Univ of Michigan ablations?

Hello -

This is my first posting, although I've been reading the board for several months, bought Hans' book, and have adopted some of the ideas, such as supplementing with fish oil and magnesium tablets (for about a month, no difference noticed so far).

First some history: I've only had lone a fib for about 3 years (I'm 49 now), and so far have had only about 6 (memorable) episodes of actual a fib, most lasting under 1 hour (one in July 2003 went on intermittently for about 6 hours) and all stopped on their own. But these episodes are absolutely horrible - pounding and racing heart, etc. - and as you all well know there is alot of anxiety not knowing when the next one may occur. Triggers are unclear, because although stress, fatigue, over or under eating have preceded events, I've experienced those same factors numerous times with no events. (Totally eliminated caffeine 2 years ago, and thought I had it beat until this year.)

After nearly all of 2002 with no episodes (on 25 mg Atenelol twice a day), have had 3 episodes in 2003, including 2 episodes within past 4 months, plus for past month numerous daily PACs and PVCs. Most recent a fib episode (yesterday) I took 300 mg Rhythmol (for the first time, as advised by cardiologist) after 1/2 hour and headed out for a vigorous walk and a fib stopped in about 15 minutes. I'm on a 30 day event monitor now, with follow-up appt with cardiologist Thursday. (So far, no noticeable adverse side effects from the medications.)

Now to my question: Has anyone had experience with ablations at the University of Michigan or Beaumont Hospital Royal Oak? I noted that Univ of Mich is mentioned in Hans' book as a center for ablation therapy. Although I realize my current status is nowhere near as bad as many, I'm considering ablation within the next year or so if it could end what is often a prevailing state of anxiety and preoccupation with avoiding triggers. (Don't know if I could get a referral to Cleveland Clinic under my insurance.)

I'd also be interested in knowing how many people on this board are considering ablation, and how many others are either postponing it or not interested in having it, and their reasons.

Thanks very much!
- Margaret

Margaret,

Sorry about your problems, but trying to stay calm and hopeful will benefit you greatly, maybe even to the point where you feel comfortable waiting a year or so until they perfect the ablation process where you can expect 90% or greater cure with no risks. That has been the advise that I have been given by my doctor who is Sonny Jackman the world renown and highly respected Ep at the Arrythmia Center at the University of Oklahoma. He said that there are advancements that he is incorporating in the next year that will be a tremendous improvement in the ablation procedure. I myself am 59 and have afib twice a month lasting on average 24 hours. But the last two episodes I have taken Rythmol on demand, 300mg, and have converted in less than 5 hours.

Sorry, I can't answer your question about U of M. I though would like to know why you did rigorous exercise after your Rythmol? Was this at your EP's suggestion? And if so, what was his reasoning and did he suggest a follow up to the initial dose if you didn't convert within a specified time frame? I would be much appreciative of your answer to this question.

Don R.

Hi Don, and thanks for your response. Helpful to know about the advice to wait that you've been given.

No, my EP did not specifically tell me to exercise at the time of an episode, that was my idea (part of my motivation in going out for a walk was that I was home alone and thought well, if I faint and collapse, someone will notice me out here! lol), but he had told me that I should definitely exercise in general (a previous EP told me I shouldn't), and last week when I was having so many PACs and PVCs, the nurse practitioner told me it was probably a result of high stress (due to death of my mom, 4 wks ago) and that exercise would be a good outlet for that. In fact, I did find over the past week or so that walking or exercising put a stop to the PACs and PVCs, sometimes for the rest of the day. So I decided to try walking to stop the a fib as well.

Regarding the Rhythmol, my EP has told me to try to stop the a fib on my own for the first 10 or 20 minutes, if that doesn't work, take the Rhythmol, just the one dose of 300 mg. If that doesn't work within an hour or two, I'm to call his office. 24 hours is the maximum time I'm to wait staying in a fib before going to ER (obviously hope I never get to that point, given all the experiences with ER I've read about here).

take care,
Margaret

Margaret:

Your stress level has got to be excessively high, what with having just lost your mother. You have my deepest sympathy. I hope that you will wait until your stress level drops before making a decision to have an ablation. It sounds like you get pretty good control with prn Rythmol. I agree with Don R., that big improvements are on the way, and you really need to investigate and weigh risks. Please wait to make your decision.

Best Regards,
Pam

Pam - thanks for your input. This is a very helpful, supportive board, and I appreciate the insights and guidance.

- Margaret

Based on your history and profile, it seems to me that you should be
working on ways to make your episodes more tolerable and waiting
a couple of years until the ablation technology is much better. There
is a lot going on right now that will yield much better techniques in
that time period. It's worth the wait. My episodes are much more
tolerable but I have had probably thirty episodes in the last 10 months
each lasting @ 12 hours. I still will wait unless things get much worse.

Have you tried other meds to slow the heart and make the episodes more
tolerable?

I see an EP at the Medical College of Ohio in Toledo, which is an hour or so from Ann Arbor. My physician, Yousuf Kanjwall, speaks in glowing terms about Fred Morady at U of M, referring to him as the "guru of the heart". When the subject of ablation comes up in my case he feels very confident that I would be in equally good hands with either Dr. Morady or Dr. Natale of the Cleveland Clinic. If your are familiar with www.a-fib.com you know that the University of Michigan is highly regarded when it comes to all things cardiac.

Hi Margaret:

I live in Michigan and I too have heard a lot of good things about Dr. Fred Morady. I don't know where you live in MI but I go to Dr. Michael Lehmann, a EP, he is the head of the electrophysiology lab at the U of M. He has an office in Livonia and is there about 3 times a week. I think he is great, he takes a lot of time with you, answers questions and is a very caring doc.

He has precribed Rythmol on demand for me, you should take it about the first 5 min. into your episode, I take 1 and a 1/2 tabs. (225 mg.), it does the trick for me, I convert in about 3 hrs, I used to be in afib for about 18 hours. I also take a 1/2 tab. of atenolol, that will bring my heart rate down and the episode is very, very tolerable.

Liz

Hi Kerry, Denny & Liz -

Thanks for your responses.

I haven't tried alot of different meds - but actually I forgot to mention that the nurse practitioner recently switched me from atenelol to Toprol XL. Don't know that it's made any difference, though. That's a good idea - to try to make the episodes more tolerable. The worst thing about the episode this week was the racing heart, over 140 bpm. In your experience, should the rate control be resulting in a lower rate than that during an episode?

Helpful to know about the EPs at Univ of Mich, thanks. I live in Ferndale (just north of Detroit), and have just switched from Henry Ford docs to an EP who works out of Beaumont, Royal Oak. T

Liz - Thanks for the info about the Univ of Mich Livonia EP. I may call his office. Do you take the atenelol only at the onset of an episode - or ongoing? Has your EP told you that it's important not to wait longer than 5 minutes before taking the Rhythmol? Sounds like he uses the minimal medication possible (I've been told to take 2 Rhythmol tabs 300 mg to stop the episode).

Thanks for all the input. It's really instructive to know that others are being advised to wait a while on the ablation procedure.

- Margaret

Margaret,

From my limited experience with the on demand approach I didn't find any benefit from taking med within the first few minutes. My experience was just the opposite. The first time I chewed 225 mg of Rythmol and washed it down in warm water and took 90 mg of dilitiazem. Four hours later after not converting I took another 300 mg of Rythmol and finally converted 2 hrs later. I decided I would never chew again because of the awful lingering taste.

This weekend I procrastinated 3 hours trying to see if I would convert on my own by experimenting with some yoga breathing and postures. I eventually gave up and downed 300 mg of Rythmol without chewing and took 30 mg of Dilitiazem. This time even though I waited 3 hrs, I converted 2 1/2 hours after taking the first dose where before I converted in 6hrs after taking 2 doses. Maybe each time will work differently....who knows. One thing is for certain there are no hard and fast rules when it comes to afib and meds. Probably everyone should do a little experimenting on their own.

I have this board to thank for this "on demand" approach and it has been a real blessing because it has reduced the duration of my episodes down from an average of 22 to 24 hours. My EP was not familiar with this approach which is a little disappointing in that he is close with all the gurus around the country. I am on no other meds and have break-throughs about twice a month. I am experimenting with magnesium glycinate and it seems to be extending the times between episodes but really too early to tell as of yet.

You need to do a search on the boards typing in "on demand' to familiarize yourself with other member's experiences.

Margaret:

I have been taking only a 1/4 tab of atenolol since about the first of the year as I have been getting a lot of palps, this helps, I don't always take it every single day however. I also take a 1/2 tab of atenolol at the beginning of a afib episode plus an asprin. Actually Hans Larsen and people on this board talked about the on demand drugs and I discussed it with Dr. Lehmann, he said to start with 1 tab. and see if that would work, it didn't, the next time I took one and a half tabs and that does it.

When I first started into my afib episodes, my heart rate would go a lot higher than it does now, (not as high as some people it would be about 140) my rate now is only 60-80, a lot of people have said that the more years that you suffer from afib, your heart rate doesn't seem to go as high.

My doc said as long as I have mild afib episodes and the on demand is working, he would not recommend an ablation for me at this time.

Liz

Liz H

I am not familiar using only a beta blocker in the "on demand" approach to ending an afib episode. Every thing I have ever read or heard about always contained an anti-arrythmic as the primary dose with a beta blocker as secondary. Beta blockers are for rate control and makes an episode more comfortable and possibly could enhance the efficacy of the Atenolol. Can you elaborate for me?

Don R.

Don:

Whoops, I didn't elaborate in the last post, my other post indicated that I was using rythmol on demand, plus 1/2 tab of atenolol and asprin. Margaret asked me if I used atenolol every day or just on demand also. The atenolol is for rate control, brings my heartrate into a confortable range.

Liz