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Touch up ablation or not?

Posted by Dirk 
Touch up ablation or not?
December 28, 2018 08:04AM
Index ablation in 05/2014. Since then isolated afib events (about 2x yearly for about 2-3 hours).

2018: 1 long event (12 hours) that self-terminated. Last week 1 long event that was terminated by 200mg Flecainid in hospital in about 45 minutes. Another event last week which I terminated myself by Flec after 3 hours. Since then all is perfect.

I am scheduled for a touch up PVI end of month but not sure whether to wait or go for it.

Thanks for your opinions.
Re: Touch up ablation or not?
December 28, 2018 09:52AM
If you’re comfortable with your EP and you feel certain that just a PVI touch-up will can the beast for good, then I’d say go for it. If not, then I’d say search for a more advanced practitioner who can detect and isolate other areas in the left atrium. Certainly if you go for a PVI do-over and it doesn’t work then you are in need of the more advanced EP. Don’t do a 3rd try with anyone less than the absolute best.
Re: Touch up ablation or not?
December 28, 2018 10:37AM
I've had a touch-up with the EP who did my PVI, and it was a mistake. He hadn't been able to ablate anything. He said there were ectopics here and there and that he couldn't reasonably burn everywhere in the atria. I'm happy he did not try!

That does not mean your EP isn't skilled enough to perform an efficient touch-up, but I agree with Wolfpack when he suggests going for the best one.
Re: Touch up ablation or not?
December 28, 2018 10:42AM
I concur about going to the best EP.

If it were me, I might get a script for on-demand flecainide to use at home. If you had a couple of episodes a year, terminated in short order with flecainide, your afib burden would be very low. I've used flecainide in this way (for infrequent episodes) for over 14 years, never having had an ablation.

George
Re: Touch up ablation or not?
December 28, 2018 11:00AM
Thanks for your input.

My EP is one of the best in Germany, if not in Europe. Dr Lewalter´s reputation is top-notch, I think.

On the other hand I am not too eager to have an ablation if not absolutely necessary. Flec worked twice perfectly after 45 minutes. So it might be reasonable to stay on this course as long as it works out well. Right, my afib burden is very low. In 2018 I had a total of about 35 hours which is less than half a percent.
Re: Touch up ablation or not?
December 28, 2018 12:35PM
Hey George....When you take the Flec., are you able to quit taking it after your heart is in sinus rhythm, or do you have to stay on it? I've taken that stuff and have all kinds of bad side effects so I can't take it on an ongoing basis. I had a electrocardioversion in November and am now in sinus rhythm but doctor is saying it can't last if I don't take medication and I can't stand to take med because any of it just makes me feel so awful when trying to run, ride my bicycle, or do much of anything physical! I've had an ablation before too and will most likely do that again. The ablation lasted a year and a half, med free.
Re: Touch up ablation or not?
December 28, 2018 04:46PM
Quote
Sunny82
Hey George....When you take the Flec., are you able to quit taking it after your heart is in sinus rhythm, or do you have to stay on it? I've taken that stuff and have all kinds of bad side effects so I can't take it on an ongoing basis. I had a electrocardioversion in November and am now in sinus rhythm but doctor is saying it can't last if I don't take medication and I can't stand to take med because any of it just makes me feel so awful when trying to run, ride my bicycle, or do much of anything physical! I've had an ablation before too and will most likely do that again. The ablation lasted a year and a half, med free.

Sunny,

I only take one dose to terminate an episode. I use it infrequently enough that I have to buy a new bottle when the old one is nearly full, but is getting very old.
Re: Touch up ablation or not?
December 28, 2018 09:10PM
Thanks, George, for taking the time to answer. I'm happy to know that you're not having to take it on an ongoing basis!
Re: Touch up ablation or not?
December 29, 2018 02:47AM
Flecainid works very well to convert to NSR in less than an hour.

But I can´t take it on a regular basis. If I do, and I tried several times, it is counterproductive while provoking afib.
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