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2020 AF Symposium Challenging Case: 75-Year-Old, A-Fib Increases, Develops Bradycardia, 12-sec Heart Pause
2020 AF Symposium: AF Management
Challenging Case: 75-Year-Old, A-Fib Increases, Develops Bradycardia, 12-sec Heart Pause
by Steve S. Ryan
One of the most interesting sessions at the AF Symposium is the “Challenging Cases in AF Management: Anticoagulation, Arrhythmic Drugs and Catheter Ablation for AF” where leading doctors discuss very frankly their most difficult cases that year.
While several cases were discussed, here I summarize just one case.
Dr Eric Prystowsky
Patient History: 75-Year-Old Female
Case presented by Dr. Eric Prystowsky, St. Vincent Hospital, Indianapolis, IN
Dr. Prystowsky described the case of a 75-year-old female with A-Fib of at least three years duration. Before she came to Dr. Prystowsky, she was on Sotalol 40 mg 2/d and aspirin.
She was doing fine until a few months before when her A-Fib attacks became more frequent and with a more rapid rate. She also developed bradycardia and had a 12-second pause in heart beat.
Pacemaker and Pericardial Effusion: She had a pacemaker installed (but not by Dr. Prystowsky). During the implanting of the pacemaker, she developed a pericardial effusion (bleeding from the heart into the pericardium sac). She was not on anticoagulants.
Two weeks after implanting the pacemaker, she felt lousy with recurring palpitations.
Treatment by Dr. Prystowsky
Flecainide added: Dr. Prystowsky put her on flecainide 100 mg 2/day. She had slightly elevated blood pressure. She was also on aspirin, metoprolol, and Atorvastatin (to lower blood pressure by treating high cholesterol and triglyceride levels).
The patient had repeatedly been offered a catheter ablation, but she declined each time.
Reset Pacemaker: The pacemaker was controlling her atrium 93% of the time. Her Ejection Fraction was 55%-60% (a good range).
Dr. Prystowsky reprogrammed her pacemaker to change her AV interval. He stopped the aspirin, and put her on apixaban (Eliquis) 5 mg 2/d. He ordered a stress echo test to check her heart.
She felt better for 5 days.
Moderate Pericardial Effusion; Medications Adjusted
The patient then developed a moderate (“significant”) pericardial effusion.
Dr. Prystowsky stopped the apixaban (probably the cause of the pericardial effusion). Because she still had some symptomatic episodes of A-Fib (although much better), he then increased the flecainide to 150 mg.
Contributing Role: Referring to the cause of the patient’s pericardial effusion, Dr. Prystowsky faced the fact that “I did it.”
She experienced bad side effects with the increased dosage of flecainide. He put her on 100 mg 3/day to reduce the side effects.
The patient had repeatedly been offered a catheter ablation, but she declined each time.
Minimizing Pacing; Medication Adjusted
The patient’s ventricular pacing produced a wide QRS which Dr. Prystowsky said “worried the hell out of me.” He tried to minimize the pacing she received.
A CT scan revealed that her pacemaker incisions were fine, and that she had no more pericardial effusion. He re-started apixaban. She felt great.
He wound up putting her on amiodarone 200 mg which she tolerated well (previously she didn’t react well to Sotalol).
Dr. Prystowsky’s Lament
He described what he called his “shpilkes” index (Yiddish for anxiousness). When he talks to his fellows, “If you go home and worry about your patient at midnight, you ought to re-think everything.”
One Year Later and Lesson Learned
A year later she came in complaining of palpitations. Her pacemaker revealed that she only had 2 minutes of A-Fib in six months. Dr. Prystowsky told her, “I can’t do better than that.”
Dr. Prystowsky told the attendees that he would never again put a woman of her age on flecainide 150 mg.
He wrote me that it’s been over a year, and the patient is doing great.
If you find any errors on this page, email us. Y Last updated: Monday, February 22, 2021
Return to 2020 AF Symposium Reports
How One Reader Detects if He’s in (Silent) A-Fib
Some people have A-Fib with no obvious symptoms. This can be dangerous, lead to a stroke and, over time, to a deteriorating heart. Many of these patients do a self-check during the day to monitor for an irregular pulse. Here’s another idea from a fellow A-Fib patient.
Taking Your Pulse
After reading our article, A-Fib Self-Care Skills: How to Check Your Heartbeat and Heart Rate, our reader, Frank, wrote us about how he goes beyond just a self-check to determine if he’s in A-Fib.
“I read your self-care skills articles and wanted to comment.
I check for when I’m in A-Fib very easily. I purchased a pulse oximeter. And whenever my reading is significantly above my normal resting pulse, then I know I’m in A-Fib. I don’t believe there’s any other reason for my resting heart rate to be elevated unless I’m in atrial fib.
A good oximeter is not very expensive at all, and it may be a very useful tool for others.”
Our thanks to Frank for sharing his advice.
How Pulse Oximeters Measure Pulse Rate
Masimo‘s MightySat fingertip pulse oximeter
Pulse oximeters are easily recognized by their associated clip-type probe which is typically applied to a patient’s finger. They are lightweight and intuitive to use.
When your heart beats, it pumps blood through your body. During each heartbeat, the blood gets squeezed into capillaries, whose volume increases very slightly. Between heartbeats, the volume decreases. This change in volume affects the amount of light (such as the amount of red or infrared light) that will transmit through your finger.
Though this fluctuation is very small, it can be measured by a pulse oximeter.
Not Just for Pulse Rates but Blood Oxygen Levels, Too
Measuring your blood oxygen saturation level (SpO2) is also important for A-Fib patients, because a very low blood oxygen level puts a strain on your heart (and your brain).
Blood oxygen saturation
Using the same type of setup to measure pulse rate, an oximeter indirectly measures the amount of oxygen that is carried by your blood. By measuring the light that passes through the blood in your finger, your blood oxygen saturation level (SpO2) is calculated and expressed as a percentage.
Accuracy: The American Thoracic Society reports that the oxygen level from a pulse oximeter is reasonably accurate. The best reading is achieved when your hand is warm, relaxed, and held below the level of your heart. Most oximeters give a reading 2% over or 2% under what your saturation would be if obtained by an arterial blood gas test. (For example, if your oxygen saturation reads 92% on the pulse oximeter, it may be actually anywhere from 90 to 94%.)
Pulse Oximeters and Sleep Apnea 
Another application for a pulse oximeter. We’ve written about using a fingertip oximeter as an inexpensive way to check if you might have sleep apnea. A blood oxygen saturation level of 90% or lower means you should talk to your doctor, that you may need a sleep study. For more, see Possible Sleep Apnea? Oximeter is DIY Way to Check your Blood’s Oxygen Level.
Know Your Pulse Rate and Blood Oxygen Level
Starting at about $25, an assortment of pulse oximeters are available at Amazon.com and other retailers. One CE and FDA approved unit is the Pulse Oximeter Portable Digital Oxygen Sensor with SPO2 Alarm ($23).
On a personal note: As many of our readers know, I’ve been A-Fib free for 20 years. But nonetheless I often will check my pulse using an oximeter at night before going to sleep. Just as Frank describes, it’s very easy to do.
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Part 3 Update: PVCs/PACs and My Medtronic Reveal LINQ Insertable Monitor
I’ve had my Medtronic Reveal LINQ insertable monitor since the middle of September. (See Has my A-Fib Returned?) It has produced a lot of false positives. The other day, I visited my EP’s office and reviewed my LINQ data results with the nurse/Reveal LINQ specialist.
My Medtronic Reveal LINQ is inserted just under my skin near my heart:
The LINQ data showed I had Premature Ventricular Contractions (PVCs) and Premature Atrial Contractions (PACs) which made my heart beat irregular but were not A-Fib.
No A-Fib for me: My data showed I always had the P wave component in my EKG signal—which is lost when one has Atrial Fibrillation.
Most PVCs/PACs benign: Most A-Fib doctors aren’t overly concerned about extra beats Premature Ventricular Contractions (PVCs) or Premature Atrial Contractions (PACs), because they are considered benign.
I’m not worried. Everybody gets PVCs and PACs, not just people with A-Fib.
Take a Look at My Premature Atrial Contractions (PACs)
When you look at my LINQ ECG signal (see excerpt below), notice how the PAC comes before one would expect a normal beat. The irregularities above the R wave indicate the signal is coming from atria above the ventricles and is a PAC.
PAC beats comes before one would expect a normal beat
…and a Look at My Premature Ventricle Contractions (PVCs)
When you look at another section of my ECG signal (see excerpt below), the R wave spikes are thicker and wider than the normal R waves indicating they are coming from the ventricles and are Premature Ventricle Contractions (PVCs).
PVCs: R wave spikes are thicker and wider than the normal
Detection Settings for A-Fib Only
To avoid false positives such as PACs and PVCs, the nurse adjusted the settings and sensitivity of the Reveal LINQ monitor to detect A-Fib only. (For Medtronic settings, see below.)
I will return to Dr. Doshi’s office in a month to see if these new setting are working properly. Look for my next update on data from my Medtronic Reveal LINQ insertable monitor.
ECG waveform diagram
Learn to Read Your ECG/EKG
An electrocardiogram, ECG (EKG), is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart.
The ECG signal strip is a graphic tracing of the electrical activity of your heart.
To learn to read your own ECG/EKG signal, see Understanding the EKG Signal.
My Medtronic Reveal LINQ is inserted just under my skin near my heart: For you tech types, here are the new settings:
• AT/AF Detection—On
• Type—AF only
• AF Detection—Balanced Sensitivity
• Ectopy Rejection—Aggressive (this is probably the most important change in the settings)
• AT/AF Recording Threshold—Episodes >= 60 min
A-Fib Self-Care Skills: How to Check Your Heartbeat and Heart Rate
Some Atrial Fibrillation patients know immediately when their heart is in A-Fib. They experience one or more symptoms including shortness of breath, palpitations, heart flutters, etc. Other A-Fib patients may have subtle symptoms (or silent A-Fib) and can’t be sure.
The following self-care skills will reassure you any time you suspect you’re in A-Fib—how to check for an irregular heartbeat and how to tell if your heart rate is too fast or too slow.
Self-Check if Your Heartbeat is Regular or Irregular
I found an informative post with these self-care skill steps on the Scope Blog by Stanford University School of Medicine. To check whether your heartbeat is regular or irregular:
♥ Begin by placing your right hand on the left side of your chest while seated and leaning forward.
♥ Position your hand so that you feel your heartbeat most strongly with your fingertips.
♥ A normal heart rhythm should feel like a regular drum beat cadence; you can usually anticipate when each beat will come after the last beat.
♥ Because heart rate and the strength of the heartbeat can vary with breathing, sometimes holding your breath for a few seconds is helpful. With an irregular rhythm, it will be hard to predict when the next beat will come.
♥ In addition, some irregular beats will be softer (less strong) than other beats, so the strength as well as the timing may not be consistent.
Self-Check If Your Heart Rate is Too Fast or Too Slow
The Stanford blog continues with a second set of self-care skill steps—how to measure if your heart rate is too fast or too slow so you know when to seek medical care. (An optimal heart rate is 50–100 bpm when you are at rest.) To check your heart rate:
♥ Place your right hand over your heart so that you feel your heart beating under your fingertips.
♥ Use a watch or timer and count the number of beats for 15 seconds.
♥ Be sure to count all heartbeats; including beats that are not as strong or that come quickly following one another.
♥ Take the number of beats you’ve counted and multiply it by four. For example, if you count 30 beats in 15 seconds, then you would calculate 4 x 30 = 120 beats per minute.
♥ Repeat this process three times right away, writing down each heart rate to later share with your doctor.
While an Electrocardiograph (ECG or EKG) or Holter monitor are the only sure ways to document you are in A-Fib, you can use the above self-care skills to recognize A-Fib symptoms of an irregular heart beat or if beating too fast or too slow.
These skills with help you remain calm and confident when you suspect you may be in A-Fib.
Part 2: Has My A-Fib Returned? 21 Day Results from My Medtronic Reveal LINQ loop recorder
In Part 1, Steve describes how during a recent medical exam, one of his doctors (not a cardiologist) detected an irregular heart beat. Steve didn’t feel any symptoms but went to see his EP who checked him over and found no A-Fib.
But, just to be sure, his EP implanted a tiny wireless heart monitor so he can review Steve’s heart activity over time. Go here to read our first post.
21 Days of Data with my Medtronic Reveal LINQ ICM
Section of Steve’s ECG
After having worn the Medtronic Reveal LINQ loop recorder for 3 weeks, I went in to check my results with my EP, Dr. Shephal Doshi, at Pacific Heart in Santa Monica, CA. (Reports are sent wirelessly each night by the bedside transmitter.)
The monitor report was saying I was having multiple A-Fib attacks, though I didn’t feel anything. When Dr. Doshi did an EKG of me, I was in perfect sinus. He suspected the monitor or I might be producing false positives.
Steve & his CAM
I Get a 7-Day Carnation Ambulatory Monitor, Too
To check the accuracy of the LINQ monitor, he gave me a Carnation Ambulatory Monitor (CAM) to wear for a week. It’s similar to a Zio Patch, but is stuck vertically along my sternum.
For the next 7 days I should avoid immersing the device in water. I was told I could take a shower, but I am being cautious and just taking sponge baths.
I’m supposed to keep a log of when I eat meals, exercise, drink any alcohol, and include any A-Fib symptoms. If I do feel symptoms, I’m to press the button on the monitor. So far, I haven’t had any occasion to press the button. I’ll return the monitor to Dr. Doshi’s office in a week.
Monitoring the Monitor
Carnation Ambulatory Monitor
Reveal LINQ loop recorder
Since the LINQ monitor is still actively collecting data, my EP can compare the LINQ results with the results collected by the Carnation Ambulatory Monitor. Hopefully, Dr. Doshi will find no occurrences of A-Fib (just false positives).
I’ll write more when I have something to report.
Have you worn a Carnation Ambulatory Monitor? Email with your experience.
Apple Watch 4: Do ECG Readings Give A-Fib Patients a False Sense of Security?
Added: 2019
To monitor for A-Fib yourself, the Apple Watch (Series 6, the gold standard of wearable monitors) can generate an ECG similar to a single-lead electrocardiogram. It’s very sophisticated and can monitor both for A-Fib and for many other health parameters. The series 6 has a blood oxygen sensor as well as a heart-rate check. Upon FDA approval, it will have real-time monitoring of blood pressure.
Added: August 6, 2020: Marilyn Shook writes “Love my Apple Watch 5! Great accurate ECG strip to share.” (Read Marilyn’s A-Fib story at https://a-fib.com/marilyn-shook-a-fib-story-86-post-pva-complication/.)
The main alternatives to the Apple Watch are the Samsung Galaxy Watch and wearables featuring Google’s Wear OS softwear. The market leader for Wear OS is Fossil (Generation 5) Another Fossil product is the Diesel On Fadelite. The Suunto 7 from Finland has GPS.
We received a couple of emails about the new Apple Watch 4. As many A-Fib patients may be aware, recently Apple unveiled the next generation of Apple Watch which includes a second generation optical heart sensor.
Among several interesting features, it can generate an ECG tracing similar to that of a single-lead electrocardiograph.
In her Sept. 14, 2018 editorial on Medscape.com, ECG Readings From the Apple Watch? This Doctor Is Leery, Dr. Hansa Bhargava gives her perspective of this feature for those diagnosed with atrial fibrillation. She writes that she finds the Apple Watch’s ability to do a one-lead ECG interesting but has some reservations.
“…Here’s what I worry about: the false sense of security that a person could have.
Apple Watch 4 screens
Being able to do a one-lead ECG is definitely interesting, but does it always help? Here’s a scenario. A 40-year-old runner starts feeling dizzy, lightheaded, and has chest pain. He worries but remembers that there is an ECG function on his watch. He proceeds to do the ECG which then reads “normal.” Because of this he decides to continue to run.
What he doesn’t know is that this is only a one-lead ECG, and even though it seems normal, it is an isolated data point; more information is needed to diagnose what is going on. What if he is having angina? In fact, 30% of cardiovascular events happen to people under the age of 65. One lead on an ECG could certainly miss this; in fact, even a 12-lead ECG, if the only isolated data point, could miss this.
Dr. Andrew Moore, an emergency department physician at the Oregon Health and Science University is also skeptical of the Apple Watch 4 ECG feature:
“The ECG thing is a little bit overhyped in terms of what it will really provide. …The tech that Apple is working with is very rudimentary compared to what we’d do for someone in a hospital or health care setting.”
While the watch can detect changes in the patterns of a person’s heart rate such as too fast, too slow, or beating irregularly—signifying A-Fib, the watch doesn’t diagnose a medical issue.
Apple Watch and Other DIY Heart Rate Monitors
Guide to HRMs and Handheld ECG monitors
Keep in mind these doctors’ concerns apply to all consumer heart rate monitors (HRM), those with optical heart sensors and those with electrode-containing monitors.
Wrist vs. Chest Bands: Wrist-band optical heart-rate monitors (like Apple Watch 4) may be more convenient or comfortable and have advanced over the years. But researchers found that electrode-containing chest-strap monitors were always more accurate than their wrist counterparts and more reliable and consistent. To learn about this research, read When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?
Blue-tooth chest-band with smartphone app
As an A-Fib patient, when monitoring your heart beat rate is important to you (while exercising or doing heavy work), you’ll want to stick with an electrode-containing monitor (chest band-style, shirts or sports bras with built-in electrode pads, etc.).
For help selecting a HRM, see our article: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors (Part I). Also take a look at Steve’s list on Amazon.com: Top Picks: DIY Heart Rate Monitors for A-Fib Patients.
Keep in mind: None of these DIY heart rate monitors are diagnostic tools. But they can be helpful once you know you have A-Fib, A-Flutter or suffer from PVCs, PACs, etc. Just don’t make medical decisions based on their readings. See your doctor if you have any concerns or symptoms.
Remember: None of these DIY heart rate monitors are diagnostic tools
Has My A-Fib Returned? I Get an Insertable Wireless Monitor to Find Out
Update 5 pm (see below): During a recent medical exam, one of my doctors (not a cardiologist) detected an irregular heart beat. I didn’t feel any symptoms before, during or after the appointment, so I wasn’t alarmed. But I did make an appointment with my EP.
Medtronic Reveal LINQ ICM
When I met with my EP, he took an ECG but didn’t find A-Fib (thank goodness). But, just to be sure, he recommended implanting a tiny wireless heart monitor so he can review my heart activity over time.
I Get a Reveal LINQ Insertable Cardiac Monitor
So yesterday, as an outpatient, I had a tiny cardiac monitor implanted just under the skin near my heart. The minimally invasive procedure took the doctor about 2 minutes to do. (Most of my time at the hospital was spent doing paperwork).
My doctor used the Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM)—one of the world’s smallest cardiac monitors—the device is approximately one-third the size of a AAA battery.
MyCareLink transmitter
The Reveal LINQ System includes a bedside unit that collects heart rhythm data from the ICM and wirelessly sends it to my doctor every evening.
The device allows my cardiologist to continuously monitor my heart for up to 3 years.
Setup to transmit: I got it all set up and it’s working. But I don’t expect to get any feedback from my EP any time soon. I’ll publish an update when I have something to report.
My incision for the ICM
Update 5 pm: I forgot to mention that I had no pain with this procedure. They used some numbing agent on the incision area, but I’ve had no pain afterwards (it’s now about 36 hours since the insertion). No sutures. They applied a clear bandage that holds the tissue together while healing.
There’s no visible sign of the device. If I press the area I can barely feel the outline of the ICM. It’s possible this will diminish with time as the surrounding tissue encases it.
I’ll write more: I’ll talk with my EP in a couple of weeks when he has reviewed some of the data received via the MyCareLink wireless transmitter. (I assume he has some data processing feature that will alert him before that if the readings are outside normal specs.)
VIDEO: The Insertion Procedure
An animated video (music, no narration) by Medtronic, shows how the Reveal LINQ ICM monitor is inserted through a tiny incision just under the skin near the heart. Special tools are used to make a small incision and another to hold the ICM and “plunge” it under the skin. About 2:45 min.
To enlarge video: click and start the video. At the lower right, click on the frame icon. To exit, click again.
Updated Article: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors
We’ve updated our Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors (Part I) with new models of chest bands/wristwatches sets, Bluetooth versions and wearable technologies.
A consumer heart rate monitor (HRM) is useful when Atrial Fibrillation patients want to monitor their heart rate and pulse when exercising or when performing physically demanding activities.
To our section on handheld real-time ECG monitors, we added the Contec PM-10. Our recent review read in part:
Three ways to hold the Contec PM-10 when taking an ECG scan
“The Contec PM10 (about $79 on Amazon.com) is a very easy-to-use small 4 oz. unit that can track a single channel ECG waveform. You can observe the scan live, then download the recordings (up to 30) to your computer or smartphone for review and print to share with your doctor.” Read the full review.
Also updated: WEARABLE TECHNOLOGY WITH WIRELESS SENSORS
From Sensoria Fitness
“Wearable technology” offers a new option for those who find a chest strap uncomfortable or chafing. Instead of the chestband, these workout clothes have sensors built-in. Just snap on your heart rate sensor from your chestband. Starting at $75.
♥ Sensoria Fitness Men’s T-Shirt with standard sensor snaps (no heart rate sensor)
♥ Sensoria Fitness Sports Bra with standard sensor snaps (no heart rate sensor)
To read the updated article, go to: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors (Part I)
Not to be Confused with Optical Fitness Wristbands
Optical LEDs on inside of fitness wristband
The HRM sensors/monitors in our guide work by being in contact with the skin. Don’t confuse DIY/consumer heart rate monitors with fitness bands like Fitbit or running/sport watches.
This group of fitness wristbands use an optical sensor to shine a light on your skin illuminating your capillaries to measure your pulse. Optical sensor wristbands are not accurate enough for A-Fib patients.
For more, see my article: When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?
Possible Sleep Apnea? Oximeter is DIY Way to Check your Blood’s Oxygen Level
As many as 43% of A-Fib patients also suffer with obstructive sleep apnea (OSA). An easy preliminary step towards finding out if you have a sleep disorder is with the use of an inexpensive oximeter. To check your blood’s oxygen level, just insert your finger.
Fingertip Pulse Oximeter Blood Oxygen Saturation Monitor
Designed for pilots and sport enthusiasts who want to obtain their SpO2 (Blood Oxygen Saturation Levels) and PR (Pulse Rate) on the go. A-Fib patients can use one, too.
The pulse oximeter LED display faces you so it’s easy to read. (The Zacurate, Facelake and Santamedical are brands of Fingertip Pulse Oximeters. Reasonably priced, starting at $13 on Amazon.com. )
Taking a reading is easy. Just clip it on to your finger and turn it on at the press of a button. The large LED display makes viewing the results a snap. (The one from Zacurate comes with 2 AAA batteries so that you can use it immediately.)
Y
our Blood’s Oxygen Level
A reading of 90% or lower means you should talk to your doctor, you may need a sleep study.
HINT for after you have taken your initial oxygen level: Take a BIG deep breath and HOLD it. You should see the reading increase as more oxygen enters your blood stream.
To learn more about sleep apnea and A-Fib, see Sleep Apnea: When Snoring Can Be Lethal and the Podcast: The Double Whammy? Sleep Apnea and Atrial Fibrillation.
Which Comes First: Sleep Apnea or Atrial Fibrillation?
Obstructive Sleep Apnea (OSA) affects about 100 million people worldwide with 85% of cases going undiagnosed.
Of Atrial Fibrillation patients, about 43% additionally suffer with Obstructive Sleep Apnea.
Could undiagnosed sleep apnea be linked to development of Atrial Fibrillation?
OSA Link to A-Fib
OSA is characterized by repetitive episodes of shallow or paused breathing during sleep that lead to a drop in blood oxygen level and disrupted sleep.
New research has found that patients with Sleep Apnea may be at greater risk of developing Atrial Fibrillation. Abnormal oxygen saturation level during sleep may be responsible.
Patients with OSA are more likely to have high blood pressure, or hypertension, which is a major risk factor for heart disease and other cardiovascular conditions.
Risk of New Onset A-Fib: The Clinical Cohort Study
Lead author Dr. Tetyana Kendzerska, Ph.D., of the University of Ottawa in Canada, and colleagues reviewed the records of 8,256 adults (average age 47) with suspected OSA. Individuals with any diagnosis of arrhythmias were excluded. Participants were followed for an average of 10 years. During that time, 173 developed A-Fib resulting in hospitalization.
Study Results
The reviewers found that the amount of sleep time spent with lower than normal oxygen saturation (below 90 percent) was a significant predictor of developing Atrial Fibrillation.
By contrast, the number of breathing pauses during each hour of sleep did not appear to affect A-Fib risk.
Study participants who developed A-Fib during the follow-up period were more likely to be older, current or former smokers, and have a high level of comorbidities (e.g. high blood pressure, or hypertension).
“The association between oxygen desaturation and A-Fib remains significant, suggesting that OSA can directly cause A-Fib.”
What This Means to Patients
In light of this study, a diagnosis of Atrial Fibrillation raises the question, ”Could my A-Fib have been brought on by undiagnosed Sleep Apnea?”
Sandy from Boston
Sandy from Boston and her doctor say ‘yes”. Updating her personal A-Fib story, she wrote:
“After my [successful] CryoBalloon ablation at BWH in 2014, I underwent a sleep study that revealed during REM sleep I stopped breathing an average of 32 times every hour. My physician suspected that my traumatic brain injury in 1995 caused my undiagnosed sleep apnea, which in turn caused Paroxysmal A-Fib. I have been using a CPAP ever since.”
Take Action: Sleep Apnea Can be Lethal: If you have untreated Sleep Apnea, you are at greater risk of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment.
So many A-Fib patients also suffer from sleep apnea that many Electrophysiologists (EPs) routinely send their patients for a sleep apnea study.
Sleep apnea isn’t a minor health problem, and it’s a condition you can do something about. To learn more, see Sleep Apnea: When Snoring Can Be Lethal.
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