Afib After 13 Years

Hi Jackie! I thought to get that out first as I couldn’t figure how to send a PM (?) Ablated LAF by Dr. Natale in 2004, about a year after Jackie’s ablation, mine was successful until now. I’ve been in touch occasionally, and peruse posts, but it’s taking arrhythmia to get me back posting.

Now on vacation in AZ,(no tools to measure heart trace) I've been diagnosed with AFib/Aflutter. (after 13 years NSR!) It came to a head after trying to play tennis and getting abnormally exhausted. I had been suspicious when feeling bad but having a regular but slightly elevated pulse rate. I’ve been fairly good in following Jackie’s “strategy” but admit to straying a bit.  Urgent care ECG showed 64 BPM but varied to 75 bpm and 6 days later an EP visit showed clear Aflutter with ventricles beating at 80 bpm constantly. Not sure what all that means but not converting and will send Dr. Natale both copies for advice on what to do on an 81 year old.

Maybe Shannon knows which approach best to receive a reply from Dr Natale==Email or letter? And I’m not sure how keen I’d be to be re-ablated at my age, although I’m in fair shape and light weight. I don’t think I’m ready for rate control so maybe cardioversion/drugs? Meanwhile before going back to CT, it’s Pradaxa and Aflutter.

The best by far, is NSR!
Anton (Tony)

Hello Anton - I've sent you a PM.

Nice to see your name here, but sorry for the reason. Your history is similar to mine. Ablation 2003 lasted for 11 years and then I also began with bouts of flutter. Nasty. I did go for the second ablation in 2014 to Dr. Natale in Austin which isolated the Left Atrial Appendage; followed by #3 in April of 2015. All has been calm since then.

Jackie

Tony,

My non medical opinion is that a rate of 80 doesn't require rate control.

George

Hi George, I agree 80bpm des not require rate control. My atrials are fluttering 4 times as high and regular so it's very tolerable-- until exercise unhinges the pattern. Evidently my refractory period is long enough so those "inbetween" atrial beats don't disturb the ventricle response.

Exercise most uncomfortable and I always worry that the VT might get triggered although there is no reasonable connection between the Afib/flutter and VT. Inexplicably it happened in the past so I wonder...

Thanks, Anton (Tony)

Anton,

The refractoriness is in the AV node between the atria and ventricles. Conduction ratios of 2:1 and 3:1 are common. Perhaps you're more like 4:1, so the ventricular rate is slow. Add some adrenaline to the mix (exercise), and that ratio will lessen but should not go 1:1. You'd be on the floor if that happened.

Wolfpack==yes 4:1 is seen in the last EKG taken; atrials beating at 320 and the AV node responding at 80bpm.

Often called AV block, it didn't make as much sense to me why the AV node would only respond every 4th beat all the time.

I do get more uncomfortable when exercising-- chest tightness included.

Anton,

Were you on an anti-arrhythmic when you had the VT episode?

Hi Tony, sorry you have to reconnect with us all due to a revisit from the beast again ... Please send me your cell number and your time zone now by PM above, or via my editor@afibbers.org email address. I assume you are still in AZ, as I am, but please confirm and will call you as soon as I can in the next couple days.

The next two days Magdalena and I are in Phoenix/Scottsdale in hopes we can get her SI joint chronic pain which over the last 4 years has gotten progressiving more intrusive, finally taken care of with an autologous stem-cell plus PRP ( platelet-rich plasma) combined therapy with an expert in this area. But I should be able to contact you, if not while on the road at some point the next couple days, then by Wednesday.

I know just what is going on here as we are seeing a fair number of folks just like you and Jackie, who even after a spectacular early success with a top level PVAI plus posterior wall isolation ablation by the maestro Dr Natale some 10 or more years ago with no breakthroughs at all for over a decade, or at least very few over all these years, and now suddenly are having what is mostly a flutter recurrence and at times with some AFIB in the mix.

Dr Natale is currently enrolling all such folks who have had the great good fortune of over a decade of silence from AFIB due to a single ablation who are now experiencing a very late recurrence of arrhythmia some 10 + years later, into a study St David's Med Center in Austin and CPMC Med Center in San Fran (Dr Natale's two prime centers he does ablation at) to help answer the question "whether or not most all of the very early success cases who never required any additional follow-up/touch-up ablations in more recent years, are likely to require such a follow up ablation again to regain long term freedom from this mostly flutter/tachycardia recurrence?

It may be that those who are recurring late have a genetic predisposition for the underlying substrate to eventually and very much more slowly that if they never had an ablation all those years ago ... to progress to the Left Atrial Appendage (LAA) and or Coronary Sinus (CS) areas at long last which are areas that were typically never addressed prior to around 8 to 9 years ago at the earliest. Dr Natale pioneered detection and ablation of these frontier areas of the ablation landscape in the let and right atria, but back during your first ablation no one on the planet had yet discovered this vital connection to these key arrhythmo-genic structures.

Those who have had more recent ablations in which Dr Natale did have to address the CS and/or LAA and who are now solidly in NSR, are not at all likely to experience any more such very late recurrences since all the main areas, including the more frontier and distal CS and LAA as the last two structures prone to trigger and sustain an atrial arrhythmia, have already been ablated and addressed.

In any event, Tony, we can talk about your particulars soon and can help get you sorted out with all this so you can get back to enjoying tennis and the good life again with out 'the beast' poking its head into the works once again.

Cheers!
Shannon

MDep
Sorry to miss your question but no I wasn't on antiarrythmics when VT supprised me. I had been on them and "failed".

I was just curious. I had an exciting VTac episode that was attributed to a recent Flecainide dosage increase, after having been on it for several months. I guess that's one way it fails.

I'm sorry you're back on the board, hope you get back to NSR soon somehow. I see the good Dr. Natale next month for the first time.
Thanks for answering!

Steady pulse but in AFIB. I've read somewhere a prominent EP questioning if ablation really is a cure or does it merely reduce or control symptoms.

I had my 2nd touch up 4 years ago and generally I'm fine. But every now and again (most weeks) I have days of numerous ectopics and that feeling that something isn't right including a tight chest but my pulse is steady. Regular check ups with my cardiologist confirm I am healthy otherwise.

Hopefully Anton you are in a temporary atrial storm phase that will pass.