43 years old - considering ablation

Hello everyone - I'll try to make this succinct. In 2012 I was a 37 year old distance runner in training, running about 30-35 miles per week while playing soccer and cycling with zero issues. 6' tall and 190 lbs. One Saturday in August I was about 4 miles into a 10 mile run when I came home for a gatorade break, and it hit as soon as the cold liquid hit my throat. Heart was racing like I'd never felt before. Dizzy. Abandoned the run, went about my day with my flopping heart in my chest the rest of it. It never resolved, so I called my doc Monday morning and got in late Tuesday where she told me I was in afib and needed to begin thinking about treatment, etc. Sent me to a cardio. He put me on cardizem and eliquis, and I was electro cardioverted 6 weeks later. I then went off all meds

After that, with his blessing, I began racing triathlons. Raced for several years, again without problems in 100% NSR through April of 2015 and then just became a regular guy who runs, because kids and life didn't allow real training. September of 2015, I went into afib again after drinking something ice cold while out on a run - same trigger, and I should have known better. This time he tried Rythmol, which was awful for me. It did nothing but make my heart race, so I went back onto cardizem, and was electro cardioverted 6 weeks later by the same doc as before. I've been on cardizem since, and in NSR outside of one episode described below.

Since then, I've been a normal guy who exercises, but I am not trained by any stretch. 240 lbs, working out 3-4 hours per week. I've had exactly one episode since 2015, and it was a result of being in 11,000 foot altitude for several days, but I converted quickly. Last week, while out on a very easy run, I went into fib during a walk break. This time, there was no real trigger like before. I've been in afib since that day. My cardio wants me to see an EP and get an ablation. My argument - a weak one, I admit - is that my data suggests I can be cardioverted and wait 3 years to see what we learn in that time. I'm only 43 at this point, so let's be patient. He contends thats a perpetual argument that will always be correct, and also always false. We have to work with the data we have today and not what we may know.

Here's what I know - My grandmother had arrhythmia so bad she had a pacemaker. Her son, my father, has been dealing with afib most of his adult life and my mothers father had it as well. My Cardio believes this was bound to happen no matter what.

So, the dilemma is this - I'm on a 3 year plan right now, meaning I go into afib just about every 37 months, staying in NSR for that whole time almost exclusively, but when I go into afib, I stay there. Beginning tomorrow I'll try rythmol with the cardizem I already take and see what happens. I'm not optimistic.

I know the consensus around here seems to be to go for the ablation, but I think my circumstances are also somewhat unique, so I'm interested in feedback.

Thanks

I was 40, running 35-40 miles/week. 6'0", 170 lbs when I got AF. Ablated 2015. Now I'm 6'0" (ablation doesn't change that ), 195 lb, running < 30 miles/week. It was an easy choice to do the ablation, and I'll do it again when the time comes.

Your circumstances are quite familiar, and I suspect you'll receive a few responses from folks who also came to AF via chronic exercise.

49 yrs here, 9 years ago I did several 70.3 and lots of Olympic and sprint distances, avid cyclist , then my daughter was born and I stopped the tri trainings completely but I kept my biking and running to putting maybe 7 hours a week.

I am 6.2 and 187 lbs. About 4 years ago Afib kicked in very strongly... my endurance capacity became almost nothing (the body is so ungrateful ,) I finally decided for an ablation with "the maestro" Dr. Andrea Natale.

I am now in the best shape I have ever been during my adulthood life, no meds (just one baby aspirin p/day) and have been following the magnesium protocol as well as the hydration rules extremely diligently..... I am putting around 25 running miles a week and around 60 cycling miles, on top of that regularly 36 golf holes per week. Dr. Natale told me if I am feeling good just go ahead with that only taking good care of my hydration.

I will never regret my decision of going the ablation route and in case of any recurrence in the future will go for it again without even questioning...



Edited 2 time(s). Last edit at 10/18/2018 12:58PM by fravi.

If you decide to have one, can we assume you've been reading a lot here and know the kind of EP you want to partner with? If not or you are unsure, ask away.

In short, look for an EP that has performed 1000's of ablations and tackles complex cases. The list is short, and generally starts in Austin, TX.

Chris, if you decide on an ablation, be sure to be in the care of an experienced EP in a facility where a lot of ablations are performed. As mentioned, Dr. Natale in Austin is one of the best among the best and many people travel to have him do the procedure. There is some thought that having an ablation done sooner rather than later increases the chances of it being successful. Since you have a history of much active exercise and also may be predisposed to a-fib through genetics, having the ablation would seem to be a worthwhile consideration. I might add that for a number of people drinking cold liquids can be be a trigger for an a-fib episode ( my husband's doctor had that same "trigger). Since you are still young, you could be facing a lot of years with medications for a-fib....and that's .another reason to consider ablation which may ultimately be needed at some time in the future. If I were you, I would "go for it" (It took 3 for me to stay in NSR for the past 4 years, but I have an age disadvantage that you do not have) Your EP should be he one to advise you and give you all the information you may need to make a decision..

Chris,

I notice you've gained 50lbs in the last 6 years. One thing that will definitely help is to try and get back down towards that 190lbs you were in 2012 if you can manage it since high BMI is a well-known risk factor for AF - do you experience any snoring/sleep apnoea at all?

Whilst your episodes have been infrequent, the sad reality is that as we get older they almost invariably become more frequent and/or become persistent (won't convert back to NSR without meds or ECV) - hence why most folks here will advocate ablation - and they are right in that ablation has a higher chance of success the sooner it is done. On the other hand you could wait until episodes become more frequent - say a couple per year? I've had episodes of AF for nearly 20 years and only just recently had an ablation once episodes starting occurring monthly rather than once or twice a year as they had up until this year. That said, none of my episodes ever lasted longer than a few hours whilst your last one either lasted several days or is still ongoing. As such, if I were you in order to avoid risking becoming a persistent rather than paroxysmal AFr I'd be looking at the ablation route now and everyone's recommendations here about who to go to are well-founded - Natale is the man. Were I an appropriately insured US resident I'd definitely have sought out Natale, but being a UK resident I recently chose to be ablated by Prof. Jais at Bordeaux who is also extremely well regarded and recommended by those in the know on this forum.

Good luck with whatever you decide to do and keep us posted.

Afib begets afib so unfortunately its more likely that things will just get worse for you. In your case its seems a bit troublesome that you aren't self converting and the afib seems to last awhile.
I would reccomend an ablation from Natale because you dont self convert, your episodes have increased, afib begets afib and IMO taking anti-arrhythmic drugs long term seems a bit dangerous to me. Lots of side effects and they don't seem to work forever in most people. They can lose their effectiveness.

Appreciate the comments. What's interesting to me is that I went into fib at 190 pounds and wouldn't convert on meds or spontaneously. Stayed in fib until my ECV. Same at 205 3 years ago, and looks like the same now. When I was 310 pounds 10 years ago, I never had an episode (that's another longer story).

I have an appt with an EP here in Dallas in 2 weeks. What I WANT is to not have to worry or think about this anymore, and be in NSR like normal. If anyone knows or has experience with Dr. Lampe here in Dallas, would also like that feedback.

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Chris H
When I was 310 pounds 10 years ago, I never had an episode (that's another longer story).
.

I’m going to hire you to ghost-write my autobiography.

You lost over 100 lbs by chronic exercise. So did I. Congratulations! It’s remarkable. It also causes a-fib. Every silver lining has a touch of gray.

You should check out Dr. Kevin R. Wheelan - Baylor Med. Center, Heart Place, Dallas, TX. He did my ablation 12 years ago and it was a BIG success. Still no afib. You can read my 12 yr anniversary report on this forum for details.

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wolfpack

When I was 310 pounds 10 years ago, I never had an episode (that's another longer story).
.

I’m going to hire you to ghost-write my autobiography.

You lost over 100 lbs by chronic exercise. So did I. Congratulations! It’s remarkable. It also causes a-fib. Every silver lining has a touch of gray.

In 2010, I lost 95 lbs. I done Weight Watchers and walked at least 30 miles a week. Many days in 100 humid Louisiana weather.
In 2011 I continued to vigorously exercise and went into AFIB. I cannot point at a specific trigger but Dehydration was probably the culprit.
Two Ablations later by Dr. Natale, I am in Sweet NSR. My LAA was isolated the second time around and Eliquis is a daily part of my life but life goes on. I have gained approx 40 lbs since 2014. I’m just Leary of pushing myself and like good food. I want to lose it but the will is not there yet.

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wolfpack

When I was 310 pounds 10 years ago, I never had an episode (that's another longer story).
.

I’m going to hire you to ghost-write my autobiography.

You lost over 100 lbs by chronic exercise. So did I. Congratulations! It’s remarkable. It also causes a-fib. Every silver lining has a touch of gray.

My grandmother, grandfather and father had no chronic exercise, and all had arrhythmia, 2 of 3 with fib. My other grandfather died of a stroke in his 40's, so read into that what you want. I think that the real problem is my genes, and as both my cardios have told me - this was gonna happen at some point, whether I was 300 pounds or 190. It's not like eating cheeseburgers and not exercising was doing me any favors.

I have my first appt with an EP on the 6th.

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Ken
You should check out Dr. Kevin R. Wheelan - Baylor Med. Center, Heart Place, Dallas, TX. He did my ablation 12 years ago and it was a BIG success. Still no afib. You can read my 12 yr anniversary report on this forum for details.

Thank you very much. I want to get at least 2 opinions locally.

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Chris H
My grandmother, grandfather and father had no chronic exercise, and all had arrhythmia, 2 of 3 with fib. My other grandfather died of a stroke in his 40's, so read into that what you want. I think that the real problem is my genes, and as both my cardios have told me - this was gonna happen at some point, whether I was 300 pounds or 190. It's not like eating cheeseburgers and not exercising was doing me any favors.

I have my first appt with an EP on the 6th.

My father and mother have AF. It is in the genes, I agree completely. Weight gain and subsequent chronic exercise bring the genie out of the bottle earlier than otherwise. That’s my opinion, with some “weight” behind it (pun intended).

I hope all goes well with the EP appointment. That’s the critical juncture. You want to pair with someone who has done thousands of complex, left-atrial ablations, and who can show success rates without continued use of anti-arrhythmic drugs over one year or more post-ablation. That is key.

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wolfpack

My grandmother, grandfather and father had no chronic exercise, and all had arrhythmia, 2 of 3 with fib. My other grandfather died of a stroke in his 40's, so read into that what you want. I think that the real problem is my genes, and as both my cardios have told me - this was gonna happen at some point, whether I was 300 pounds or 190. It's not like eating cheeseburgers and not exercising was doing me any favors.

I have my first appt with an EP on the 6th.

My father and mother have AF. It is in the genes, I agree completely. Weight gain and subsequent chronic exercise bring the genie out of the bottle earlier than otherwise. That’s my opinion, with some “weight” behind it (pun intended).

I hope all goes well with the EP appointment. That’s the critical juncture. You want to pair with someone who has done thousands of complex, left-atrial ablations, and who can show success rates without continued use of anti-arrhythmic drugs over one year or more post-ablation. That is key.

Thank you - I hope my comments above didn't come off as argumentative, and I appreciate your reply. That said, yes, I agree - I think that if I had sleep apnea, didn't exercise and weighed 210, this would have happened at some point. Anything that puts the heart under enough stress essentially is going to flip the switch for those of us predisposed to it. I also think that it's possible while I was horribly overweight, I could have had undetected episodes that presented in ways I didn't understand at the time, but who knows.

All good. I read nothing into it.

Let us know how the EP visit goes. These guys are “high-fallutin’” specialists but don’t let fast talk get the better of you. Ask pointed questions and evaluate the answers. We’re here to help.

Got my PVI ablation done today. Man, I hate hate hate hospitals, doctors, needles, etc. I was in full on cortisol production till the anestesologist gave me the first hit.

Everything went perfectly. I'm back in NSR, but my 3 observations are:

1: I am more sore than I thought I would be. I won't be driving to work tomorrow for sure.
2: They electrocardioverted me while I was out. This actually makes sense to me, as I wondered how NS would be restored by just eliminating the activity coming from the PV's, but it makes sense how it will prevent it going forward.
3: Some PAC's and a higher than before RHR as expected.

Fingers crossed...

How are you doing, Chris? Hope all settled down!
Assume it was with a cryo balloon? If so, did the EP have an RF catheter in case there were other areas in the atria?

Hi Joe - I'm not sure I understand the question. "In case there were other areas in the (left atrium)" that would need to be ablated? If that's what you meant, then yes, he was prepared to do additional ablation if it was necessary, but based on everything he and the team found, they're confident that PVI is the best course of action at this point....

I could be wrong, Chris. My understanding is that cryo balloon is restricted to the 4 PVIs? If that's the case then a RF catheter would be needed for other areas?
Didn't know that the EP can determine where the stray signals in the atria comes from without having a catheter inserted?

OK - I guess I misunderstood, sorry. The PVI was what he suggested as the initial treatment with this ablation. Knowing my age, history, health, etc he was confident that PVI gave 70%80% success probability on the first try, knowing that I might need a 2nd depending on the outcome. They didn't have an RF catheter in there for this time.

As to me, I pulled something in my left groin 3 days after surgery, so I was laid up for the weekend. I've been having some pretty persistent bouts of arrhythmia since yesterday morning, so I got an EKG done today. I'm in atrial flutter, not afib, which they've given me a beta blocker to see how it goes. EP said this isn't uncommon, and isn't a predictor of long term success, and not to worry, it's probably good that it's just flutter and not afib, but it kinda sucks for me. I can't help but think this means I'm headed for round 2 in a couple of months. I liked being in NSR for those 6 days.

We scheduled a cardioversion for Thursday in the event that I don't convert on my own. He seems to think I will. I'm hopeful, but not confident.

Fair enough Chris. Hope your ablation works 100%!
I'm most likely in the same position when i see the EP on the 17 Dec. He does cryo so i don't want to ask stupid questions.

So, we went with a pretty conservative option given my age and infrequency of episodes. When you add up all the known episodes, I've spontaneously converted 3 times and had to be cardioverted 3 times. Doc wanted to go with a high probability option, then make decisions based on those results. We discussed that I might need RF touch ups down the road, but also might not, so why kill cells unnecessarily. I agreed. I probably didn't articulate all those points, but let's be honest, if each of us spelled out every intricacy of our individual cases, we'd each write a short book probably.

I converted back to NSR last night. I can't tell you what a relief that is. Outlook on life is very different under these circumstances. So make that 3 spontaneous cardio-versions, 3 electrical cardio-version and now one chemical.

Great!