Check out the image above. Each spike represents a heartbeat. (contraction of the bottom two of four chambers) The top line is atrial fibrillation. The bottom line is normal. The normal beats are perfectly regular and slower. In atrial fibrillation, the heartbeats are much faster and completely irregular. It feels like something flopping around in your chest. It is an unpleasant symptom for me.
Atrial fibrillation is a dangerous heart condition, and it is increasing in frequency because the American people are getting older. That is a major risk factor. One in four of you will develop atrial fibrillation at some point in your life. Since my cancer treatments 25 years ago, I have had atrial fibrillation. I have it in spells about five minutes long. That kind of atrial fibrillation is called paroxysmal—a fancy medical term meaning it occurs intermittently. For a long time, it occurred once every six months.
Atrial fibrillation usually occurs because the left upper chamber of the heart becomes enlarged and scarred. That happened because I was making too much of a couple of hormones (angiotensin II and aldosterone) because I was too heavy. About 5 years ago, it became much more frequent, and I doubled my eplerenone which blocks the effect of aldosterone. My spells returned to my previous 6 months frequency. I was very happy with that result, because if atrial fibrillation becomes permanent, it is much more dangerous. For example patients with type 2 diabetes and atrial fibrillation are 61% more likely to die. They are much more likely to die of heart disease and to develop heart failure. When the heart goes into atrial fibrillation, the top two chambers quiver but they don’t beat effectively. Because the top chambers don’t beat, blood flow can nearly stop in parts of the chamber and clot. If a piece of the clot breaks off, it can fly through the arteries to the brain, block an artery, and cause a stroke which is very often devastating. I understand that, and I definitely don’t want permanent atrial fibrillation.
For about the last two weeks, my episodes became more and more frequent, and my cardiologist told me that I needed to go on blood thinners if that happened again, so I called his office last Friday to make an appointment. I told the nurse about my situation, and she said, have you considered a Watchman device. (The initial cost of the Watchman device is $20,000.) I told her that I was not interested in the Watchman device, but that I know atrial fibrillation is dangerous. I need to see the doctor as soon as I can. She said that the cardiologist could see me in September. I told her I was in danger and I needed help. I needed to see someone. She said that I could see the nurse practitioner at the end of July (over a month away). At some point in these conversations, I was transferred to another nurse. She offered me an appointment with another cardiologist the next week at 8:30 Monday morning. I knew that I would need a blood thinner if my atrial fibrillation became permanent and they might want to attach a monitor to see what my heart was doing. I saw the cardiologist three days later, and he gave me a prescription for the blood thinner to use if my spells began to last longer or became permanent. The only way that I was seen in a timely fashion was through sheer persistance.
I could not help but think. I have been a doctor for 50 years. What if I knew little or nothing about atrial fibrillation. What if I had no medical background. I would not know about the danger. I am sure that most laymen would just see the cardiologist in three months in September. Because they could not get in for a simple office visit, they might very well have a stroke and be in the hospital and then the nursing facility. A stroke is terrible and very expensive. I am certain there have been many sad events because of just this type of encounter.
After I made my appointment for Monday, I began to wonder. Why am I having more trouble? I am old of course, but I have been watching my diet, losing weight slowly, and getting as much exercise as my knees and balance will permit. Then I remembered, I had reduced my metformin and I wondered if that could have an effect.
So I looked up atrial fibrillation and metformin. There was an article that suggested that metformin might be beneficial in preventing atrial fibrillation. It has an impact on 30 genes that are associated with that disorder. Another article pointed to the effect of metformin in preventing hospitalization for atrial fib. If an individual with type 2 diabetes had been on metformin regularly for over 56 months, the risk of hospitalization was one third that of people with diabetes not on metformin. I resumed my prior metformin dose and returned to my baseline status of very infrequent extra beats. It is pretty convincing. I was having ten episodes a day. Now they are much improved and getting still better. This is really important. Staying in a normal rhythm is safest. If you have type 2 diabetes metformin can help keep you in a normal rhythm. I have prediabetes and that is why I take it. Metformin is an inexpensive drug that is very safe. It is a very big deal if taking it cuts the risk of hospitalization for atrial fibrillation in half.
Followup: When I was seen last Monday, they made an appointment for me for 9am this morning to put a monitor on me for a week. I drove 30 minutes to the hospital and walked into the cardiology office. I walked up to the same clerk. Again, she said that I don’t see an appointment for you. She looked further and she said, you cancelled your appointment two days ago. I did not cancel my appointment and I told her so. She said, “Well, someone cancelled it. Maybe your wife did it.” I told her my wife did not even know I had an appointment. She did not do it. The clerk said someone canceled it in the automatic system. I did get a call while I was in a business meeting and I could not answer it. She made no effort to see if the staff could put the monitor on me. When I protested that I did not cancel the appointment, she said it was not her fault, and said I was attacking her. I was not attacking her. I was expressing my frustration with a system that inconvenienced me and did not meet my needs. She asked if I wanted to reschedule. I just told her to forget it. I can check my pulse and tell what is going on. If this happened someone who did not know about healthcare, it would put them in danger. We all deserve better and we should fight to get it.
This is not the first story I've heard of people not getting (in your case, without persistence) needed treatment quickly. Imagine if it were a plumbing situation, or something to do with electrical wiring. Someone would come within 24 hours. Second response, I'm sorry you are having this dangerous occurrence, and glad you may have found the cause and can likely reverse what has happened. All the best.
A-Fib occurs in nearly everyone’s life time. Some people have it occasionally then recover spontaneously. Some people will have more frequent occurrence, some will develop “permanent” A-fib. The problem is what causes A-fib? Why some people recover spontaneously, some recover after some seemingly unrelated treatments for other diseases, some never recover even after repeated Pulmonary Vein Isolation treatments? We are beginning to discover the mysterious factors by applying the systematic computational electrophysiology studies using Multifunction CardioMatrix Technology Platform. We are establishing a large database to monitor millions of people 24/7/365 to sort through these classes of people to fundamentally understand what causes A-fib and how we can prevent it, or to reverse it entirely. Stay tuned!