What is the aim of ablation?

Hi,
since I am scheduled on a PVI ablation next Wednesday (no, I am not getting cold feet and won´t back away ) I'm mulling over this question. I'm not even sure how to put it into words but will give it a try anyway.

What ist the aim of a PVI ablation (paroxysmal afib, lone afib) - may it be a one and done procedure or an index ablation combined with a touch-up later?

Should we expect to be cured in a sense of no afib anymore anytime? There must be an underlying process which makes us prone to develop afib (fibrosis, inflammation). Will this process be halted or even reversed? I doubt this is realistic.

Or should we be content with managing the disease. Keeping it under control for maybe five years or so? Time with significantly less afib than before during which the structural remodelling process is being slowed and the electrical remodelling can be reversed. Time after which another ablation - possibly now in other areas of the heart - buys more time and so on unitl the day when the mechanisms are fully understood and a real cure is on the horizon.

Personally I would be fine with only having one or two afib episodes during a month (afib burden around 0.1 %) without having to take any meds. Is this a reasonable approach? Or is it too pessimistic?

What do you think?

You want to shoot for the greatest amount of NSR time in your life that your body, your choices and the skills of an expert ablationist can secure for you.

While in many respects once finished with a fully successful ablation process its often more or less like a functional cure in that a decade and more can go by without a blip of arrhythmia, but the wise person takes AFIB as a wake up call to learn about and adopt the kind of healthy lifestyle and dietary/nutrient repletion efforts so thoroughly discussed and promoted on this website first and foremost.

And when that proves insufficient to put a lid on the kettle then go for the best ablationist you can possibly set up for yourself and do not take the easy convenient compromise just because you think you can get by with another EP who just seems 'good enough' to probably handle your case.

But at the same time, this is an ongoing process and underlying changes with aging will continue. We may well need a future touch up in 15 or 20 years even with a relative 'cure' in hand now. But we can address that possibility if, and when, the time comes at a distant point when no doubt great advances over the major strides we have already made against this disease will have continued to evolve.

For now, learn to take care of yourself and your heart while embracing the reality that it is a management process and not an actual permanent 'cure' on offer, as yet. Making major strides in terms of reduced AFIB burden, such as is common after a good index ablation, even if a touch up is required to really stop AFIB in your life, is a great thing and major accomplishment on your path toward optimal management for yourself and your own unique body and circumstances.

Take heart in that Dirk and don't let any wayward ideas distract you from getting that major step done with Dr LeWalter coming up soon and best wishes on what will surely be a major step forward for you towards making AFIB more a distant memory in your life rather than a dominating topic in your awareness.

And Duke, saying 'Index' ablation is just another way to say first or primary ablation in what could we become an ablation process of two, or on rare occasion three, total procedures ... or even quite a few more can easily be on the table if you make an unwise compromised choice for your ablationist.

Shannon



Edited 2 time(s). Last edit at 05/23/2014 09:44PM by Shannon.

Dirk,
Good luck next week. Please let us know your progress post ablation. I'm schedule to see Dr. Natale on June 23rd for consultation.
Yesterday, Linda (Dr. Natale's NP) called to discuss some preliminary stuffs.

Shannon,
You often mentioned "index" ablation. What is an "index" ablation? Thanks again Shannon, for often, you take out the time to explain things quite thoroughly. I appreciate it very much.

Duke

Hello Dirk - Great questions.

Responding to your musings… My observations from reading and participating here for the past 12 years (including my personal experiences) indicate that while a properly performed ablation procedure does obliterate the areas of disrupted electrical conduction and restore NSR, it does not address how that disruption came about in the first place. For ablations to remain successful over time, many former afibbers have reported that they have changed diets, lifestyle habits and continued with the supportive nutritional supplements recommended here and they have learned, if they become lax, they can experience AF breakthroughs. These are all positive reinforcements that contribute to the success of the procedure and restore our lives back to welcome normalcy and blessed NSR.

Foremost on list of crucial nutrients is the importance of magnesium in that it reduces the formation of cardiac fibrosis which physically interferes with the proper electrical conduction pathways. Dietary magnesium is typically low in most individuals and especially low in afibbers. That may be from low intake and can also be linked to a genetic mutation that prevents proper assimilation of whatever magnesium does manage to find its way into the diet. Remedies include lifelong heroics for magnesium repletion inside heart cells where it’s critically important for heart function… but as is documented, magnesium is needed for over 300 enzymatic reactions that help systems and organs function.

It’s also documented that magnesium deficiency is prevalent in endurance athletes who tend form cardiac fibrosis as a result of oxidative stress damage. There are two Conference Room sessions devoted to Cardiac Fibrosis… (24 and 75).

Another critical influencing factor for Afib is the typical dietary overload of sodium (salt) from commercially processed foods that overpowers the critical mineral or electrolyte potassium. This imbalance in the ratio of potassium to sodium manifests in heart arrhythmias and hypertension. There are other examples that have been presented and reviewed over the years as influences including the increasing prevalence of environmental toxins that cause cellular function interference with heart cells being one of many vulnerable targets.

So, in one regard… yes, ablations done properly can be effective but it’s also known that unless foundational changes are implemented, it may not be long lasting.

My own experience with just one ablation is that anything that promotes inflammation of heart tissues or imbalances the critical electrolytes is likely to re-introduce Afib into the mix… as evidenced by my treatments for chronic Lyme disease.

I wish you well with your ablation.

Kind regards,
Jackie


Report on myocardial fibrosis:
[www.sficv.com]