Got The Call

Well I got the call this morning my ablation for Afib is Feb. 25!!!!! I am afraid
Am I overthinking this thing? I'm just afraid of making things worse!

Central Baptist, Lexington, KY Dr. Gery Tomassoni. We will use Topera new study basket cath
This is my first left side ablation for Paroxymal Afib

What if I go into constant afib when I stop my flecainide 5 days prior?? Just ride it out?

Congratulations on the date! Good for you. I'm three weeks post-ablation. Was I afraid? Of course. Only natural. But try to counter or follow each anxious thought with a positive or more rational one. The anxieties won't likely go away but you can keep them manageable by practicing some cognitive self-statement therapy. For example: "I'm just afraid of making things worse." Counter that anxious thought with something like "Things might not get worse despite my anxieties" or (tongue in cheek on this one) "There is only so much damage I can do in just the remaining 11 days!" or "I expected to have an anxious thought like this given the circumstances, but I'm just going to label it as anxiety and not pay much attention to it" or "Instead of focusing on the anxiety, what is it I need to be doing right now, let me get back to the task at hand." Anyway, you get the idea. Don't let the anxious thought get the last word in. Have a more positive or more rational "comeback" to the negative thought.

Regarding D/C flec, I had the same concern. I stopped flec five days before (and D/C or tapered some supplements at the same time) and within 48 hours, my afib increased, even had my longest ever episode of over 24 hours mid-week, then somehow I converted back to NSR after that. It wasn't the most pleasant week of my life but I rode it out and you can too. Just keep your focus on the fact that in just days (then hours) from A-day, it will all be over and you'll feel so much better.

Thanks randy, I'll try. Hope you are doing well !

So you're getting a FIRM Ablation, does that include a PVI ?

McHale

Hi McHale,

Dr Tomasonni who trained with Dr N for a period of time a while back does do a full PVAI ablation right after using the Topera system to try and ferret out focal hot spots like rotors and foci to zap first. He is one of the EPs experimenting with FIRM as a tool to perhaps help improve over simple PVI alone and give some guidance on areas to ablate.

Fortunately, Tsco will get a very good PVAI though as well and not just a FIRM-only flip of the coin, which I find reassuring and making his odds very good for a nice outcome.

Shannon

Thanks Shannon and McHale
Shannon is correct. dr. Tomassoni does both, the PVAI after we give the Topera and a new improved basket catheter a try. We are planning on starting the left atrium and then coming back inside the right (where I originally had problems before) to touch up any flutter or tachy that might be lurking over there.
I have had an ablation with Natale in the past (for persistent tachy)and he is the best but as Shannon said Dr. tomassoni is one of his protege's. The center in Lexington is studying new software and catheters and Dr. Tomassoni's approach is very re-assuring to me as he is thorough but not too overly aggressive. I am very nervous just afraid of starting some other problem!! seems I started with tachy then to flutter now to afib. Just hate the thought of making things worse but I have to have faith. I dont want my episodes to gain momentum on me. I asked about the LAA and he seems very cautious in that area as explained ablating it may require a life on blood thinners and Im not sure I want that either

Hi Tsco.

The process of progression from a right sided flutter or tachycardia into AFIB is a common one and happens all the time whether or not you had any ablation to address those other arrhythmias located at first in the early stages in the right atrium mostly. So don't worry too much about making it worse.

The issue with the LAA, is simple. If you have a demonstrable source of AFIB/FLutter or Tachy triggering from the LAA and you do not address it, you will only be postponing the inevitable and will almost certainly require further ablations. I fully understand the reticence in wanting to potentially have to stay on blood thinners indefinitely, in the 50% of so of people who might require anti-coat after an LAA isolation ablation.

But the idea that this is optional is a false bargain. Yes you can wait and do everything else first which is what Natale also does. But he now sees no point in postponing until a guaranteed later ablation is required when he finds a very definitely major trigger source active within the LAA in the index ablation.. The vast majority of the time though he will do everything else first and if there are only ectopics triggered from the LAA he usually waits and sees how you do... knowing that the odds are very high that LAA area will become more and more active until its a full blown source of tachy, flutter or AFIB again.

But when the LAA is perhaps the only source of arrhythmia left active during a first ablation, it makes no sense to postpone and put the patient and everyone else through al that added expense and hassle as well as added risks.

Hopefully you will not have any triggers in the LAA, but its can be a real art knowing how to reliably discern what is actually coming from the LAA and what might be reflections into other areas of the LA and look like their are triggers originating from this other spots when, in fact, they are originating straight from the LAA. That is where vast experience really pays off and when, understandably, most EPs never dream of ablating around the LAA to avoid the possible long term anti-coag issue, they also get much less experience in ferreting out just how these LAA based triggers behave.

In any event, with the nature of your case, it looks like the approach Dr Tomassoni is taking is a good one for you and should really help. He is at least using the still investigational Topera gear in a good way and is not overshooting the mark by trying to avoid even doing a PVI to see how much he can get done with just the FIRM approach which at this point would have amounted to experimenting on you and not following the accepted guidelines for core end points for catheter ablation set by both Eurpoean and US cardiology and EP societies.

Best wishes and keep us posted as you move through the process.

Cheers
Shannon

Thanks Shannon, I'll keep you posted. So the progression of tachy or flutter to Afib, does that mean if you kill the afib those show back up? or did it morph into Afib and you kill the afib and its all hopefully dead? I guess Im not sure of the exact progression or mechanics of all this.