Afib 24hrs after ablation called a success

I received my discharge from my EP on Wednesday as I had not had afib for 6 months post ablation. Last night I went into afib. It was for only 3 minutes but Im concerned this classifies my ablation as a failure. Waiting to hear from Dr now. Is this common? At least I was able to celebrate for 24 hours

Hi Axiomtherapy,

I wouldn't be too quick to throw the baby out with the bathwater just yet with only a 3 minute run. Its still possible that was a 'one off' and may not return. Are you sure it was AFIB and not a run of ectopics like PACS or PVC which, when they come in consecutive runs, can feel an awful lot like bonafide AFIB?

On the other hand, if it was real AFIB it is a warning sign that you may well need a touch up going forward but the fact that you went a full 6 months in quiet is a great sign that if that were the case and you do start to have more of these runs, that any follow up ablation will very likely be more of a true minor touch up procedure to zap one or a few small areas and not have to deal with a lot of repeat ablation of areas already done.

I wouldn't call that a failure in any case as well, and calling it a success at 6 months is a statistical call in any event, The large majority of those who have been quiet the whole 6 months or at least totally quiet from after the real 2 months blanking period after the ablation onward until the 6 month point or later, are truly done for the long term ... though not necessarily forever.

But you do have some who are quiet and then trigger again late like you have 6 months to a year or year and a half after the procedure that has otherwise been successful and that is because there is no 100% accuracy in predicting such things as yet.

Re-double your efforts on the Strategy electrolyte repletion and then see if it all doesn't stay quiet going forward. But if it is real AFIB it does show you still possess the tendency to fibrillate and that can rear its head again either sooner or much later from now and require a bit more work.

Often late recurrences like that can be from either new trigger sources developing outside of areas previously ablated, as in a case where you have a regular PVI or PVAI only and nothing more extensive in the first ablation. And it can be from a flutter circuit that appears as a result of the ablation pattern of burns needed to quell your AFIB and which is unpredictable in any given person beforehand,

That is why its always the best psychology to fully expect a main index ablation and then one touch up procedure if you have a highly skilled ablationist, and then if you wind up being 'one and done' then celebrate the extra good fortune.

If it happens again and you can confirm it is AFIB or Flutter then you can start to plan for that touch up.

Best wishes,
Shannon



Edited 1 time(s). Last edit at 06/27/2014 12:26PM by Shannon.

Thanks so much Shannon. I appreciate you taking the time to write all that. Im pretty sure it was afib. I was fine all day until i put my head on the pillow to go to sleep and then I felt the thump of pacs and I was in Afib. It was fast beats then normal rate then fast then normal rate. I could hear it in my stethoscope. My usual afib was 8 hours so i was glad this was 3 minutes. After the 3 minutes my heart was quiet as a mouse. Im very interested to see what my Dr recommends. Thanks again.

Several months ago I also had a short run of what I just knew was afib, over two years after my ablation. I captured part of it on my AliveCor monitor, brought it to my EP's office, and his PA confirmed to me that it was afib. But, when I saw the EP himself last week he said that it wasn't afib, but instead a run of ectopics. He said I never lost the P wave. Sure felt like afib.

Had something similar a year previous but didn't have the monitor then. That device is a real help in identifying and documenting what we think is happening.

Just ordered one!

An EP once told me that the ablation lines might not stop AF from happening but they should prevent it from sustaining itself. FWIW!

Gill

I have heard mroe than a few times that some Dr. or nurse thought I was in Afib, and then the next Dr. told me I wasn't, and vice versa. I'm thinking that it's not that easy to read those ECG's..Dr. Natale commented last week that he didn't feel that the AliveCor was all that accurate, which surprised me as I thought it was. I believe it only has 1 lead, whereas they use more than that in a "regular" monitor. I have one too, but am now wondering if it really is that helpful for more than reistering pulse rate.

Shannon, I know you are a big proponent of the Alive Cor. What are your thoughts about his comment?

Barb

I think it takes a good EP to read an ECG accurately. I was once told by 2 ER doctors that mine showed AF but the EP later said it was just bursts of ectopics. After 8½ years of nsr post ablation I was very relieved.

Gill

Barb,

An ECG taken in the office usually has many leads rather than just two. This allows them to look at the electrical signature of the heart from many different perspectives. Though I have an AliveCor and for many years before that, a similar two lead ECG for the PC, I tend to rely on my Polar beat to beat heart rate monitor. The output is heart rate (or beat duration in ms) versus time. In EP terms this is called a "tachogram." Sometimes they look at tachograms as output from a Holter monitor. Most docs aren't used to looking at tachograms, but I find them quite useful. This example <[books.google.com] compares afib with bigeminal and quadragemial PVC's (every other beat is a PVC or every 4th beat is a PVC). What you notice is the randomness of afib and the regularity of the others. These graphs are prepared with beat to beat (r to r) time in ms on the Y axis. You could construct such a graph from your Alive Cor. You'd have to measure the length of each beat in ms and plot it versus cumulative time in seconds. There are may more examples in CR52 and 52a <[www.afibbers.org] <[www.afibbers.org] These examples are plotted with heart rate rather than RR time on the Y axis. The result for the shape of the curve is one is the inverse of the other.

I currently use the <[itunes.apple.com] HRV logger app on the iPhone with a Polar H7 Bluetooth transmitter. I download the data to Dropbox and view it in the Polar app on my PC, though you can also view the data in Excel and graph it. This is a bit of a "techy" solution, but I'm happy to give more details if anybody is interested.

George

Barb,
The AliveCor has its limits as a single lead EKG but it can catch most AFIBs or flutters but sometimes its not as clear and you have to not squeeze it too hard with your fingers on the electrodes and those fingers/electrodes much be moist enough.

Then put it on enhanced view to clean up some of the noise too and its pretty good. But Dr N is right in that it's not 12 lead EKG accurate by any means, nevertheless we were ab able to successful capture my friends very low speed brady-cardic AFIB using the AliveCor as his irregular R wave spacing was clear as a bell in spite of the low HR, so it is a valuable tool. However there will be some instances where its not so clear whether it is AFIB or Flutter when its a close call or even sinus tachycardia.

Its much better than just an accurate pulse monitor though.

Shannon