13 Year Anniversary Update

I guess I didn't foresee that the number 13 was going to be unlucky. On Nov. 11, I went into my 5th episode of afib in the last 13 years and thought that it was just another short bout. Well, it lasted 10 days and in the mean time, without a cardiologist or EP where I now live, it was a struggle to work on a resolution and find a Dr. After some "string pulling", I got in to see an EP on day 8 of the episode. He put me on Eliquis and scheduled a TEE and cardioversion for 7 days further down the road. After two more days in afib, I converted on my own. I was told to stay on Eliquis for one month via the Dr's nurse, and that's pretty much where it now stands. With a CHADS2 score of 0, I didn't really need a blood thinner, but at the time, I was on two 325 mg aspirin a day because of a hip replacement. The Eliquis was primarily for the cardioversion and no more aspirin.

The EP that I saw pretty much ignored antiarrhythmics and a touch up ablation during our appointment, and just said to come in for cardioversions as needed (easier said than done). Needless to say, the story isn't over yet as I try to come up with a more appropriate resolution/plan, and maybe a different EP. More than likely, a touch up ablation will be needed and I am trying to see if I can meet with Dr. Kevin Wheelan in Dallas during a visit in a couple of weeks. He is the Doctor that did my original ablation. I am now in Raleigh NC.

It was a nice run as long as it lasted.

Ken,

Sorry to hear about this. I'd at least hope you can get in with someone who'd prescribe something like flec PIP. That, along with my other mitigation strategies, has stood me in good stead for ~15 years with no progression in AF burden (after my initial 2.5 month episode). The flec usually converts me in 1-2 hours. I never wait to see if I'll convert on my own, take it as soon as I realize I'm in afib (which is normally immediately), chew it so it will get into my system as fast as possible. I've only used it twice in the last 17 months.

Good luck!

George

Hi Ken,

If you are in Raleigh, NC - as I am - it shouldn’t be hard to find a specialist. We are sandwiched between Duke, UNC, and WakeMed. I’d be happy to share with you the names of my cardiologist and EP.

Wolfpack,

Absolutely, I would like to here your recommendations for both, a cardiologist and an EP. I have had treatments of one kind or another in many of the area systems, but mostly Duke. However, Duke is really busy and tough to get a timely appointment regardless of one's need. The EP that I saw is in the Duke system at the main Duke Clinic in Durham, just a guy that the earliest opening. Your help will be very much appreciated. Off hand, I don't recall any details of you afib history from previous posts (I will have to check), but a short description of what treatment(s) you had locally would be helpful.

Hi Ken, Im very sorry to hear of your recurrence especially after 10/11 years of such great success. But this is not uncommon. Dr Wheelen did a super job for you with a PVI back in the 2007/2008 time frame. However, please keep in mind not to expect this next ablation to be just a 'touch up' of previous lesions Dr Wheelen did long ago, as it is extremely doubtful that those lesions that served you so long and so well would have failed after over a decade of durable NSR!

Also, in choosing an EP to perform such a very late recurrence after such long term initial success, has to done with extra care.

What is likely to have happened, Ken, is a gradual progression of your tendency for atrial arrhythmia to have spread well beyond the original boundary's of your first precedure, especially how long ago it was.

I know in Dr Natale's vast experience, having had thousands of early PVAI patients prior to 2008 who, like yourself, enjoyed a decade plus of freedom from the beast, only to then discover that a good number of these great long term success cases starting coming back to Natale's EP lab with AFIB or AFlutter (or a mix of both) after the 10/11 year mark.

Natale's group has done, by far, the most research on this very class of patients with initial long-term durable PVAI success, followed by very late after 10+ yrs recurrence of AF/Flutter, and then having discovered that almost 100% of such a similar cohort of patients nearly all had new firings from the more frontier areas of the left and right atria where later progression most often spreads to and manifest as all new trigger sources many years after a successful zz PVAI.

In these large numbers of previously happy campers, the vast majority had very little, to no, new activity detected in or around the original PVI/PVAI areas!

If you would like, please send me your cell number Ken and I'll be happy to share more of these details by phone for your consideration to hopefully help you sort out all of your best options going forward.

Best wishes,
Shannon



Edited 1 time(s). Last edit at 12/01/2019 02:18PM by Shannon.

Ken,

I believe I sent you a PM a few days back, but if for whatever reason it didn’t go through I’ll try again. It contained the names of my local cardiologist and EP.

Wolfpack,

I got the message, forgot to look for it until now. Thanks, I will likely follow up sometime soon.