PAF and Ablation, or not...questions to the forum

Good Day All-
I was diagnosed with PAF last August but I am certain that my first bout of Afib recurred in June of 2012. I am 53 in good health, no underlying heart issues, no diabetes, no high BP, no high cholesterol. I am an afibber with a 43mm LA.
I am now on rhytmol 225 twice a day and Pradaxa. Prior to being on meds I had almost daily bouts of afib lasting between 2 and 5 hours. I have had one run lasting 12 hrs. All my episodes resolved by themselves. Since I have been on Rhytmol I have experienced two episodes in just about 20 days.Overall my quality of life has improved and I am able to jog and exercise regularly. Rhytmol seems to control my electrical system and so far I have not experienced any side effects. I am also scheduled for an ablation with one of the top EP in the Country on December 12 but I am debating with myself whether to move forward with the procedure or delay it. I was told that the procedure will not be that complicated being young, paroxysmal with a short history of afib. And here I need your assistance and expertise to answer a few questions:
For the time being my afib is pretty much controlled by the meds. Shall I consider to postpone the ablation for a year and allow the improvement of technology in order to increase the success rate and lower the risks? I often read in the forum that a second ablation is in order to consider to defeat the disease and this is something I would like to avoid.
Could the ablation make things worse than they are right now?
Your advise and comments will be greatly appreciated.
Gianfranco

Hi Gianfranco,

With your vitals spelled out above, I would encourage you to give the whole Strategy protocol The Strategy a serious and dedicated try for the next year and see if that doenst help buy you as much NSR while further strenghtening your overall health .. in addition to the drug regime you are now on.

I would not be on Pradaxa if you have no heart disease, not TIAs and no high BP wit ha low CHADs score at your age and with your very recent onset AFIB. That is definitely overkill and Pradaxa and due to its lack of any kind of real world refersal agent in ERs around the country, it brings some very serious survival risks if you have any kind of accident or real trauma at all involving moderate to significant bleeding!

Based on everything you have said about your health and AFIB history, it seems extremely unlikely that you would even meet the official criteria for an anti-coagulation med as it is!!

If you go off Pradaxa do so only under your docs guidance, and then try Nattokinase, adequate Omega 3 and other natural blood thinners that pose no such risks and will more than likely help provide a good measure of protection for someone like you with very little any added risk factors for stroke above the general non-AFIB population.

If the drug rhytmol is working that is fine and wont be a problem for learning about and pursing the dietary and nutritional support programs that many here have found very beneficial in controlling the beast and keeping things quiet.
But with the natural protocols, if you are religious and focused on doing it full on, can often allow you to switch to a PIP regime with the anti-arrhythmic drugs rather than have to take them every day to keep things quiet for the most part.

If and when after doing all that, you start to have more breakthroughs, then by all means make t hat appointment with the best EP you can find and go for the ablation then. You are still very early in this game and may well be able to buy yourself a lot of valuable NSR time without ablation yet, and as you noted there is progress being made .. although the technology and methods havd matured significantly over the last 6 years or so to a very high degree with the best operators.

Remember, when and if it comes time for the ablation, its the quality and experience of the EP that is, by far, the most important consideration!

Good luck,
Shannon

Shannon, thank you very much for your post. As for pradaxa, I have had a DVT last September of 2011 which resolved successfully. I was on Coumadin for six months and after that my hematologist decided to take me off the Coumadin. I forgot to mention that I am prone to form clots having tested positive for the prothrombin gene mutation and Leiten V factor. This is the main reason as to why my current EP put me on pradaxa but I guess it is worth another conversation with him about the anticoagulant strategy.

Hello Gianfranco,

Excellent advise from Shannon. Considering your issues with clotting along with your afib, a blood thinner makes total sense. There are a number of newer blood thinners on the market right now, unfortunately none of them have an antidote. The only attractive thing about the old standby warfarin is that it does. I think warfarin will be a thing of the past once the other blood thinners find a reversing agent.
I was on rythmol for about two years before it started losing it's effectiveness. I have been dealing with afib for twenty years now. A number of ineffective drugs and two ablations later and I'm still trying to deal with it.
Your history with afib is very short, but it sounds to me that it is at an advanced stage with regards to regularity. If you are certain about your EP's abilities and experience I would be really tempted to stick with your Dec. date. Remember, I have been battling afib for a long time plus I am 68 years old, so I my advice may not be for you. Afib treatment is advancing very quickly so a wait and see approach may work for you too. It's a tough call. Certainly follow Shannon's advice and check out The Strategy.
All the best with whatever you choose.

Lou

Gianfranco,

Thanks for posting this question. I'm in a similar boat to you. I'm on Flecainide which is working really well. Before going on it I was having daily attacks (actually usually at night) ranging from 2-12 hours and sometimes more. I've been completely free of afib on Flecainide (and a beta blocker, my understanding is a beta blocker or calcium-channel blocker is necessary to take with Flecainide to avoid long-QT syndrome).

I also wonder whether to get an ablation soon, or to wait one or two year and see if techniques improve. The EP who I plan to have do it, also told me if he were in my boat, he'd wait a year or two before getting it done to see if some great new technique comes out.

But, on the other hand, I think if I get it done right away, maybe ablation has a better chance of working well. My big concern is, if Flecainide stops working, doesn't that mean the afib becomes more advanced and ablation has less chance of working? If that's the case, then why wait at all and take that chance? So I'll see what people say.

Before going on Flecainide I tried natural means of controlling afib. They improved my afib a little, but after a while stopped working at all, which was when I decided to go on Flecainide and think about when to get an ablation. I tried cutting things out of my diet, but noticed that as time went on, new foods wood trigger AFib, even healthy foods like carrots. Now, on Flecainide, I can eat chocolate and drink Coke without getting AFib (but, of course, still need to limit those things to avoid gaining back the weight I lost while trying to control AFib through diet).

Thank you for your replies. I was wondering if Hans could share his vision and comments. Have a great day.
Gianfranco

Hello Gianfranco,

I have the following comments:

1. Like Shannon, I don't see why you need to be on anticoagulant unless it is in preparation for your scheduled December 12 ablation. Your CHADS score would seem to be low enough that you would not need it on a permanent basis [circ.ahajournals.org]

2. I assume the Rythmol you are on is Rythmol-SR (sustained release). The 225 mg twice daily is quite a low dose. A dose of 325 mg twice daily may completely eliminate your afib, especially if you are also following the Strategy [www.afibbers.org].

3. Your EP is probably correct in saying that an ablation procedure in your case is likely to be successful in the first go.

4. It is unlikely that the procedure will make things worse if done by a top EP.

5. "Waiting for the technology to improve" is not really a good reason to postpone an ablation if it is to be done by one of the top EPs in the US. Technology improvements primarily benefit less experienced EPs.

To wait or not to wait for an ablation is a difficult decision especially at your age. We only have data for about 10 years in regard to longevity of procedures. There is some indication that the effects may begin to "wear off" after 8 to 10 years, so you may, if you have the ablation now, need to have another one at age 63, 73 and maybe 83 (a worst case scenario). In your case I would tend to stay on the Rythmol for as long as it works, but definitely go for an ablation if:

1. You experience side effects from the Rythmol

2. Your episodes start occurring weekly or more frequently or becomes highly symptomatic.

3. If you ever have an episode lasting 24 hours or longer

4. If your CHADS score changes so that you need to be on anticoagulant for life

5. If your left atrial diameter starts increasing. My personal "danger sign" would be 47 mm.

Hope this helps.

Hans

Dear Hans-
Thank you VERY VERY much for your detailed feedback. I truly appreciated it. Your comments make total sense to me and I will take them in due consideration in the ablation decision making progress.
Gianfranco

Hans on a different note:

1. I am on propafenone 225mg SR twice a day. I began the anti arrhythmia therapy on October 1st and so far I have experienced three episodes of Afib. The last two lasting about 2 hourseand they always took place in the middle of the night. Should I then have a conversation with my EP whether I need to up the dose to 325?

2. I tested positive to the prothrombin gene mutation and to the factor V leiden. Additionally, I have had a DVT in September of 2011 which resolved successfully. In lieu of these elements, do you still think that I should be off the anticoagulants?

Thanks again.

Gianfranco

Gianfranco,

If your episodes occur in the middle of the night your lone atrial fibrillation is likely of the vagal kind. In this case propafenone may not be a good choice as it has beta-blocking properties. Depending on how quickly you metabolize the drug this may be a problem and actually increase your risk of having episodes. A better choice, considering that you have no underlying heart disease, would be flecainide (Tambocor). You may wish to switch to that - with your doctor's approval of course, starting at 50 mg every 12 hours, but going as high as 100 mg twice daily if needed.

I am afraid I don't know much about Factor V Leiden and it seems to be not entirely clear how long you need to be on an anticoagulant after you suffered the DVT. Personally I would think that nattokinase might be an acceptable choice for long-term protection starting 6 months after the DVT incidence. For more on this see [www.yourhealthbase.com] and for more on DVT prevention [www.yourhealthbase.com]

Hans

I asked my EP that, whether I should wait until the methods improve and he said even if some breakthrough occurred, it would take a while for the practice to become widely accepted and he felt that in my case a PVI would do the trick. We'll see. Seems most people here try diet, supplements, avoiding triggers, then on to Flec and Pill in Pocket if it's PAF then maybe taking the drugs every day to avoid the onset. In my case I had 2 months with 10 incidents in each and I wanted to get an ablation before it got worse.

Hello,
I am new to the forum and looking for advice...i am hoping that i am making the right decissions.
In reverse order...
I am scheduled for ablation at mgh with dr. Mansour in less then 2 weeks.

Until recently i was on 40 mg of sotalol. I am currently on xeralto.

Earliest record of afib was in 2009.... Kept quiet about it for years...sessions last 3 hours or so.
After hip replacement surgery in july 2012, i was hospitalized with afib...sotalol in very low dose worked for several months....but have been gaining weight (25lbs since then)
Came off it twice before with doc 's permission and lost weight each time. Second time off for about 4 weeks and had migraine with afib. Back to hospital. One neurologist called it TIA the other convinced it was " complex migraine".

Went back on sotalol but started having afib once or twice a week. About three hours...heart converts on it's own. Heart feels jumpy. Went off sotalol about three weeks ago as doc sugests it is not working anyway.

For the last year and a half i have removed caffiene, all sweeteners, gluten, meat, poultry, eggs and recently dairy. Eat fruit ,veggies, nuts, fish....feel great!
Exercise at least 4 times a week. Take ubiquinol and sinatra supplements, added vit. D.

I am 61. Female. Overweight.

In august i was diagnosed with severe obstructive sleep apnea. Cpap machine works wonders....no afib at night.

Very anxious about this proceedure. Looking for support and long term success/outcomes. Suggestions? Missing anything?

Many thanks,
Mep