A few ablation questions...

First off, thanks so, so much to everyone on this forum — I have learnt a great deal in a very short space of time and am now awaiting an uncomplicated (I hope!) ablation with Dr Sabine Ernst at London's Royal Brompton Hospital. This is on the NHS and is likely to be in January.

I am, though, still not 100% certain whether I want to go ahead and would appreciate some feedback...

I'm a fit 60-year-old — I compete as an age group triathlete up to half-Ironman distance and also compete as a runner — and the AF apart I have no other health issues whatsoever, am on no medication for anything, only very rarely take any OTC drugs like paracetamol or ibuprofen, and only score 1 on CHADS2 (for being female). I've had the symptoms on and off for around five years, but was only formally diagnosed this summer when I was finally in the right place at the right time to be hooked up to an ECG. An echocardiogram revealed an otherwise very healthy heart.

While I accept that my AF may have its origins in 30+ years of exercising, it is not in itself triggered by it and I can often flip the switch back by running, cycling or swimming. My AF most often occurs in the night and I wake up to it. I can also revert by using mindfulness techniques, which suggests it may have unconscious emotional/stress-based origins. It leaves me feeling more tired than usual, I sometimes get that horrible AF haze, and it definitely top slices my output when cycling and running, but I'm not totally disabled by it. I do though realise that it's now unlikely to right itself spontaneously and may become more of an issue as I get older, and while I'm doing all I can to address it through diet, supplements, relaxation and other therapies I accept that ablation may be the only pragmatic route.

So my first question is addressed to anyone else on here who's a keen amateur athlete: How long did it take you to recover from having your ablation and get back to full training? I am, for example, entered in a half-Ironman race at the beginning of June. Is this unrealistic if I have the procedure in January? Were you able to return to your pre-ablation competition levels or have you had to scale back? Anything else I need to know about as a regular competitor?

I'm also really intrigued by something: does ablation address the cause as well as the effect, or just the effect? In other words, will the abnormal electrical activity persist post-procedure but just be firewalled (with varying degrees of success)? If so, where do the extraneous electrical pulses go? Sorry, this is probably a stupendously stupid question and that's why I can't find the answer, but if there is still superfluous electrical activity this must be channelled somewhere else in the body...

Thanks again for this invaluable resource — I'm truly immensely grateful that if I do go ahead I know as a result of this forum that I'll be in safe hands with Dr Ernst.

Eugenie

PS Of interest to those of you in the UK: I saw Dr Ernst privately, she then wrote to my NHS GP recommending me for surgery, he wrote to my NHS Trust, and the referral came through without me having to take any medication. I had seen a local cardiologist before the formal diagnosis, but at no point did he or anyone else prescribe anything for me (I wouldn't have taken it anyway!). So you maybe don't need to demonstrate drug therapy failure to get the surgeon of your choice after all!

The post right before yours by Ken discusses this.

[www.afibbers.org]

I think at 6 months you would be recovered, or as recovered as you were going to get.
I heard of another guy your age who worked out, not as serious as you, but he said it took 6 months to recover.

Might be a slight permanent loss in Atrial Contractibility due to all the burns, which in turn would slightly reduce Cardiac Output. I think there has been studies done on this, some other responder may try to say their is a near full recovery based on some study.

Does Dr Ernst want to do a full Ablation, or just a PVI Isolation?


Just based on what you said, I don't think you would have to get an Ablation yet.
If it starts in your sleep, have you been checked for Sleep Apnea? That is a cause of AFIB.
If you are that active, have you thoroughly looked at your electrolyte and IC electrolyte levels?
Mg has helped alot of people.

What "mindfullness techniques"? Some sort of Psychic Self-Conversion? That is definitely a sign that you are far from having no other alternative than to submit to an Ablation.



Edited 1 time(s). Last edit at 11/18/2014 02:26AM by The Anti-Fib.

Eugenie

AF often gets worse over time, progressing eventually to persistent AF which is much more difficult to ablate. This is what happened in my case. I had ablation, followed by touch up three days later, in Bordeaux in January 2003 - it wasn't available in UK at that time so I paid for it myself. Best money I ever spent.

I felt fully recovered within 48 hours. Since then I have had almost 12 years of glorious nsr. I can exercise as much as I want, eat and drink whatever I like, live life to the full without worrying about triggers.

The opportunity to have an ablation by Dr. Ernst on the NHS is not to be missed. I would go for it in a heart beat!!

Gill

Everyone is different, but given your excellent physical condition, you will likely recover quickly from an ablation. As I said in my 8 year anniversary post, I felt great the day after and could have worked out immediately. However, that would not have been wise since time was needed to allow my heart to heal from the burns. The term "recovery" is very subjective. For me, when only considering day to day activity (no athletic training), recovery was immediate - next day. As I also mentioned, it took about a year to get back to what I would coin "pre-ablation training response level". Since you are involved in lots of aerobic sports, you will lose some ground for some time and may not be able to reach your potential peak conditioning level for 6 months to a year. Just a guess. Your heart simply will not function as efficiently until there is complete healing. I didn't mention in my report that my wife and I also ran a half-marathon a few years ago. 25 years ago, we ran lots of 5K's, but that faded over time. We did the 13 miles just because we could, a one time thing. We didn't train super hard, and came up with a run, walk, run plan so we could finish the run. It worked out to 9 miles of running and 4 miles of fast walking. It was the Rock and Roll Half Marathon in Dallas, TX with 14,000 runners and a rock and roll band every mile on the run.

As I understand it, the burns leave scar tissue that creates a dam that obstructs the "extraneous electrical pulses". The ablation does not stop them from occurring, just blocks them. This is where the expertise of the Doctor is critical. I do believe that the use of Taurine, Magnesium and Potassium helps minimize the extraneous electrical pulses. I am a skeptic when it comes to supplements, but I think there is some benefit to using the three above.

Good luck.

Thanks for your responses — much appreciated.

Anti-Fib: I think it's just a PVI — I need to clarify that, really! Mindfulness is a form of very basic meditation, where you keep your attention on your breath for between 10 and 30 minutes and train your mind not to engage with distracting thoughts. Very calming way to start the day!

Gill: I know I'll be in good hands with Dr Ernst if I go ahead — she is very impressive and instilled maximum confidence, and hats off to the NHS for turning it around quickly and without putting hurdles in the way.

Ken: I'm already supplementing with those three, plus Vitamin D and the B spectrum. Yours and Gill's experiences are very heartening (excuse pun) and do nudge me closer towards going ahead, though I'll carry on exploring all options until I'm formally offered a date and have to commit

Thanks again

Eugenie

Hi Eugenie,

You will be in excellent hands with Sabine Ernst, the best in the UK in my view, especially for the kind of AFIB you describe.

Best wishes,
Shannon

Eugenia I am also a 60 year old chronic exerciser. I have been succesfully ablated but have had to change my relationship with sports and exercise.

The trigger in the night could be associated with a number of things, but the most important is to consider digestion disfunction (dysbiosia) which in turn affects your absorbtion of nutrients and minerals. It has been said that afibbers are chronically low in magnesium as well as other factors, and while an exact cause / relationship has not been established it is very possible you are not absorbing these important nutrients through your gut wall.

You could also be sweating out a lot of the electrolytes. You could also be not providing enough of them in your diet intake. Another possibility is that you could be having a hypoglycaemic reaction in the night. These are important ideas to consider, but the most important is to look at whether you have damaged gut wall (villi), and are therefore not absorbing these critical elements.

There is a never ending trail of cookie crumbs to follow while you are chasing down the cause of this perplexing ailment, but for my money I would start by looking at these possible digestion issues. I found that a food sensitivity test was very instructive. Mine was from ALCAT, but there are other labs that provide the same thing. I spared no expense when it came to testing my system and found the other two valuable tests were Exatest and NutrEval.

An ablation does not cure whatever underlying issues you most definitely have, so regaining your health in tandem with an ablation is critical to the outcome.

As has been said many times here, afib is a canary in the coal mine and indicates that something in your system is seriously out of balance. We are very luck that our canary shows up as afib, as many others with depleted nutrients show up as cancers and more serious diseases.

In regard to your question about whether to go ahead with the ablation - I would not hesitate. My afib was active for 5 years and I bargained with the devil for about one more year than I should have. It's a quick and effective cure in the right hands. Amazing really that they can slide in to your heart, give it a quick tune up and pull out all within about two hours, and give you your life back.

All the very best to you in what ever path you choose.
Ron

Hi Eugenie,

I had an Ablation performed by Dr Chow at the Wellington Hospital, London last January and similarly to yourself initially always went into Afib during the night, this would last until it naturally stopped a couple of days later or I could force it with a cardio workout. Although this was particularly unpleasant as my heart rate would range between 140 and 220 bpm.

Post ablation I had a few minor complication, a month of ocular migraines and lots of variation in my heart rate but that soon settled.

I'm a keen cyclist and my first post op ride occurred after about 3 weeks. As I was feeling quite good I sprinted up the first hill I hit and went straight into Afib, although this subsided a couple of hours later. That was the last time I was in Afib, it's been NSR ever since.

I've since ridden nearly 4,000 miles this year and rode in both the Dragon Ride in June and the Maratona Dles Dolomites July with no issues what so ever. I can now train 7 days a week if I want and while I think for the first 6 months my cardiac output was a little down I now feel that I'm back where I was post ablation.

Good luck with the OP you'll be back to normal before you know it.

Andy