Ablation at what afib burden?

Hi folks,

first I would like to introduce myself. My name is Dirk, I´m living in Germany (47 yo) and suffering from lone afib for about 15 years. Otherwise I am in pretty good condition and feeling well. Since English is not my native language please excuse any typos or mistakes in my posts.

My afib episodes are quite frequent. Five times a week is not uncommon but most of the runs are very short (about 60 sec or so). Longer episodes (say once a week) terminate after 3-5 hours as a rule. The longest episode lasted about 7 hours.

I´m doing fine during my afib events - slightly weak and sometimes a little dizzy. Not too bad after all.

My overall afib burden is between 1% and 4% and this leads to my questions:

I am considering having an ablation in a specialized center in Germany (Prof. Lewalter in Munich) - he definitely is an expert with excellent reputation.

Would you go into an ablation with an afib burden varying between 1% and 4% or is this "not bad enough"? Do I have to fear any atrial remodelling at a burden like this?

I would be glad to read your opinion on these questions.

Thanks a lot in advance.

Best regards

Dirk



Edited 1 time(s). Last edit at 05/30/2013 11:54AM by Dirk.

HI Dirk - I have had Afib for 10.5 years, and have a similiar story to yours. I have been able to tolerate the episodes, and have never had one lasting longer than 14 hours - also never had to be cardio-converted. They did get to the point that I had an episode daily however about 5 years into it, so I finally decided to take Flecainide.

I have had "breakthrough" episodes on and off during the past 5 years of being on Flec. Sometimes it's several times/week, and sometimes it's just once/week or less. But I really don't see this every going away on it's own, and as I get older (I'm 60), I realize that I'm running more of a risk. Should I get another health condition, I'd then have to worry about drug interactions, and also, I know doctors like to push blood thinners as we get older and have Afib..

Now that Dr. Natale (THE doctor to go to for ablation here in the US), is in the NY area and only about an hour from where I live, I am thinking it's time. While an ablation is scary, a stroke is even scarier, and having this interfere wiht my life on a fairly regular basis is getting OLD....I can manage, but is that how I want to live my life? (NO)

If you don't have any other health issues and your heart itself is in good shape, AND you are managing well, then you could certainly hold off. But if they are frequent, you may be running the risk of getting Afib even more frequently, and that could lead you down an uncomfortable path...IN either case, there doesn't seem to be an immediate need to do anything.

Just my opinion. I'm sure more people will join in with their thoughts.

Welcome to the Board You've come to the right place for support, answers and knowledge ~ Barb

Hi Barb.. to reach Dr Natale's scheduling nurse, Michele, at Al Sabah in NYC call: 212-523-2400. I think it was in another thread that you asked me for his NYC number.

Best wishes,
Shannon



Edited 1 time(s). Last edit at 05/30/2013 08:08PM by Shannon.

118 views and only 1 answer (thx). Please help!

Hello Dirk,
I was diagnosed in August of 2012. My afib surfaced almost on a daily basis and I always converted on my own after a few hours. I was on Rhythmol Pradaxa but the Rhythmol did not do anything for me. I am 53 years old and have no underlying heart issues. The disease affected me deeply emotionally and physically and on top of everything else I did not want to be on meds for the rest of my life. I researched the Internet and got as much information possible ...finally I made the decision to get an ablation. I was lucky enough to meet dr. Pinski one of the top EP who resides and works in Weston Fl only 40 minutes drive from miami where I live. He told me basically two things: afib is not life threatening and can be effectively managed but need to be on meds or get an ablation being paroxysmal with no other health issues. I decided for the latter. It was the best decision I could ever made . i had my ablation at the end of jan. i have had a few bumps along the way thru my blanking period Of the past four months, but overall I feel much much much better. My quality of life has much improved and I have resumed my running and my gym activities. . I am off the Rhythmol but still on pradaxa. If I would need a touch up ablation I will be ready to go for it. At the very end it is a very personal decision about getting your heart ablated. I hope my journey may help you make your decision. (You are young in good health, paroxysmal and so a perfect candidate for a successful ablation). Moreover, invest time to learn about the disease. There is another website you want to check out www.stopafib.org.
Good luck and ciao for now.
Gianfranco

Dirk - in a recent thread considering whether to ablate 'sooner' or later, I responded with my personal observations and experiences. I've reproduced it again in this thread. I am and always have been of the opinion that unless there is a medical/physical imperative that ablation needs to be done quickly, it then becomes a personal decisiion as to how much it interferes with your life and whether you are interested in trying to reverse the trend yourself with nutritional and lifestyle interventions. As with all surgical procedures, none are guaranteed 100% risk-free and the number one important factor is to choose an 'elite' EP who has an excellent track record for safe and successful ablations.

I wish you well in making your decision.

Jackie


Re: Impact of timing on AF ablation success/failure
May 26, 2013

It may be that in some cases, sooner is better for ablations but based on my history, waiting didn’t seem to interfere with the success of the procedure once I gave in to it eight turbulent years after the onset.

I recently wrote the following to an afibber who asked for my history:

..." My AF history – 8 years of escalating events starting with one event in 18 months (age 59), then 2 a year, then 3-4 a year and in years 7 and 8 increasing until every day or every other day… often lasting 24 – 27 hours… NSR for 4 hours and then back in AF for another 24. Because I had been mislead in the past about the need for other surgical procedures rather than addressing the core cause, I was determined not to make another mistake. Reluctantly, I consulted for an ablation thinking I was progressing to “permanent” and had no quality of life at that point. My only other health issue was longstanding hypothyroidism which never seemed to be fully addressed in spite of the test numbers being “normal.”

I was given an ablation date 6 months out and since I never, ever wanted an ablation, I decided to do everything possible as a last ditch effort to avoid the ablation. These heroics included homeopathy, acupuncture, chiropractic and increasing doses of the core AF supplements including proteolytic enzymes. Nothing seemed to make much of a difference until I had the chiropractic adjustment for the stomach/diaphragm area. Then everything changed. This was apparently an irritated vagus nerve which, once out of the line of fire, calmed down and was no longer a trigger. I was also doing heroics with magnesium, potassium and taurine.

In a matter of weeks, I went from daily AF to zero events, but was still on 150 mg flecainide BID. My next goal was to wean slowly off Flec and did so for two months by shaving off portions of the pills until virtually nothing remained but a crumb. I then had a significant rebound which required only 50 mg to maintain NSR until the ablation date. I was tempted to delay the date to give weaning off more time but my insurance situation was not solid so rather than risk that complication, I had the Natale ablation in 11/03.

At 103 days post ablation, I had AF breakthrough which was electro-cardioverted. No other AF until year 4 when I had two breakthroughs which were easily converted back to NSR with the PIP protocol. Then, more AF biannually 6 – 9 months apart in years 4, 5, and 6.

Hindsight reflection on those breakthrough years led me to realize that I had become lax in making sure I had the daily core nutrients in place without fail… so I shored up those and added d-Ribose, more carnitine, Ubiquinol form of CoQ10 in substantial doses and focused on pH and alkalinity faithfully. I became a student of energy medicine techniques and practiced grounding or Earthing as a way to replace missing electrons that helped optimize cellular voltage.

Then, last summer, Lyme disease was diagnosed in year 9 post-ablation (now age 76) and with aggressive treatment, all hell broke loose and I had dramatic, turbulent AF… 9 events in 16 days and 1 electrocardioversion. A nightmare of a situation. Back on heart meds for 3 months. I saw three EPs (another long story) all of whom thought I’d need the second ablation since mine was done “so long ago” with the older technique.

I stopped the aggressive Lyme treatment and focused on calming my heart once again with extra emphasis on pH and voltage. And once again, I weaned off heart drugs and maintain NSR. At the last EP visit, I was down to 50 mg flecainide daily and he said… “Well, it’s not the drug.. that amount is virtually nothing. Your heart is doing it all by itself…it’s rock solid and the ECG looks perfect. When do you want to see me again… I said how about 6 months?” That was December, 2012.

My personal observation is AF is a result of a waning supply of critical nutrients and balances plus interferences that keep the heart energy (voltage) from being optimal. Inflammation is a huge contributor as is acidic tissue pH and the subsequent low-voltage factor which has been discussed frequently in other threads. In my case, when imbalances become dominant, I get AF. Others may manifest in different chronic ailments or diseases such as hypertension, cancer and neurodegenerative diseases. Since more afibbers are diagnosed at earlier ages, the nutrient deficiencies and environmental influences are coming into play more frequently than in previous years... indicating once again getting to the core causes is an important consideration. AF is the canary in the coal mine that systemic imbalances interferring with appropriate neurological conduction are present. "

Jackie

HI Dirk, I think when it's time you will know. I have been dealing with AF for 8+ years and in the begining spent a lot of time in hospitals with testing, trying medications, feeling like a zombie and experiencing worsening AF. Then I found this web site and began to take charge of my treatment. In collaboration with with a patient friendly cardiologist and EP I was able to manage my af pretty well. Using the PIP I terminate an af episode generally in two hours and within 24 hours or so I am back to normal. I feel good and have not been inside a hospital for af since early 2007. I generally eat well and generally avoid the things af'ers are supposed to avoid. I haven't eliminated the triggers but have made pretty steady progress over the years in reducing the # of episodes per year. Stress is one of my triggers. I have had 4 af episodes this year while I was helping to attend to my mother who passed away after threee months of suffering. Every time i have an episode I get depressed and would do anything to not have to endure it again. Then after a day or so I begin to feel good again and start thinking that it is not so bad and I can keep doing this until.... forever I guess! Forever?? I just recently decided that I don't want to do it forever. Motivated by McHale's bravery I dropped off my records with Michelle in Dr Natale's office here in NY. If He doesn't give me too much time to think about it I will take the plunge. Hope this helps. Dennis

Dennis,
I'm glad I could be an inspiration! I waited 4 years stroked out September 5 and I was a CHADS 0!!!!!! I tried all the natural supplements we talk about on here and at one point I thought for a month I had it beat! Yea right! In hindsight I had it for many years before being diagnosed but it was such short duration I never thought it was anything but the minoxidil I was using being absorbed into my system. I'm using all the supplements post ablation and will continue but in my judgement this beast will keep coming at you! The Flecainide was failing me not that it worked that good anyway but instead of every 10-14 days in NSR the last 3 months it was weekly with the last month really unnerving. After I came off Flec a week before my ablation I realized how bad my symptoms were and I couldn't live like that the rest of my life. I had the best now here in New York and I pulled the trigger without even meeting the man.

Best,
McHale

PS sorry to about hear your mom as I'm dealing exactly with that situation now.



Edited 3 time(s). Last edit at 05/31/2013 11:45PM by McHale.

Ah, Dennis - I can SO relate to your comments about getting depressed and then you feel good again and hold off thinking it's not so bad, only to get hit with another episode, and so on...round and round. Like you, I am going to call Dr. Natale this week, as I do feel that it IS time. And McHale's bravey and move to finally DO this has also motivated me too.

McHale - So very happy for you. I guess things went really well and you "sound" like a very happy man! You are definitely one of the reasons I've decided to make that call. I am pretty scared to come off of the Flec when it's time, as I know I really need that med to stay in any reasonable NSR, so it's likely to be pretty bad during that time, but...not much choice, I dont' think.

Shannon - yes, you probably did give me the number before and I'm sorry for asking again... a little scattered lately - lots going on.

I hope the posts you got here Dirk have been helpful to you. ~ Barb

Thank you very much for your help.

I wish you all the best.

Dirk

I had paroxysmal AF, undiagnosed, for many years. The episodes became more frequent and lasted longer, until eventually they all joined up and I was in persistent AF. This progression happens with a lot of people, though not everyone.

Ablation is much more difficult with persistent AF so it is better to get it done before you get to that stage, but it is hard to decide exactly when that is, and it is different for each person.

After 18 months of persistent AF I felt as though my life was over. I went to Bordeaux for ablation in January 2003, had to have a second one three days after the first because of recurrence, but have now been in sinus rhythm for over 10 years. I wish I had done it earlier, though that was early days in the ablation story and very few centres had the necessary expertise and experience - Bordeaux was one of them. Best thing I ever did, gave me my life back.

The most important thing, as everyone here keeps saying, is to choose the EP with the most skill and experience. There are many who are still learning what is a very difficult procedure, and they are keen to rush to ablation and do as many as possible. I wouldn't want anyone practising on me. If you do decide to go ahead, choose carefully.

Gill

Hi Gill,
Wow ten years and counting! We went to the best!
NSR feels so nice doesn't it!

Barb,
I'm feeling great at day 4 now not a flip, jump, hiccup yet and Dr Natale ablated not just the 4 PV's but also found lots of activity in the coronary sinus and shut that down he told me. He also ablated the superior vena cava for my sleep apnea trigger. That's why you go to a top Tier EP he finds other areas of rotor activity while everyone is getting caught up on FIRM like I did. Heart rate at a steady 70-72 today was running at 78-82 the first few days. Before the ablation my heart rate would drop to below 50 and I knew soon after afib would hit within a few days. My normal NSR heart was around 55-60 on a Beta Blocker. I didn't have much too Fibrosis and my left atruim was mildly enlarged. That's was my concern the last few years of those two conditions worsening. So I knew I must act soon besides having a TIA! Once you turn persistent your stoke risk goes way up and God forbid you must stop anticoagulation for any reason whether it be long term or for a few weeks then you're screwed!

I think this sums up the AFIB conundrum as expressed by Latronia:

My fear is my autonomic problems will trump any holistic corrections -- the healthier I get, paradoxical sympathetic reactions to increased relaxation will still trigger a-fib. Therefore, I am thinking a physical barrier such as that provided by ablation lesions might be necessary to stop the perseveration of arrhythmia!



Edited 2 time(s). Last edit at 06/01/2013 10:11AM by McHale.

Thanks for quoting me, McHale.

Little did I know my oddball paradoxical reactions would shed some light on decisions for others.

So glad you are doing so well, McHale. I assume you are back home now, yes? I'm not sure what you mean in your last paragraph. Are you saying that an ablation should stop the problem or that you think you need something more...?

I have an appt. with him on Monday for a consult. A bit nervous as I can't believe I am finally doing this....

Have a great, quiet, blissful night ~ Barb