ready for PVA

Hi All--just found this board through another AF site that I have been monitoring for several years. I'm pleased to see many people who take the time to provide thoughtful and well-informed information for newbies and old-timers alike. I'm 48 yrs. old and have had paroxysmal (maybe Lone) AF for 12 yrs. Had the usual progression from terror to acceptance and have now been taking Flecanide (200mg/day) + ToprolXL (50mg/day) for 4 yrs. following 3 cardioversions in 3 months at the end of 1999. Since then, I have averaged 6 episodes per year with typical duration of 24 hrs. Of course, I long ago stopped all the "goodies" like caffeine and alcohol to avoid an episode. Had been doing so well recently that earlier this year, I added back very light social drinking (1 - 2 drinks per week), fortified with an extra 100 mg Flecanide as a preventative measure. I finally seemed to have a semblance of my old life back. All was great until a couple of weeks ago when I got an attack that wouldn't stop. Went to the ER after the recommended 36 hrs., and was once again cardioverted with the "paddles". My cardiologist has been after me to take coumadin but I have refused for the last 2 years, sticking with my daily dosage of 325 mg aspirin. After this recent cardioversion, he really put the pressure on to start coumadin. I finally agreed but ONLY if we could talk about a PVA--I just don't want to be on coumadin for a long time without hope of getting off. I'm tired of all the drugs and I don't want to return to a state of fear where every new episode might require a trip to the ER--as you all know, this worry sure puts a damper on vacation plans. ENOUGH! Dr. Natale from Clevelanc Clinic travels to Marin County, CA once a month and is now affiliated with the Cardiology practice that I use. I hope to have a consult in March. If I am accepted as a candidate for the procedure, I am ready to get it done. I am otherwise healthy and active and I mainly want to be free of the drugs. The only thing that I question is the frequency of my episodes balanced against the risks of this procedure. So MANY people have AF a good deal of the time but here I am with maybe 5 - 6 episodes each year, wanting to have the procedure--I still believe that for me, the reward will outweigh the risk--I think my family also needs to have a break from the disruption and worry that AF generates.

Hi Charles,

I get about the same number of afib episodes as you. I have had one unsuccessful ablation back in February 2001. I am on 300mg of flecainide per day--200 mg would not hold me in NSR. I also take 160 mg of aspirin per day--no coumadin.

I am slated for a PVI in May 2004. I am hoping that the procedure has advanced enough since 2001 that this attempt will be successful.

I believe that the dangers of taking drugs, the risk of stroke and the negative affect on my lifestyle physically and mentally warrants another shot at a cure via PVI.

I live in Canada and do not have the privilege of obtaining Dr. Natale for my PVI but if I had the option, he would be my first choice.

Good luck and keep us posted on your condition.

take care
keith

Charles:

My PVI was done by Dr. Natale on 11/14 [ now 32 days with no AF episodes.] You will like him and the EP staff. The hospital is first rate.

Be patient with the timetable--it is worth the wait.

Good Luck,

Fred

I noticed my first severe Prematue Ventricular Contraction on July 12, 1964 and it felt like it jerked the breath out of me in my throat. I was 28 years old at the time. I didn't know what was happening. Since that time I started having 5-6 hours at a time of Atrial Fibrillation episodes with ER visits in 1971. I've been plagued with episodes/attacks every since then. But I didn't have to go to the hospital ER again until 1988, 1990, 1997, 1999, 2003. I've had many Afib and PVC attacks that were just as bad or worse without going to the ER. I just load up on Betapace, xanax, and take more Norvasc to help lower my blood pressure that shoots up into stroke range, (192/123), and hope it gets better. A couple times at the ER they have given me hypo's of digitalis to convert to normal sinus rhythym. What a relief when it finally converts. This past Saturday I had a severe attack here at home, but never went to the ER. The past two times I've been taken to the ER, all they have done is take a chest x-ray, draw some blood and do an analysis, insert a hep-lock in a vein. Tell me my electrolytes look normal and blood in general looks normal. Well, something is not normal. I'm so disgusted with Cardiologists and Electrophysiologists not knowing anything to do except say "take more medicine." I know they're just human, but looks like after all these years of research and practice that doctors would know more how to handle these problems.

I also wish there was someone like Dr. Natale in Cleveland, Ohio, closer to me here in Texas. At least Dallas needs someone like him. I wish.

Glenn Camp
Kilgore, Texas

Charles - My PVI with Dr. Natale was on 11/12/03, here in Cleveland at the CCF. I have high praise for him and the procedure. In 3 weeks, I'll go off the flecanide and that will be the true test of how successful the procedure is. I'm very confident. Heart has been in NSR and it feels great.

I encourage you to sign on with Dr. Natale and just be patient - do whatever you have to do until then. If I were in your place, I would proceed with it for all the reasons you mention, not the least of which is getting on with a normal life for both you and your family. It is a drag after a while. You are young enough that the difference in the quality of your life is going to make a huge impact for you in the long run.

The other major influencing factor is that you have followed the path that most of us have...afib for quite a few years leading to progressive resistance to drug efficacy....increased doses, etc. My opinion is that undoubtedly used long term, any of the antiarrhythmic drugs don't do us any good so if there is a way to get off them, then after such a long trial, it is just best to recognize that it is only a matter of time before the higher dose of flecanide doesn't hold and you are at the mercy of whatever treatment is available at the time. Better to have Dr. Natale lined up and use the interim to prepare for the procedure.

I wish you well. I know you will be as pleased. Feel free to ask for help and support...we are all here to provide it.

Best wishes. Jackie

Hi, Charles...

I've been in AFib (or now AFlutter) for the last couple of years. Perhaps longer. I may have had episodes previously, however. They began episodically, usually following some sort of exercise, but often just coming out of 'now where'.

The episodes increased in frequency and duration as well. I have had episodes that lasted for 2-3 weeks with perhaps a few days of "rest" before the next example of AF pops up. It has interfered with my life a great deal. I could not shovel snow, hook up the snow plow, ride my bike, work out, split wood, have sex, or even go for a fast walk on vacation without some risk of AF coming on and hanging 'round. It didn't always come about, but enough of the time that I was quite skittish doing anything.

I was placed on Toprol, which made me worthless and more tired than ever. I was switched from one med to another, including coumadin (only for a month, I stopped on my own). I was placed on Flec and went 'haywire' for three days. I stopped that on my own as well. Back to another "...ol" beta blocker.

Finally, I went on a calcium channel blocker, Cardizem 360, at my request. This seems to work better than any of the other meds... for me.... 'side effect-wize' than any of the beta blockers or anti-arythemics ever did. I also take 325 mg aspirin, too. (along with the loooooooooong list of 'supplements' recommended by many on this board) This combination seems to have changed the AFib to AFlutter... or perhaps it is just a 'normal progression' for me. No one knows. I don't have any other health/heart/system problems, altho I am borderline for elevated BP.... and recently was placed on Zocar which seems to work quite well.

My EP thinks this 'evolution' from AFib to AFtr doesn't seem to be as big a deal as the AFib did before. I can work out, ride my bike, and do many physical things .... albeit at a less intense rate than normally.... even when I'm having an episode. The EP also wants to do a "flutter ablation" ...which he says is "...quite EZ and you will either be 'fixed' or the same".

I guess the point is: I'm not ready for an ablation (still scares the crap outa me thinking about it!) and I'd like to 'hang in there' a couple more years before laying on the cold table with a catheter or six up my groin. And, I'm 57 and in pretty good shape. Yeah, I still consume some vino pretty much every day (doesn't seem to matter for me), don't drink much caffeine, exercise when I can (3-4 times a week.. in AF or not) and just basically 'deal with it'. I've never been to the ER for cardio conversion either. If I went to the ER everytime I was in AF for over 24 hours, I'd have my own WING there by now and the ER would be Numero Uno on my nav system!

So, seek all the information you need and chart your course. I plan to review my 'status' in another 2 years along with the results of all the ablations that will be history by that time. I'd like to see if newer tech makes this less scary to me and that the results well be very, very predictable in a positive way. Until then, I'll just continue to do what I do presently.

Charles: You are taking the right step to being cured, without major lifestyle changes, which I tried for nearly a year, right up to a couple weeks before my Cox Maze procedure at the CC in Jan.'01. I got slight relief with dietary changes/supplement therapy suggested by Hans in the early days of this site, but not enough to persuade me that I could do without the meds. Had the PVA procedure been as far along then (at the CC), I might well have tried it before the Maze, but within 12 days post full open-chest Maze, I was doing 3 miles, twice a day at a 10-11min/mile pace. Before the Maze, I was lucky to climb one flight of stairs without having to sit down on the stairs like some drunk. I take no meds, and one year post maze, ran up 42 flights of stairs in Hot'lanta in July, just because I felt like doing it in (business clothing). I am cured, as are many other vets of the Maze and the PVA by Natale (or his very fine associates at the CC). Find some input from many of those vets at: mazesurgery.com

Does PVA stand for Premature Ventricular Ablation or what?
Also, I see the hospital/Clinic in Cleveland referred to as CCF..... Is that the same as Cleveland Clinic Heart Center?

I forgot to ask in the previous post...... what does PVI stand for? I've been through all the drugs for Afib and PVC's for thirty plus years and they no longer are effective. Now I can't do anything like walk around the block or up a flight of stairs, hardly on flat ground very far. oh well...........what else is new?

PVI stands for pulmonary vein isolation. PVA stands for pulmonary vein ablation (same thing). They have nothing to do with PVCs (premature ventricular contractions), those arising from the lower chambers - the ventricles. I believe that sometimes PVCs are increased in cases of increased endocardial irritability and think that with a successful ablation, those would also decrease, or disappear, but not necessarily. That would be an interesting question, and I think I'll post it.

Pam

CCF stands for Cleveland Clinic Foundation. It is also called Cleveland Clinic. It is also called Cleveland Clinic Heart Center.

My advice to anyone contemplating an ablation is to pick what you think is the best place and the best doctor and have it done there. Don't let saving a thousand dollars on airfare and hotels be a factor in your decision. Your body and better odds of a successful ablation surely are worth more than a thousand dollars. Pick the best.

Newman