Questions for EP

I am having my 3 month post ablation followup appointment with my EP tomorrow and was looking for suggestions on appropriate questions on the procedure and next steps.

On August 13 he alblated me for afib and flutter. Since then I have had no recognisable fibrillation events (I previously would know immediately when in afib). I do have occasions with a pounding feeling but with a pulse around 70. I have had a post procedure cardiac mri, 48 HR holter and a recent complete blood work up. Post procedure my resting heart rate seems to have settled at a higher 70 level compared to 55 pure procedure. Blood pressure good at a normal level. Currently taking pradaxa, carvedilol (originally prescribed for rate control) and irbesarten (for hypertension). I have been off a amiodarone since June (thank goodness). I will be pushing to get off pradaxa and carvedilol if possible and with help from my GP get off irbesarten over time if possible.

This is my first post procedural followup and was looking for suggestions for questions. I want to get details on the actual procedure, indications from the mri and holter. Blood work up indications etc.

I am happy to be in NSR and want to stay here. I want as much as possible to get off pradaxa and stay away from amiodarone permanently.

Any suggestions from this helpful community would be greatly appreciated to help me in my quest for continued afib free days.

Hi Roberts,

Congrats on smooth sailing at three months ...sounds like a winner!

Will be nice to get off the blood thinner soon. As far as questions for your EP ...

1. If you haven't already, ask him for a full copy of your official 'Ablation Report' he will have compiled soon after the ablation. You should always secure a copy of that report as soon as its available, not only to better understand all the aspects your ablation entailed, but to have on hand should you even need to give a copy to another physician seeing you for any reason they might need to know about this.

2. The higher pulse is normal and is a good sign that significant ablation was done, the rate will slowly come down over time but it can take quite a while for some people, even up to a year and a half or more on occasion ( though more commonly around 6 months or a bit longer) for the pacing cells that were ablated regrow and re-establish your something close to your previous natural resting pulse.

3. In the meantime, you might want to not rush off the rate control med. It's worth giving it a try without it for sure, but if you are in the mid 70s as a true resting pulse upon waking while still in bed lying down, its possible your true resting rate temporarily may be considerably higher once the rate control med is stopped. If that proves to be true and its a little uncomfortable .. though not dangerous or a problem .... you could ask for something relative mild like Bystolic which is a very cardiac-specific beta blocker and taking the lowest 2.5mg dose once a day is very often enough to keep the lid on that ablation derived higher pulse rate for the next year while it slowly returns to a more normal level again and they slowly wean off the beta-blocker. If you can't tolerate any beta blocker, even one with as few of side effects typically as Bystolic, you might try a calcium channel blocker as well as that can lower heart rate as well and are relative safe in modest doses.

4. Ask him too to go over again all that he addressed in your ablation an ask is he did any work in non-PV areas, in other words, did he venture beyond just a straightforward PVI ablation into other areas of the left or right atrium?

Shannon

Thanks Shannon. Great Guidance. And I hope the regular rhythm continues.

Being 50 years old and living with afib and then drugs such as amiodarone (and pradaxa) had me very very uneasy. Which is why the ablation was planned for. Amiodarone is out of the picture (knock on wood). My primary goal now is to get rid of pradaxa and understand procedure, prognosis and next steps towards staying afib/flutter free.

I don't know about getting a copy of the report here in Alberta, Canada but will ask. He has been great to deal with so far. Regarding the rate control I'll go slow on this. Either this in combination with my irbesartan or diet or ? have done a tremendous job managing my blood pressure. If the rate control post ablation is useful for the next year or so then that is good to know. The downsides to carvedilol are low although my chilled feet keep me up many a night.

I will certainly do my best to understand the ablation scope, areas worked on, # burns, observations by him etc.

Once again, thank you for your help.

Robert (from the great white north)

Hi Roberts did you have your ablation in Canada? Can I ask who did in and in which clinic?
Ron - fellow Albertan

Hi roberts, I'd also be interested in who did your ablation and where in Alberta.

Adrian from Edmonton