Ablation date set...now no afib

After 13 years of afib, at age 73, I finally went to an out of state EP and scheduled a procedure. That was in September. The ablation has been postponed a time or 2 and is now on for April. Since my initial consult, the 100mg daily flec has worked without failing. The flec thing has worked more or less the last 3+ years depending on how much I take. Before flec, I was getting afib 10-12 times a year, 8-10 hours average. What started the flec was 2012 when I had afib 19 times, total of 152 hours. Then when starting flec I tried pill in pocket which didn't work well for me as I was having it every few days, a total of 16 more times and another 40 hours. After that, I had an echo which showed an enlarge heart (moderate).

In recent years I have struggled as to if I really needed to have the procedure or not. My local EP's say to wait, but I believe it is because they are not skilled enough to get good results. By the time I get to the ablation, it will most likely be 7 months of NSR. After such a long time with this afib there is a good chance they just can't do a simple procedure and may have to get into the left appendage. That opens a new set of challenges that I am concerned about. I believe they will stop the afib but it may take a couple tries. After that, I may be stuck on blood thinners unless I can get medicare to pay for one of those new procedures.

One positive thing that has come of waiting is that my heart is now normal size compared to my echo of 2 1/2 years ago which showed it was moderately enlarged.

My goal of course is to get rid of the afib and get off all the meds(both now and in the future), especially the flec which might be causing some side effects.

Anyway, as the clock keeps ticking, I wonder if I am right in going ahead with this....I am thinking yes.

...ronH



Edited 2 time(s). Last edit at 02/08/2015 09:11PM by ron.

Ron:

You didn't list your age, since AFIB is a supposedly a degenative condition with age making a big difference in a patients prognosis, it would help your post to list your age.

Why get an Ablation if your maintaining NSR, and if your tolerating the Flec? Your self-converting, risk of Stroke is minimal.

13 years of AFIB, at about 100 hours/year is not that much AFIB. Maybe someone else like Shannon can speak about weather or not that amount of AFIB would cause negative remoldeling or not. There is alot of other Afibbers with much more AFIB, that have had successful Ablations. Also the longer you maintain NSR, the more your Heart returns to normal, and you recover from the negative effects of the AFIB.



Edited 1 time(s). Last edit at 02/08/2015 06:07PM by The Anti-Fib.

Ron:

I can totally empathize with you as my situation is somewhat similar. I have had afib for 9 years now but until 2014 I only had one episode per year - sometimes once every two years. In the summer of 2014 my afib spun out of control and I was getting episodes every month and then every week or two. Believe it or not, I never took Flecainide daily because I didn't want to be on drugs - period. Instead, I took Flec as a PIP.

I had two choices - go to Flec daily or get an ablation. I choose the latter so my ablation is scheduled for March 5th. And wouldn't you know it, the minute I booked the ablation my afib got better. I'm now back to having "only" one episode every 3-4 weeks (vs. the weekly episodes I was having). I started questioning my decision to have an ablation. Hell, I still question it but I'm not backing out!

Shannon had a great response to my second guessing the ablation. You can read his response here:

[www.afibbers.org]

Bottom line, you are making the right decision. Don't look back.

Travis

Thanks ant-fib and Travis. I edited the above post with age and a little detail about 2012, the year that forced me into flec.

> Before flec, I was getting afib 10-12 times a year, 8-10 hours average.

Doesn't seem a lot to me. I started Flec PIP only after getting AF 2-3 times a week then got fed up and had an ablation
2.5 years ago

No AF since

Hi Ron,

AS noted in my PM to you, with long standing case like yours of 13 years, even with the present decent control of Flec, you are better off getting your ablation process taken care of .. assuming you have a highly experienced ablationist on tap, as I assume you do noting that you have traveled out of state to set this up.

Just know too, that not a lot of EPs are familiar with how to properly screen for LAA involvement and then who are also experienced in how to isolate the LAA/CS structures, though you may well not have any as yet. You certainly want an EP who is very familiar with all possible scenarios that you might need addressed and not just someone who does mostly PVI or PVAI with some occasion additional work venturing beyond these anatomical ablation regions.

The problem with waiting now, as your local EP suggests, is that after 13 years there is a very high likelihood of having undergone a good degree of remodeling. How this thing works is that when we continue trying to judge when the best time for an ablation is by postponing it always until you have really severe AFIB again that, after so many years as you have, the odds greatly increase that when (not if) the Flec starts to go south on you and stops working very well, you can easily find yourself suddenly in persistent AFIB or a much more advanced stage of paroxysmal AFIB that technically isn't much different from persistent AFIB.

In either case, this added procrastination, simply because your got a temporary respite, is far more apt to land you with a LAA isolation for sure being required and if you don't have a real maestro at doing LAA isolation, then you likely wont get one even if you need it and thus the merry-go-round of more repeat ablations continues.

I'm all for doing everything we can both naturally and with drugs when appropriate in the early days for a serious dedicated effort of 6 months to a year max at going real and near total control over your AFIB. But at 13 years of gradually progressing AFIB, even the fact that FLEC is helping for now should better be seen as a gift and a fortuitous window open to you now to get an expert ablation process done will the heart is relatively quiet and less daily remodeling is likely taking place.

The procrastinating mind LOVES to figure out one one angle or one more method to try to stay one step ahead of the beast, I understand that mind intimately and was a real maestro myself at procrastinating rationale's for postponing even considering an ablation for at last a year to two longer than was in my best interest.

Its so alluring the idea that "hey Im in NSR why bother with an ablation now" ... it sounds common sense and even many less experienced EPs who have seen far too much of the effect of mediocre to poor quality ablations in the past and thus are naturally weary of ablations, from their limited experience of what is possible in more skilled hands, often reinforce that reticence in their patients.

Yet it often turns into a very poor bargain and decision unfortunately. AFIB is relentless, and we all know how as soon as we hit NSR within half an hour the thoughts of needing an ablation fade into the sunset as we start bargaining with ourselves and figuring out why there is no rush to get this taken care of.. Believe me, I fully understand the apparently but misleading logic.

If you can't get this thing under control fairly early in the game once you have started on dedicated effort at natural/drug based management, then don't back out of an ablation you have set up with a truly experienced ablationist who does not only paroxysmal but it very skilled at persistent AFIB ablation as well.

I'm all for including all of the above methods as and when needed, but don't start backing out of an expert ablation process this last in an already 13 year game .. as the odds only increase exponentially that you will misjudge when that razors edge has been crossed and you can no longer avoid a more extensive multi procedure process and possible with added complexity such as LAA isolation being required.

It all sounds clear and logical and common sense not to go for an ablation when you are currently in NSR, but you have to look at the context of that NSR within the big picture of you AFIB history and in your case view this golden window of temporary respite from the FLEC as a great chance to get on top of this now once and for all.

Also, with regard to reverse remodeling, it takes basically perfect NSR for a prolonged period to make substantial headway with reverse remodeling. If a person is still having short or even widely spaced episodes it has a tendency to arrest that reverse remodeling in its tracks. After 3 to 4 months of pure unbroken NSR the electrical remodeling will start to become more noticeable, and after six plus months some degree of structural remodeling may begin to happen. However, it is felt that more advanced structural remodeling is very hard, if not impossible to truly reverse even though there are a few promising but not yet proven, drugs and peptide-like agents being investigated now, such as the mammalian hormone peptide Relaxin-2 (and a couple other investigative agents) which might truly help reverse existing scarring and fibrosis within the heart, though its still far too early in the research to count on those methods as sure things.

Shannon

Hi Ron, just dropped by to get some things from the vitamin shop and saw your post.

I've had 5 ablations, 1 in New Delhi and 4 in Bordeaux so I probably know a few things about AF or at least I did, not got the best memory.

In two of those ablations exactly the same thing happened to me if I remember correctly i.e. as soon as I booked the ablation the AF stopped. The first time this happened I actually had gone about two or three months with no AF from having daily/every second day attacks of up to say 8 hrs. One week before travelling to France and in solid NSR I got my exercise weights out and forced myself into AF to prove to myself that I needed to go. My countless posts are all in the archives.

There's far more to this Afib than the body just being short of this or that, there's the mental aspect which was where I failed badly. How could just knowing I had booked an appointment stop the AF? if I was really damaged or short of certain supplements.
One of the first posts I ever read on the BB was from a guy/gal who was so torment with the AF that he/she probably needed a brain ablation which seemed a bit over the top. Over the next few years I understood exactly what he/she meant.

Many people have reported similar posts as yours on the BB. I would recommend the ablation if you have a connection to a top EP.

Been AF free for about four years now and take Magnesium, Potassium, Vitamin C, Iodine tablets and drink two ltrs- 3 pints?- of high pH water every day without fail. Not sure if the supplements actually do anything but just edging my bets.The water is to help keep the body alkaline as against acidic which simply makes sense.
Would just note that Amiodarone the strongest drug on the market is based on Iodine to a fair degree, or so I believe.

You're only here once, go for it and best of luck.

Barry G.