Long story.. advice would be greatly appreciated April 11, 2018 01:58PM |
Registered: 6 years ago Posts: 49 |
Re: Long story.. advice would be greatly appreciated April 11, 2018 03:12PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 06:37PM |
Registered: 6 years ago Posts: 49 |
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kong2018
Hi Billy, sorry to heart your struggle. So you got your first afib at age 37...I got mine at 36 when having multiple stressful events and anxiety. Through your post I can kind of seeing my not so bright future. I’m sure someone is going to advise you to get an ablation with Dr Natale. But well, you’ll need to get proper insurance first...
I jut wanted to know how was your quality of life in the past 17 years. I know you had put in some history in above.
Good luck!
Re: Long story.. advice would be greatly appreciated April 11, 2018 06:39PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 08:19PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 08:47PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 09:13PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 09:45PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 11:12PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 11:52PM |
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Re: Long story.. advice would be greatly appreciated April 11, 2018 11:53PM |
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Re: Long story.. advice would be greatly appreciated April 12, 2018 07:17AM |
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Re: Long story.. advice would be greatly appreciated April 12, 2018 09:09AM |
Registered: 11 years ago Posts: 615 |
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wolfpack
AV node is the atrio-ventricular node. It is the “gate” between the heart’s atria (upper chambers) and ventricles (lower chambers). It is responsible for passing the electrical activity in the atria down to the ventricles. In Afib, it will often reject every other pulse from the atria (something called 2:1 conduction), which is why our atria may fibrillate at something like 300 beats per minute, but our ventricles only respond at 150 bpm. It’s not fun, but it does keep us alive.
If the AV node is ablated, that permanently breaks the connection between the sinus (SA) node in the right atrium and the ventricles. At that point, your heart would only have the ability to beat autonomously at the rate of ventricular repolarization, which is something like 20 to 30 beats per minute. That is insufficient to pump enough oxygenated blood through the body and would be fatal in just a few minutes. Hence the need for a pacemaker to replace the “broken wire” between the SA node and the ventricles. Your atria will fibrillate uncontrollably, but the pulses will have no way to get to the ventricles, which will only respond to the pacemaker. The beat may feel more regular, but some cardiac insufficiency will remain due to the lack of atrial “kick” priming the ventricles and you will be on anticoagulation therapy for life to prevent clots from forming in the atria since at that point all attempts at atrial rhythm control have been forever abandoned.
Sinus (SA) node ablation is something I’ve never heard of. While it may be performed in some exceedingly rare cases of something called “sick sinus syndrome” it certainly has no bearing on AF management.
Re: Long story.. advice would be greatly appreciated April 12, 2018 10:38AM |
Admin Registered: 6 years ago Posts: 5,337 |
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mwcf
So far as I'm aware in the absence of anything from the atria the junctional rhythm from the AV node to the ventricles is around 40-60 BPM which just about keeps things going, so when you refer to 20-30 BPM do you mean that once the AV node has been ablated there is no more junctional rhythm with it just being the ventricles that kind of just chug along on their own without anything from the now-ablated AV node? This is one aspect of it all I remain a little unsure about.
Re: Long story.. advice would be greatly appreciated April 12, 2018 11:55AM |
Registered: 11 years ago Posts: 615 |
Re: Long story.. advice would be greatly appreciated April 12, 2018 04:36PM |
Registered: 6 years ago Posts: 49 |
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The Anti-Fib
I don't know how your complicating Health issues relates to your AFIB, but in general, Yes trying a Calcium Channel Blocker would make sense. It should help lower your BP. Also makes sense to try Flecainide, although I would recommend that you start out slow with a low dose, and titrate up. Still good options like this to explore. Many of us have used Cardizem and Flecainide successfully.
Re: Long story.. advice would be greatly appreciated April 12, 2018 04:47PM |
Registered: 6 years ago Posts: 49 |
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Joe
Commiserations Billy!
I'd try to establish what causes your high BP. Is is ischemia, reaction to food or environmental or perhaps a combination. Also crohn's disease needs to be dealt with at the same time.
Seems to me that both would/should respond to some, perhaps radical, changes to diet?
20 or so years ago i had high BP (about 170/180 over ???) and it turned out that my habit of using thymol as a mouth wash was the cause. Stopped using it and BP went down to normal range.
Re: Long story.. advice would be greatly appreciated April 12, 2018 04:55PM |
Registered: 6 years ago Posts: 49 |
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wolfpack
First off, you need a new EP. You do not want, repeat do NOT want, an AV node ablation and pacemaker. That is an irreversible process and every second of your life will depend on a machine in your chest.
It certainly sounds like you could benefit from a more experienced EP such as Dr Natale. Health insurance will be an issue. You can always go “fee for service” but it won’t be cheap. Others can perhaps give a ballpark number.
My number one advice for now is don’t do something that is permanent. That eliminates options in the future.
Re: Long story.. advice would be greatly appreciated April 12, 2018 05:15PM |
Registered: 6 years ago Posts: 49 |
The dept of health would pay for another ablation as I was offered on by my current Dr. It is still offered but I don't want him to do it because hes already done 2 and I've had no improvement at all. I would have no confidence with him doing another.Quote
Elizabeth
Billy:
Would the Florida dept. of Health pay for another ablation? There is a Hospital in Florida that is part of the Cleveland Clinic, a few people have gone there for their ablations and did well. Dr. Natale, who is in Texas now and a famous doctor once was with the Cleveland Clinic in Ohio.
Cleveland Clinic Florida | Highest Ranked Hospital in ...
[my.clevelandclinic.org]
Find out more about Cleveland Clinic Florida's medical center. Home to over 240 of the world’s top physicians and specialists representing 40 specialties.
Your doctor mentioned you might need a pacemaker, just a pacemaker without a node ablation (you don't want that, I have a pacemaker I got it because when I was in AF and going back into NSR I would almost black out, my heartrate would almost flatline. The pacer stops that from happening, but for gosh sakes don't let them ablate your AV node. You could have a heart block and beta blockers make it worse unless you have a pacer.
Liz
Re: Long story.. advice would be greatly appreciated April 12, 2018 05:17PM |
Registered: 6 years ago Posts: 49 |
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Elizabeth
wolf:
I didn't mean to call it a snus node ablation, it is a AV node ablation, but I said and I strongly said DO NOT ABLATE THE NODE. His doctor mentioned a pacer and the node ablation/pacer, two options, Bill said he almost passed out a few times, he may have a heart block, that may be why his doctor mentioned a pacer, that is set at anywhere from 50 to 60 (heartrate) so if his heartrate falls below 50 the pacer kicks in.
Liz
Re: Long story.. advice would be greatly appreciated April 12, 2018 05:23PM |
Registered: 6 years ago Posts: 49 |
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DavidK
Billy, I hope you find a solution. As you no doubt can tell, Natale is highly regarded on this forum and of the best, if not truly the best, EPs on the planet.
If you are looking into an ablation with him, here are the details on the three locations where he works in the US and the fees for the preliminary consultation with him if paying cash: Natale insurance, location and availability
FYI, the receptionist at Natale's San Diego office recommended getting a PPO-type plan if shopping for insurance for an ablation procedure there.
Re: Long story.. advice would be greatly appreciated April 12, 2018 05:35PM |
Registered: 6 years ago Posts: 49 |
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tiggwigg
Sorry to hear of your problems.
Your research would have revealed that the three key triggers associated with AF are weight, high BP and sleep apneoa.
A question is whether you have all three of those under control?
I am 63 and have had AF for over 20 years. I have had four Catheter Ablations, the most recent only two months ago was unsuccessful. Now I am scheduled for a Cox IV Maze next week.
Cox IV Maze may not be appropriate for your condition, but it is something you should look into...there are a number of variants such as the Wolf Minimaze: minimally invasive or fully endoscopic. All involve Bipolar radio-frequency devices and cryo are used to burn through the entire thickness of both atrium walls, in a pattern which blocks off the Pulmonary Veins and completely fences of atrial walls that are the source of electrical activity. Surgical access to the heart: and some variants create the lesions using Atricure RF clamp only from outside the atrium.
Cox IV involves surgical access to the heart, then incisions in the atrium through which the RF and Cryo ablation tools are inserted to create lesions...this scar tissue is electrical inert. Cox IV lesions are continuous, go through the entire atrium wall and completely enclose and isolate the main electrically active problem areas, it is expected that the electrical isolation will be complete and that AF will be fully controlled.
The procedure also involves removal or clamping of the Left Atrial Appendage, which is a small sac on the left atrium which is the source of 95% of clots in AF sufferers, and the source of our main risk of stroke...so it is the main reason we take anti-coagulants. My LAA will be removed, which will mean that in the course of my recovery I will go off anti-coagulants for good.
Cox IV is the gold standard for ablation, with a success rate of over 90% across its population, around 10% of whom continue to require some Anti Arrhythmic Drugs. That population includes patients whose procedure combines valve replacement or coronary artery bypass, for whom the success rate is reduced. After 5 years, studies show over 80% remain AF free.
Re: Long story.. advice would be greatly appreciated April 12, 2018 07:09PM |
Registered: 11 years ago Posts: 4,222 |
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Elizabeth
Billy:
Would the Florida dept. of Health pay for another ablation? There is a Hospital in Florida that is part of the Cleveland Clinic, a few people have gone there for their ablations and did well. Dr. Natale, who is in Texas now and a famous doctor once was with the Cleveland Clinic in Ohio.
Cleveland Clinic Florida | Highest Ranked Hospital in ...
[my.clevelandclinic.org]
Find out more about Cleveland Clinic Florida's medical center. Home to over 240 of the world’s top physicians and specialists representing 40 specialties.
Your doctor mentioned you might need a pacemaker, just a pacemaker without a node ablation (you don't want that, I have a pacemaker I got it because when I was in AF and going back into NSR I would almost black out, my heartrate would almost flatline. The pacer stops that from happening, but for gosh sakes don't let them ablate your AV node. You could have a heart block and beta blockers make it worse unless you have a pacer.
Liz
Re: Long story.. advice would be greatly appreciated April 12, 2018 08:43PM |
Registered: 8 years ago Posts: 1,102 |
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What is a "heart block"? I just had an echo a few weeks ago and I was in NSR and they said everything was fine.
Re: Long story.. advice would be greatly appreciated April 12, 2018 09:34PM |
Admin Registered: 6 years ago Posts: 5,337 |
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Billyjeans
Your research would have revealed that the three key triggers associated with AF are weight, high BP and sleep apneoa.
Re: Long story.. advice would be greatly appreciated April 12, 2018 09:59PM |
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Re: Long story.. advice would be greatly appreciated April 13, 2018 04:25PM |
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Re: Long story.. advice would be greatly appreciated April 13, 2018 06:14PM |
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Re: Long story.. advice would be greatly appreciated April 14, 2018 11:57AM |
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Re: Long story.. advice would be greatly appreciated April 14, 2018 08:10PM |
Registered: 6 years ago Posts: 49 |
Have you ever heard of anyone trying the supplement GABA? I just recently found this and thought it was curious.Quote
Jackie
Hi Mike - The MSG is not only the sodium issue, but also has the excitotoxic effect from the glutamate component. Together, they undoubtedly spell double-trouble for afibbers.... especially those who may be low in potassium, magnesium or both.
Glutamate can certainly stimulate arrhythmia. Remember Fran Ross and her story about the glutamate content as a result of long cooking times of meat and how she eliminated her AF by significantly reducing the cooking time and thus, the free glutamate content. So, makes sense if one consumes packaged, processed foods that have taste enhancers added such as MSG.. and of course, a lot of extra salt for taste appeal, those prone to AF are easy prey. Today, the increasing popularity of bone broth should be a concern for those who tend to be sensitive to free glutamate as well.
Soon I'll be posting a reminder about the role of taurine that's especially helpful for irritation to heart nerves from exposure to the excitotoxic damage of glutamate. Hope to finalize it this weekend.
Jackie
Re: Long story.. advice would be greatly appreciated April 14, 2018 09:34PM |
Registered: 8 years ago Posts: 1,102 |
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Billyjeans
Have you ever heard of anyone trying the supplement GABA? I just recently found this and thought it was curious.
[examine.com]
Re: Long story.. advice would be greatly appreciated April 15, 2018 04:11AM |
Registered: 11 years ago Posts: 615 |
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Jackie
Hi Mike - The MSG is not only the sodium issue, but also has the excitotoxic effect from the glutamate component. Together, they undoubtedly spell double-trouble for afibbers.... especially those who may be low in potassium, magnesium or both.
Glutamate can certainly stimulate arrhythmia. Remember Fran Ross and her story about the glutamate content as a result of long cooking times of meat and how she eliminated her AF by significantly reducing the cooking time and thus, the free glutamate content. So, makes sense if one consumes packaged, processed foods that have taste enhancers added such as MSG.. and of course, a lot of extra salt for taste appeal, those prone to AF are easy prey. Today, the increasing popularity of bone broth should be a concern for those who tend to be sensitive to free glutamate as well.
Soon I'll be posting a reminder about the role of taurine that's especially helpful for irritation to heart nerves from exposure to the excitotoxic damage of glutamate. Hope to finalize it this weekend.
Jackie