When to go to hospital and other questions

I’m new here and very thankful for the info and support on this forum. 45 years old developed afib 3 months after last baby whom I developed preeclampsia with. So I’ve had it for about 2 years. No other cardiac issues, slightly high bp and on eliquis. I had ablation in January with one of Natale’s protégés. We though it worked until month 5 when the roof fell in. We just got confirm on he monitor that it’s afib and it looks like 2 or 3 veins reconnected. I am awaiting surgery with the same guy- hopefully in the next 8 weeks. I’m much worse than I ever was before initial ablation. Now that it’s broken through I’m having at least minor daily episodes, and a big one every 10 days. Since January I’ve lost 25 pounds (25 to go), no caffeine or alcohol, doing yoga and walking a ton- and somehow I’m worse. I’m highly symptomatic and can’t talk durIng an episode let alone take care of my three young kids. This had been a nitemare.
When you are in a bad episode when do your call it quits and hit the ER? I was so close this afternoon but rode it out and 2 hours later it left as if a phantom. But my symptoms are now getting to the point where I almost pass out. Highest rate was 182- generally runs 163 when afibbIng. I took my 360 diltiazem early and think that helped. Is it possible my first ablation made it worse? I feel as if I have no choice but to do the second as I can’t tske flec or propafenone- and they don’t help anyway. I’ve heard that a touch up to fix the regrowing is a straightforward fix. Is that correct? I’m terrified that this is my new normal. No triggers just constant bouts of misery. I’ve seen so many positive optimistic posts on this site and could really use some of that energy right about now. You guys are the best.
Tracy

Your index ablation didn’t make it worse. I’m not sure how anyone can determine a vein reconnection just by an EKG. It’s certainly possible and even likely that that is what has happened, but it’s also quite possible that a new source of ectopy elsewhere in the left atrium has arisen. Does your EP perform more advanced ablation outside of standard PVI?

My regular ep says he could see it on the ekg- and he too does ablations. My guy who is doing it trained under Natale so I expect he can handle it.

Given his heritage I’d expect so as well, but it’s certainly worth asking.

As for going to the ER, my experience is that they are horrible places to treat AF but if you are highly symptomatic then there’s no other choice. What’s your history with cardioversion? Do they work?

I usually revert at home with an extra diltiazem in a couple of hours. Hospital is generally the same- always reverted with medicine thus far.

Max dose of diltiazem should bring the pulse rate into the the safety zone while you await your touch up ablation. Don't think this is any "new normal", just need a touch up.

(I'm guessing you're taking regular vs extended release for immediate benefits).



Edited 1 time(s). Last edit at 09/01/2018 10:11PM by jpeters.

Dino dog -hang in there. Just remember that it is all a process. You really have no choice as afib begets afib. The earlier you take care of it, the better chance of being fixed permanently. I have about the same story as you! I had my first ablation at TCAI with a Natale associate in February. I had about 3 afib/aflutter episodes the first 5 weeks, then it seemed fine. But, I developed vertigo from ear issues and threw up so violently that it threw my heart into arrhythmia in May. My second ablation was June 5th. I felt much more stable after that ablation. My EP explained that he doesn’t subscribed to a scorched earth policy on a first (or any) ablation. He ablated around the PV and other areas in the left atrium. The second ablation, he really hammered the same areas and then there were new areas in my right atrium (atrial flutter) and areas around my LAA. As I said, this ablation seems much more stable. I have had runs of PACs about 10 weeks post ablation and yesterday I had 2 min. episode of atrial tachycardia. I didn’t like it but it did resolve itself.

Just keep telling yourself it is a process. It will get better and get the second ablation done, sooner rather than later. Unfortunately, the worse part is being aware of every beat of our heart. I am told that that will also be a memory - just keep moving forward! There are many who have been fixed of Afib - and those with not just paroxysmal but permanent afib. They are usually not on these forums as they are out living their lives - as we all should! Again, hang in there and we are here for you!

My Cardiologist told me to try not to go to the hospital when I have an afib attack. My pulse gets pretty high and I am sympomatic but he said to take my meds, grab my IPad or Watch tv or take a short walk and try to ride it out at home. If I cant....I cant....but the E.R. Is generally overkill.

For me, if my anxiety kicks in....it just makes everything worse, so I try to manage my anxiety during AFib and it is helpful.

My Doc also gave me a timeframe to wait it out and he to call anytime for support.

When to go to the ER:

When your heart rate exceeds 200
When you experience pain anywhere in the upper torso, jaw, neck or arms
When you experience fainting, near-fainting or dizziness
When you experience difficulty breathing or shortness of breath
When you experience nausea or vomiting
And last but not least.... When you just can't take it any longer

Until then, you're usually better off taking your beta blocker or PIP if you have one, making yourself as comfortable as you can, and waiting it out. You're not going to die and the ER knows that, so unless you have one of the things listed above, it's unlikely an ER will do anything more for you than you can do for yourself.

Dinodog:

360mg of Diltiazem, that sounds like the extended release form at that dosage?
The ER form is not fast acting, you need the regular non-ER form. The dosage would be much lower, but immediate-release should be effective within 30 minutes. It doesn't sound like your episodes last that long? Maybe 2-3 hours?

You'll feel alot better in AFB, if you can lower your rate. I would talk to your Dr. about adding a Beta-Blocker for use just during episodes, if the Diltazem is not enough.

As for going to the ER Room, there is nothing wrong with that if you feel so bad, and it is probably warranted. They would give you Diltiazem through IV, and probably a Beta-Blocker to bring your HR down under 100. Also, If you go to the ER, you should be able to leave at any time if you really wanted to. Until you find the right Drug-Regimen for Rate-Control, going to the ER would be fast treatment in a monitored setting, and you would be able to glean what Drug or Combination of Drugs is effective for your Rate-Control.

I hope this helps, the good thing is that you are reverting back to NSR on your own, Effective Rate-Control will make this situation much easier for you.

Thanks so much for all of your help!