AFib Rhythm vs rate

There are only 2 important dimensions to life as far I see it.
The first is length of life and the second is quality of life.
It is important not to mistake these two as being synonymous.
Just because we may have a great quality of life does not automatically mean that we will live till we are hundred and just because we have a poor quality of life does not mean that our death is round the corner.
Ill give you in example - people with bad migraines may have a terrible quality of life but have a normal life expectancy and people with a brain tumour may not have many symptoms but their prognosis may be very limited indeed - and therefore whenever we are faced with a medical condition it is always good to ask
How will this condition affect my length go life and what measures can help improve my length of life
How does this condition impact on my quality of life and what measures can improve my quality of life.
Today I wanted to talk to you about Atrial fibrillation which is a disorder both or heart rhythm, and of heart rate and one that can adversely affect both quality of life and length of life. In terms of quality of life, AF may cause symptoms just because the heart beats irregularly or because it beats irregularly and fast and therefore there are 2 strategies to improve symptoms.
The first is a rate control strategy which means that you simply try and stop the heart from racing excessively by using medications such as Beta blockers and digoxin or sometimes using a technique called PACE and ablate.
The second is a rhythm control strategy where you try and get the patient back into a normal rhythm by medications (eg Flecanide) or cardio version or an AF ablation.
The automatic assumption at first glance would be if you can get rid of the AF then that surely would be better in the long run compared to leaving the patient in AF as being in AF could put more strain on the heart etc. However what does research tell us - which strategy is better for our long term outcome/ our prognosis/our length go life.
The question that we will try and address is which is a better strategy for length of life. Is it indeed better for us in the long run to be out of AF or not?
There are 3 important studies that I will talk about.
The first was a study called AFFIRM.
In AFFIRM, 4060 patients with recurrent AF were divided in 2 groups. The first group was a rate control arm where patients were allowed to remain in AF but the rate of AF was controlled. The second group was a rhythm control arm where patients were given antidysrhtyhmic medications to keep them in a normal rhythm. This trial predated AF ablations so we can not use this trial to guide us re: AF ablations.
Nevertheless at the end of 3.5 years, there was perhaps a slight decrease in all-cause mortality in the rate control arm. There was no difference in the 2 groups with regards to cardiac death, arrhythmic death, or deaths due to strokes or brain bleeds. There was also no difference in global functional status. There was a much lower number of patients requiring hospitalisation in the rate control arm.
It may have been that the afntidysrhtyhmic medications could have caused the slightly higher trend towards increased mortality in the rhythm control arm.
The second study was RACE which looked at 522 patients again with AF or flutter of less than 1 year duration and again compared a rate control strategy to a rhythm control strategy. Again they found similar results to AFFIRM. There was no difference in cardiovascular mortality between the two groups but there was a trend to a higher incidence of non-fatal complications such as heart failure, blood clots, adverse drug reactions and need for permanent pacemaker in the rhythm control group. Again RACE predated AF ablation and therefore the conclusion was that ideally if you are trying to use a rhythm control strategy it would be better to do so in way which may not require long term use of antidyrhythmic agents. This is where Catheter ablation comes in.
If we use catheter ablation as a means of controlling the rhythm would we see different results.
A more recent trial looked at the same question but also enrolled patients who were having catheter ablation as a rhythm control strategy. This was called EAST-AFNET 4. In this trial 2789 patients who had been diagnosed with AF within a year and who were deemed high risk (older, previous strokes, diabetes, hypertension, heart failure, kidney diesease, LVH) were assigned to either rhythm control (by meds/ablation) versus rate control. After 5 years or so, the trial was stopped early because the death from cardiovascular causes and even strokes was seen less frequently in the rhythm control group. Conversely side effects from medications etc were more common in the rhythm control; group.
So what does all this tell us?
Find out in this video:-)

[@peretistifanus2544]

So sorry for the loss of your Dad, Dr Sanjay. May his soul rest in peace.

[@YorkCardiology]

thank you so much Peret

[@lifeontheedge357]

Was in Afib for over a year with heart rate of 110-140. A week ago I was shocked back to normal rhythm with a rate of 48-80. Feeling so much better.

[@raff23able]

Hey did your cardioversion last ??

[@jmarie8004]

Dr Gupta, may God continue to guide and bless you. You have continued to make videos after the loss of you're dear father. You make a great difference to many people with these videos. Thank you!

[@YorkCardiology]

So nice of you - thank you!

[@yorkymc]

very true

[@tanveershah4974]

nothing can replace parents. bodies die but souls lives.

[@YorkCardiology]

You are so right:-) Thank you Thank you for your support- it would mean a tonne if you’d consider subscribing to the channel. Also I try and do some regular broadcasts via WhatsApp on [phone]

[@capyboppy]

I join everyone in saying how sorry I am for the passing of your father. I hope and pray that the precious memories that you have that have built up over the decades, will help sustain you and your family, and will help dull the pain. Both my parents have been gone a long time now, but their presence is still in my heart as I know your father's will be in yours.

[@yelesomeus4534]

My Grandfather has had Afib for years and he is now 98 years old and still having a whisky and ginger every night 😀

[@vjgibs]

Hi what does he use for his af

[@songsofthecentury3909]

What does he use for his AF?

[@alexbruce5659]

Thanks for posting . I am 57 years old and have been having bouts of AF since I was 23 years old . I went to Dr Jane Somerville in London who really helped me. I presently were treated at Northampton but have been left to defend for myself. Your posts are a great help to me and I thank you.

[@YorkCardiology]

Thanks for watching Alex!

[@413smr]

I so appreciate your videos. I'm recently diagnosed with Afib and am trying to "wrap my head" around it. These are so helpful and reassuring. Sincere condolences on your father's death.

[@jeffreybaier5312]

Glad to see you answering the posts, people really do care about you and this means a lot to us.

[@YorkCardiology]

Awww thank you. And all of you mean alot to me. The feeling is totally mutual:-)

[@stephaniewall2011]

So very sorry to hear of your profound loss. Condolences to you and your family. Thank you for your excellent videos. They are very helpful.

[@deborahjones9872]

Thank you Dr Gupta. Your videos are invaluable. Your dad must have been so proud of you.

[@moturn8614]

My condolences for your loss. He will continue to watch over you and your success. Thanks for all that you do.

[@peternorman2563]

Many thanks again for a very explicit explanation, most of our large chain hotels are a disgrace and care not a jot for food quality. We don't need gourmet food just a well prepared and thought out menu. As for sweets most don't have a clue and I won't go into cream from a spray can.

[@jamesm90]

Thank you very much for bothering to post these videos, it helps me to have an understanding of my condition and what I should be doing about it.

[@jolantamsk3894]

Love and support your rant:) - you are a Gift to us - it is nice that hotel admin is watching too:) and will hopefully improve their “new practice”. I am watching from Canada, eh:)

[@smallfootprint2961]

Such great info. Thank you for taking the time.

[@lionhearttt3540]

So sorry for your loss, your dad will always be with you in your ❤

[@elyssaberger5901]

I loved the picture and tribute to your dad. My dad passed 10 yrs ago and i always think of him and miss him so. This was really interesting. Thanks so much. I’m a HH RN who does triage and a good majority of our pts are cardiac with w/ Afib.

[@Fourcatz]

I'm so sorry for your loss, Dr. Gupta. That food is indeed scandalous, I hope you are in the comfort of your own home very soon. You are a brilliant man!

[@joyceparis]

Im looking forward to the results of the ablation studies from you Doctor. Thank you for all your videos on a-fib for the last few years. You explain everything beautifully! Please accept my condolences regarding the loss of your Father. 🙏🏻

[@richardglithero139]

Thank you for an extremely informative and useful video. The quarantine conditions imposed on you, at your expense, are an utter disgrace. Condolences for the loss of your father. Richard G

[@marleangreene6117]

So sorry for your loss , my deepest condolences to you and your family

[@josealfaya1]

My Sincerest Condolences to you, Dr. Gupta, and your Family on the passing of your Father. Wishing you lots of Strength, Peace and Faith. Thank you so much for sharing of your knowledge. Many Blessings to you. 🙏💪🙏

[@1011Ink]

Sorry about your dad. You are a lifeline for us and my respect and admiration of your father for raising a fine human being. Says alot about who he was. Thank you sir. RIP & Be blessed. 💜 🙏

[@2fast4ua]

Dr Gupta, I like many people am sincerely saddened by the news of your father’s passing, he must have been a truly exceptional man based on the wonderful son he has and Feel he must have been so proud of who you are and the help and support you have offered so many. After a heart attack in 2015 that was miss diagnosed I have watched many of your videos and over the years they have been a source of calm and simple explanation regards a number of heart issues that a lot of us face. Words cannot express how thankful I am to you that you give so much of your time to us in explaining the facts to our sometimes unanswered questions which in turn helps us to better understand our health concerns and minimise the anxiety most of us suffer. A lot of your subjects also help to validate that what we are experiencing is in most cases real and not always just symptoms of anxiety. You are an amazing man, best wishes from New Zealand, take care good sir.

[@Nabil-zf5im]

I do enjoy watching all your videos for the useful substance and objective advice and your decent smile and recently your deep love to your late father ( peace be upon his soul ) 🌷❤️

[@YorkCardiology]

Thanks Nabil. I appreciate your kindness Thank you for your support- it would mean a tonne if you’d consider subscribing to the channel. Also I try and do some regular broadcasts via WhatsApp on [phone]

[@jamesschock4296]

Dear Doctor, My Father died 27 years ago this May. I still miss him 😢. But we are left with wonderful memories and a great legacy. I am truly sorry for your loss. P.S. I don't like Marriott properties I prefer Hilton Properties. Hang in there things will start 🙏 to get better.

[@YorkCardiology]

Thanks - ill avoid marriott like the plague from now on

[@jamesschock4296]

@@YorkCardiology Your welcome. I used to travel a lot for business. Now I am blissfully retired.

[@peggymicsky8607]

Glad to see somebody helping the Indian people - what a sad tradegy! Second, metoprolol sounds like it's effective in several ways in my case and it was good to hear because I believe I get every negative side effect from it. Also sounds like it's for life! I wish my Cardiologist would have explained this to me instead of relying on you but I thank you anyway. It's just like you to make good use of a bad situation. That's what makes you a great doctor and a great man! Welcome to our world, Sanjay, and God bless you. I'm sure your beloved Dad is beaming from above ❤!

[@buckie48192]

Your awesome Dr Sanjay So sorry to hear of your father’s passing. May the Lord give your heart the peace it needs at this difficult time. I’m sure your father was very proud of you and all your accomplishments and how you truly have a Big heart and love people.!! God bless you always 🙏❤️😊 Sorry about the so-called food they dish out at that sorry hotel 🏨🤑

[@alexandrastevens8892]

Over 20 years my beloved mum has been gone and I miss her every single day and don't think it will ever alter

[@YorkCardiology]

:-(

[@pateli2008]

I lost my mom almost 11 months ago, and I still cry every day. It's been tough for me :(

[@affsheenyousaf9961]

Hi Doctor, I appreciate you and your videos. Your fan, Affsheen 😊

[@arminwadia2660]

So sorry for the loss of your dad.. Very informative video ... God Bless u

[@DBurgg]

Yikes! That’s outrageous...shame on Marriot. Thanks so much for continuing to educate those of us with AF. Sending you 🥑🫐🥦

[@YorkCardiology]

thank you! Hopefully the #feedsanjay hashtag will gain momentum and the Marriott will notice:-)

[@sassysandie2865]

Love your comments about the Marriott food! So much for them “truly” caring about people’s health by giving you crap food. Don’t you love their science of the bus ride and then the forced isolation in a hotel room? Tyranny.....

[@YorkCardiology]

it sure feels like it:-)

[@haggismunchers69]

Thanks for another great video Dr Gupta 👍

[@27dnichols]

This was extremely helpful for me, thank you!

[@lgwiffen4376]

Glad you got the food issue sorted, so sorry to hear about your Dad, it is a very sad time when a parent dies.

[@anisrehman5361]

May God Bless your father and rest him in peace n give u courage to bear the irreparable loss

[@mygarden365]

Thank You,Doctor for a very good lesson.

[@sparczzz]

another great video thanks Sanjay

[@frankdoyle3716]

You are what all doctors should be! My nephew is a Pulmonologist at UC Davis and is just like you. You should meet sometime! Thank you for your way.

[@shantalvandeweerd4088]

You are so amazing Dr Gupta! I wish you were my cardiologist. My cardiologist in the Netherlands only subscribed me Bisoprolol for my svt's and pvc's and anxiety. You tell sooo much more and give me so much more knowledge. Thank you so much! I send you a lot of strength during your quarantaine stay in that hotel. I can't believe the food is from such a bad quality while you pay so much per night. And I wish you a lot of strength for your grieve after the loss of your father. Heartshattering.. X Shantal from NL

[@YorkCardiology]

awww thank you!

[@Youmetube7]

My condolences. I love your video's and they helped me understand what is afib. Can you please make an episode on proximal Afub. For me was 6 months apart and i am in perfect condition middle aged men! Thank you so much.

[@cherrymetha3185]

Dr Sanjay I will definitely Tweet about this hotel . It’s disgusting that they charge so much money and they provide such a bad service . The room from what I can see looks very shoddy . I’m so sorry that you’re stuck there for two weeks. Disgraceful !

[@scarsonish]

thanks so much for all your videos they are so helpful particularly as currently there is such a long waiting time for NHS cardiology in my area of Lincoln, So sorry to hear about your farther,I have seen your instagram feeds regarding the outrageous food being offered

[@YorkCardiology]

:-) Thanks Stephen. Hopefully the #feedsanjay hashtag will go viral:-)

[@vancestinson2523]

Some cardiologists urge rhythm control as first option because of the association of long-term afib with the development of fibrosis. However, I saw a study (can't remember who conducted it) showing data suggesting that development of fibrosis in afib patients may be due to pathologies associated with afib (such as high blood pressure) rather than the afib itself. This might be a good topic for a video. Thanks for all you do, and so sorry about your loss.

[@hrobert745]

Condolences for your father. His legacy is that he raised an amazing son. When you talk about a -fib triggers, I haven’t heard you discuss medications. Maybe I just haven’t come across that video. I have discovered that many medications I was taking were aggravating my condition, such as over the counter allergy pills, albuterol for asthma, and my most recent attack I think was caused by a nasal spray the doctor recommended for post-nasal drip. This has been a really critical issue for me; by eliminating these medications, I have reduced a-fib episodes from three or four a week to once a month.

[@suecondon1685]

Very interesting. My GP has increased the Bisoprolol, he wants to control the rate, but my AF is always a rhythm problem, misfiring all over the place, and sometimes flutter. He said don't take extra Flecainide as pill in pocket. I couldn't understand this. Thank you so much. Oh dear me, what a dreadful hotel experience!

[@jorgerivas1424]

My sincerest condolences, Doc. I had a one-time AF attack 10 months ago at 68 yo. Never had one before, never had one since. It was both rhythm & rate. They got me back to sinus in about 1 hr. Two weeks later, I got a serious condition--sympathetic NS took over my body. I couldn't sleep, eat or breathe for about 6 weeks, became allergic to everything I ate & to medications. I'm recovered & very healthy now but have chronic fatigue. I'm taking Verapamil & Trandolopril & they work very well. Not taking any other meds. Why did I get so sick two weeks after my AF attack? Is that common? You don't know how much I appreciate your videos.

[@kathleenfubler431]

Thank you so much! 💓Appreciate you.

[@YorkCardiology]

You are so welcome - and ditto:-) Thank you for your support- it would mean a tonne if you’d consider subscribing to the channel. Also I try and do some regular broadcasts via WhatsApp on [phone]

[@kathleenfubler431]

@@YorkCardiology I already subscribe. Don't know how to get the what's app stuff though I am on it.

[@julesflores8137]

Ohhh Dr. Gupta I’m so so sorry abt your father passing. I know your heart is broken it was obvious how much you loved, respected him and how close you two were😢 My fib heart hurts for you🥺 I’m sorry you’re stuck in this horrid hotel. I hope you can get home and get some good food soon!!! Idk what some of the breakfast food is😂😂😂 Thank you for the video and again for your knowledge and compassion when we had a consult. You take good care xx♥️🙏

[@YorkCardiology]

Awww thanks Julie!!

[@lulzimzeka1991]

My condolences to you and your family, Dr Sanjay.

[@sangreesraro3996]

Great video. They are giving me Lorpressor for my paroxysmal afib and feel more at ease being on being blocker meds (with fewer side effects) vs the rhythm control.

[@YorkCardiology]

I am glad the beta blocker is working for you! Thanks for your support scott

[@arminwadia2660]

Superrrr and good. Thx so much

[@warrenarthur6293]

Sorry for your loss 😔

[@bernitamadott6130]

Sanjay, Your father is looking over you and we are all so proud of you. Bless your heart ❤️ and soul.👩🏻‍🦰💕

[@californiadreamin5093]

Another great video! What sets you apart from other physicians is that you don’t talk down to people- you speak intelligently to us. Thank you for that. I’m interested in the possible connection of the MTHFR gene and Afib. Would you consider making a future video on that? Sorry you’re stuck in a flea bag motel.. that’s false imprisonment and so unnecessary! This covid hysteria has got to stop.

[@YorkCardiology]

yes definitely. Thank you for your lovely kind words

[@aprilgarcia4523]

Bless you sir..ty for sharing your knowledge 🙏

[@steveone9375]

Thankyou for this video it has helped me a lot 💗

[@gloriamaryhaywood2217]

I cannot imagine being in Afib continually. #YIKES. I only experience Afib every few months and absolutely can't wait to get back into normal sinus rhythm!! My Afib is felt immediately and very strongly. Thank goodness I have so far been able to bring myself back into sinus rhythm, in usually just a few minutes. And yes, my heart rate is also always racing at about 150 bmp. Thank you for sharing the importance of staying on blood thinners no matter what! Your quarantine experience at the Marriott is something Else!!!🤢 They Do NEED to be Called Out and need to Step Up Much Better!!😉👊

[@angelaricottawarriorrose9917]

When I go into AFib I drink a large cup of Celery Juice and it relaxes my heart.

[@YorkCardiology]

Thanks Gloria!

[@craigperry7376]

Sorry for your Loss Dr. It’s bad enough going through your grief, but obviously made worse by having to endure COVID lockdown in a 2nd rate Hotel. I watch your Vids with interest as my Wife has AF on an ongoing basis. It’s been 7 yrs now since diagnosed, but recently her heart rate has increased & the flutter has became more noticeable. She’s due to visit her Cardiologist in 2 weeks so hopefully he’ll have a solution to this problem. In the mean time she finds it a challenge to go out of the house, as she’s getting breathless walking any distance. Not sure why of this either. Her GP can’t find any reason other than Wife has AF. 🙄 I feel for all Drs having to find answers to improving human health.Yor blood would be worth bottling, Dr. I believe that’s an English saying, but also used by older folks in Australia. Stay safe & healthy to continue helping the sick. Cheers 🇦🇺🦘

[@stephenroberts7194]

Thank you for your fantastic and educational videos, doctor. I had aortic valve replacement and partial aorta replacement almost 14 years ago and I have been in AF for about the last twelve years. My heart rate is okay so I just try to live as normal a life as possible. Good luck at the hotel. The food looks awful! 😩

[@YorkCardiology]

Thank you so much. I am hoping the bad food will mean that i shed my extra weight:-) Its a great idea to live as normal as possible. We should all do so without worrying :-) I wish you well

[@YorkCardiology]

Thank you for your support- it would mean a tonne if you’d consider subscribing to the channel. Also I try and do some regular broadcasts via WhatsApp on [phone]

[@lynettetucker5236]

Thanks for sharing this video I enjoyed watching the video 👍

[@YorkCardiology]

thanks lynette!

[@teddybear3552]

Welcome Back Dr Sanjay - enjoy your re-union with your Family. Take Care...

[@YorkCardiology]

awww thank you Teddy!

[@teddybear3552]

@@YorkCardiology x

[@peggymicsky8607]

Awwww thank you "Teddy" How Special! SOS!

[@weichong6108]

Dear Dr Gupta, I am a 48 year old male Singaporean, 3 to 4 years ago, I started developing AF for no reason. I was prescribed Sotahexal by my doctor. My AF condition did not improve at all. My AF would come all of the sudden and only go away after a night of sleep (3 to 4 times a week). Furthermore, I noticed I can get breathless and my heart would be racing like mad when I climbed 3 flights of stairs. After watching your videos 1 month ago, I started taking Magnesium citrate and vitamin C. The AF literally disappear on the first day of taking these supplements. Me and everyone around cannot believe it! Why hasn't my doctors recommended such simple solutions??? I am deeply indebted to you for your videos. You are a real life saver!!! You really improved my QUALITY OF LIFE. Thank you Doctor!

[@klaviernova]

Hi, which brand of magnesium citrate and vitamin c did u take? What is the dosage and frequency? I tried searching at Singapore's GNC but they mainly carry magnesium oxide

[@doctorrobert60]

I had atrial flutter with occasional atrial fibrillation beginning Sept. 2020. With sick sinus syndrome as well as first degree heart block was given pacemaker before any medical treatment. I was started on rate control with bisoprolol and dosage was increased gradually to control rate but I noted symptoms of congestive heart failure and titrated the dosage down but did not feel that well since I had been active physically even though am over 70 years old. I requested cardioversion that was done Aug. 2021 and continue in NSR. Prior I had been supplementing with taurine and L-arginine to try and improve cardiac function. Taurine is approved as treatment for CHF in Japan and felt nothing to lose. I wanted to try and minimize electrical remodeling and enlargement of left atrium. For me rate control did not work well but was concerned of side effects of amiodarone which the cardiologist wanted to prescribe. I am feeling much better in sinus rhythm compared to atrial flutter/fibrillation. Sorry for the long post but others may find some interest. As always Dr. Gupta your talks are enlightening for us all. I will make a donation to help the dire situation in India.

[@zogzog1063]

A truly beautiful face <a href="#" class="seekto" data-time="4">0:04</a> Best wishes from Andrei in New Zealand.

[@mariascott4507]

I found this very interesting but wanted to ask you about rate and rhythm control at the same time not either or, what do you think about this practice? Hope that you come out of your present situation soon and can look forward to many delicious and healthy meals to come, stay strong, and many many thanks for all your posts I have found them immensely helpful in my own Aib experience.

[@conniec9840]

Hi Doctor, I have watched your videos for a long time and you have helped me so much. I've had paroxysmal afib for 18 years. I've never taken any medication for it. My heart races very fast when in afib. I can't take blood thinners, because I tried Eliquis for 7 days and had bleeding gums. My EP wants me to go on propafenone, but I have resisted doing that for the past 3 years. I'm very healthy otherwise, low blood pressure and normal heart rate, heart is fine, no health issues. No apparent reason to have afib. It never lasts for more than a couple of hours and usually less than 30 minutes and goes back to NSR on it's own. I had a small dose of cardizem once in the ER because the rate was 212. Your videos help relieve my stress over this, because I can't see a good treatment for me at this time. The medicines can have bad side effects and the people I know who have had ablations need more than one. Thank you for your videos.

[@Radoslaw731]

I know exactly how you feel. I lost my Dad 3 years ago do to prostate cancer at age 75, and my mother also last year, she to was 75 years old 😭. Still miss them.

[@srigopitraders4058]

Thank you Mr Guptha

[@YorkCardiology]

Always welcome

[@kikianne8788]

Thanks for this. It's very useful and important to know. I'm listening to you while cooking my dog his dinner. He eats chicken and liver which I hate but he adores. I'm cooking it and the smell is horrible. So anyway I'm telling you this so you know my dog is gonna have a lovely dinner. Lol. Look after yourself and remember memories are God's gift to us. They remain forever and can never be deleted or lost. Hold on to.your lovely memories and you will get there. Xx

[@YorkCardiology]

awww thank you. and i hope your dog enjoyed his dinner- what is his name?

[@kikianne8788]

@@YorkCardiology His name is Geoffrey and he's Shih Zhuh. He's spoilt but he's a very gentle boy and loyal

[@johnbould7544]

Dear Dr Gupta, condolences for the loss of your dad. May he Rest In Peace. On the subject of anticoagulants, would you consider a daily aspirin as effective / sufficient in this regard?

[@woodgie1806]

Very sorry for the loss of your Father. I have watched many of your videos and suffer very badly with AF. Last year to the day I had my Aortic Valve replaced and then started to suffer with AF. I can barely walk and have struggled in the last year. Because of covid I've not been able to have a cardioversion and I do not know when I will receive this. I would like to ask your opinion of D Ribose. I am currently on bisoporal, Lasarton a blood thinner and diretic. I've taken magnesium but this hasn't helped with AF. Any info you have on D-Ribose would be fantastic. Thank you.

[@martharuiz1436]

Dr So sorry for your loss of your Dad may god give you resignation soon .I wanted to mention to you that I have 63 years old and Diabetic and Insulin dependent my problem is when I eat minutes after my heart goes fast and it scares me .

[@jamescasey8544]

Thank you for your videos they are very informative. When I go into AF it is permanent. I have had 3 Cardioversions (after being in AF for a few months each time) and have stayed out of AF for around a year each time. I have been offered an ablation but am unsure whether to take up the offer. To complicate matters I have a pacemaker fitted ( for 2nd degree heart block) and have Brugarda Syndrome. Any advice/suggestions?

[@cherrymetha3185]

✨OM SHANTI SHANTI. ✨🙏 PRAYERS FOR YOUR DAD 🙏✨

[@bradfordtunell3779]

Dr. What are your thoughts about the more recent hybrid ablation procedure vs the AV ablation/pacemaker approach for people diagnosed with permanent afib? My care group here in NC does not perform the hybrid procedure and I am investigating whether that procedure has been effective? Thanks in advance. Brad Tunell

[@ag666999]

I sympathise with your quarantine situation having done disease control for DEFRA. We knew what worked but were still told to control situations cheaply using lies and withholding facts as “the public are stupid” (a similar message Stanley Johnson wrote in published books on population control which I have no doubt influenced his son). You are being handled based on cost rather than as an individual health risk and more worryingly, the personal risk you were exposed to on the bus. Hopefully your immune system will do the job it has done for thousands of years before crisps and cola appeared on the scene. It is not in a virus’ interest to kill the host but then the virus is unaware of our current toxic way of living. Been to hospital 7 times since Sept for BP investigations since I had the current virus (I have learnt more from you than my GP or any Worcester based specialist, many thanks) and every time the hospital has been practically empty so I wonder how many are dying of cancer etc. Good luck to you Sir and thank you for your work and support... My personal belief is that we all pass on but only truly die the day our name is used by loved ones, one last time.

[@longstaffemedia]

Sad news about your father / he will be very proud of you indeed I am sure of that

[@dailydoseofmedicinee]

👏👏

[@YorkCardiology]

thank yoU!

[@wajahat2338]

May your dad Rest In Peace.

[@rossaforbes9787]

Thanks, Dr. Gupta. It is possible that many people are confused about what constitutes "quality" of life when it comes to A-fib. My first cardiologist dropped me as her patient because I wouldn't allow any type of surgical intervention. I felt fine, but she was hell bent on proving that I wasn't. Yes, I have chronic A-fib, a high heart rate that I'd like to better control (digoxin brings it down somewhat, but is no panacea), but each time I visit my current cardiologist's office, it is the staff who seem to assume that I must have a terrible quality of life, or else why would they be urging me to rethink having an ablation? They also wanted me to have a nuclear stress test, which I refused. l think I know the answer to their opinions masquerading as facts and it's call "profitable hospitals". The point I'm trying to make is that I would like not to have A-fib, but otherwise I feel well, I exercise, I take a blood thinner, but the forces of doom are making me doubt myself. The scenario I just describes affects "my quality" of life. What I had to do to combat the forces of doom was to find a functional medicine doctor (in addition to keeping the cardiologist onboard) who agrees with me that I'm not wrong at this point. We are working on clearing up other issues which may be producing the arrhythmia and strengthening the heart muscle. Even if the arrhythmia never clears up, having a medical "buddy" has gone a long way to alleviating the stress of fending off people who think I can't possibly function without resorting to surgery. (You are a medical buddy, too! Thanks so much for your greatly informative posts. I really appreciated speaking with you for a telemedicine conference over a year ago.)

[@YorkCardiology]

Awww thanks Rossa. Good to hear from you after such a while.

[@cosmetolo-joyclassroom6573]

Could the same conclusion be made for someone diagnosed with tachycardia? When ablation be beneficial for someone like that? I have been on beta blockers for 18 years and in considering an ablation. Thank you for your videos.

[@yesitavegaandreu1714]

I had to quarantine for a week when I returned to Chile. I chose the cheapest hotel ($300) but the food was fabuloso!! Too bad yours was not so great. Thanks for this video, I’m still confused about my afib and the meds. Having bradycardia also complicates things? Anyway, I feel great for my age.

[@dilwich]

Rest in peace Mr Gupta.

[@johns3106]

I have periodic afib following a bout of endocarditis resulting in an aortic valve replacement. The discussion of quality/quantity of life is interesting to me. As a very active person, my afib has a definite lowering of my quality of life, as I cannot do my normal beloved sports & activities when in afib. Fortunately my afib happens rarely (about every 6 weeks for about 12 hours) and after starting a magnesium regime, the incidence dropped to about 1 episode every 6 months! The fact that my anti-arrhythmia medication (Doefetilide) may somewhat shorten my life is an acceptable trade-off to me, as that medication allows me to live the life I want to lead NOW! And as an interesting side note, my afib really doesn’t result in a radically increased heat rate…if my normal pulse is 60bpm, my pulse during afib is probably only around 80bpm…but is very irregular, causing me to get out of breath just climbing the stairs to the second floor of my house!

[@hermannbuerger9748]

my sympathies

[@rossmurdock9861]

Hi Doc - Sorry for your loss I have stayed at that Marriott. It's a rip-off even in good times. I have watched everyone of your videos, and have shared your links multiple times. To me it's like an extra No Charge trip to the doctor!. I am 65 and have had bradycardia for over 30 years with no adverse symptoms until I got AFIB about 2 months ago. No my life is dizziness, and feeling vacant. I have never had a speedy heart rate, but my rhythm is now way off with 3-5 second pauses. Not sure if i would need an ablation or a pacemaker? My dob at U of Penn is recommending a pacemaker. My fear is that if I get the pacemaker, an ablation would not be possible in the future, as a Pacemaker won't fix my rhythm issues and I'll still feel vacant?

[@lovelee_1990]

Have a nice day Dr Sanjay Gupta

[@YorkCardiology]

Thanks - you too!

[@valman008]

Thanks for the video Dr. Gupta! I Had an ablation 2 years ago thinking I would be able to come off the anti-arrhythmic meds. I was on flecanide for 6 years prior to ablation. Now I’m on Propafenone. My Afib is more controlled but I gotta continue to take the meds to keep it controlled. After watching this video I’m thinking more now about my prognosis since I’m on long term medication. I understand prognosis may not be that different if I choose to come of the meds but my quality of life would decrease. I do enjoy exercising. Doc, can you share studies on long term anti arrhythmics? Are there any reliable studies that you can share for those who choose to stay on the meds long term? Thank you Dr. Gupta!

[@YorkCardiology]

yes ill definitely work on a video to address this

[@angelaricottawarriorrose9917]

How does a person get rid of AFib? You're Dad raised a very good man. The meds gave me Supine Hypertension, I took Metropol er Succinate.

[@YorkCardiology]

Thanks - good lifestyle, meds and an abalation can all reduce how much AF you get Thank you for your support- it would mean a tonne if you’d consider subscribing to the channel. Also I try and do some regular broadcasts via WhatsApp on [phone]

[@stuartkelly3106]

Hello, since you never mentioned it I could then assume that there is little in the way of strategies to deal with both rhythm and rate.

[@YorkCardiology]

anything that deals with the rhythm will automatically deal with the rate but not the other way round

[@dinahsoar6982]

Totally understand you missing your dad. My mother died 9 years ago and I still miss her everyday.

[@YorkCardiology]

Thanks:-) I appreciate it.

[@renovation-maison]

Hi . I was recently considering the Ablation procedure; I have had occasional Afib nearly all my life. I have no comorbidities and my arrythmia gets worse if I exercise too hard. I've been reading about the ablation procedure and it doesn't seem super attractive to me at the moment: First they have to push a pipe down your Oesophagus to map your left Atria while you're awake (Like a sort of medieval torture according to some people). Then there are risks: The doctor may accidentally burn through the wall of the atria and the oesophagus (The food pipe) This gradually leads to food getting into the bloodstream. Which is usually fatal.

[@YorkCardiology]

I know it is daunting and you should think about it carefully esp if you are not too symptomatic.

[@buckie48192]

Yikes!!! 😳 😬

[@geoffsullivan4063]

Vitamin c / l - lysine / l - arginine in high doses are the natural way forward with any sort of heart related problems which in turn feeds down to other major organs ie the liver / lungs / kidneys / spleen /pancreas /bowel and so on and so forth.

[@edshimkus1139]

My condolences for the passing of your dad and yet, he lives on in you and I am sure he is most proud. I have PAF and am currently treated with flecainide, 50mg b.i.d., and diltiazem ER, 120mg daily. All is well. However, your video, rate vs. rhythm, piques a question: why is it rate or rhythm and not rate AND rhythm? But, in effect, isn’t that how one is treated regardless. In my case, flecainide address rhythm control and diltiazem rate control or at least a rapid ventricular response, yes? So why can’t a cardiologist prescribe a rate/ rhythm control combination with a view towards obtaining ideal control of both? Thank you for your efforts .

[@pateli2008]

Great videos doc. I was diagnosed with atrial flutter a year ago, I'm 66. Don't have any symptoms, my rest HR is 40-45 bpm. I've been a runner for decades, the only irregularity is that my HR rockets to over 200bpm even on slow runs, but it doesn't make me feel bad or exhausted. I'm under anticoagulant, but nothing else. My quality of life is as good as ever, I don't intend to undergo any invasive procedure, at least for now. I'd love to hear your opinion on my approach. Thanks in advance.

[@alicejwho]

I'm 56, healthy, a cyclist. My hr just sitting around is 42/43. And it goes up to 184 cycling up steep hills. My doc said if I feel absolutely fine, it's just just normal resting hr for me, and not to worry. But I still sometimes feel disconcerted my resting hr is so low!

[@jenniferbate9682]

Please can you give a chat about leaking mitral valve again. I had an echocardiogram which revealed leaking but my cardiologist says it’s not clinically a problem, but I has suggested I have a TOE to make sure. He says if this reveals a bigger leak I will have to have an operation …I am 78 years young, so I’m rather concerned about this.

[@nitro-ww6sk]

I made the mistake and read some medical papers on PubMed about IVF (Idiopathic Ventricular Fibrilation). It made me kinda anxious and i worry i might get sudden death out of the blue. The more i tried to research about this topic the more anxious it made me. Also the fact that i am not a doctor made things worse, because i didn't understand various medical technicalities in the paper and that made me go into wrongful conclusions about this topic. To those of you who are not doctors, try to avoid reading professional medical papers online because they might cause health anxiety and fear like they did to me.