Atrial Fibrillation, My Story

[NewGuy]

Hi All (and especially Sheryl),

For the last four months I’ve had numerous incidents of “racing heart”, usually lasting less than a few hours. Three months ago I was concerned enough over a long episode to go to Pattaya’s BP hospital where I stayed overnight in the ECU. Meds brought my HB under control and I easily passed a stress test and echocardiograph. Apparently I have Atrial Fibrillation and was prescribed Nebilet (2.5 mg once a day). That was about all I was told and I didn’t do much follow up research. I left the country for a six week trip and when back had a follow up doctor’s visit. My condition hadn’t changed.

I bought a blood pressure/heart beat monitor; all BP readings have been normal. Usually my HB has been in the 60-75 range with the machine sometimes flashing “irregular”. Occasionally I would wake with a funny feeling, my heart beating at 120 for an hour or three. Sometimes I would take an additional 2.5 or 5 mg of Nebilet. It seemed to help.

On Monday morning I got readings of 145 and went to the hospital again. My HB was all over the place. I was given meds (orally and by injection) to control the arrhythmia and reduce the chance of blood clotting. I chose to overnight in my condo, taking the Nebilet, Orfarin-X (5 mg before bedtime), 400 mg of Cordarone after meals (since stopped) and Isoptin-SR, one 240 mg tab after breakfast (since stopped). The doctor told me I had a 10% to 15% chance of stroke.

I’ve just done a lot of Wiki-type research into management of blood clots; my kids helped me with a link about Chad screening where my risk was less than I’d heard. The doctor described today's echocardiograph as “perfect” and told me to take the Cordarone if the arrhythmia returned. My HB has been ranging from 45 to 55.

Please give me your recommendations for hospitals and doctors in Bangkok who are tops in this field, good communicators, and questions I should ask, tests I should get. I guess I’ll take a cd copy of my exam results. Can I postpone doing this for a week or so?

Thanks.

[cathyy]

It looks suspiciously to me like you have something besides atrial fibrillation going on. Not being a doctor, I won't even speculate what it may be.

There is a new cardiologist at the Bangkok hospital in Korat. He is only there on Wednesday and Thursday from 0800-1600. His name is Dr. Warin Arora. He trained for his MD and cardiology specialty in the US, and so speaks good English. They brought him in to help establish a cardiac care center at the Bangkok Hospital here. So I am told by the International liaision, Weena.

[Sheryl]

First of all - should you postpone: no

You may be having runs of what is called "paroxysmal atrial tachycardia" in addition to the AF.

Dr. Visut at Bumrungrad has been highly recommended by several TV members

Dr. Chumphol at Bangkok Hospital also had a favorable recommendation and, as he is at Bkk Hosp, this may be more convenient for you in terms of follow-up if you live in Pattaya (routine blood tests etc could be done there and results sent to him).

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

These are by no means the only 2, there are a number of good western-trained cardiologists to be found at all of the major international hospitals (Bumrungrad, Bangkok Hosp, Samitivej, BNH). But these 2 have personal recommendations.

With new onset of atrial fibrillation (and especially when it is proving hard to control the rate) the preferred treatment is to attempt to stop the fibrillation altogether and return the heart to normal rhythm. The main means of doing this are ablation and cardioversion. There are risks and contraindications to both approaches so need to discuss thoroughly with cardiologist as to whether or not you are a candidtae for either procedure.

The advantages of them is that if successful you will have a normal cardiac output (AF, even with rate controlled by meds, reduces cardiac output by about 20%), not need chronic medication and avoid the clot/anticoagulant problem. The latter being that AF carries with it a risk of blood clots which in turn carry risk of stroke etc, to prevent that need anti-coagulants (e.g. the warfarin you are currently on), these in turn require close monitoring of blood levels and carry some risk of excessive bleeding...etc etc

So it is much better to get the heart rhthm back in normal sinus if at all possible. If it is not possible, then the rate needs to be well controlled with medication, anticoagulants need to be taken, and you need frequent medical checks and blood tests to make sure dosages are in proper range.

The othetr issue is why you are (apparently suddenly) in AF. There are many possible causes and all should be investigated.

For sure you need to go to Bangkok for a thorough work up and possible ablation or cardioversion.

Tests you may need in addition to the echo you already had include stress test, 24 hour EKG, and angiogram.

Questions to ask: (1) possible causes for the sudden onset of AF 2) are you a candidate for ablation or cardioversion? risks and benefits

Good luck and keep us posted on the outcome

I assume you have already been told, but in case not: AVOID caffeine and smoking, both will trigger rapid rate. (Smoking avoid forwever, caffeine you can return to in small amounts once your condition has stabilized, but you'd do well tosteer clear of it now)

[NewGuy]

Thank you Sheryl. Very clearly put. I'll stop the coffee now - hadn't been told, I don't smoke), and will choose the Bangkok hospital in the new few days. A doctor back home told my daughter that I am taking the right meds but might have AV Block, if I've got that right.

Thanks again and I'll post updates.

NewGuy

Edited June 26, 2008 by NewGuy

[Scalawag]

Sheryl has given you excellent advice. Obviously she has a medical background! I too have artrial fibrillation and have been treated for the last several years and live a normal life. One of the leading cardiolgists in Thailand is at Prince Songkla University in Hat Yai. He was dean of the medical school there and has taught many cardiologists in this country after training at the University of Washington. His name is Dr. Tada and he is one of the best doctors I have had anywhere including the U.S. Perhaps a little far for you to travel but it is another option.........Good luck.

[Wrong Turn]

I don't want to interrupt "Newguy's" thread, but I feel my resting HB is often high, and even in bed, my HB is too high.

To count my HB per minute am I doing it right? I do a six-second BH count, and times it by 10. This = avg. HB per minute (pulse).

I don't smoke, I am probably 40-50 lbs. overweight and I drink about 5-7 big Tiger beers, about 6 days per week. I do not exercise, except for walking. I am 38 years old.

[Tammi]

I don't want to interrupt "Newguy's" thread, but I feel my resting HB is often high, and even in bed, my HB is too high.

To count my HB per minute am I doing it right? I do a six-second BH count, and times it by 10. This = avg. HB per minute (pulse).

I don't smoke, I am probably 40-50 lbs. overweight and I drink about 5-7 big Tiger beers, about 6 days per week. I do not exercise, except for walking. I am 38 years old.

Tell us what your resting HB is after you have been in bed and relaxed. Please take your pulse for a full minute and try to also calmly note any irregularity, increase, softening, pounding.

6 seconds is way too short to take a pulse.

If I drank 7 big Tigers almost every day I would be 3 1/2 stones overweight too and probably very uncomfortable lying in bed. Your stomach lies right next to your heart and the heart objects to having a heavy stomach lying on it.

But you should see a recommended cardiologist to put your mind at rest, put you on a diet, and give you an excercise routine. Cardio will be happy you don't smoke.

Edited June 26, 2008 by Tammi

[nohave]

Atrial Fibrilation (AF) can be life threatening as there is a small possibility of clots forming. A cardiologists should advise further. A friend took medication for 9 months but the "Paroximal" Arithmias were still there. He described them as very annoying and extremely uncomfortable. He eventually went for a procedure called "Catherter Ablation" abroad (Bordeaux/France). The "ablation" done on him cured him completely. Here in Thailand, there aren't any experienced centers doing this type of procedure, hence most cardiologists in Thailand aren't great believers in the procedure. However, it is the best and safest solution for most patients.

[NewGuy]

Thanks all for the info and support. I've got an appointment with Bangkok Hospital's Dr. Chumphol on Monday. Will bring an overnight bag just in case.

[Tammi]

Atrial Fibrilation (AF) can be life threatening as there is a small possibility of clots forming. A cardiologists should advise further. A friend took medication for 9 months but the "Paroximal" Arithmias were still there. He described them as very annoying and extremely uncomfortable. He eventually went for a procedure called "Catherter Ablation" abroad (Bordeaux/France). The "ablation" done on him cured him completely. Here in Thailand, there aren't any experienced centers doing this type of procedure, hence most cardiologists in Thailand aren't great believers in the procedure. However, it is the best and safest solution for most patients.

I was offered ablation by Dr. Buncha at Bumrungrad Hospital. He specialises in cardiac arrhythmias and cardiac electrophysiology.

[nohave]

Interesting. Did you have the ablation done at Bunmungrad in the end, and how much was the cost? I still beleive that ablations are tricky medical procedures and should only be performed by the most experienced surgeons in the world for optimal results. The center in Bordeaux, France is world famous so he got on a plane spent 4 nights in the Bordeaux hospital, paid 500,000 Baht (all inclusive) and came back cured. I wonder how much such a procedure will cost at Bumrungrad and waht the success rate over here is? In France it's I think around 90%.

Edited June 27, 2008 by nohave

[Sheryl]

They are doing ablations in Thailand, even at the government hospitals. Success rate, I don't know, and of course one should seek a doctor who has perfromed a large number of procedures, which will usually mean one who has done a stinit in the west in rcent past.

[Tammi]

Interesting. Did you have the ablation done at Bunmungrad in the end, and how much was the cost? I still beleive that ablations are tricky medical procedures and should only be performed by the most experienced surgeons in the world for optimal results. The center in Bordeaux, France is world famous so he got on a plane spent 4 nights in the Bordeaux hospital, paid 500,000 Baht (all inclusive) and came back cured. I wonder how much such a procedure will cost at Bumrungrad and waht the success rate over here is? In France it's I think around 90%.

No, I didn't have anything done. My palpitations/arrythmias come and go. I can have none for months and months. Probably brought on by stress or alcohol or MSG. But if I were to have done I would consult with Dr. Visuit at Bumrungrad and get the go-ahead to use Dr. Buncha and would ask Dr. Visuit to be there too!

The Bordeaux deal sounds like a good deal! A friend had his ablation done in Australia and he is looking (and feeling) absolutely great now.

[NewGuy]

I’ve had an interesting three weeks.

I met Dr. Chumpol at the Bangkok Heart Hospital, showed him my B-P results and had Thyroid, INR and Echocardiograph tests. My thyroid was fine, INR was low at 1.15 (apparently it should be in the 2.0-3.0 range) and Echocardiograph was okay. He said the Pattaya results showed I had a “strong, healthy heart”, didn’t think I’d had a heart attack, confirmed I have paroxysmal atrial fibrillation, told me a pacemaker was for a low heart rate, didn’t need an angiogram, didn’t have AV Block, could have two standard drinks, told me to take “not too much coffee”, to wait before going back to Tony’s gym. And yes, I’m a candidate for catheter ablation.

I went back to Pattaya, slept well and came back to Bangkok the next evening for an appointment with the ablation guy, Dr. Tachapong. He told me in his American-accented English to increase my Orfarin (was then taking 5 mg at bedtime) to raise my INR. I didn’t ask him to what level but later figured 7.5 mg should do it. He told me to avoid Vitamin K laden foods such as leafy green veggies; they clot the blood and fight the Orfarin’s effects. He said my echocardiograph was okay and that my heart wasn’t too big.

He is a Rhythm therapy advocate, not a Rate therapy one. This means his first choice is anti-arrhythmia plus anti-coagulant meds. Rate therapy, which I am on, dictates beta blocker and anti-coagulant meds. Apparently the life expectancy of patients in both groups is about the same. The anti-arrhythmia drugs have a lot of side effects; I think my quality of life can be better with the Rate approach. He suggested taking Cordarone which I’ve had in hospital to stop the A-Fib (and keep on hand for that). He said he would normally put me on this for 6-12 months, review my situation, and probably then go for the Ablation surgery. But, if I wanted, I could have it right away.

We talked about the operation and his experience. His mentor is Dr. Nademanee who developed the CFAE (complex fractionated atrial electrogram) electro-anatomic mapping system (quite a famous guy, now working at the Tommy Lasorda Center in California; I’ve read related abstracts in which Dr. Tachapong was a co-author along with Dr. Nademanee, Dr. Buncha and others). He’s done the op 80 times in four years (on mainly local doctors and foreign patients), with an 80% success rate (not as bad as it sounds, because success means not even a single A-Fib episode in a year). He’s had one serious incident involving a perforated a heart muscle as well as four bleeding groins.

If I understood correctly, there is no data now showing better life expectancy between those that had the operation and those that didn’t. I guess quality of life is the determinant.

As recommended by BUPA, I asked him to have them contacted to see if they would pay for the operation. At this point it went weird. One of Bangkok Hospital’s nurses called me a few days later asking if I wanted the operation and no, they hadn’t contacted BUPA. I felt she was abrupt. We got into a very stupid go-around; I gave her BUPA’s Silom Road phone number (as if they weren't contacted regularly) and hoped to hear from her shortly. She called again in four or five days, saying they’d called America and I wasn’t an international customer. I asked her again to do as I’d asked. In frustration at her manner I ended with “if you send me a confirmation, ok”, “if not, ok too”.

Back in Pattaya I really started to research, reading tons of stuff on Dr. Nademanee’s method and the more practiced Bordeaux technique – (Who does this one in Thailand?) – and lots else. Wow. Buyer beware.

About 10 days later I had an INR in Pattaya; now at 2.12 – ok. Vitamin K is strongly present in lettuces, broccoli, green beans, cabbages, herbs such as parsley, etc. Downloaded a thorough USDA document. So I’ve changed my diet, making me a candidate for osteoporosis. I suggested to my B-P doctor that if I take more Orfarin I could eat healthier; he’d have none of that, “risk of bleeding”. When I told him I’d been investigating ablation he cautioned me against it.

Later, for the first time in three weeks, I had noticable irregular heartbeat, and when it hit 125 I took 400mgs of Cordarone. Two hours later it was at 145 so I went to the hospital. This was the first time I’d taken this med outside of hospital and didn't know how it would affect me. When I turned up, of course, all my readings were normal.

There are a lot of communication issues. It seems I just don’t understand things that are unsaid. And a variety of crazy things have happened. I now figure that I should just keep on keeping on. If I lose a day or two in three weeks, so be it. The ablation operation, I gather, would strongly affect me for up to a year; there wouldn’t be any assurance I could stop taking meds or that the A-Fib would definitely be a thing of the past. But I’d still like to know more.

On Thursday I’ll have a carotid artery ultrasound and a Trans esophageal echocardiogram (TEE) here in Pattaya. Bet'cha a beer I'll have more to research.

[SurichTan]

Hi new guy,

I am following you story closely as I too have AF and want to do ablation procedure in BKK. Singapore General Hospital is asking for S$15K, about 360K bahts (3 times the charges in BKK).

Surich

[zzdocxx]

Also lay off the booze if you are a drinker.

[Sheryl]

AFAIK it is custiomary for the patient, not the hospital, to contact BUPA for pre-approval of elective surgical procedures; this is what I have done in the past, and may be why the difficulties with the hospital. Just call them and tell them you want to seek pre-approval for surgery and they'll walk you through it (I forget if you fill out a form or just gove the info by form, but they'll tell you). BUPA then takles care of contacting doctor and hospital for more info and gets back to you with a decision as to whether or not they will cover it. Since ablation is a relatively new approach, and there is still debate as to whether it should be first-line treatment, it is possible they won't cover it or will cover it only if other therapuies haven't worked, so definitely worth looking into this.

You do not need to try to avoid foods with Vitamin K; as you note, that would result in an unbalanced diet. Usually no particular instructions are given about diet in my experience. The only thing to avoid would be supplemental Vit K or ususually excessive amnounts of foods high in Vt K, normal amounts are fine.. In any case if your Vit k intake was causing a problem you would see that in the INR result, as long as the INR is in desired range you're OK on that score:

" Experts now advise a reasonably constant dietary intake of vitamin K that meets current dietary recommendations (90-120 mcg/day) for patients on vitamin K antagonists like warfarin." Booth SL, Centurelli MA. Vitamin K: a practical guide to the dietary management of patients on warfarin. Nutr Rev. 1999;57(9 Pt 1):288-296.

There is, AFAIK, no data on the relative life expecrancy of people treated with ablation vs rate control or vs nionsurgical rhythm control (i.e. drugs) since ablation has not been widely used for long enough. What you were told about no difference in life expectancy between the 2 approaches comes from the results of 2 trials conducted in 2002. Although these did indeed show no significant difference in long term survival between patients treated with rate control vs. those treated with rhythm control:

(1) the rhythm control grouop were all treated with anti0arrythmic drugs and in some cases cardioversion, not ablation; as a result, morbidity and mortality in this group of patients included drug-related events (bith from the anti-arrythmioc drugs and also from anticoagulation, which they still had to take) and (2) 40% of the rhythm control group were not successfully maintained in sinus rhythm and the mortality data includes them; if one examines only patients who were in sinus rhythm against those in the rate-control approach group there was significantly better survival among the latter.

There is reason to expect that people who are successfully returned to sinus rhythm without needing long-term medication would have significantly better survival rates than people who are maintained on antiarrythmic drugs or people treated with rate control. It will, however, need to be many more years before this can be proven and quantified. And of course, ablation is not always successful.

I'm a little puzzled by what you say in terms of being strongly affected by the procedure for a year. You would need frequent follow-up during the first year as most relapses into a-fib occur then. However in terms of recovbery from the procedure per se and return to normal activity, that is complete in about a week. You may find this link helpful in terms of what to expect during and after an ablation procedure:

http://www.af-ablation.org/patients/faq/

Good luck and keep us posted whatever option you decide to pursue

[SurichTan]

AF Ablation is relatively a new procedure and even in Singapore Heart Center, they have government grant to perform the procedure at heavily subsidized cost for Singapore Citizen so that doctors gained more experience in the procedure. As I am NOT a citizen, I will have to pay $15K++ to have the procedure.

A friend of mine has AF in his twenties and now at his 30's, the AF is gone. So I am still waiting for the procedure to be perfected. Does any one has statistics on the success rate, mortality rate other horror story like what is the procedure go wrong and what the grave consequences.

Thanks.

[bunnaag]

Sheryl has given you excellent advice. Obviously she has a medical background! I too have artrial fibrillation and have been treated for the last several years and live a normal life. One of the leading cardiolgists in Thailand is at Prince Songkla University in Hat Yai. He was dean of the medical school there and has taught many cardiologists in this country after training at the University of Washington. His name is Dr. Tada and he is one of the best doctors I have had anywhere including the U.S. Perhaps a little far for you to travel but it is another option.........Good luck.

How can I contact Dr.TADA?Does he have a private clinic also?

[klikster]

Hi All (and especially Sheryl),

For the last four months I’ve had numerous incidents of “racing heart”, usually lasting less than a few hours. Three months ago I was concerned enough over a long episode to go to Pattaya’s BP hospital where I stayed overnight in the ECU. Meds brought my HB under control and I easily passed a stress test and echocardiograph. Apparently I have Atrial Fibrillation and was prescribed Nebilet (2.5 mg once a day). That was about all I was told and I didn’t do much follow up research. I left the country for a six week trip and when back had a follow up doctor’s visit. My condition hadn’t changed.

I bought a blood pressure/heart beat monitor; all BP readings have been normal. Usually my HB has been in the 60-75 range with the machine sometimes flashing “irregular”. Occasionally I would wake with a funny feeling, my heart beating at 120 for an hour or three. Sometimes I would take an additional 2.5 or 5 mg of Nebilet. It seemed to help.

On Monday morning I got readings of 145 and went to the hospital again. My HB was all over the place. I was given meds (orally and by injection) to control the arrhythmia and reduce the chance of blood clotting. I chose to overnight in my condo, taking the Nebilet, Orfarin-X (5 mg before bedtime), 400 mg of Cordarone after meals (since stopped) and Isoptin-SR, one 240 mg tab after breakfast (since stopped). The doctor told me I had a 10% to 15% chance of stroke.

I’ve just done a lot of Wiki-type research into management of blood clots; my kids helped me with a link about Chad screening where my risk was less than I’d heard. The doctor described today's echocardiograph as “perfect” and told me to take the Cordarone if the arrhythmia returned. My HB has been ranging from 45 to 55.

Please give me your recommendations for hospitals and doctors in Bangkok who are tops in this field, good communicators, and questions I should ask, tests I should get. I guess I’ll take a cd copy of my exam results. Can I postpone doing this for a week or so?

Thanks.

Two comments:

1 - I just had an exam, stress test and echocardiograph at Bamrungrad two weeks ago by Dr Visut. He was recommended by a number of people. I wouldn't hesitate to see him again (actually, I will do a follow-up).

2 - I had a cataract evaluation at BP Hospital .. and had severe cataracts. They wanted me to get both eyes done the same day, and to have an "auto focus" lens put in my "good" eye. They kept telling me, "Be sure you bring Bt 100,000 when you come"

I got a second opinion from the Wavefront Clinic on Chan Rd in BKK (friend of a friend). He did the procedure .. one eye at a time .. telling me that both eyes at one time is a very serious no-no. He also told me that the "auto-focus" doesn't work very well. Nothing was mentioned about money prior to my visit. Both eyes cost me Bt 70,000 and my vision improved about 500%.

I no longer trust BP Hospital at all!

[Sheryl]

Does any one has statistics on the success rate, mortality rate other horror story like what is the procedure go wrong and what the grave consequences.

Thanks.

Some links below that may be helpful. Success rates vary with the specific technique and will also vary with the skill and experience of the dioctor performing it. Also, success rate is higher in younger patients and patients whose a-fib is episodic..

Serious complications do sometimes occur, the incidence overall is in the 5-10% range. Mortality as a result of the procedure is less than 1%.

links:

http://www.medscape.com/viewarticle/558370

http://www.medscape.com/viewarticle/532503_3

[SurichTan]

I am reading a book "The Cardiovascular Cure" by John P Cooke, MD, PHD.

http://www.amazon.com/Cardiovascular-Cure-...7741&sr=1-1

“This book should be read by all patients with heart disease as well as anyone at increased risk for a heart attack or stroke. The comprehensive risk reduction program recommended by Dr. Cooke uses the most advanced research to help everyone improve the health of their blood vessels.”

--William L. Haskell, Ph.D., Stanford Center for Research in Disease Prevention

The recipes contained in the book are really for Farang and not for Asian chef.

This title looks interesting too.

No More Heart Disease: How Nitric Oxide Can Prevent--Even Reverse-- Heart Disease And Stroke

[NewGuy]

Sorry for not keeping up my end of this thread - I thought I had set up email notification of replies; not getting any emails meant, I figured, no replies. Anyway, thanks for the informative updates and I'll fill in my long story's long gap shortly.

[fishhooks]

Quote nohave:

Atrial Fibrilation (AF) can be life threatening as there is a small possibility of clots forming. A cardiologists should advise further. A friend took medication for 9 months but the "Paroximal" Arithmias were still there. He described them as very annoying and extremely uncomfortable. He eventually went for a procedure called "Catherter Ablation" abroad (Bordeaux/France). The "ablation" done on him cured him completely. Here in Thailand, there aren't any experienced centers doing this type of procedure, hence most cardiologists in Thailand aren't great believers in the procedure. However, it is the best and safest solution for most patients.

*****************************************************************************

I 'think' this procedure is now being practiced in Thailand.

I stand corrected, but I'm fairly sure the Senior Cardiologist at Bangkok Hospital, Korat, told me that this is the latest method they are now using here in Korat.

Edited February 21, 2009 by fishhooks

[hanoianne]

I was a bit shocked to see having an ablation being discussed so soon after diagnosis and before other treatments have been tried. There are numerous websites detailing methods of reducing the frequency and duration of AF. Vitamin and mineral supplements have been all some people have needed to come off meds completely - B vitamins and large doses of magnesium being the ones most frequently mentioned. Given the weather, dehydration and mineral loss are common complaints in Thailand and this can lead to all sorts of problems, including AF.