14 months post ablation - Back In Afib

I have had a great 14 months but today I had two dental procedures, 2 hrs 20 mins....I asked for no epi......but not sure they did it???? 4 hrs later afib.....415 PM now over 2 hrs! Im freaked..........what to do..............

Yom

PIP?

George I had 2 propafanone and took them with one metropolol 90 mins ago

also took a vallium

I just cant believe it

Tom

Im at 2.5 hrs now

Tom

I have felc but should I take it after 2 propafanne?

Tom

Not unless you talk to a doc...

I don't know what happens if you double up.

ok

4 hours now no end i site

T

Have you tried working out - exercise bike etc?

I will af....good idea.....but never worked before

I'd just take a 300mg Flec.

AF,

I've never seen anything about combining flec and propafanone. As I mentioned I'd wouldn't do it without an OK from a doc.

George

Hi Carolina Tom-P

So sorry to hear of your breakthrough episode! Dental work can be a trigger culprit, but typically shouldn't trigger without a cooperative substrate allowing it to kick start and sustain. A brief run is one thing at this stage 14 months post ablation, but when it sustains like that while you may well still be able to get the genie back in the bottle and it might behave for a long while again with vigilant trigger avoidance and more optimal biochemical repletion with Strategy supplements by itself, and/or with AAdrugs, it could indicate
it could also indicate a possible touch up might be indicated on the horizon.

First things first, though, before considering what the longer range next best step might be.

Is it AFIB for sure or Flutter?? Do you have an AliveCor Iphone monitor to check which one it is ? Flutter will be regular staccato-like and usually pretty fast, while AFIB, of course, is more irregular like a fish flopping around inside your chest. Although, fast AFIB can sometimes be hard to distinguish from Flutter and the two are sometimes mixed. Especially after a first ablation when there is a delayed breakthrough like this it is not infrequently found to be a left atypical flutter appearing.

Have you been indulging in recent months too in the old triggers like beer, wine, caffeine?? Maybe it was just the dental trigger which can do it all alone if you are prome to flippies still, but with any going back to old triggers that too can predispose one to an eventual breakthrough in the absence of an iron-clad solid ablation.

If you have not converted by morning I suggest you head quickly to the ER after calling your EP and letting them
know and tell them you want to get ECV before it's been 24 hours. Then the ER can either try a chemical cardioversion first, if you really prefer (I would go for the ECV) but if that doesn't work then go for a quick ECV and minimize the time you are in AFIB/Flutter... If you are in high speed flutter then just go straight for the ECV and no need to muck around with the drugs.

You have about 24 hours ... Actually it is technically 48 hours but most ERs won't ECV you beyond the 24 hr point after you triggered unless you are already on Coumadin.

If you are not on Coumadin but are still inside the 48 hr window yet are beyond the 24 hours when most ERs will convert you sans you having a blood thinner on board already, you could discuss with your EP or ER Doc going on a short course of Eliquis or Xeralto to allow them to proceed safely with the ECV ... Ask your EP but try to get their before the first 24 hrs is up and get zapped back to NSR as quick as you can.

I recall you had a quite simple paroxysmal case originally with only widely spaced episodes if my memory serves?? As such, getting you back to steady quickly might keep things quiet again for a long while..

In any event, get back to NSR -ASAP so don't waste any time in the morning if you are still in AFIB or Flutter and call your EP office and tell them you need to get SB ECV soon in case they might want to do it or recommend where to go and ask them then to call the ER and start getting it arranged while you drive in to save time. The sooner you get back to NSR the better to help prevent more remodeling from getting started.

Hang in there Tom, you will be fine, and be happy you've had 14 great months with a first PVI ablation. You still may well get a good deal longer time of a quiet heart but also keep in mind this is often an ablation 'process' that is needed to really put the lid on the kettle for the long term. So don't feel discouraged in any event.

We can talk more later if you wish and PM me your email and number if you have more questions and need faster answers.

Best wishes Tom,
Shannon



Edited 1 time(s). Last edit at 10/17/2013 02:36AM by Shannon.

Tom, bummer. Could be and hopefully is just an isolated event. Did your dental treatment involve removal or replacement of amalgam (mercury) fillings?

Here's hoping to a swift conversion.

MikeJ

yes Mike the problem tooth had a big chunk of silver too

Tom

Tom,
Going forward get some Xarelto and use that as a PIP in the event you go back into afib and it lasts longer than 48 hours before you get an ECV.

McHale

Does Xeralto really work as a pip? It is an anticoagulant, not an antiarythmic.

I still have a supply of it, but I am thinking of asking for some flec, just in case.
Ron

Hi Ron I think McHale was suggesting to literally keep a few Xeralto pills in your pocket or handy so that if you did trigger into Afib or Flutter past the blanking period after an ablation that you could get started right away with an anti-coagulant if you did not convert in the first 24 hours and, as such, would then not have to wait a longer time before getting an ECV conversion.

But Xeralto is not at all a traditional 'pill-in-the-pocket' protocol for helping you self convert chemically back to NSR..

The advantage of Xeralto or Eliquis in this case is that you don't have to slowly ramp up as you do with Warfarin if you start taking the anti coag drug say after the 24 to 48 hour period after AFIB/Flutter triggers..

I'm not sure how quickly normal dosing of Xeralto or Eliquis might resolve a potential clot should one form in that first 48 hrs after an episode starts while you were not anti-coagulated? As such, it might not save you much time in terms of having to wait a lot less than the three to four weeks the Docs like to keep you on AC drugs after you have been in constant AFIB for more than 48 hours.

However, if you started one of these two new anti-coag drugs that don't require a gradual blood level increase over a minimum of five days to start stabilizing INR like warfarin does, by having a little Xeralto or Eliquis on hand (provided it isn't expired ) if you started it just toward the end of the first 24 hour period after a non-stop AFIB episode began, then you could get an ECV anytime in the next couple days without having to wait a month to first stabilize the INR in the first week or so and keep it stable for several weeks to insure enough time to dissolve any possible clot that may have developed in the first 48 hours post AFIB triggering.

Better yet, is to just get yourself to the closest ER and get an ECV before the first 24 hour period is up and not have to even deal with the anticoagulation issue in any event....

If you don't convert in the first 12 hous after triggering some months after the blanking period post ablation ... And particularly if you are in a high speed flutter which may well be atypical left flutter which rarely will ever self convert, nor convert easily on drugs, in that case you want to make sure you are at the ER in plenty of time for them to process you and prepare you for an ECV before that first 24 hrs is up.

That's basically what McHale was suggesting.

Shannon



Edited 1 time(s). Last edit at 10/18/2013 10:22PM by Shannon.

Yep that's exactly right Shannon!
If I had and knew about the fast ramp up time of Xarelto last year when i was going in and out of AFIB over the Labor Day weekend I would have used it as a PIP.
I told my brother that weekend I got to get ablated before I have a stroke and sure enough 3 days later I'm in the ER.
As soon as Dr Natale landed in New York I was one of the first to get ablated Thanks to Shannon!

McHale



Edited 2 time(s). Last edit at 10/18/2013 02:34PM by McHale.