I watched a few videos. Absolutely the best AFib channel on RUclips. Im going to mention you on Reddit AFib. So many people there lost in the wilderness of AFib. Me 67 m 2 PFA ablations this year at a top hospital. I did a year of research when I decided PFA was the way to go. It wasn't approved yet in US. Had to get unto a trial fo5the the first PFA. Then Farapulse for the second. NSR is great so far.
I see you are practicing here in Florida. I definitely want to go to your office and get the procedure I need to stop my A-Fib. Thank you for your informative videos. I will be in touch with your office soon.
I'm so glad you found the information useful. Because Afib is not directly life threatening and mostly treated for symptoms, the decision whether to just live with Afib and control the rate (least risky), versus try to suppress it for a few years at a time with a strong antiarrhythmic drug then in 15 years accept when it is permanent (more risky), or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But again we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. Hopefully an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. This is the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving pt's the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication.
Dr. Lee, thank you for taking the time to create these videos. Would you explain who needs to be on blood thinner even after an ablation? and who does not.
Thank you for watching! Yes, besides the fact that AFib can take over control of your heart and temporarily increase your heart rate causing symptoms, and that it is caused by aging and increases over time, AFib can also lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
Thanks Dr Lee, great explanation. I have permanent afib but don't get rapid heart rate, but i get periods lasting few hours when i feel wretched. Could this be caused by the irregularity of afib? I am only on blood thinners, calcium channel blocker made heart too slow.
Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. Also, the amount of time you are currently spending in AFib correlates with how progressed your AFib is and the stage. If you are going in and out of AFib and your episodes are less than 7 days at a time you are technically Paroxysmal AFib (early stage). If you are spending more than 7 days at at time in AFib you are Persistent AFib (mid stage). If you are in the Persistent stage spending more than a week at a time in AFib and you have been that way for more than a year then you are Longstanding Persistent AFib (late stage). And if you are spending 100% of the time in AFib and it doesn’t go to sleep at all by itself and it is too strong to get it to go back to sleep with an antiarrhythmic drug (AAD) or too much to get rid of it from the inside with an ablation then you are Permanent AFib (end-stage). (See my videos “Stages in Afib Explained” and “Ablation Techniques #1”) But even if you ever reach Permanent AFib stage, as long as you don’t have a clot and stroke from your AFib (the decision as to whether you need to be on a blood thinner to prevent this depends on your exact risk which in turn is based on your age and comorbid medical problems-see the video “Can AFib Cause a Stroke?”) you won’t directly die from AFib because it is not life threatening and mostly treated for symptoms. It’s just that once your Afib reaches permanent status and is always there, we no longer have the option of keeping it asleep with an antiarrhythmic med or getting rid of it from the inside with an AF ablation. All we can do at that point is slow the speed of it down with a “rate controlling” medication to a level where hopefully you can tolerate it. And remember the symptoms are usually palpitations depending on how fast the Afib is making your heart speed up to, and even if your Afib is well rate controlled it can still cause fatigue. If it is true that your Afib is “permanently” there and they are just protecting you from clots and strokes with the blood thinner and slowing your Afib rates down with the Calcium Channel Blocker such as Diltiazem or Verapamil, then that’s fine. While the periods of a few hours where you feel wretched could just be from the irregularity of the Afib rhythm, it probably isn’t since your Afib by definition is irregular all of the time so why don’t you feel wretched all of the time? It’s possible that at those times your rates in Afib may be much faster. Remember, Afib makes the speed of your heart go all over the place. It may start at 80-90bpm which you don’t feel then speed up temporarily to 150-160bpm then come down to 100bpm then back to 70-80bpm. While your “average” heart rate may be relatively controlled, that doesn’t mean every moment your Afib is going at that rate. The way to know for sure is to wear an external heart rhythm monitor to catch what rate your Afib is going at when you feel your symptoms of “wretchedness.” It may even be possible that at those times maybe the calcium channel blocker med which is slowing the speed of your Afib down, is making your Afib too slow temporarily! The Event Monitor would allow us to know for sure. I hope this helps!
Fast hr proportional to symptoms during af? Not so. Slow hr during af still causes major discomfort- not much difference in my experience : any episode is extremely disconcerting. I have never heard this from actual sufferers. Just the phenomenon, with slow or fast hr, is quite intolerable for many and is fairly consistently underestimated, even so.
I appreciate your feedback and your viewpoint. However, after seeing patients with AFib virtually every day for over twenty years (due to the prevalence of this disease process) as a Cardiac Electrophysiologist, I must politely and respectfully disagree. Symptoms are proportional to the speed at which the AFib is making the heart go at, it’s just that everyone is different in terms of how sensitive they are to their body. I just consulted on a patient two days ago who was diagnosed with AFib in 2018 when he had palpitations during an initial episode going at 190-200bpm but came for a routine appointment to his Cardiologist recently and was found to be back in AFib at 107bpm completely asymptomatic. Then yesterday a 61 y/o patient of mine who has had symptomatic episodes of AFib intermittently for the last 10 years presented for his yearly follow up feeling fine and was in AFib on ECG at 78bpm, completely asymptomatic. On the other hand I’ve seen plenty of patients who even with their AFib going at rates of 70-90bpm, which overall isn’t that fast and not that much faster than their normal rhythm speed, have symptoms of feeling lousy or where they just don’t feel right. Once again, everyone is different in terms of how sensitive to their body they are and how symptomatic they are with their AFib. That is why we have multiple ways of treating AFib including simple rate controlling meds to slow it down just for symptoms, versus a stronger antiarrhythmic medication to suppress it in order to keep one in their normal rhythm at a completely normal speed, versus an AF ablation to try to get rid of the AFib directly from within the heart. But bottom-line we are just treating symptoms. As long as one doesn’t have a clot and a stroke from their AFib, AFib is not directly life threatening. The more symptoms you have from your AFib, the more aggressive a treatment you will likely desire. The less symptomatic you are the less risky a treatment option you may choose. And as your AFib progresses over time and you start spending more time in it, your level of symptoms may change as well. The truth is that if one’s heart rate in AFib is 180-190bpm, most people will feel symptoms, but if one’s heart rate in AFib is below 100bpm not everyone will feel that. It is true that AFib doesn’t just make your heart rate go faster, it also causes your heart rhythm to be very irregular and this is likely the reason why you and your friends, who are more in tune with your bodies than others, can still feel the AFib even at slower speeds.
I watched a few videos. Absolutely the best AFib channel on RUclips. Im going to mention you on Reddit AFib. So many people there lost in the wilderness of AFib. Me 67 m 2 PFA ablations this year at a top hospital. I did a year of research when I decided PFA was the way to go. It wasn't approved yet in US. Had to get unto a trial fo5the the first PFA. Then Farapulse for the second. NSR is great so far.
I see you are practicing here in Florida. I definitely want to go to your office and get the procedure I need to stop my A-Fib. Thank you for your informative videos. I will be in touch with your office soon.
You're welcome. Thank you!
I just found Dr. Lee's videos today. They have helped my understanding so much-- thank you Dr. Lee. (Now if I could just find the right EP!).
I'm so glad you found the information useful. Because Afib is not directly life threatening and mostly treated for symptoms, the decision whether to just live with Afib and control the rate (least risky), versus try to suppress it for a few years at a time with a strong antiarrhythmic drug then in 15 years accept when it is permanent (more risky), or trying to turn back the clock with an ablation (most risk) depends on your level of symptoms (the more symptoms you have the more aggressive a treatment you will desire), age (the older you are the more risky procedures become and vice versa), preferences (older people tend to be risk averse and younger people tend to be willing to accept more risk upfront for a longer lasting result), long term goals, and risk tolerance. But again we are just treating symptoms. As long as you don’t develop a clot and stroke from Afib by staying on your blood thinner, you will never directly die from Afib. Hopefully an informed and ethical doctor is available to both offer you all available choices and review the risks and benefits of each long term treatment option in a way that helps you come to the right decision for your situation. This is the reason why I created this channel and website. Because there is a lot of misinformation and lack of information out there, by giving pt's the correct information hopefully they can be empowered to know if a doctor is practicing 30 year old medicine and not offering all treatment options versus on the other extreme a less scrupulous Electrophysiologist that spends less than 5 minutes and then tries to bully you into an ablation making you think that without one you will die, because he/she makes more money to do a procedure than to use a medication.
Dr. Lee, thank you for taking the time to create these videos. Would you explain who needs to be on blood thinner even after an ablation? and who does not.
Thank you for watching! Yes, besides the fact that AFib can take over control of your heart and temporarily increase your heart rate causing symptoms, and that it is caused by aging and increases over time, AFib can also lead to a stroke. Every time you go in and out of AFib there is a small 3-6% chance on average that a small clot can form in your heart that if it does so can then break loose, float out of your heart, float up to your brain, cut off blood supply to your brain and cause a stroke. That is why most people who have AFib are placed on a powerful blood thinner in order to reduce the risk of this to less than 1% (not zero but close). In fact, the possibility of stroke with Afib is the most serious problem it can cause and needs to be treated first. Then everything else we do to treat Afib is based just on symptoms because as long as Afib doesn’t cause a stroke it is not directly life threatening. See my video “Can AFib Cause a Stroke?” While the average risk of clot and stroke with Afib is 3-6%, everyone’s exact risk is different. The older you are and the more comorbid medical problems you have, the greater your chances of having a clot and stroke with your Afib. The actual risk ranges from less than 1% at baseline to as high as 10-12%. There is a risk score called the CHA2DS2VASc score that can calculate your exact risk of clots and stroke with your Afib. Every point on the risk score confers a 1-1.5% increased risk of clots and stroke every time you go into Afib. If your overall risk of stroke with your Afib is 2% or greater, we are supposed to recommend that you be on a powerful blood thinner that will reduce your risk not to zero but to less than 1% which is close to zero. If your risk of stroke with your Afib is already less than 1% then a blood thinner would not reduce your risk any further. If your risk is between 1-2% then it is your choice as to whether to go on a blood thinner and reduce your risk to less than 1% or to accept a 1-2% risk and not be on a blood thinner. And remember, it can’t be just any blood thinner. Aspirin (which is used to prevent cholesterol blockages in your heart vessels or Plavix which is a common blood thinner used to prevent blood clots forming on a heart stent) will not protect you from clots forming in your heart during Afib. And vice versa. Blood thinners like Warfarin, Eliquis, or Xarelto which are commonly used for Afib won’t help with blocked heart arteries or stents which are “plumbing” issues, not electrical. Secondly, your risk of bloods and stroke with Afib has nothing directly to do with how much Afib you are having or whether you have symptoms with your Afib. You can still have a clot and stroke being in Afib 1-2% versus 90-100% if your risk score is high enough. Your overall risk has more to do with your age (being over 65 y/o confers a point and being over 75 y/o confers two points on the CHA2DS2VASc score), whether you are treated for high blood pressure, diabetes, have heart blockages, have a weak heart, have previous strokes, etc. This is why even after a successful ablation by a competent Electrophysiologist where all of your Afib is gotten rid of, instead of how many docs do it where they don’t do enough to get rid of your level and stage of Afib because they are doing a simple “1 wall” procedure that is easy and quick and makes them more money then they do it 3-5 times because it’s not enough each time but they can bill for this, Afib is never completely cured and we don’t usually stop the blood thinner. As one gets older the Afib cells/sources/triggers will grow back in other areas of the heart walls, but the more you get rid of the longer it will take to grow back to the level you were at. But if any Afib grows back even if you don’t feel it, the risk of clots and strokes is present which is why we keep people on their blood thinners post ablation if their CHA2DS2VASc score indicates a risk of over 2% if the Afib were to ever come back. We don’t do an ablation to get people off their blood thinners, we do it for symptoms. Long term, however, some people have difficulty being on a powerful blood thinner either because of bleeding issues or because they fall a lot and could hit their head and bleed into their head. For these people a Watchman device can be implanted to get them off their blood thinner. We found out that 90% of the clots that form in the left upper chamber of your heart where Afib is, forms in a little pouch-like structure called the Left Atrial Appendage (LAA). The Watchman device closes off this structure so that any clots that form in it can’t get out to cause a stroke. But putting a Watchman in won’t necessarily protect you against developing a clot and stroke better than a blood thinner because 10% of clots can form outside that Left Atrial Appendage structure, and a blood thinner can prevent clots from forming anywhere in that chamber not just the Appendage (LAA). So I would say protecting against clots and strokes is best with a blood thinner (less than 1%), and second best with a Watchman (maybe 1-2% risk). Therefore it is up to you to decide which treatment option makes the most sense for your situation based on how much you want to reduce your risk of strokes in AFib and your desire not to be on a blood thinner. See my video “Watchman in AFib Explained.” I hope this helps!
Thanks Dr Lee, great explanation. I have permanent afib but don't get rapid heart rate, but i get periods lasting few hours when i feel wretched. Could this be caused by the irregularity of afib? I am only on blood thinners, calcium channel blocker made heart too slow.
Afib is usually caused just be getting older. Once you hit your 50’s y/o 3% of people develop Afib. Once you hit your 60’s y/o it is 7%. Once you it hit your 70’s y/o, 12% have Afib. At 80’s y/o it is 20%, and by 90’s y/o 30% have Afib. So it is truly an age related disease. Also, the amount of time you are currently spending in AFib correlates with how progressed your AFib is and the stage. If you are going in and out of AFib and your episodes are less than 7 days at a time you are technically Paroxysmal AFib (early stage). If you are spending more than 7 days at at time in AFib you are Persistent AFib (mid stage). If you are in the Persistent stage spending more than a week at a time in AFib and you have been that way for more than a year then you are Longstanding Persistent AFib (late stage). And if you are spending 100% of the time in AFib and it doesn’t go to sleep at all by itself and it is too strong to get it to go back to sleep with an antiarrhythmic drug (AAD) or too much to get rid of it from the inside with an ablation then you are Permanent AFib (end-stage). (See my videos “Stages in Afib Explained” and “Ablation Techniques #1”) But even if you ever reach Permanent AFib stage, as long as you don’t have a clot and stroke from your AFib (the decision as to whether you need to be on a blood thinner to prevent this depends on your exact risk which in turn is based on your age and comorbid medical problems-see the video “Can AFib Cause a Stroke?”) you won’t directly die from AFib because it is not life threatening and mostly treated for symptoms. It’s just that once your Afib reaches permanent status and is always there, we no longer have the option of keeping it asleep with an antiarrhythmic med or getting rid of it from the inside with an AF ablation. All we can do at that point is slow the speed of it down with a “rate controlling” medication to a level where hopefully you can tolerate it. And remember the symptoms are usually palpitations depending on how fast the Afib is making your heart speed up to, and even if your Afib is well rate controlled it can still cause fatigue. If it is true that your Afib is “permanently” there and they are just protecting you from clots and strokes with the blood thinner and slowing your Afib rates down with the Calcium Channel Blocker such as Diltiazem or Verapamil, then that’s fine. While the periods of a few hours where you feel wretched could just be from the irregularity of the Afib rhythm, it probably isn’t since your Afib by definition is irregular all of the time so why don’t you feel wretched all of the time? It’s possible that at those times your rates in Afib may be much faster. Remember, Afib makes the speed of your heart go all over the place. It may start at 80-90bpm which you don’t feel then speed up temporarily to 150-160bpm then come down to 100bpm then back to 70-80bpm. While your “average” heart rate may be relatively controlled, that doesn’t mean every moment your Afib is going at that rate. The way to know for sure is to wear an external heart rhythm monitor to catch what rate your Afib is going at when you feel your symptoms of “wretchedness.” It may even be possible that at those times maybe the calcium channel blocker med which is slowing the speed of your Afib down, is making your Afib too slow temporarily! The Event Monitor would allow us to know for sure. I hope this helps!
@afibeducation many thanks for your detailed response much appreciated.
What’s concise red exercise rate, speed.
Thank you for your comment. Unfortunately, I'm not understanding the question.
Fast hr proportional to symptoms during af? Not so.
Slow hr during af still causes major discomfort- not much difference in my experience : any episode is extremely disconcerting. I have never heard this from actual sufferers. Just the phenomenon, with slow or fast hr, is quite intolerable for many and is fairly consistently underestimated, even so.
I appreciate your feedback and your viewpoint. However, after seeing patients with AFib virtually every day for over twenty years (due to the prevalence of this disease process) as a Cardiac Electrophysiologist, I must politely and respectfully disagree. Symptoms are proportional to the speed at which the AFib is making the heart go at, it’s just that everyone is different in terms of how sensitive they are to their body. I just consulted on a patient two days ago who was diagnosed with AFib in 2018 when he had palpitations during an initial episode going at 190-200bpm but came for a routine appointment to his Cardiologist recently and was found to be back in AFib at 107bpm completely asymptomatic. Then yesterday a 61 y/o patient of mine who has had symptomatic episodes of AFib intermittently for the last 10 years presented for his yearly follow up feeling fine and was in AFib on ECG at 78bpm, completely asymptomatic. On the other hand I’ve seen plenty of patients who even with their AFib going at rates of 70-90bpm, which overall isn’t that fast and not that much faster than their normal rhythm speed, have symptoms of feeling lousy or where they just don’t feel right. Once again, everyone is different in terms of how sensitive to their body they are and how symptomatic they are with their AFib. That is why we have multiple ways of treating AFib including simple rate controlling meds to slow it down just for symptoms, versus a stronger antiarrhythmic medication to suppress it in order to keep one in their normal rhythm at a completely normal speed, versus an AF ablation to try to get rid of the AFib directly from within the heart. But bottom-line we are just treating symptoms. As long as one doesn’t have a clot and a stroke from their AFib, AFib is not directly life threatening. The more symptoms you have from your AFib, the more aggressive a treatment you will likely desire. The less symptomatic you are the less risky a treatment option you may choose. And as your AFib progresses over time and you start spending more time in it, your level of symptoms may change as well. The truth is that if one’s heart rate in AFib is 180-190bpm, most people will feel symptoms, but if one’s heart rate in AFib is below 100bpm not everyone will feel that. It is true that AFib doesn’t just make your heart rate go faster, it also causes your heart rhythm to be very irregular and this is likely the reason why you and your friends, who are more in tune with your bodies than others, can still feel the AFib even at slower speeds.
Very good presentation.
Thanks!