the outcome wouldn't be good…it wouldn't be. (You are what you think.) We worked very hard on my mindset.

By the ablation date, I had been afib-free for two months (but still on the drug). I faced all my concerns about the ablation and concentrated on thinking nothing but positive thoughts about the outcome. With the help of the energy work, I became comfortable and at peace with having the procedure I never wanted. I even accepted the Coumadin issue.

All thoughts were about the positive outcome and I developed a mantra which I said anytime my mind began to waver or I had negative thoughts: "Manifest Peace in My Heart"….. either out loud if I were alone, or to myself, otherwise. I did this while placing one hand on my solar plexus. Sometimes I positioned my hands differently or if I were driving, I just held on to the steering wheel and focused on breathing through my heart with positive energy and positive thoughts. I developed a whole script of "manifests" that I said then and continue to say now. I connect with my spiritual being many times a day. Any time I feel my thoughts drifting into negative territory or I feel stressed, I become centered again with my focus or grounded by my mantras.

Coupled with this mantra ritual, I incorporated my use of therapeutic essential oils from plants known to create cellular energy and to posses strong antioxidant properties. This was just a natural complement.

I had an energy session with Dr. Jordan about 4 days prior to the ablation to eliminate any negative energy or fears and to create only positive energy and acceptance. He pronounced that I tested very strong and was ready for the procedure. I repeated the sequence, visiting him again 4 days after ablation for more clearing.

The night before the ablation, I was calm and peaceful. I went to bed with my "manifests" in place and slept well until early morning. Normally, the hour's drive to the hospital would have been an anxious one…. I was very calm and I said my mantra constantly. I had absolutely no fear or anxiety at any time before, during or after the procedure.

On a physical level, in mid-September, I began working out more days and more intensely. This was difficult with the burden of the extra Flecainide but I kept pushing. By the time of ablation, I was doing well; my stamina had increased and I felt stronger, overall. I hated to think I would have to lay off during the recovery period.

Additionally during this time of no afib but still on Flecainide, I was able to do some things that had previously triggered afib….. bending over from the waist for an extended period of time; lie or sleep on my left side; lie down flat in bed; and even some of the former triggers such as dessert or cheese did not bring on afib.

About three weeks prior to ablation, I took increased doses of vitamin C (2 grams daily) with bioflavonoids to reduce trauma effects and inflammation. I was given that instruction with another surgery. Thought it couldn't hurt with this procedure. And I stopped the use of ginkgo, vitamin E and the occasional aspirin, since I was going to be on Coumadin two weeks before ablation and at least 6 weeks after.

By the date of ablation, I was comfortable with taking 800 mg of magnesium glycinate a day. The brand I chose was Metagenics. I took it to the hospital with me and planned to take it at my first opportunity after I was free to move around. My reasoning was that stress depletes magnesium and I had no reason to think that my body would not consider ablation a huge stressor.

I took 200 mg of the MgG every couple of hours until it was time for discharge. I also took regular doses of vitamin C with bioflavonoids (500 mg) to reduce inflammation and a natural, plant-based product called Phytoprofen. The reasoning was to control as much inflammation as possible.

Of course, I did not share any of this with the hospital staff. However, they knew I was using the therapeutic essential oils of plants because of the lovely, calming fragrance and effect of Lavender oil…just entering my room made the staff wonder what the wonderful "smell" was. Some came in to get a "fix" and left. It was fun. My room mate who had terminal liver failure found it especially comforting.

Once home, I continued my daily supplement routine but added increased amounts of natural anti-inflammatory plant-based products….like quercetin, bromelain and turmeric. And I maintained the higher C dose for six weeks.

Additionally, I continued with all the good blood thinning support like Omega 3 oils even though I was on Coumadin. I was only taking CoQ10 at 100 mg when I came home, but soon realized with the problems created by Lipitor, I needed much more so I increased it to 500 a day.

The Results
From the time of the ablation to present, I have been afib-free.

• 2 months before ablation on Flecainide - no breakthrough afib
• 2 months after ablation on Flecainide & Coumadin - no afib
• 1 month off both drugs - no afib - added nattokinase for anticlotting
• 3 months post ablation - calm heart - no drugs - no afib
• I have no residual symptoms of afib or the ablation.

In the first two months post ablation, I had 9 PACs and six of those beats were a pattern that felt as if it would progress to afib. It did not. While off all drugs, I get an occasional single missed beat or a thud. Nothing else.

When I work out, my elevated heart rate returns quickly to normal. Occasionally when I lie down for the night, I feel a jittery feeling in my chest, but my heart beat is normal. I just do my mantras and fall asleep. My sleep is deep and uninterrupted.

I take no prescription drugs except my natural hormone patch and cream. My last official blood pressure reading was 114/68 - pulse 76. At rest, my pulse is around 65.

My heart is peaceful. I'm grateful. I thank God, Dr. Natale and all the wonderful people on this Bulletin Board for helping me reach this goal. Your support is invaluable and very much appreciated.

Thank you with all my heart! (and soul)

Abbreviated list of my nutritional supplements
My diet is modified Paleo type with whole foods, organic when available, cooked from scratch, no bad fats. Moderate portions. No sugar, no caffeine, no alcohol. 3 meals a day and 2 snacks. Hydrate with unsoftened water…in abundance and at least 16 oz a day of the Waller Water.

In addition to my Core Supplements program, here's what I took to calm my heart.

• 800 mg magnesium glycinate - reduced to 600 mg. one month post-ablation
• 1 teaspoon, bulk taurine - reduced to ½ teaspoon one month post-ablation
• 300 mg herbal potassium
• 100 mg CoQ10 - 500 mg after ablation
• Mitrochondrial Resuscitate (Metagenics product)
• Omega 3 essential fatty acids fish oil, 6 grams
• 2 grams vitamin C with bioflavonoids
• 100 mcg selenium
• 400 IU vitamin E in the tocotrienol form - stopping prior to ablation
• 120 mg Ginkgo biloba - again stopping 3 weeks prior to ablation
• Phytoprofen - plant based anti-inflammatory product
• Cholarest - plant based lipid lowering product
• Min Tran Food-based minerals for heart support.

Many other daily nutrients are supplied in a combination form in preparations targeting specific systems…. and for conserving space, I've only listed the systems addressed by supplementation. (You don't want to see the list!)

• Anti-inflammatory
• Antioxidant
• Lipid lowering
• Methylation
• Glucose handling
• Probiotics
• Digestive enzymes
• Proteolytic enzymes
• Thyroid support.

By early April 04, the results of my post ablation labs will be evaluated and we will be making adjustments in supplement protocol so I can cut down or eliminate where cellular testing indicates I've reached proper levels.

Post Script
One wise poster on the BB once cautioned, "never get cocky." I didn't think that my Calming the Heart post was bragging or cocky. I just wanted to share the joy of having a calm heart with fellow afibbers.

Not long after that post and after 103 days post ablation, breakthrough arrhythmia began on 2/24/04, lasting 39 hours, terminated by cardioversion; placed on Flecainide for one week; then off again; then 9 days later, I had another brief run of AF for 20 minutes.

Now what to think?

At my check back on 3/3/04 with Dr. Natale at the CCF he said if this pattern continues, I'd be a candidate for a touch up but to wait for a couple of months to see what develops.

Initially, when the 2/24 AF occurred, I blamed a high stress level; I was dealing with the failing health of my beloved cat who is about 16 and is most likely on the last of his nine lives. Now, I'm inclined to also attribute a low-functioning thyroid to a large portion of the problem. But, that brings up the question….if the ablation was successful, how could hypothyroid conditions trigger an event? I do not have an answer.

There is good news, however. Recent blood tests indicated my C-reactive protein level had dropped from 1.08 to .439. This marker for inflammation had been rising continually as AF was worsening and on-going. The closer to zero, the better for this number. So my concerted effort using natural anti-inflammatories was successful, that and not having the heart in constant afib.

Additionally, Fibrinogen, was within range – 444 in a range of 170-460 – and had been 656 and 556. More work needs to be done here but at least it is coming down.

Homocysteine came down from 9.1 to 7.1 …5 or lower is considered excellent.

Hemoglobin A1C - indicator for diabetes - 5.5 (<6.5 = non-diabetic)

Candida Immune Complexes - .10 in a range of .10 - .90

Thyroid Imbalance
The thyroid profile survey results indicate an imbalance. All the numbers are in range, except Reverse T3 which is elevated. This is called Euthyroid Sick Syndrome (ESS).. meaning the thyroid numbers are normal but hypothyroidism exists nevertheless.

In ESS, when the body is under stress, instead of converting T4 into T3 (the active form of thyroid hormone that works at the cellular level) – the body makes what is known as Reverse T3 (RT3) as an inactive form of the T3 hormone, to conserve energy. ….thus the hypothyroid symptoms such as fatigue, which I have been experiencing since December but what I had chalked up to the aftermath of the PVI. In fact because I had the adverse Lipitor side effects, I thought it triggered fibromyalgia again. My major symptoms: muscle and joint aches and pains, internal chilliness, cold in a normal room temperature, cold skin, basal temperature reading around 97.2 and oral temp at any time during the day ranging 97.4 – 97.7, outer third of eyebrows now missing (again), thinning hair, brittle fingernails, and absolutely no energy…go to bed tired, wake up tired. …all classic symptoms of hypothyroidism.

ESS is frequently exacerbated by extreme stress, such as surgical trauma or critical illness. My doctor zeroed in right away when she saw the RT3 number and said…it was undoubtedly the stress of the PVI procedure. Some diagnostic descriptions of ESS indicate a stage of subclinical exhaustion imposed by pre-existing, undue stress…either emotional or physical.

In addition to the stress factor, ionizing radiation can have an adverse impact on the thyroid gland. The PVI does provide exposure from the fluoroscopy but I doubt there is a way to shield the thyroid because of the carotid artery catheter insertion.

Also, when evaluating thyroid function, we have to consider age as a factor. Aging generally decreases thyroid function. I also had a dye contrast spiral CAT scan to rule out post ablation stenosis…. but this was after the thyroid panel. Still, the iodine-based dye is damaging to the thyroid. I won't be submitting to another CAT scan any time soon.

My doctor is reluctant to begin a course of the natural hormone, Armour Thyroid, because of the risk of initiating an afib event and has placed me on a course of neonatal glandular support formulated to improve the communication between the pituitary, hypothalamus and thyroid which is apparently where the problem with ESS lies.

However, it is also well known that too low thyroid hormone levels can also initiate an afib event. In fact, I am convinced that my unusual breakthroughs were the result of a low-functioning thyroid since I had previously gone so long without arrhythmia. But, there is still the question about how this could occur if the ablation is successful.

Within a week of taking this supplement, I have actually begun to feel human once again. The first thing to diminish - the muscle and joint aches. Welcome relief. I had stopped exercising for over two weeks due to the intense discomfort and fatigue. I am now feeling much less fatigued, but my body temperature is still low, and I know I have a long way to go to regain the lost ground.

This experience with diminished thyroid function (identified as subclinical hypothyroidism - SCHT) and my recent recurrence of afib compels me to remind everyone to pay attention to your thyroid numbers; but also, to be ware that the single-most important diagnostic tool is how you feel. If you have hypothyroid symptoms, yet you are told your numbers fall into the normal range, do the research on why hypothyroidism is called " the unsuspected illness." It is estimated that over 27 million people are thought to be subclinically hypothyroid and under- diagnosed. This estimate would make thyroid disease more common in North America than diabetes. Be sure you aren't a statistic.

Hypothyroidism is a definite, contributing factor to atrial fibrillation. There are many symptoms of SCHT often mistaken for and treated as other conditions. Internal (basal) body temperature is a key diagnostic tool.

I've initiated this topic for examination in the Conference Room. Be sure you go here to note, at the very least, the many and often subtle symptoms. Everyone should be aware of SCHT and the potential for what it can mean in terms of your general health in addition to the impact this deficiency can have on atrial fibrillation. I invite you to become informed and aware.