Possible it was just a bump along the road??

Hi all,

Ablation about 7.5 years ago. Lovin’ life til about 4 months ago. PAC-PVC’s, little bits of afib, then one biggie episode lasting on and off about 3 and a half days. Did the pill in the pocket method of Flec and metropolol. Worked after about 2 hours. This was 6 weeks ago. NSR, not even a blip this whole time. Completely off drugs. Back to riding my bike hard daily, taking the protocol of supplements, drinking tons of electrolyte water, lost 10 lbs, lovin’ life again!

I have an appointment for another ablation in 6 weeks. Do I or don’t I?

My gut feeling is to take a rain check and see how it goes. Was this few week period of erratic heart rhythms just a bump in the road or ???

Thoughts?

Thanks all in advance!!!



Edited 1 time(s). Last edit at 09/15/2018 05:44PM by Socalsteve.

There's certainly no guarantee that you will be better off with an ablation. In fact, things could get worse, so I'd need a good reason to get one.

Following my first PVI ablation back in 2009 I was afib free for the first five years. Following that, some years I had anywhere from one episode over a years time to thinking I was going to need another ablation in others. There really did not seam to be any rhyme or reason to it.

Last year (2017) I probably felt the best I have ever felt. Was doing allot of cycling and was riding really strong. Had one or two events during the entire summer, then during the fall they became more and more frequent until I ended up in the ER in January of this year. Had my second ablation that month but it did not take as my EP only fixed reconnected triggers around the PVI.

Had a third, more comprehensive ablation in Texas witih Dr. Natale in July and I'm not sure where that one stands right now. Im am having my second cardioversion done this week.

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rocketritch

Had a third, more comprehensive ablation in Texas witih Dr. Natale in July and I'm not sure where that one stands right now. Im am having my second cardioversion done this week.

Does he have you on medications?

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jpeters
Does he have you on medications?

Yes.

I started back on Ticosyn and Metoprolol following the ablation. Then I switched back to Flecanide and Metoprolol because I had the coincidental nerve pain when on the Ticosyn. I was off the Ticosyn for several days before starting back on the Flecanide. Looking back I should have probably stayed on the Ticosyn.

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rocketritch

Does he have you on medications?

Yes.

I started back on Ticosyn and Metoprolol following the ablation. Then I switched back to Flecanide and Metoprolol because I had the coincidental nerve pain when on the Ticosyn. I was off the Ticosyn for several days before starting back on the Flecanide. Looking back I should have probably stayed on the Ticosyn.

I'm taking some berberine (with Milk Thistle). Probably can't hurt.

"We find that berberine and amiodarone are equally effective for conversion of AF and maintenance of normal SR."
[www.hindawi.com]

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jpeters


Does he have you on medications?

Yes.

I started back on Ticosyn and Metoprolol following the ablation. Then I switched back to Flecanide and Metoprolol because I had the coincidental nerve pain when on the Ticosyn. I was off the Ticosyn for several days before starting back on the Flecanide. Looking back I should have probably stayed on the Ticosyn.

I'm taking some berberine (with Milk Thistle). Probably can't hurt.

"We find that berberine and amiodarone are equally effective for conversion of AF and maintenance of normal SR."
[www.hindawi.com]

Interesting

For newer members ... just an FYI...
RE: Amiodarone

…. Be aware that in past posts, several afibbers reported not doing well on amiodarone.
For some cases there may be no choice, but it would be wise to check out all possible options first.

In the Cleveland Clinic Journal of Medicine… there was a report from years ago on the properties of
various drugs used for AF Titled: "Approaches to restoring and maintaining normal sinus rhythm"…
and under the Pharmacologic Management segment Part I… it listed Drug Categories and General Issues.

Under Class III Antiarrhythmics, it says

Amiodarone

Actions – Amiodarone was developed a an antianginal drug but was later found to have antiarrhythmic properties and was introduced in 1986.

It is generally categorized as a class III antiarrhythmic, though it has properties of all four classes. Amiodarone has unique pharmacokinetics. It is highly lipid soluble and because a long time is required for adequate loading to saturate body lipids, drug levels build up slowly with repeated doses. Plus, the very large lipid stores act as a massive drug reservoir when treatment is stopped, resulting in a very long elimination half-life (about 50 days).

Safety – Amiodarone is associated with a variety of adverse effects including pulmonary fibrosis, corneal microdeposits, skin photosensitivity, gray-blue skin discoloration and reversible liver enzyme abnormalities. Central nervous system side effects are relatively common and include anxiety, tremor, headaches, and peripheral neuropathy. Hypothyroidism also is relatively common. Although QT prolongation occurs often, torsades de pointes is uncommon.

Role - Other than dofetilide, amiodarone is the only antiarrhythmic that has been found safe and effective in patients with moderate-to-severe left ventricular dysfunction. Like dofetilide, amiodarone is a first-line agent for patients with AF and structural heart disease. Because of its potential for organ toxicity, we generally reserve amiodarone as a second- or third-line agent for other types of patents with AF.

Source: Cleveland Clinic Journal of Medicine
Volume 70
Supplement 3 July 2003 p. S15


On the berberine use... It's important to understand that berberine is very effective at reducing blood glucose and related insulin issues... so when using it, be very aware if you notice symptoms of low glucose levels since one symptom can be palpitations and/or arrhythmia due to the mechanism that triggers an 'alert' response (adrenaline) in the body when glucose become too low and that whole resulting scenario. For most people it is probably a non-issue but it makes sense to recognize the potentials.

Jackie

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Jackie



On the berberine use... It's important to understand that berberine is very effective at reducing blood glucose and related insulin issues... so when using it, be very aware if you notice symptoms of low glucose levels since one symptom can be palpitations and/or arrhythmia due to the mechanism that triggers an 'alert' response (adrenaline) in the body when glucose become too low and that whole resulting scenario. For most people it is probably a non-issue but it makes sense to recognize the potentials.

Jackie

Yes, another benefit as a preventative for diabetes. I noticed my glucose up near the top end (I like carbs...and I'm slender).



Edited 1 time(s). Last edit at 09/16/2018 06:39PM by jpeters.

Ami simply has no business in a paroxysmal, younger patient with no other structural heart disease or comorbidites.

Write that in red ink and underline it three times.

What wolfpack said. In spades.

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wolfpack
Ami simply has no business in a paroxysmal, younger patient with no other structural heart disease or comorbidites.

Write that in red ink and underline it three times.

Okay, but who's taking Amiodarone? Am I missing something? I guess Jackie posted warnings after I noted a study supporting Berberine, a supplement.

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jpeters
Okay, but who's taking Amiodarone?

A surpising number of people who shouldn't be.

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Carey

Okay, but who's taking Amiodarone?

A surpising number of people who shouldn't be.

I was wondering the same thing. BTW I converted back to NSR at some point this evening. I generally feel it right away but have felt really crappy the past couple days. That coupled with getting called out to work last night.



Edited 1 time(s). Last edit at 09/17/2018 05:22AM by rocketritch.

rocketritch,

Glad you're back in NSR.

If you don't mind me asking, what was Dr Natale's findings and verdict on the procedure he did for you this last July?

I wish Wolfpack had been around 20 years ago when I was diagnosed with Vagal and prescribed Amiodarone, Coumadin and Lanoxin by both my Internist and Cardiologist.

The iodine in Amiodarone sent me into a hyperthyroid condition and burned up my thyroid so now I'm hypothyroid taking Naturethyroid daily.

UCSF switched me to Flecainide and Atenolol which worked fine until my Natale ablation in 2012. Been in NSR ever since.

Gordon

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ggheld
I wish Wolfpack had been around 20 years ago when I was diagnosed with Vagal and prescribed Amiodarone, Coumadin and Lanoxin by both my Internist and Cardiologist.

Wolfpack has been around about 2 years, so there's abundant information all over the internet on side effects. Probably 20 years ago less was known and there weren't as many alternative options. I'm taking diltiazem, which I've heard a number of users describe as pure evil as well. It works fine for me at the 120mg dose. Best alternative is no drugs, but not if you're suffering from afib.

I know someone whose been on Amiodarone following one ablation 20 years ago. It probably wiped out his thyroid, but he's in rhythm and going to the gym everyday. His brother is on his 7th ablation. He's definitely not interested in trading places with his brother.



Edited 2 time(s). Last edit at 09/17/2018 10:16AM by jpeters.

Well, I've been around about 44 years but only the last 4 as an a-fibber!

In my experience a lot of well-intentioned but perhaps less currently informed cardiologists jump too quickly to the "nuclear option" of amiodarone. It happened to me with my first cardio. He suggested it. It's one of the two main reasons I left his practice. Yes, it's a very powerful anti-arrhythmic, and will probably achieve some success in maintaining NSR where other medications like propafenone or flecainide have failed. But it comes with some VERY serious side effects, not the least of which is pulmonary fibrosis. That can be fatal. The other thing to remember about amiodarone is that it is lipid soluble and not cleared renally. So it builds up in all of the body's tissues. Often times it can cause a blue discoloration of the eye sclera, patches of skin or even the entire body. The only way for it to "get out of your system" is to literally wait for the cells to die. That mechanism of action right there is why amiodarone is almost always started IV in the hospital with very high loading doses to "speed up" the process of saturating the body's tissues to therapeutic levels of the drug. Afterwards the patient is placed on a daily oral (pill) regimen to maintain. If you want to stop, it'll be like 30-60 days until it's gone.

For the record, I've never been on amiodarone. But my father has. It wasn't a good choice. That was probably 10 years ago, maybe a few more.

My second ever episode of AF was 11pm one evening in May 2002. (Don’t ask.....large meal too much booze relaxing in hot bath....yeah I know!)

Carted off to a local hospital where cardiologist gave me digoxin.....20hrs of worst fastest and longest episode of AF I’ve ever had. Yeah like I really needed to shove more Ca into my cardiac cells LoL! A week later he wanted me on Amio. Yeah right. Have never been to that particular local hospital again since.



Edited 1 time(s). Last edit at 09/17/2018 03:58PM by mwcf.

All this is very interesting, but...it’s a real thread drift.

Anyone interested in weighing in on my original posting?

Thank you!!!

Apols Steve.

Re your Q, my guess is you’re going to be looking at another ablation in the not too distant future. 7.5 years isn’t a bad run but a reoccurrence on that scale is what it is and IMO is hard to ignore/disregard. But at the end of the day it’s obviously your call as to what feels right to/for you.

BTW, why did you wait so long before taking the PiP?

I wouldn't schedule a second ablation based on one episode. It's only one data point and one can draw an infinite number of lines through a single point.

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wolfpack
I wouldn't schedule a second ablation based on one episode. It's only one data point and one can draw an infinite number of lines through a single point.

I agree. Afib is tricky and like I mentioned before, can come and go as it did in my case.

MWCF,
I'll respond to your question here. [www.afibbers.org] This thread has been hijacked enough already



Edited 1 time(s). Last edit at 09/17/2018 05:49PM by rocketritch.

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mwcf
Apols Steve.

Re your Q, my guess is you’re going to be looking at another ablation in the not too distant future. 7.5 years isn’t a bad run but a reoccurrence on that scale is what it is and IMO is hard to ignore/disregard. But at the end of the day it’s obviously your call as to what feels right to/for you.

BTW, why did you wait so long before taking the PiP?

Good question!

Bad advice from cardiologist. Figured it out on my own after a couple miserable days ( I mean, I had the resources_drugs and knowledge, just didn’t do it) .Then went to see the EP cardiologist who laid out a few options for me. One of them being PIP long term. Since I hated being on the drugs more than anything, I decided to go this route. So far, so good!