Wait or Ablat??

Looking for consensus/advice

Afibb for 7+ years flecanide/met seem to be working last 5+yrs. (38yr old Male)

Last 5+ years on flec/met I have had 23hr episode, 12 hr episode, 66 hrs episode along with 12-15 very short afibb episodes all spread out over the last 5+. Convert on my own everytime.

Recently started supplementing taurine, mag and potassium feel great.

Wait or Ablat??

Sending my local records to Dr. Natale asap when they arrive for his advice. Trying to obtain as much advice from the pros, and patients.

Thanks!!!



Edited 1 time(s). Last edit at 11/23/2018 03:05PM by Kleinkp.

As a general rule, earlier is better than later. Waiting gains you nothing and afib just becomes more difficult to ablate the longer it continues. There's also the fact that antiarrhythmics like flecainide almost always become ineffective sooner or later, and they can even become pro-arrhythmic. You'll be free of the meds, and you'll probably find that your energy levels and overall sense of well being will improve once you're off them. Plus, given your age, you might also be able to stop the anticoagulant.

Had my first PVI ablation in 2009 after living with intermittant affib for many years without medication. At that time my affib burden had become much worse. I had decided many years before this that if my afib cam to a point to weather or not I needed to go onto meds that ablation would be the way I would go. My thoughts then were that if it progressed to the point that I needed meds, at some point the meds would not work and I would need an ablation. So why not just cut to the case.

Went about 5 years and afib returned in much the same way it all started. Fast forward to this time last year and my afib burden was becoming much worse and I found myself back in the hospital in January of this year having my second ablation with the same EP. That ablation lasted about 3 moinths before I found myself back in afib and worse off than before. Flecanide had always worked for me but wasn't anymore. Ended up on Ticosyn which did not work completely but was better than the Flecanide. I also had found my way back to this board that I had not visited since since well before my 2009 ablation. I started asking questions to the wonderful people here about how to go about seeing Dr Natale to possibly have a third ablation. And it wasnt long before I was on the phone with Shannon disucussing my afib history, my current condtition and my desire to see Dr. Natale.

I Flew to Austin in July to have my third ablation done with Dr Natale and I could not be happier.

That all being said it comes down to what you think is best for you and your comfort zone when it comes to someone mesing around inside of your heart.. Like I stated before. I never hesitated when it came to having an ablation. It was a decision I had made long before the time came to do it.



Edited 1 time(s). Last edit at 11/23/2018 04:16PM by rocketritch.

My name is Bettyann. I am 76 yrs. old I have a 6 yr. old stent and a pacemaker because I have sick sinus syndrome. I am on atacand, eliquis, lipitor and diltiazem. The diltiazem is supposed to help with afib but lately I have been getting afib attacks twice a month and they last 3 days leaving me exhausted. My cardiologist will probably suggest ablation but I was wondering if anyone is taking a better afib medicine that diltiazem. My pacemaker stops my heart from stopping but does nothing to prevent afib from occurring.



Edited 1 time(s). Last edit at 11/23/2018 04:36PM by Bobby.

Hi Bettyann,
I was taking Metoprolol when I had my first episode of afib. I spent five days in the hospital while a team of cardiologists got things straightened out. I found that Metoprolol was absolutely worthless.
They put me on Diltiazem for about a year before it quit working. My new cardiologist said this wasn't unusual. He took me off the Diltiazem and put me on Sotalol. The Sotalol has been a godsend for me.
I am also taking Dr Sinatra's protocol for heart problems. This seems to help me considerably.
Anyway, talk to your cardiologist about the Sotalol--it's not for everyone.

I would wait.

"Recently started supplementing taurine, mag and potassium feel great."
You haven't given these Supplements time to see how much they will help.

You are averaging about 20 hours of AFIB/year, and converting on your own. Ablation is not medically necessary.
Stroke risk is minuscule since your episodes are short, and you Self-Convert.

Are you Symptomatic? If so how much? The more Symptomatic you are, the more Ablating sooner than later makes sense. Asymtomatic Patients are still not advised for Ablation, although they say it is reasonable in some cases.

You asked for a Consensus. Have you looked at the 2017 HRS/EHRA/ECAS/APHRS/SOLAECE consensus statement? [academic.oup.com]

There are also several articles with interpretations and summaries of these guidelines:
[www.medscape.org]
[www.hrsonline.org]

Finally I agree with what Carey is saying, but I believe it is a premature analysis to apply it to your situation and thus go for immediate Ablation.



Edited 1 time(s). Last edit at 11/27/2018 06:54AM by The Anti-Fib.

I would wait. I dont disagree entirely with the opinion that the younger you are, the greater chance for success, but with all the talk about ignorant EPs who have no right performing ablations, Im questioning the validity of that opinion. Ablation doesnt guarantee you will be drug free. I would ride that unablated horse, and actually still am at nearly 65 (9yrs afib), for as long as you can, IMHO.

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Kleinkp
Last 5+ years on flec/met I have had 23hr episode, 12 hr episode, 66 hrs episode along with 12-15 very short afib episodes all spread out over the last 5+. Convert on my own everytime.

Recently started supplementing taurine, mag and potassium feel great.

I'd ask my doc if I could increase my flec, on demand, to convert any episode that doesn't convert on its own in a short (and what is short? an hour?) period of time. As you likely know, afib begets afib and if you can minimize the time in afib, you lower that issue.

In my case, it was magnesium to bowel tolerance that did the trick. Also detraining from endurance activity, though I maintain excellent fitness, as I've posted elsewhere. It is the product of intensity and duration that is the trigger for me. Can do one or the other, but not both together. After a 2.5 month episode 2 months after my first, I've had 14 years of very nominal afib and my frequency and duration are not increasing. I'm 63 and initially had afib at 49. That being said, if frequency and duration increase materially, I'm headed to Austin as soon as it can be arranged.

George

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GeorgeN

Last 5+ years on flec/met I have had 23hr episode, 12 hr episode, 66 hrs episode along with 12-15 very short afib episodes all spread out over the last 5+. Convert on my own everytime.

Recently started supplementing taurine, mag and potassium feel great.


I'd ask my doc if I could increase my flec, on demand, to convert any episode that doesn't convert on its own in a short (and what is short? an hour?) period of time. As you likely know, afib begets afib and if you can minimize the time in afib, you lower that issue.

Less then 5 maybe 10 minutes in and out of afibb in the short episodes.

Last long afibb episode 66hr was after bad flu vomiting and diarrhea for 12hrs. Other long episodes after over indulging on alcohol. Gave up alchohol totally 1yr + ago.
Never had any afibb with just few drinks only when it was over done. None the less gave it up all together.

Afibb begets afibb?? Gets worse?



Edited 1 time(s). Last edit at 11/27/2018 09:10PM by Kleinkp.

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Kleinkp

Last long afibb episode 66hr was after bad flu vomiting and diarrhea for 12hrs. Other long episodes after over indulging on alcohol.

Afibb begets afibb?? Gets worse?

The flu & vomiting could cause an electrolyte imbalance leading to afib.

Afib begets afib. There are both physical and electrical remodeling that occurs during afib. This remodeling makes it easier for the next episode to occur and also harder to convert to NSR.

Sounds like without the alcohol and the illness your episodes are very short. How frequent are these: daily, weekly, every 6 months???

Since they are short, I'd certainly give the supplements a try and see how it goes.



Edited 1 time(s). Last edit at 11/27/2018 09:44PM by GeorgeN.

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Kleinkp
Afibb begets afibb?? Gets worse?

Yep, that's what it does. It progresses and gets worse with time no matter how much magnesium, potassium or whatever you take. Putting up with afib and taking antiarrhythmics and beta blockers and who knows what until your afib becomes persistent and forces your hand -- and is then much more difficult to ablate because you waited so long -- is a poor strategy. Find the absolute best ablationist you can who has done thousands of afib ablations and be done with it. No, that doesn't guarantee you'll be free of drugs, but a successful ablation does mean you'll be free of antiarrhythmics and beta blockers and above all, afib episodes.

"it gets progressively worse over time" . Not for everybody, I have had episodes of AF for almost 20 years, it is not worse, in fact, I have gotten less episodes since May of this year not more. George N. also does not get episodes due to his regime, a guy on here stopped his AF by eating Natto. there has been others over the years.

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GeorgeN


Last long afibb episode 66hr was after bad flu vomiting and diarrhea for 12hrs. Other long episodes after over indulging on alcohol.

Afibb begets afibb?? Gets worse?

The flu & vomiting could cause an electrolyte imbalance leading to afib.

Afib begets afib. There are both physical and electrical remodeling that occurs during afib. This remodeling makes it easier for the next episode to occur and also harder to convert to NSR.

Sounds like without the alcohol and the illness your episodes are very short. How frequent are these: daily, weekly, every 6 months???

Since they are short, I'd certainly give the supplements a try and see how it goes.

Past 5+ years 15-20 of the short episodes.

Will say this last spring/summer while sleep deprived, stressed building a house, and working nights when I got home and laid down at night about 4-6 different nights I experienced short less the 5min afibb episodes.

Now I get more sleep, supplement, stressing less appears to be doing me good. Fingers crossed!

Love all the advice and help thanks!!

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Carey

Afibb begets afibb?? Gets worse?

Yep, that's what it does. It progresses and gets worse with time no matter how much magnesium, potassium or whatever you take. Putting up with afib and taking anti-arrhythmic and beta blockers and who knows what until your afib becomes persistent and forces your hand -- and is then much more difficult to ablate because you waited so long -- is a poor strategy. Find the absolute best ablationist you can who has done thousands of afib ablations and be done with it. No, that doesn't guarantee you'll be free of drugs, but a successful ablation does mean you'll be free of anti-arrhythmic and beta blockers and above all, afib episodes.

It does get worse and it can happen like flipping a switch. Like I stated before I had my first ablation in 2009 at age 43. At that point I had been dealing with it for about 20 years. Up until 2009 I would go a year without any symptoms to 1-5 short bouts a year getting progressively more frequent as time went on. 2009 however was a nightmare. By June/July of that year I was in full blown persistent afib with a mix of flutter.

That first ablation freed me from having to take any drugs for the first five years and only use flecanide as a PIP for the years following up until this past year. Had I gone to a more seasoned EP in 2009 it is quite possible I would have never had to revisit the situation or at the very least had to have such a comprehensive ablation the third time.

Thank you so much Carey, for the sound advice. I’m seeing my cardiologist this p.m. and I now have a more positive attitude towards ablation. Love this site.
Bettyann

"Yep, that's what it does. It progresses and gets worse with time no matter how much magnesium, potassium or whatever you take. "
Couldnt prove that by me or a few others I know near my age. Mine took a hiatus 2 years ago after 3 months of weekly afib.

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hwkmn05
Couldnt prove that by me or a few others I know near my age. Mine took a hiatus 2 years ago after 3 months of weekly afib.

That's great!

Well, my cardiologist suggested cryoblation...freezing the part of my heart that is malfunctioning rather than ablation. I am also on 240 mg. Of diltiazem which helps a bit. I haven’t finished researching the difference. Sometimes, cardiologists tell you only what they want you to hear!

A cardiologist isn’t really qualified to suggest a type of ablation rather than ablation itself. He or she simply doesn’t do the procedure. That would be an electrophysiologist (EP). Certainly make an appointment with one, but be aware that cryobaloon is more limited than radio-frequency (RF) and is limited to pulmonary vein isolation (PVI) only.

Thank you so much for the info. I will do some more intense research. Wow! I am so glad to have found this site. Has anyone had the cryoblation procedure and I am wondering what the success rate is. Bettyann.

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Bobby
Well, my cardiologist suggested cryoblation...freezing the part of my heart that is malfunctioning rather than ablation.

I agree with what wolfpack said, and just to make sure you fully understand, whether they use freezing or RF doesn't make much difference. They're both ablations. The objective is to kill heart tissue and that's what both techniques do. There's nothing softer and gentler about cryo. Its only advantages over RF are it's simpler and requires less training and experience, and it's a much shorter procedure.

I have talked to several EP's who do both Cryo and RF, and they told me that Cryo is less traumatic on the Heart than RF. How much less traumatic I don't know. Also, they can put the CryoBallon long the Posterior Wall to ablate that area. So it's not always strictly PVI.

Thanks for the info. The wait list is almost a year and I’m already in another afib episode. Better to have a plan though, than not. Thanks again.....I appreciate the knowledgeable advice.
Bettyann

Dr. Natale officially has my medical records and will offer his opinion on wait or ablat. I was told around the 17th of this month I should hear back. Anticipation is going to do me in. Feel very grateful that he's taking the time to review my case.



Edited 1 time(s). Last edit at 12/06/2018 12:37PM by Kleinkp.