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A-fib or not ?
Posted by Pompon
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A-fib or not ? July 28, 2018 08:36AM |
Registered: 6 years ago Posts: 920 |
Hi,
Since my last ablation procedure (touch-up, end of March), it seems I'm mostly a-fib free, but I've sevral kinds of ectopics from time to time, especially at rest and soon after meal. I'd say there's no a-fib, even if sometimes it feels like a-fib, as I can see some P waves here and there in the 30 sec. tracings I've recorded.
Here are some recent tracings about which I'd like having your comments.
16A : I'd say it's SV-tach, with some attempts to go back to SR. There are some strange beats in the 3rd line. Other ectopics? Flecainide-induced effects? (I was still taking flec back then).
24A & 24B : SV-tach again, back to SR and ectopics. There are strange oscillations (24B, line 2) : artifacts?
27A to 27E : Those tracings are from July27, 15-20min after my midday meal. I was sitting at my desk and this chaos suddenly began. Happily, it was of short duration. The rhythmic sensation was often that of a-fib, but without the usual other effects linked with a-fib (low BP, weakness, dizziness, need to urinate...). So, surely several runs of SV-tach, various ectopics and maybe other things I'm too ignorant to identify... Any opinions?
Thanks for your answers and enlightenments.
(Edit: wrong link rectified)
Edited 1 time(s). Last edit at 07/28/2018 12:13PM by Pompon.
Since my last ablation procedure (touch-up, end of March), it seems I'm mostly a-fib free, but I've sevral kinds of ectopics from time to time, especially at rest and soon after meal. I'd say there's no a-fib, even if sometimes it feels like a-fib, as I can see some P waves here and there in the 30 sec. tracings I've recorded.
Here are some recent tracings about which I'd like having your comments.
16A : I'd say it's SV-tach, with some attempts to go back to SR. There are some strange beats in the 3rd line. Other ectopics? Flecainide-induced effects? (I was still taking flec back then).
24A & 24B : SV-tach again, back to SR and ectopics. There are strange oscillations (24B, line 2) : artifacts?
27A to 27E : Those tracings are from July27, 15-20min after my midday meal. I was sitting at my desk and this chaos suddenly began. Happily, it was of short duration. The rhythmic sensation was often that of a-fib, but without the usual other effects linked with a-fib (low BP, weakness, dizziness, need to urinate...). So, surely several runs of SV-tach, various ectopics and maybe other things I'm too ignorant to identify... Any opinions?
Thanks for your answers and enlightenments.
(Edit: wrong link rectified)
Edited 1 time(s). Last edit at 07/28/2018 12:13PM by Pompon.
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Re: A-fib or not ? July 28, 2018 11:27AM |
Admin Registered: 6 years ago Posts: 5,336 |
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Re: A-fib or not ? July 28, 2018 02:26PM |
Registered: 6 years ago Posts: 920 |
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Re: A-fib or not ? July 28, 2018 03:47PM |
Registered: 9 years ago Posts: 1,085 |
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Re: A-fib or not ? July 28, 2018 04:13PM |
Registered: 11 years ago Posts: 4,222 |
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Re: A-fib or not ? July 28, 2018 07:11PM |
Admin Registered: 6 years ago Posts: 5,336 |
Quote
Pompon
Carey, would you tell me in which tracings you see afib and flutter ? Is it atypical flutter (LA)?
I see afib and flutter in most of them. You seem to waver between the two, which isn't all that unusual. You would need a 12-lead to distinguish between left and right flutter, and even EPs can't always tell the difference with certainty until they get you in the lab.
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Re: A-fib or not ? July 29, 2018 12:03AM |
Registered: 5 years ago Posts: 129 |
I find reading these is really confusing. I bought an Emay monitor and am disappointed that it tells my I am having arrythmia, (no shit Sherlock, a can use my finger on my neck to tell that), but not whether it is AFib. I *thought* that when I was irregular and the base line got squiggly that was AFib.... That made sense until I let 'normal' people try my device (fun party game lol)... And it turns out they are often squiggly too.... But in rhythm. So now I'm confused about how to recognize AFib.
Any tips?
Any tips?
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Re: A-fib or not ? July 29, 2018 01:11AM |
Admin Registered: 6 years ago Posts: 5,336 |
Sure. It's easy and you already know how because you just told us how.
Afib is irregular. Normal sinus rhythm is regular, flutter is regular, atrial tach is regular, SVT is regular. It really is that simple. Anything that's regular isn't afib, and if it's irregular it's almost certainly afib since you already know you have it.
Afib is irregular. Normal sinus rhythm is regular, flutter is regular, atrial tach is regular, SVT is regular. It really is that simple. Anything that's regular isn't afib, and if it's irregular it's almost certainly afib since you already know you have it.
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Re: A-fib or not ? July 29, 2018 01:54AM |
Registered: 5 years ago Posts: 129 |
Quote
Carey
Sure. It's easy and you already know how because you just told us how.
Afib is irregular. Normal sinus rhythm is regular, flutter is regular, atrial tach is regular, SVT is regular. It really is that simple. Anything that's regular isn't afib, and if it's irregular it's almost certainly afib since you already know you have it.
Except that when I had my 48 hr monitor I had PACs 16% of the time, and AFib only 0.03% of the time, so it seems I have other arrythmia way more than AFib. I'm still waiting on the results of my 30 day monitor to see if that is more universally true.
I have lots of times where my arrythmia seems sort of patterned, 3 or 4 rhythmic peaks and a pause, repeated a few times, I also see a lof of what I think are p waves, but I'm still irregular.
My monitor probably says arrhythmia about 4 out of 5 times I randomly check. I've been doing 30 second scans but I bet if I only did 10 seconds I would read normal most of the time. For this reason I'm surprised the cardiologist only did a 10 sec ecg. That doesn't seem long enough
I'll have to look through data and dig up and example or two when I have more time.
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Re: A-fib or not ? July 29, 2018 03:10AM |
Registered: 6 years ago Posts: 920 |
Thanks for your answers.
It seems i'm trying to convince myself I'm nearer from this...
... than from this:
The fact is I've still afib. It's now unsustained, but it's still afib.
As Bolimasa explained, afib is only a small part of our arrhythmias.
I don't know what to do now. AA drugs are ineffective, I've recently stopped them, and it's the same except I'm feeling a little better when exercising. I've short runs of afib, SV-tach or premature contractions, but I always go back to NSR spontaneously.
I could live with that, but I'm afraid things might go worse in the future; and I know that the more I wait, the more my afib may be hard to ablate.
Both my cardiologist and the 1st EP I met say I'm a quite complicated case. The EP who made my recent touch-up ablation said the chances of success of a new procedure are limited.
It seems i'm trying to convince myself I'm nearer from this...
... than from this:
The fact is I've still afib. It's now unsustained, but it's still afib.
As Bolimasa explained, afib is only a small part of our arrhythmias.
I don't know what to do now. AA drugs are ineffective, I've recently stopped them, and it's the same except I'm feeling a little better when exercising. I've short runs of afib, SV-tach or premature contractions, but I always go back to NSR spontaneously.
I could live with that, but I'm afraid things might go worse in the future; and I know that the more I wait, the more my afib may be hard to ablate.
Both my cardiologist and the 1st EP I met say I'm a quite complicated case. The EP who made my recent touch-up ablation said the chances of success of a new procedure are limited.
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Re: A-fib or not ? July 29, 2018 03:56AM |
Registered: 9 years ago Posts: 1,085 |
Quote
bolimasa
Sure. It's easy and you already know how because you just told us how.
Afib is irregular. Normal sinus rhythm is regular, flutter is regular, atrial tach is regular, SVT is regular. It really is that simple. Anything that's regular isn't afib, and if it's irregular it's almost certainly afib since you already know you have it.
Except that when I had my 48 hr monitor I had PACs 16% of the time, and AFib only 0.03% of the time, so it seems I have other arrythmia way more than AFib. I'm still waiting on the results of my 30 day monitor to see if that is more universally true.
I have lots of times where my arrythmia seems sort of patterned, 3 or 4 rhythmic peaks and a pause, repeated a few times, I also see a lof of what I think are p waves, but I'm still irregular.
My monitor probably says arrhythmia about 4 out of 5 times I randomly check. I've been doing 30 second scans but I bet if I only did 10 seconds I would read normal most of the time. For this reason I'm surprised the cardiologist only did a 10 sec ecg. That doesn't seem long enough
I'll have to look through data and dig up and example or two when I have more time.
The best way is to monitor your Heart Rate. When in AFIB, your HR will fluctuate quite a bit. The easiest way to see this is to use a Pulse Oxymeter. In AFIB, the rate will jump around. For example, when I am looking at my Oxymeter when I am in AFIB, I get readings like 70 for 5 seconds, then 92, then 84, then 108, then 73. But if I contrast this to when I am just having heavy Ectopy, my rate will still be relatively stable, holding at about 70-74.
The other way to tell without a fancy machine, but it is harder, is to Pulse check and feel for Pulse strength variation.
When in heavy Ectopy, the Heartbeats that are not preceded by a PAC, should have relatively the same Pulse strength.
But in AFIB, since the Ventricles are firing randomly, the Beat strength will fluctuate. Stroke Volume will vary, as the corresponding levels of Blood getting into the Ventricles will vary before contraction.
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Re: A-fib or not ? July 29, 2018 09:51AM |
Registered: 6 years ago Posts: 197 |
Like you said its only going to get worse...but thats no dif. then the rest of us with this condition.
Well to me the answer to this Q. is as the old saying goes x2 DUCK SOUP aka THIS IS A JOB FOR SUUUUUUPERMAAAAAN.
The good doctor in austin was made for cases like yours.....as experts tell athletes sometime in the heat of the battle......don't think so much......just react.
Start to make that process happen with the help of shannon and just relax....prob. just that alone will help those waves calm down.
Well to me the answer to this Q. is as the old saying goes x2 DUCK SOUP aka THIS IS A JOB FOR SUUUUUUPERMAAAAAN.
The good doctor in austin was made for cases like yours.....as experts tell athletes sometime in the heat of the battle......don't think so much......just react.
Start to make that process happen with the help of shannon and just relax....prob. just that alone will help those waves calm down.
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Re: A-fib or not ? July 29, 2018 12:20PM |
Admin Registered: 6 years ago Posts: 5,336 |
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Re: A-fib or not ? July 29, 2018 12:44PM |
Registered: 5 years ago Posts: 129 |
I feel like it's hard to tell other arrhythmia from Afib, and of course what I want to know is when I am in Afib Here are 2 examples of times my monitor says arrythmia, but I'm not sure it is afib.
Any advice on interpretion?
This is one where I do think I see Afib:
Edited 1 time(s). Last edit at 07/29/2018 02:34PM by bolimasa.
Any advice on interpretion?
This is one where I do think I see Afib:
Edited 1 time(s). Last edit at 07/29/2018 02:34PM by bolimasa.
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Re: A-fib or not ? July 29, 2018 01:31PM |
Registered: 6 years ago Posts: 920 |
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Re: A-fib or not ? July 29, 2018 01:42PM |
Registered: 6 years ago Posts: 920 |
Quote
Carey
The EP who made my recent touch-up ablation said the chances of success of a new procedure are limited.
His chances of success are limited.
Yeah. Maybe.
And maybe should I take a chance going to Bordeaux. It's somewhat complex for me because here in Belgium we have an official health insurance we're paying for. Health care is then nearly free as long as we stay in the system. Having a procedure in another EU country may be covered by our health insurance, but it's not simple.
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Re: A-fib or not ? July 29, 2018 02:03PM |
Registered: 6 years ago Posts: 444 |
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Re: A-fib or not ? July 29, 2018 02:11PM |
Registered: 5 years ago Posts: 129 |
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Pompon
I'm no expert but I'd say the 1st example is NSR with PACs.
The second is more confused. I see some P waves, it looks like normal beats with successive PACs. Some of my own tracings look like this: more ectopics than normal beats. I don't know if they may be called unsustained afib.
Yeah I'm pretty confused... I bought the monitor to try to figure out if I can tell when I am in afib.... but since the monitor doesn't tell me when I'm in afib and my scans confuse me I'm not having much luck.
It seems to me like most of my 30 second scans are some other arrhythmia... sometimes with a beat or 2 or 3 that I *think* looks like it might be afib. I also get boughts of arrhythmia that seem regular like this one:
I suppose maybe it doesn't **really** matter as it all means I'm screwed up. But since I need to decide if I should do the ablation I feel compelled to figure out what my real problem is. Perhaps I'm over thinking it all... I dunno... Of course if ablation fixes all these other problems that would be good too... Mostly I want a shot at getting off blood thinners.
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Re: A-fib or not ? July 29, 2018 02:31PM |
Registered: 6 years ago Posts: 444 |
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bolimasa
. Perhaps I'm over thinking it all... I dunno... Of course if ablation fixes all these other problems that would be good too... Mostly I want a shot at getting off blood thinners.
Well, find someone who can get you back in rhythm, and get on their waiting list. That should give you about three months while you figure it out.
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Re: A-fib or not ? July 29, 2018 03:04PM |
Registered: 5 years ago Posts: 129 |
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jpeters
. Perhaps I'm over thinking it all... I dunno... Of course if ablation fixes all these other problems that would be good too... Mostly I want a shot at getting off blood thinners.
Well, find someone who can get you back in rhythm, and get on their waiting list. That should give you about three months while you figure it out.
That's another thing I'm confused about...By back in rhythm do you mean by some other means than ablation? Or do you mean go ahead with the ablation?
I've only seen my cardiologist twice and spoken to various PA's. His suggestion is ablation.. but he's an ablation guy. Nobody seems terribly concerned about my otherwise being out of rhythm... just about the the afib (which seems sporadic) and a bit of concern about tachycardia (during my 30 day monitor) but I'm fairly certain the latter is just when I'm climbing the 100 stairs to my lab or hiking uphill so I'm not terribly worried about that.... they did order a stress echocardiogram... and other than having some afib during it I was normal.
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Re: A-fib or not ? July 29, 2018 03:25PM |
Registered: 6 years ago Posts: 444 |
Quote
bolimasa
. His suggestion is ablation.. but he's an ablation guy. Nobody seems terribly concerned about my otherwise being out of rhythm...
Well, if you find the afib is causing problems for you heart (which is typical) and it's progressing (which is typical), you have a window of opportunity for getting rid of it. So it's meds or ablation. If ablation, you'll need someone top notch. At this point, ablation has become quite refined. I had one with Richard Hongo in San Francisco about a week ago, and was back to normal activities within about three days..no ectopics, groin pain, or anything. And mine was a complex case of persistent afib. I had it done because afib was wrecking my heart (although I didn't feel any symptoms).
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Re: A-fib or not ? July 29, 2018 03:45PM |
Registered: 5 years ago Posts: 129 |
Quote
jpeters
. His suggestion is ablation.. but he's an ablation guy. Nobody seems terribly concerned about my otherwise being out of rhythm...
Well, if you find the afib is causing problems for you heart (which is typical) and it's progressing (which is typical), you have a window of opportunity for getting rid of it. So it's meds or ablation. If ablation, you'll need someone top notch. At this point, ablation has become quite refined. I had one with Richard Hongo in San Francisco about a week ago, and was back to normal activities within about three days..no ectopics, groin pain, or anything. And mine was a complex case of persistent afib. I had it done because afib was wrecking my heart (although I didn't feel any symptoms).
That is what my doc says ....that I should be back to normal in about 3 days... he says I have about at least an 80% percent chance of success (he said he never promises 100 %) He seems to think I'm a good candidate for success because the afib is paroxysmal, my echo and MRI are normal, and my Utah score low (6% fibrosis) ... I guess the conventional wisdom is that things will only get worse and it will be easier to fix now. It's just a little hard to want to sign up for a scary procedure when you don't really feel bad.... my worst symptom at this point is stress from worrying about the problem.
But curious... what do you mean by Afib wrecking your heart?
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Re: A-fib or not ? July 29, 2018 04:55PM |
Registered: 6 years ago Posts: 197 |
Quote
Pompon
The EP who made my recent touch-up ablation said the chances of success of a new procedure are limited.
His chances of success are limited.
Yeah. Maybe.
And maybe should I take a chance going to Bordeaux. It's somewhat complex for me because here in Belgium we have an official health insurance we're paying for. Health care is then nearly free as long as we stay in the system. Having a procedure in another EU country may be covered by our health insurance, but it's not simple.
I am in the same boat as you...i am canadian with a 2nd procedure free up here also but no thanks...i am willing to pay more than 50k cnd to get this 2nd one done correct in austin and my case is pretty str. forward. If i had your case i would do 1 of 2 thinks...work out the best deal with your belgium ins. company for a trip to bordeaux and if you have to foot the bill yourself....foot it.....its 1 heart 1 life...can never spend money better than on your health or just wait....you appear not to be suffering anywhere near the debilitating effects as most so just wait it out a few years when the ablation tech. will evolve and get better and then do it but by that time in all likelyhood you will be worse or much worse....i am currently feeling near perfect like you doing some dif. things the last few months but i know that this is only slowing the inevitable so i am going to austin even if i don't get an ARR. between now and dec......i want to live to 100 and much more maybe and i know i will not be doing that with this monster incubating inside of me with the opposite of the old rolling stones song that Trump plays at all his rallies..."time is on my side". Well its not so i say strike when the iron is hot (strong and fit instead of a few years from now when its weak and soft).
Edited 1 time(s). Last edit at 07/29/2018 05:01PM by vanlith.
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Re: A-fib or not ? July 29, 2018 04:59PM |
Registered: 9 years ago Posts: 1,085 |
Quote
bolimasa
I'm no expert but I'd say the 1st example is NSR with PACs.
The second is more confused. I see some P waves, it looks like normal beats with successive PACs. Some of my own tracings look like this: more ectopics than normal beats. I don't know if they may be called unsustained afib.
Yeah I'm pretty confused... I bought the monitor to try to figure out if I can tell when I am in afib.... but since the monitor doesn't tell me when I'm in afib and my scans confuse me I'm not having much luck.
It seems to me like most of my 30 second scans are some other arrhythmia... sometimes with a beat or 2 or 3 that I *think* looks like it might be afib. I also get boughts of arrhythmia that seem regular like this one:
[s22.postimg.cc]
I suppose maybe it doesn't **really** matter as it all means I'm screwed up. But since I need to decide if I should do the ablation I feel compelled to figure out what my real problem is. Perhaps I'm over thinking it all... I dunno... Of course if ablation fixes all these other problems that would be good too... Mostly I want a shot at getting off blood thinners.
On this last graph, based of the distinct irregularity of the QRS Complex, that looks like AFIB to me.
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Re: A-fib or not ? July 29, 2018 05:57PM |
Admin Registered: 6 years ago Posts: 5,336 |
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Re: A-fib or not ? July 29, 2018 06:46PM |
Registered: 5 years ago Posts: 129 |
Quote
Carey
It seems to me like most of my 30 second scans are some other arrhythmia... sometimes with a beat or 2 or 3 that I *think* looks like it might be afib. I also get boughts of arrhythmia that seem regular like this one:
That's not regular at all. That's definitely afib.
This is where I am confused... as I see a pattern there.... 4 regularly spaced beats followed by a gap, beat, gap then 4 beats again... repeat... I guess I thought that was regularly irregular, not irregularly irregular. I also see lots of P waves thought they are more apparent in slow beats,less apparent in the the series of 4 fast beats... Does that mean the slow beats aren't afib but the fast beats are? Does afib sometimes follow a pattern?
Thanks for your patience in helping me try to sort these things out,... I'm pretty new to all this!
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Re: A-fib or not ? July 29, 2018 06:48PM |
Registered: 6 years ago Posts: 444 |
Quote
bolimasa
But curious... what do you mean by Afib wrecking your heart?
The heart remaps and the pumping ability of the ventricals weakens, heart chambers get bloated, etc, etc.
You want to catch it before you need to isolate the LAA, or you're looking at either a Watchman or thinners for life.
My afib had an interesting rhythm also, but it's still afib.
Edited 1 time(s). Last edit at 07/29/2018 06:54PM by jpeters.
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Re: A-fib or not ? July 29, 2018 06:56PM |
Registered: 5 years ago Posts: 129 |
Quote
jpeters
But curious... what do you mean by Afib wrecking your heart?
The heart remaps and the pumping ability of the ventricals weakens, heart chambers get bloated, etc, etc.
You want to catch it before you need to isolate the LAA, or you're looking at either a Watchman or thinners for life.
So it would be prudent for me to go ahead and try to get fixed now while all my other heart tests are so good?
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Re: A-fib or not ? July 29, 2018 07:13PM |
Registered: 6 years ago Posts: 444 |
Quote
bolimasa
So it would be prudent for me to go ahead and try to get fixed now while all my other heart tests are so good?
I can tell you're a wise man
I kept pros/cons lists for the entire waiting period, but there was no doubt. It's very easy to convince yourself to wait when you're not having symptoms.
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Re: A-fib or not ? July 29, 2018 07:14PM |
Registered: 11 years ago Posts: 4,222 |
Quote
bolimasa
It seems to me like most of my 30 second scans are some other arrhythmia... sometimes with a beat or 2 or 3 that I *think* looks like it might be afib. I also get boughts of arrhythmia that seem regular like this one:
That's not regular at all. That's definitely afib.
This is where I am confused... as I see a pattern there.... 4 regularly spaced beats followed by a gap, beat, gap then 4 beats again... repeat... I guess I thought that was regularly irregular, not irregularly irregular. I also see lots of P waves thought they are more apparent in slow beats,less apparent in the the series of 4 fast beats... Does that mean the slow beats aren't afib but the fast beats are? Does afib sometimes follow a pattern?
Thanks for your patience in helping me try to sort these things out,... I'm pretty new to all this!
Are you, can you get more of a Type II presentation by holding the left electrode on your left leg, either hip or knee? This will make the p wave stand out better. The X - time scale will make a difference. So a sample of a few beats less than a minute will look different than a 20 or 30 minute window in these samples.
As to the pattern, do the exercise of converting the r to r time in ms to heart rate See the last section Calculation of the heart rate: The R-R interval: <[courses.kcumb.edu] Then plot the heart rate vs time.
You can compare to the HR vs time graphs in this CR52 pdf <[www.afibbers.org] and CR 52a <[www.afibbers.org] and many graphs from one of our posters, Mark: <[www.afibbers.org]
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Re: A-fib or not ? July 29, 2018 07:18PM |
Registered: 11 years ago Posts: 4,222 |
Quote
bolimasa
So it would be prudent for me to go ahead and try to get fixed now while all my other heart tests are so good?
Not a bad idea, but you should talk to Shannon first about the EP you are considering in Utah. The EP that jpeters used ins San Fran was trained for quite a few years by Dr. Natale.
Using the best EP is VERY important.
If you want me to connect you with Shannon, let me know.
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Re: A-fib or not ? July 30, 2018 01:01AM |
Registered: 5 years ago Posts: 129 |
Wise gal... Age 57.... so I feel like I have quite a few years left that I need a good heart for. I still have a lot of skiing and hiking to do. I don't want to screw up my future because I'm not feeling bad now.Quote
jpeters
So it would be prudent for me to go ahead and try to get fixed now while all my other heart tests are so good?
I can tell you're a wise man
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Re: A-fib or not ? July 30, 2018 01:12AM |
Registered: 5 years ago Posts: 129 |
My EP is Nassir Marrouche....he seems like a big wig in the field.... Lots of current papers in the journals, runs the UofU CARMA center. He's definitely be pro ablation...
Whether he's good at them or not? Not see sure how to tell. So any info would be helpful.
Being new to the diagnosis and having an otherwise healthy heart hopefully makes mine is fairly easy fix that doesn't require the extrordinary.
Edited 1 time(s). Last edit at 07/30/2018 01:18AM by bolimasa.
Whether he's good at them or not? Not see sure how to tell. So any info would be helpful.
Being new to the diagnosis and having an otherwise healthy heart hopefully makes mine is fairly easy fix that doesn't require the extrordinary.
Edited 1 time(s). Last edit at 07/30/2018 01:18AM by bolimasa.
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Re: A-fib or not ? July 30, 2018 01:13AM |
Admin Registered: 6 years ago Posts: 5,336 |
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Re: A-fib or not ? July 30, 2018 08:49AM |
Registered: 8 years ago Posts: 1,102 |
Quote
bolimasa
My EP is Nassir Marrouche....he seems like a big wig in the field.... Lots of current papers in the journals, runs the UofU CARMA center. He's definitely be pro ablation...
Whether he's good at them or not? Not see sure how to tell. So any info would be helpful.
Being new to the diagnosis and having an otherwise healthy heart hopefully makes mine is fairly easy fix that doesn't require the extrordinary.
If I were you I'd get on his list ASAP. From what you describe there's no reason not to. You are paroxysmal AF with no serious comorbidies and relatively young. This is what ablation does best.
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Re: A-fib or not ? July 30, 2018 08:50AM |
Registered: 5 years ago Posts: 128 |
Quote
jpeters
. His suggestion is ablation.. but he's an ablation guy. Nobody seems terribly concerned about my otherwise being out of rhythm...
Well, if you find the afib is causing problems for you heart (which is typical) and it's progressing (which is typical), you have a window of opportunity for getting rid of it. So it's meds or ablation. If ablation, you'll need someone top notch. At this point, ablation has become quite refined. I had one with Richard Hongo in San Francisco about a week ago, and was back to normal activities within about three days..no ectopics, groin pain, or anything. And mine was a complex case of persistent afib. I had it done because afib was wrecking my heart (although I didn't feel any symptoms).
Jpeters, Interesting. I got my diagnosis at CPMC a few years back by my cardiologist but at the moment my AFib experiencs are limited to a few times a year. However I'm aware that at some stage I'll probably need an ablation. I had looked into Steven Hao and Richard Hongo. Are they well thought of? Would they be recommended for a PAF patient like me? Why did you decide on Hongo versus going with Natale? Or even Hongo over Hao?
Thanks a lot.. appreciate your train of thought in choosing him.
Brian
Edited 1 time(s). Last edit at 07/30/2018 08:54AM by Brian_og.
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Re: A-fib or not ? July 30, 2018 09:03AM |
Registered: 5 years ago Posts: 128 |
Quote
bolimasa
My EP is Nassir Marrouche....he seems like a big wig in the field.... Lots of current papers in the journals, runs the UofU CARMA center. He's definitely be pro ablation...
Whether he's good at them or not? Not see sure how to tell. So any info would be helpful.
Being new to the diagnosis and having an otherwise healthy heart hopefully makes mine is fairly easy fix that doesn't require the extrordinary.
Dr John Day is in Salt Lake and has done over 4000 ablations. I know nothing really about him other than reading his blog but believe he's well thought of.
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Re: A-fib or not ? July 30, 2018 09:19AM |
Registered: 11 years ago Posts: 4,222 |
So two Natale stories. I live in the Denver area. A friend here went to the Univ Colo Health and his EP there gave him what I thought was bad and outdated advice. I suggested Natale. When he and his wife walked in the hospital in Austin, the volunteer docent asked where they were from. When they said Denver, she replied, you must be here to see that Italian doctor, people are always coming in from all over the world to see him. Friend continues to do well and thank me for sending him there.
My best friend from childhood lives in Houston. In 2014 he said he had afib. I strongly insisted he go to Natale in Austin. His cardio objected saying he would refer him to the best EP in Houston. So my friend call the EP and asked how many left sided afib ablations he'd done. The answer, a lot - at least 800. So he contacted Natale's office. At the time, it was north of 10,000. My friend was visiting a week ago and he thanked me again for strongly insisting he go to Nalate. He got two ablations with Natale, including LAA. My friend lucked out and is now cleared to be off all anticoagulants. He's been in continuous NSR since the last ablation. Turns out my friend needed more time on his initial ablation that even Shannon, who it right up there for complex cases.
My best friend from childhood lives in Houston. In 2014 he said he had afib. I strongly insisted he go to Natale in Austin. His cardio objected saying he would refer him to the best EP in Houston. So my friend call the EP and asked how many left sided afib ablations he'd done. The answer, a lot - at least 800. So he contacted Natale's office. At the time, it was north of 10,000. My friend was visiting a week ago and he thanked me again for strongly insisting he go to Nalate. He got two ablations with Natale, including LAA. My friend lucked out and is now cleared to be off all anticoagulants. He's been in continuous NSR since the last ablation. Turns out my friend needed more time on his initial ablation that even Shannon, who it right up there for complex cases.
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Re: A-fib or not ? July 30, 2018 10:21AM |
Registered: 6 years ago Posts: 444 |
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Brian_og
Jpeters, Interesting. I got my diagnosis at CPMC a few years back by my cardiologist but at the moment my AFib experiencs are limited to a few times a year. However I'm aware that at some stage I'll probably need an ablation. I had looked into Steven Hao and Richard Hongo. Are they well thought of? Would they be recommended for a PAF patient like me? Why did you decide on Hongo versus going with Natale? Or even Hongo over Hao?
Thanks a lot.. appreciate your train of thought in choosing him.
Brian
Hongo met the requirement regarding experience and expertise, and I spoke with people who had successful ablations with him. I also gave him some points for being local for me for future consults. He was also very highly regarded by their staff nurses, who have worked both with him and Natale. Hongo had a longer waiting time (which I thought was a good sign), although Hao was available on my busiest client day.
I also gave Hongo points for having great respect for Natale during the interview, and his detailed description of the technicalities of the procedure. My local EP sneered at both Natale and Hongo.
Edited 1 time(s). Last edit at 07/30/2018 10:26AM by jpeters.
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Re: A-fib or not ? July 30, 2018 11:28AM |
Registered: 5 years ago Posts: 129 |
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GeorgeN
It seems to me like most of my 30 second scans are some other arrhythmia... sometimes with a beat or 2 or 3 that I *think* looks like it might be afib. I also get boughts of arrhythmia that seem regular like this one:
That's not regular at all. That's definitely afib.
This is where I am confused... as I see a pattern there.... 4 regularly spaced beats followed by a gap, beat, gap then 4 beats again... repeat... I guess I thought that was regularly irregular, not irregularly irregular. I also see lots of P waves thought they are more apparent in slow beats,less apparent in the the series of 4 fast beats... Does that mean the slow beats aren't afib but the fast beats are? Does afib sometimes follow a pattern?
Thanks for your patience in helping me try to sort these things out,... I'm pretty new to all this!
Are you, can you get more of a Type II presentation by holding the left electrode on your left leg, either hip or knee? This will make the p wave stand out better. The X - time scale will make a difference. So a sample of a few beats less than a minute will look different than a 20 or 30 minute window in these samples.
As to the pattern, do the exercise of converting the r to r time in ms to heart rate See the last section Calculation of the heart rate: The R-R interval: <[courses.kcumb.edu] Then plot the heart rate vs time.
You can compare to the HR vs time graphs in this CR52 pdf <[www.afibbers.org] and CR 52a <[www.afibbers.org] and many graphs from one of our posters, Mark: <[www.afibbers.org]
i will have to to look at this.. Thanks for for the links!!!! (so much to think about not enough time!!!!! I'd likely not found those links on my own!)
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Re: A-fib or not ? July 30, 2018 11:40AM |
Registered: 5 years ago Posts: 129 |
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GeorgeN
So two Natale stories. I live in the Denver area. A friend here went to the Univ Colo Health and his EP there gave him what I thought was bad and outdated advice. I suggested Natale. When he and his wife walked in the hospital in Austin, the volunteer docent asked where they were from. When they said Denver, she replied, you must be here to see that Italian doctor, people are always coming in from all over the world to see him. Friend continues to do well and thank me for sending him there.
My best friend from childhood lives in Houston. In 2014 he said he had afib. I strongly insisted he go to Natale in Austin. His cardio objected saying he would refer him to the best EP in Houston. So my friend call the EP and asked how many left sided afib ablations he'd done. The answer, a lot - at least 800. So he contacted Natale's office. At the time, it was north of 10,000. My friend was visiting a week ago and he thanked me again for strongly insisting he go to Nalate. He got two ablations with Natale, including LAA. My friend lucked out and is now cleared to be off all anticoagulants. He's been in continuous NSR since the last ablation. Turns out my friend needed more time on his initial ablation that even Shannon, who it right up there for complex cases.
All the posts here sure make me feel like I've stumbled on some sort of Natale fan club. I did just check pubmed and it turns out that Marrouche and Natale are co-authors on a crap load of papers... a number of which one was first author and the other last author... these are the two significant author positions (LOL I know this world...I'm always an insignificant middle person ) I will take his association with Natale as a good sign. Hopefully he has good hands as well.
I've read some of Marrouche's recent papers... but it had not occurred to me to look into his coauthors. Hearing your praises of Natale, and knowing they are associates makes me feel a little better about considering the procedure.
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Re: A-fib or not ? July 30, 2018 12:30PM |
Registered: 6 years ago Posts: 444 |
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bolimasa
All the posts here sure make me feel like I've stumbled on some sort of Natale fan club. I did just check pubmed and it turns out that Marrouche and Natale are co-authors on a crap load of papers... a number of which one was first author and the other last author... these are the two significant author positions (LOL I know this world...I'm always an insignificant middle person ) I will take his association with Natale as a good sign. Hopefully he has good hands as well.
I've read some of Marrouche's recent papers... but it had not occurred to me to look into his coauthors. Hearing your praises of Natale, and knowing they are associates makes me feel a little better about considering the procedure.
See, you ARE a wise woman. He certainly looks good to me...
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Re: A-fib or not ? July 30, 2018 01:00PM |
Registered: 5 years ago Posts: 129 |
Probably not that wise... cuz if I was I would have tried harder to loose the extra weight I've had the that last few decades, and maybe I wouldn't have this problem. That and I wouldn't have let stress erode my exercise program this last year... it's probably not a coincidence that this problem popped up while I'm in my worst shape.Quote
jpeters
See, you ARE a wise woman. He certainly looks good to me...
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Re: A-fib or not ? July 30, 2018 01:15PM |
Registered: 6 years ago Posts: 444 |
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bolimasa
See, you ARE a wise woman. He certainly looks good to me...
Probably not that wise... cuz if I was I would have tried harder to loose the extra weight I've had the that last few decades, and maybe I wouldn't have this problem. That and I wouldn't have let stress erode my exercise program this last year... it's probably not a coincidence that this problem popped up while I'm in my worst shape.
Hard to say.. I was doing 85 laps swimming 7 days a week when mine kicked in (and I'm slender). Many athletes get it.
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Re: A-fib or not ? July 30, 2018 02:05PM |
Registered: 5 years ago Posts: 129 |
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jpeters
See, you ARE a wise woman. He certainly looks good to me...
Probably not that wise... cuz if I was I would have tried harder to loose the extra weight I've had the that last few decades, and maybe I wouldn't have this problem. That and I wouldn't have let stress erode my exercise program this last year... it's probably not a coincidence that this problem popped up while I'm in my worst shape.
Hard to say.. I was doing 85 laps swimming 7 days a week when mine kicked in (and I'm slender). Many athletes get it.
Who knows. I've always been pretty active...skier, hiker, I used to run a fair amount, just not one to loose weight easily.... never lost it after kid 2, then gained some. This last year I hit an all time low.... changed jobs, had a lot of stress, lost the convenient gym access the year before, nursing the last year of the dogs life really tempered our hiking, I really did let fitness slide this last year. It's pretty easy to self-flagellate. Funny thing is that after a year the job stress has mellowed some and Memorial Day weekend we lost the dog... and I told myself... "No more excuses"... then the week after I end up in the ER and get this shitty diagnosis. Now I back to feeling super stressed, and still not doing a good enough job on the exercise program. Doesn't help that I'm a July hater... too hot and smokey for me to want to go for a run... so other than some hiking (not insignificant on mountain trails, and walking (I know it's still good for me and I like to walk, but it never never seems terribly impactful unless I walk for hours). I really need to be doing better!
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Re: A-fib or not ? July 30, 2018 03:30PM |
Registered: 6 years ago Posts: 444 |
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Re: A-fib or not ? July 30, 2018 04:31PM |
Registered: 5 years ago Posts: 128 |
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jpeters
Jpeters, Interesting. I got my diagnosis at CPMC a few years back by my cardiologist but at the moment my AFib experiencs are limited to a few times a year. However I'm aware that at some stage I'll probably need an ablation. I had looked into Steven Hao and Richard Hongo. Are they well thought of? Would they be recommended for a PAF patient like me? Why did you decide on Hongo versus going with Natale? Or even Hongo over Hao?
Thanks a lot.. appreciate your train of thought in choosing him.
Brian
Hongo met the requirement regarding experience and expertise, and I spoke with people who had successful ablations with him. I also gave him some points for being local for me for future consults. He was also very highly regarded by their staff nurses, who have worked both with him and Natale. Hongo had a longer waiting time (which I thought was a good sign), although Hao was available on my busiest client day.
I also gave Hongo points for having great respect for Natale during the interview, and his detailed description of the technicalities of the procedure. My local EP sneered at both Natale and Hongo.
Thanks for that. Why did your local EP sneer? Implying that he was as good?
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Re: A-fib or not ? July 30, 2018 04:34PM |
Registered: 11 years ago Posts: 4,222 |
Quote
jpeters
Hard to say.. I was doing 85 laps swimming 7 days a week when mine kicked in (and I'm slender). Many athletes get it.
That is not surprising. I too followed the path of chronic fitness to afib. Creating stereotypes, I look at paths to afib as either chronic fitness (usually younger) or those with many comorbidities in a bimodal distribution with many more of the later than the former.
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Re: A-fib or not ? July 30, 2018 05:05PM |
Registered: 6 years ago Posts: 444 |
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Re: A-fib or not ? July 31, 2018 12:32PM |
Registered: 6 years ago Posts: 920 |
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jpeters
Unfortunately, when you have complex issues that need a great specialist, local is generally NOT the way to go.
Well, you're surely right. That's things we are not aware of when we suddenly discover we've afib. Of course, the cardiologist explains what it is - basically. And he prescribes meds. The first I met was open minded. She advises me seeing a rhythmologist and said, as I was young (57) and healthy, the option of an ablation was worth considering.
I've googled all that but, as I'm french speaking, it took me some time before searching for advises in English. I came reading this website long after having been ablated.
Now I know I need an expert EP. I'm not the easy patient one would figure on first sight.
I must say I've met other cardiologists and GPs when going to the ER, and most of them weren't open minded. I remember a cardiologist, having heard my story and having checked I had still afib, telling me "go see this doctor who performed your ablation".
Lots of doctors still consider we, afibbers and EPs who ablate us, are playing with fire. They don't trust the procedure nor those who perform it.
This makes me think the first remedy for afib is information.
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