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How I spent my Spring Vacation
Posted by Jackie
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How I spent my Spring Vacation April 09, 2015 07:17PM |
Registered: 6 years ago Posts: 18,881 |
How I spent my Spring Vacation…. or..... "Third time's the charm," hopefully.
On Wed. 4/1, I flew to Austin, TX for an “touch up” ablation on Friday 4/3 to my previous LAA isolation procedure last August. Met with Dr. Natale and team the day prior and my procedure was the first of the day on Friday. Initially, Dr Natale said what seemed to be indicated on the EKGs was a type of an atypical or focal tachycardia but not a true flutter…which explains why I kept saying it is tachycardia but not the typical flutter feeling that I have known in the past.
I was scheduled on 3/24 to have the post ablation, 6-mos TEE evaluation on the LAA clearance velocity which was actually almost at 7 mos. when I began having bouts of tachycardia interspersed with various bursts of Afib and another rhythm that felt almost like flutter but not quite. I sent tracings on the HeartTrak monitor, but all that seemed to show was PVCs and some tachy. Thanks to Shannon conveying my sudden activity to Dr. Natale, I was instructed to come to Austin as quickly as possible for the touch up and not to have an electro-cardioversion. The stars were lined up because when I phoned for a date, I learned that two cancellations were open the next week, so I chose April 3 and made the flight arrangements immediately.
Following is a brief description of the procedure but before that, let me comment once again that I am totally grateful to be able to take advantage of the Texas Cardiac Arrhythmia Institute… especially Dr. Natale and his great team. It was like ‘old home week’ to be there again in so short a time and the Texas hospitality certainly was alive and well. It was an additional treat for me to come out of still cold NE Ohio into Austin 80+ degree weather, sunny skies and not wear a coat. First time since last fall. Texas Bluebonnets were in full bloom to welcome me as well.
My procedure was short and as I’ve reported with the other two procedures, amazing that one could feel so well afterward. I had only a slight discomfort in the carotid area caused by the adhesive and probably the requisite positioning of the neck during the procedure since it has felt a bit strained since…but no big deal. Even the 6 hour stabilization period seemed to pass quickly; and I was up and about by 6 pm Friday evening and discharged just before 11 the following morning. As with the last trip, my son was my chauffeur and caregiver. I flew home alone yesterday. All my flights and connections were ‘as advertised.’
However, my NSR was interrupted Monday evening around 6 pm with some weird activity later interpreted as PVCs…and again on Tuesday in the around 9 pm. I sent in a recording and was told to send another in 15 minutes. Then, after arriving at the airport at 10:30 am yesterday (4/8) and the check-in counter, I also had more irregular beats that were a mix of tachy, missing beats and a pattern of something between Afib and a lot of missed beats that continued during my flight home. Once home, I sent a recording to HeartTrak, had a snack, took my magic potion powders of Magnesium, potassium, taurine, glutamine, Theanine and Bach Flower Rescue Remedy and went to bed around 10:30. Fortunately, this morning, I was back in NSR.
Highlights of procedure #3.
1. With initial femoral access, there was spontaneous focal tachycardia, (406 msec).
2. During mapping, all of the pulmonary veins and posterior wall of the left atrium remained isolated.
3. The tachycardia was mapped to the left atrial appendage. Ablation at the base of the LAA terminated the tachycardia. Further radiofrequency energy was delivered to isolate the appendage. Dissociated firing was documented.
4. There was spontaneous atrial flutter, 253 msec that terminated with ablation along the cavotricuspid isthmus. There was a vagal response while ablating close to the coronary sinus ostium on the ridge of the isthmus. Bidirectional istmus block was documented.
5. There was another spontaneous atrial tachycardia (235 msec) with the earliest atrial activation from the coronary sinus. This tachycardia degraded into atrial fibrillation. Ablation of the coronary sinus was done which organized the atrial fibrillation back into atrial flutter. Isolation of the coronary sinus terminated the atrial flutter.
6. Following infusion of Isuprel, there were sporadic PACs from the right atrium.
7. The circular mapping catheter was then placed in the superior vena cava and the superior vena cava was silent.
A total of 25.3 minutes of radiofrequency energy was delivered.
Post procedure Diagnosis: Atypical atrial flutter s/p redo PVAI
Now, I’ll be waiting another 6 months or so before the TEE evaluation.
I’m so glad I was able to have this managed quickly. As I wrote in an email to friends before I left for Austin…
Let’s hope this settles the errant culprits. Needless to say, I’m ready to move on with this whole ordeal. May of this year marks the anniversary of my 20-year Afib saga and I’m really more than tired of coping. I’ll gratefully accept your good thoughts, prayers and positive energy in abundance.
The good news is that while I was traveling down, in recovery and then traveling back, I had loads of time to listen to some really interesting health webinars I had recorded to my iPod, so eventually, I’ll be sharing some of that info with you.
Meanwhile, I’ll be reading here on the forum about what went on during my Spring Vacation and responding where I have some helpful comments on the topic.
Healthy regards to all,
Jackie
PS if there are typos in this, pls excuse… I’m still a big brain fogged from the anesthesia. Always affects me that way.
On Wed. 4/1, I flew to Austin, TX for an “touch up” ablation on Friday 4/3 to my previous LAA isolation procedure last August. Met with Dr. Natale and team the day prior and my procedure was the first of the day on Friday. Initially, Dr Natale said what seemed to be indicated on the EKGs was a type of an atypical or focal tachycardia but not a true flutter…which explains why I kept saying it is tachycardia but not the typical flutter feeling that I have known in the past.
I was scheduled on 3/24 to have the post ablation, 6-mos TEE evaluation on the LAA clearance velocity which was actually almost at 7 mos. when I began having bouts of tachycardia interspersed with various bursts of Afib and another rhythm that felt almost like flutter but not quite. I sent tracings on the HeartTrak monitor, but all that seemed to show was PVCs and some tachy. Thanks to Shannon conveying my sudden activity to Dr. Natale, I was instructed to come to Austin as quickly as possible for the touch up and not to have an electro-cardioversion. The stars were lined up because when I phoned for a date, I learned that two cancellations were open the next week, so I chose April 3 and made the flight arrangements immediately.
Following is a brief description of the procedure but before that, let me comment once again that I am totally grateful to be able to take advantage of the Texas Cardiac Arrhythmia Institute… especially Dr. Natale and his great team. It was like ‘old home week’ to be there again in so short a time and the Texas hospitality certainly was alive and well. It was an additional treat for me to come out of still cold NE Ohio into Austin 80+ degree weather, sunny skies and not wear a coat. First time since last fall. Texas Bluebonnets were in full bloom to welcome me as well.
My procedure was short and as I’ve reported with the other two procedures, amazing that one could feel so well afterward. I had only a slight discomfort in the carotid area caused by the adhesive and probably the requisite positioning of the neck during the procedure since it has felt a bit strained since…but no big deal. Even the 6 hour stabilization period seemed to pass quickly; and I was up and about by 6 pm Friday evening and discharged just before 11 the following morning. As with the last trip, my son was my chauffeur and caregiver. I flew home alone yesterday. All my flights and connections were ‘as advertised.’
However, my NSR was interrupted Monday evening around 6 pm with some weird activity later interpreted as PVCs…and again on Tuesday in the around 9 pm. I sent in a recording and was told to send another in 15 minutes. Then, after arriving at the airport at 10:30 am yesterday (4/8) and the check-in counter, I also had more irregular beats that were a mix of tachy, missing beats and a pattern of something between Afib and a lot of missed beats that continued during my flight home. Once home, I sent a recording to HeartTrak, had a snack, took my magic potion powders of Magnesium, potassium, taurine, glutamine, Theanine and Bach Flower Rescue Remedy and went to bed around 10:30. Fortunately, this morning, I was back in NSR.
Highlights of procedure #3.
1. With initial femoral access, there was spontaneous focal tachycardia, (406 msec).
2. During mapping, all of the pulmonary veins and posterior wall of the left atrium remained isolated.
3. The tachycardia was mapped to the left atrial appendage. Ablation at the base of the LAA terminated the tachycardia. Further radiofrequency energy was delivered to isolate the appendage. Dissociated firing was documented.
4. There was spontaneous atrial flutter, 253 msec that terminated with ablation along the cavotricuspid isthmus. There was a vagal response while ablating close to the coronary sinus ostium on the ridge of the isthmus. Bidirectional istmus block was documented.
5. There was another spontaneous atrial tachycardia (235 msec) with the earliest atrial activation from the coronary sinus. This tachycardia degraded into atrial fibrillation. Ablation of the coronary sinus was done which organized the atrial fibrillation back into atrial flutter. Isolation of the coronary sinus terminated the atrial flutter.
6. Following infusion of Isuprel, there were sporadic PACs from the right atrium.
7. The circular mapping catheter was then placed in the superior vena cava and the superior vena cava was silent.
A total of 25.3 minutes of radiofrequency energy was delivered.
Post procedure Diagnosis: Atypical atrial flutter s/p redo PVAI
Now, I’ll be waiting another 6 months or so before the TEE evaluation.
I’m so glad I was able to have this managed quickly. As I wrote in an email to friends before I left for Austin…
Let’s hope this settles the errant culprits. Needless to say, I’m ready to move on with this whole ordeal. May of this year marks the anniversary of my 20-year Afib saga and I’m really more than tired of coping. I’ll gratefully accept your good thoughts, prayers and positive energy in abundance.
The good news is that while I was traveling down, in recovery and then traveling back, I had loads of time to listen to some really interesting health webinars I had recorded to my iPod, so eventually, I’ll be sharing some of that info with you.
Meanwhile, I’ll be reading here on the forum about what went on during my Spring Vacation and responding where I have some helpful comments on the topic.
Healthy regards to all,
Jackie
PS if there are typos in this, pls excuse… I’m still a big brain fogged from the anesthesia. Always affects me that way.
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Re: How I spent my Spring Vacation April 09, 2015 08:44PM |
Registered: 11 years ago Posts: 77 |
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Re: How I spent my Spring Vacation April 09, 2015 09:34PM |
Registered: 12 years ago Posts: 164 |
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Re: How I spent my Spring Vacation April 09, 2015 09:45PM |
Registered: 11 years ago Posts: 4,232 |
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Re: How I spent my Spring Vacation April 09, 2015 09:46PM |
Registered: 10 years ago Posts: 1,748 |
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Re: How I spent my Spring Vacation April 09, 2015 10:23PM |
Registered: 11 years ago Posts: 42 |
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Re: How I spent my Spring Vacation April 10, 2015 04:23AM |
Registered: 11 years ago Posts: 133 |
Jackie,
I am so glad to know that you are doing well now. NSR rules! You are one of THE BEST educators here. I'm just sorry that it has taken a 20 year bout with the beast to train you to be able to share with us your TREMENDOUS KNOWLEDGE concerning this mysterious malady.
Our hearts reach out to yours with wishes for your continued healthy recovery.
JohnB
I am so glad to know that you are doing well now. NSR rules! You are one of THE BEST educators here. I'm just sorry that it has taken a 20 year bout with the beast to train you to be able to share with us your TREMENDOUS KNOWLEDGE concerning this mysterious malady.
Our hearts reach out to yours with wishes for your continued healthy recovery.
JohnB
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Re: How I spent my Spring Vacation April 10, 2015 07:41AM |
Registered: 12 years ago Posts: 239 |
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Re: How I spent my Spring Vacation April 10, 2015 02:21PM |
Registered: 9 years ago Posts: 150 |
Jackie,
Sorry to hear you had to go back in!
I am about a month behind you. I had my second Natale ablation Sept 2014 at Scripps.
I am a month late doing the TEE because I stayed on Sotalol longer than Natale wanted me to.
Next month if the second 7 day monitor is clear I will schedule the TEE to check the appendage.
At this stage of the game I will be surprised if afib stays away more than a few years. I know my odds went up with Dr.Natale vs a regular doctor. I guess I think of afib like it is a cancer. Whenever you feel an odd beat you think the cancer is back.
I was 45 when diagnosed and just turned 51 a few days ago.
Here hoping this is your last time dealing with this nasty disease!
Don
Sorry to hear you had to go back in!
I am about a month behind you. I had my second Natale ablation Sept 2014 at Scripps.
I am a month late doing the TEE because I stayed on Sotalol longer than Natale wanted me to.
Next month if the second 7 day monitor is clear I will schedule the TEE to check the appendage.
At this stage of the game I will be surprised if afib stays away more than a few years. I know my odds went up with Dr.Natale vs a regular doctor. I guess I think of afib like it is a cancer. Whenever you feel an odd beat you think the cancer is back.
I was 45 when diagnosed and just turned 51 a few days ago.
Here hoping this is your last time dealing with this nasty disease!
Don
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Re: How I spent my Spring Vacation April 11, 2015 11:47AM |
Admin Registered: 11 years ago Posts: 2,779 |
Hi Lynn,
I can answer that question about my little part of the equation for helping Jackie get in early this time. Jackie had already been in contact with Dr Natale's nurse assigned to her after she noticed the tachycardia and thus they were already getting up to speed on her monitoring before I first learned of her tachycardia episodes a couple days later. So I only greased the wheels a bit after speaking with Jackie that morning by confirming with Dr Natale whether or not he wanted her to undergo a cardioversion she was at the moment setting up with her local EP Dr Schweikert at the time, or what might he want her to do.
Had Jackie and I not spoken on the phone, no doubt she would already have been ablated by now in any event as it is, since that is what Dr N wanted her to do in her case and the process was well underway already.
However, it's important too to understand that just because you have an ongoing monitoring systems that records 24/7 hours does not mean that Dr Natale or his staff is watching your monitor 24/7 at all times and knows the very moment something happens. His staff only interrogate the monitor periodically and the advantage of 24/7 monitoring is that they can catch literally everything that has happened in your heart over that time period since the monitor has been in place ... So it is not that they will known instantly when your heart goes akimbo for a bit. They monitor the recordings periodically and more frequently during the blanking period and less so progressively after the blanking period and mainly do so after blanking only before any scheduled appointments with Dr Natale or his staff, and/or if, and when, the person calls reporting any new activity.
If they were to have to monitor every little blip it would quickly overwhelming whatever network they set up to monitor so many people. Any individual person can call and check with the monitoring company at any time to see if they had any activity during a specific period of time, but these post ablation systems are there to insure each persons arrhythmia history post ablation while they still have the monitor is fully captured and documented, not to police it in real time indefinitely.
In any event, I too am hoping this is the last visit to Austin for Jackie too. With LAA/CS isolation there is roughly a 30% chance of needing a true touch up since the structures are quite variegated and more complex and the coronary sinus and LAA electrically interact, so to speak, instead of being bolder in doing a more kitchen sink approach especially with the LAA. Often times while ablation the CS the LAA becomes isolated and vice versa via their close interconnection.
With the LAA, Dr Natale quite rightly prefers to confirm full isolation during the initial LAA isolation and then see how it does longer term, knowing the odds are a bit higher for needing such a return trip as Jackie required to address a small two to three ablation lesions and rarely any more for what is a comparatively light load on the heart and body. Often you will hardly even feel much at all after such an ablation as was my experience as well compared to the index procedure which most of us also find to be less pain and discomfort involved than we expected before hand.
Another option for LAA isolation patients that experience additional triggering instead of another touch up follow up procedure, is to go for the Atriclip or Lariat as it becomes more rolled out and insurances inevitably become more familiar and extend coverage more often toward the Atriclip and Lariat. Now the the lead dog in the Watchman has achieved FDA approval, the expectation is this will ramp up the entire LAA closure industry and the coverage will surely expand for faster access in the not too distant future.
The Atriclip and Lariat not only eliminate the need for ongoing OAC drugs through full vascular isolation of the LAA .. in effect removing it from the scene entirely ...but also fully confirm electrical isolation as well such that the LAA can never become a source of such annoying and frustrating tachycardia or flutter triggering again. That is one of the main reasons I went with the Lariat when it was clear my LAA empty velocity was too low to stop OAC drugs after my LAA isolation.
No one wants to have to do another procedure for sure, but it is true as well that touch up for tachycardia or flutter, more rarely with some mixed AFIB at times, is a notably less intensive procedure than is the index full tilt left and right atrial ablation and that, combined with our familiarity with the process when done in very experienced hands makes the whole venture a good deal less stressful than going into the first one. And you are very unlikely to be offered an LAA isolation by anyone other than very experienced hands for sure.
Most EPs have not even considered doing LAA isolation as it is more of a technical challenge and for the growing number of us with more advanced atrial progression, Im very glad we do have a few pioneers who have blazed the trail here to help the rest of us achieve a quiet heart even if with an extra touch up or two as part of the bargain.
Hope that clarifies the situation Lynn,
Shannon
I can answer that question about my little part of the equation for helping Jackie get in early this time. Jackie had already been in contact with Dr Natale's nurse assigned to her after she noticed the tachycardia and thus they were already getting up to speed on her monitoring before I first learned of her tachycardia episodes a couple days later. So I only greased the wheels a bit after speaking with Jackie that morning by confirming with Dr Natale whether or not he wanted her to undergo a cardioversion she was at the moment setting up with her local EP Dr Schweikert at the time, or what might he want her to do.
Had Jackie and I not spoken on the phone, no doubt she would already have been ablated by now in any event as it is, since that is what Dr N wanted her to do in her case and the process was well underway already.
However, it's important too to understand that just because you have an ongoing monitoring systems that records 24/7 hours does not mean that Dr Natale or his staff is watching your monitor 24/7 at all times and knows the very moment something happens. His staff only interrogate the monitor periodically and the advantage of 24/7 monitoring is that they can catch literally everything that has happened in your heart over that time period since the monitor has been in place ... So it is not that they will known instantly when your heart goes akimbo for a bit. They monitor the recordings periodically and more frequently during the blanking period and less so progressively after the blanking period and mainly do so after blanking only before any scheduled appointments with Dr Natale or his staff, and/or if, and when, the person calls reporting any new activity.
If they were to have to monitor every little blip it would quickly overwhelming whatever network they set up to monitor so many people. Any individual person can call and check with the monitoring company at any time to see if they had any activity during a specific period of time, but these post ablation systems are there to insure each persons arrhythmia history post ablation while they still have the monitor is fully captured and documented, not to police it in real time indefinitely.
In any event, I too am hoping this is the last visit to Austin for Jackie too. With LAA/CS isolation there is roughly a 30% chance of needing a true touch up since the structures are quite variegated and more complex and the coronary sinus and LAA electrically interact, so to speak, instead of being bolder in doing a more kitchen sink approach especially with the LAA. Often times while ablation the CS the LAA becomes isolated and vice versa via their close interconnection.
With the LAA, Dr Natale quite rightly prefers to confirm full isolation during the initial LAA isolation and then see how it does longer term, knowing the odds are a bit higher for needing such a return trip as Jackie required to address a small two to three ablation lesions and rarely any more for what is a comparatively light load on the heart and body. Often you will hardly even feel much at all after such an ablation as was my experience as well compared to the index procedure which most of us also find to be less pain and discomfort involved than we expected before hand.
Another option for LAA isolation patients that experience additional triggering instead of another touch up follow up procedure, is to go for the Atriclip or Lariat as it becomes more rolled out and insurances inevitably become more familiar and extend coverage more often toward the Atriclip and Lariat. Now the the lead dog in the Watchman has achieved FDA approval, the expectation is this will ramp up the entire LAA closure industry and the coverage will surely expand for faster access in the not too distant future.
The Atriclip and Lariat not only eliminate the need for ongoing OAC drugs through full vascular isolation of the LAA .. in effect removing it from the scene entirely ...but also fully confirm electrical isolation as well such that the LAA can never become a source of such annoying and frustrating tachycardia or flutter triggering again. That is one of the main reasons I went with the Lariat when it was clear my LAA empty velocity was too low to stop OAC drugs after my LAA isolation.
No one wants to have to do another procedure for sure, but it is true as well that touch up for tachycardia or flutter, more rarely with some mixed AFIB at times, is a notably less intensive procedure than is the index full tilt left and right atrial ablation and that, combined with our familiarity with the process when done in very experienced hands makes the whole venture a good deal less stressful than going into the first one. And you are very unlikely to be offered an LAA isolation by anyone other than very experienced hands for sure.
Most EPs have not even considered doing LAA isolation as it is more of a technical challenge and for the growing number of us with more advanced atrial progression, Im very glad we do have a few pioneers who have blazed the trail here to help the rest of us achieve a quiet heart even if with an extra touch up or two as part of the bargain.
Hope that clarifies the situation Lynn,
Shannon
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Re: How I spent my Spring Vacation April 11, 2015 12:07PM |
Registered: 6 years ago Posts: 18,881 |
Thanks Shannon for helping to clarify my message.
Lynn... I had been in regular contact with Shirley Seever, my EP nurse since the first of the new heart activity as it was definitely dramatic and difficult to ignore. I would let her know if I sent a recording that seemed either "different" or overly dramatic at the time and she would then check that particular date. She had alerted Dr. Natale immediately and we were all watching to see how it unfolded. When it seemed to escalate, that's when the talk turned to getting on the schedule.
I hadn't been in specifically in contact over that with Shannon because of his other demands but in an email on another topic, I shared my "news" and with my permission, he forwarded my description to Dr. Natale ....and as they say... the rest is history.... but the wheels were already in motion for me to get to Austin quickly.
Fortunately, these new events were self-terminating; otherwise, I'd have been just a little crazy since I had been so good for those 7 months after the LAA isolation.
Jackie
Lynn... I had been in regular contact with Shirley Seever, my EP nurse since the first of the new heart activity as it was definitely dramatic and difficult to ignore. I would let her know if I sent a recording that seemed either "different" or overly dramatic at the time and she would then check that particular date. She had alerted Dr. Natale immediately and we were all watching to see how it unfolded. When it seemed to escalate, that's when the talk turned to getting on the schedule.
I hadn't been in specifically in contact over that with Shannon because of his other demands but in an email on another topic, I shared my "news" and with my permission, he forwarded my description to Dr. Natale ....and as they say... the rest is history.... but the wheels were already in motion for me to get to Austin quickly.
Fortunately, these new events were self-terminating; otherwise, I'd have been just a little crazy since I had been so good for those 7 months after the LAA isolation.
Jackie
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Re: How I spent my Spring Vacation April 11, 2015 05:24PM |
Registered: 12 years ago Posts: 239 |
Thanks for your replies Shannon and Jackie.
Jackie,
I can certainly understand your sensitivity. The one thing that has given me a bit of apprehension about ablation is that sometimes the devil you know is better than the devil you don't ...new and unfamiliar rhythms would cause me to become unglued.
Jackie,
I can certainly understand your sensitivity. The one thing that has given me a bit of apprehension about ablation is that sometimes the devil you know is better than the devil you don't ...new and unfamiliar rhythms would cause me to become unglued.
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Re: How I spent my Spring Vacation April 11, 2015 06:19PM |
Registered: 9 years ago Posts: 34 |
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Re: How I spent my Spring Vacation April 14, 2015 11:29PM |
Registered: 12 years ago Posts: 549 |
HI Jackie - it is so strange that I was thinking of you these past few days and wondering if you had your TEE yet, and what transpired, and then wrote to you - only to find out all of this had taken place! I"m sorry you had to go through all of this, as it IS tiring and draining and maddening to have to deal with any rhythm disturbances again. While my history with Afib doesn't go back quite as far as yours (mine is a 12 year history), we have very similiar track records and Afib occurrences, I believe. And the shared LAA isolation experience, of course, too.
I'm glad you were able to get in to see Dr. Natale so quickly, and that you seem to be on the road to recovery once again. I will keep my fingers and toes crossed, as well as saying a prayer for you, that you may enjoy NSR for the rest of your years - and peace of mind.
Thanks for keeping us all up to date. We all have gained so much value from your knowledge and support
Best to you ~ Barb
I'm glad you were able to get in to see Dr. Natale so quickly, and that you seem to be on the road to recovery once again. I will keep my fingers and toes crossed, as well as saying a prayer for you, that you may enjoy NSR for the rest of your years - and peace of mind.
Thanks for keeping us all up to date. We all have gained so much value from your knowledge and support
Best to you ~ Barb
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Re: How I spent my Spring Vacation April 15, 2015 09:29AM |
Registered: 6 years ago Posts: 18,881 |
Thank you, all for your kind thoughts and good wishes.
I was especially fatigued after the trip home so have just been giving in to that and resting when needed. Today, I'm going to the fitness center just to walk slowly on the treadmill to get back into the routine (slowly) and hopefully recapture my stamina very gradually.
Best to all of you,
Jackie
I was especially fatigued after the trip home so have just been giving in to that and resting when needed. Today, I'm going to the fitness center just to walk slowly on the treadmill to get back into the routine (slowly) and hopefully recapture my stamina very gradually.
Best to all of you,
Jackie
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Re: How I spent my Spring Vacation April 15, 2015 02:04PM |
Admin Registered: 11 years ago Posts: 2,779 |
Hi Jackie, Barb and Doreen, Liz, Lynn and Dee,
Im working non stop now on the next AFIB report and hope to have it out by weekend after this coming one at latest and am including a new follow up study that is well done overview meta-analysis of Gender impact on ablation recurrance, and sure enough the women draw a bit shorter straw here too once again.
Seems like with all the child bearing issues and hormonal challenges that also tend to exceed what men typically have to go through several know variables and a few other likely but not confirmed associations stack the deck for women and tending to have a somewhat longer road to hoe in this game and not infrequently with an extra step or two over the average man.
All the more reason to be glad to partner up with a maestro level EP when ever you can to insure you will need the minimum amount to work in your given case.
Its not a bit difference in number of recurrences but is statistically significant.
Here's counting on Jackie having full punched her ticket by now, and you too Barb!
And Jackie, I don't have to tell you, but do take it easy as there is not rush to break any records here on energy rebound you will round out in good form soon enough no doubt so please continue to take it real easy and enjoy the spring flowers .. and sun ... as they both appear.
Be well,
Shannon
Im working non stop now on the next AFIB report and hope to have it out by weekend after this coming one at latest and am including a new follow up study that is well done overview meta-analysis of Gender impact on ablation recurrance, and sure enough the women draw a bit shorter straw here too once again.
Seems like with all the child bearing issues and hormonal challenges that also tend to exceed what men typically have to go through several know variables and a few other likely but not confirmed associations stack the deck for women and tending to have a somewhat longer road to hoe in this game and not infrequently with an extra step or two over the average man.
All the more reason to be glad to partner up with a maestro level EP when ever you can to insure you will need the minimum amount to work in your given case.
Its not a bit difference in number of recurrences but is statistically significant.
Here's counting on Jackie having full punched her ticket by now, and you too Barb!
And Jackie, I don't have to tell you, but do take it easy as there is not rush to break any records here on energy rebound you will round out in good form soon enough no doubt so please continue to take it real easy and enjoy the spring flowers .. and sun ... as they both appear.
Be well,
Shannon
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Re: How I spent my Spring Vacation April 15, 2015 06:50PM |
Registered: 11 years ago Posts: 318 |
Jackie - all the best wishes to you. I am only on this forum periodically now as: a) my afib is calm, and b) life has caused me to be very busy with some other issues. You were such a support to me during my struggles and through my ablation and repeat in 2013, and I can only hope that you are now done with it.
Here's a little story, about my repeat ablation, that might bring a smile.
My first procedure in Bordeaux (June 2013) failed, and one month post ablation Pr. Jais asked me by phone to come back for a touch up. At the time of the phone conversation (July 1, 2013) my wife and I were in Paris waiting for the taxi to take us to the airport to return to Canada. We had to make a quick change of plans which included tossing our plane tickets in the garbage and jumping on the train back to Bordeaux. The second ablation one week later was the charm and now almost two years later I am still in blissful nsr.
Jackie I hope you can find the time to really just relax and let your heart heal.
Kindest Regards, Ron
Here's a little story, about my repeat ablation, that might bring a smile.
My first procedure in Bordeaux (June 2013) failed, and one month post ablation Pr. Jais asked me by phone to come back for a touch up. At the time of the phone conversation (July 1, 2013) my wife and I were in Paris waiting for the taxi to take us to the airport to return to Canada. We had to make a quick change of plans which included tossing our plane tickets in the garbage and jumping on the train back to Bordeaux. The second ablation one week later was the charm and now almost two years later I am still in blissful nsr.
Jackie I hope you can find the time to really just relax and let your heart heal.
Kindest Regards, Ron
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Gender and Recurrence of Afib after Ablation April 16, 2015 12:49PM |
Registered: 11 years ago Posts: 77 |
Shannon Wrote:
-------------------------------------------------------
> Hi Jackie, Barb and Doreen, Liz, Lynn and Dee,
>
> Im working non stop now on the next AFIB report
> and hope to have it out by weekend after this
> coming one at latest and am including a new follow
> up study that is well done overview meta-analysis
> of Gender impact on ablation recurrance, and sure
> enough the women draw a bit shorter straw here too
> once again.
>
> Seems like with all the child bearing issues and
> hormonal challenges that also tend to exceed what
> men typically have to go through several know
> variables and a few other likely but not confirmed
> associations stack the deck for women and tending
> to have a somewhat longer road to hoe in this game
> and not infrequently with an extra step or two
> over the average man.
>
> All the more reason to be glad to partner up with
> a maestro level EP when ever you can to insure you
> will need the minimum amount to work in your given
> case.
>
> Its not a bit difference in number of recurrences
> but is statistically significant.
>
Shannon - not to highjack Jackie's thread about how she spent her spring vacation, but your comment about recurrence after ablation by gender caught my eye.
When I first started reading this board I was convinced I could keep this nasty thing called afib at bay by diet and supplements. 6.5 years later and I've been on propafenone for 6 years, and my finger is ready to press the trigger for ablation with the next occurrence. I gradually came around mentally to the ablation strategy, and lately I've been processing the whole "maybe two or three ablations will take care of it" reality. Up until recently I held out hope that there was still something I could tweak in my diet (my last removal was squares of 90% cocoa chocolate and unsweetened Silk soymilk) that would send afib away long term. Then I could gradually get off the meds, and lead a normal life. The truth is that there is a lot of truth still out there (sorry for the old X-files reference), and they're learning more every day.
I so admire people like George who can go from persistent afib to not needing medication, but for now, the best I can do is keep my heartbeat normal with medication. I know I'm blessed that the propafenone has held so long. I will throw in the towel after a truly random occurrence that I can't blame on anything, and go for the ablation hoping that I could be a "one and done" despite my gender. But the study you referenced above tells me once again that there are no guarantees, even with aggressive ablation treatment and there are still a lot of research questions to be addressed.
Doreen
-------------------------------------------------------
> Hi Jackie, Barb and Doreen, Liz, Lynn and Dee,
>
> Im working non stop now on the next AFIB report
> and hope to have it out by weekend after this
> coming one at latest and am including a new follow
> up study that is well done overview meta-analysis
> of Gender impact on ablation recurrance, and sure
> enough the women draw a bit shorter straw here too
> once again.
>
> Seems like with all the child bearing issues and
> hormonal challenges that also tend to exceed what
> men typically have to go through several know
> variables and a few other likely but not confirmed
> associations stack the deck for women and tending
> to have a somewhat longer road to hoe in this game
> and not infrequently with an extra step or two
> over the average man.
>
> All the more reason to be glad to partner up with
> a maestro level EP when ever you can to insure you
> will need the minimum amount to work in your given
> case.
>
> Its not a bit difference in number of recurrences
> but is statistically significant.
>
Shannon - not to highjack Jackie's thread about how she spent her spring vacation, but your comment about recurrence after ablation by gender caught my eye.
When I first started reading this board I was convinced I could keep this nasty thing called afib at bay by diet and supplements. 6.5 years later and I've been on propafenone for 6 years, and my finger is ready to press the trigger for ablation with the next occurrence. I gradually came around mentally to the ablation strategy, and lately I've been processing the whole "maybe two or three ablations will take care of it" reality. Up until recently I held out hope that there was still something I could tweak in my diet (my last removal was squares of 90% cocoa chocolate and unsweetened Silk soymilk) that would send afib away long term. Then I could gradually get off the meds, and lead a normal life. The truth is that there is a lot of truth still out there (sorry for the old X-files reference), and they're learning more every day.
I so admire people like George who can go from persistent afib to not needing medication, but for now, the best I can do is keep my heartbeat normal with medication. I know I'm blessed that the propafenone has held so long. I will throw in the towel after a truly random occurrence that I can't blame on anything, and go for the ablation hoping that I could be a "one and done" despite my gender. But the study you referenced above tells me once again that there are no guarantees, even with aggressive ablation treatment and there are still a lot of research questions to be addressed.
Doreen
|
Re: Gender and Recurrence of Afib after Ablation April 16, 2015 06:09PM |
Registered: 10 years ago Posts: 1,748 |
Doreeen:
I too have been taking Propafenone for about 10 years, I take it at night before bedtime as I am Vagal and it is still working. I do get some break through of AF every 2 months or so, they usually occur at Night and I generally sleep them off, so it isn't too bad. I read where some of the women have at least 2 ablations and had problems in between, Jackie has had 3, that sounds worse to me then what I am going through, and she went to the top Doc., so that wasn't the reason.
There still is a lot we don't know about AF, I do know anytime you mess with the heart you can get AF, my husband when he was in the hospital some years ago, had to be put on life support and it put him into AF, same with my brother, the heart reacts.
Liz
I too have been taking Propafenone for about 10 years, I take it at night before bedtime as I am Vagal and it is still working. I do get some break through of AF every 2 months or so, they usually occur at Night and I generally sleep them off, so it isn't too bad. I read where some of the women have at least 2 ablations and had problems in between, Jackie has had 3, that sounds worse to me then what I am going through, and she went to the top Doc., so that wasn't the reason.
There still is a lot we don't know about AF, I do know anytime you mess with the heart you can get AF, my husband when he was in the hospital some years ago, had to be put on life support and it put him into AF, same with my brother, the heart reacts.
Liz
|
Re: How I spent my Spring Vacation April 16, 2015 06:15PM |
Registered: 12 years ago Posts: 283 |
|
Re: How I spent my Spring Vacation April 18, 2015 07:51PM |
Registered: 10 years ago Posts: 73 |
|
Re: Gender and Recurrence of Afib after Ablation April 19, 2015 10:02AM |
Registered: 6 years ago Posts: 18,881 |
Doreen - Thanks for posting your personal experiences and observations.
I totally agree with you that the best approach is just what you are doing... assessing and making adjustments to whatever influences you find are contributory and just "coasting" as long as you are comfortable. In the process, you help yourself become healthier overall and that's a very beneficial and positive step. That was my initial plan as well and over the 20 years of my saga, I've managed to overcome other health issues as a result; so for me, that's a very huge plus.... to be my age (79) and have no other significant health issues and take no meds other than the requisite Eliquis is most gratifying.
I, too, commend the former afibbers ... Erling, Fran, George, Peggy and so many others who were able to manage their nutrient shortfalls in a relatively timely fashion and have successfully avoided the surgical procedure. Having been a victim of several unnecessary other surgeries, I'm not a fan of rushing into surgery as the first option.
You may recall my commenting that I view Afib as our "canary in the coal mine" ...in that Afib is the canary warning us that something is out of balance in our body. When we take the time to eliminate the incompatibilities and nutritional deficiencies, toxins and other unhealthy influences, the resulting healthier body will serve us well for many years to come.
If the time does come that your meds stop working and Afib is intolerable, be sure that you seek the care of a top tier EP.
I wish you well,
Jackie
I totally agree with you that the best approach is just what you are doing... assessing and making adjustments to whatever influences you find are contributory and just "coasting" as long as you are comfortable. In the process, you help yourself become healthier overall and that's a very beneficial and positive step. That was my initial plan as well and over the 20 years of my saga, I've managed to overcome other health issues as a result; so for me, that's a very huge plus.... to be my age (79) and have no other significant health issues and take no meds other than the requisite Eliquis is most gratifying.
I, too, commend the former afibbers ... Erling, Fran, George, Peggy and so many others who were able to manage their nutrient shortfalls in a relatively timely fashion and have successfully avoided the surgical procedure. Having been a victim of several unnecessary other surgeries, I'm not a fan of rushing into surgery as the first option.
You may recall my commenting that I view Afib as our "canary in the coal mine" ...in that Afib is the canary warning us that something is out of balance in our body. When we take the time to eliminate the incompatibilities and nutritional deficiencies, toxins and other unhealthy influences, the resulting healthier body will serve us well for many years to come.
If the time does come that your meds stop working and Afib is intolerable, be sure that you seek the care of a top tier EP.
I wish you well,
Jackie
|
Re: Gender and Recurrence of Afib after Ablation April 19, 2015 12:25PM |
Admin Registered: 11 years ago Posts: 2,779 |
The issue with the gender gap in terms of about a 20% overall increase likelihood of needing a follow up procedure assessing a large pool EPs doing the work we will review more in the upcoming AFIB Report am working on non stop now through this coming weekend when I hope to have it all wrapped up. However, much of this apparent gap is multifactorial and a good portion of it stems from the general fact that women are not recommended or offered for ablation as early in the process as are men and thus generally are older with longer standing more advanced atrial disease than men when they start the an ablation process. In addition women are more likely to put off an ablation once recommended than men, again allowing a more advanced substrate before starting off with the process of adding a top quality ablation to whatever drug and/or life style modification methods they might be using to try to control their AFIB and avoid an ablation to begin with.
Of course, many of us, including me did much the same thing and it seems prudent and reasonable ... and up to a point it is, but the more I've learned about AFIB and the more insidious its nature, the more obvious it is that it's also a timing game in which it makes all kinds of sense to establish risk factor avoidance and life style modification as key initial foundational steps that are adopted as life long changes, but at the same time understand that anything less than near total control .... George or Erling for example ... Via the natural means alone ... Increasingly put you at risk for more advanced disease and greater likelihood of needing one, two or possible even three touch ups tops after fully successfully completing an expert ablation process, where the odds of being one or two and done with a top EP are a good deal higher when the ablation process is added into the mix of a comprehensive treatment program that includes ALL of the best tools in our tool kit earlier on in the overall progression of the condition.
Getting too wedded to the idea that exclusively one side of the coin or the other is the only way to go is, overall and for the vast majority, a far less favorable strategy.
That's the one big concern I have with the very understandable and natural inclination to continue rationalizing postponing starting such an expert ablation process until the AFIB has become totally intolerable and too hard to control at all.
The problem is that our minds are uncannily good at subliminally stretching the degree of AFIB we interpret as 'not yet intolerable' and still hoping against hope we can still find that magic formula to put it all back in the bottle even after years of continued modestly frequent breakthroughs inspite of heroic natural and drug efforts combined. And it is SO easy to slide into that no mans (or woman's) land without realizing it where in spite of doing everything right we are nevertheless still pouring gasoline on the fire, albeit perhaps a little more slowly than when doing nothing for sure, and thus are too often inadvertently fostering further progression and increased odds of a more challenging ablation process to occur by the time even the most ardent of the diehard group who swear "I'll never get an ablation" is finally ready to throw in the towel.
To combat that natural tendency toward excessive caution that thus becomes more reckless and risky when taken too far, we must get rid of the idea that logically assessing when is the best time to go for an index ablation with the best possible EP is considered some personal 'failure' of will power or lacking the smarts and thus are unable to solve our individual AFIB riddle on our own. A kind of premature hubris can often creep in there as well after a good period of a seeming cure-like success as well.
Even the comparatively few who have been so fortunate ., and a wonderful Hallelujah to each and everyone who have worked hard and also
been so fortunate ... to truly gain long term control over the beast without an expert ablation as at least part of their equation for success. Perhaps a good measure of that natural-only success has been baked in for some of these comparatively smaller numbers due to genetic good luck or just jumping on it early enough and with the right choices to nip the progression in the bud. But our experience shows that the numbers who have truly been able to pull this off long term are not high at all to this point of of knowledge and understanding.
Yet everyone who embarks on the highly recommended life style risk factor and life style mods naturally assumes and hopes they will be among the true success stories without an ablation, and yet this very thought when latched onto too firmly can undermine ones chances for real success which is stopping AFIB as early as we can in the process by whatever combined means is necessary ... NSR is the main and only real goal... Not how you got there.
In Jackies case, she was very wise to recognize the value of a truely 'holistic' approach early on and got her index ablation back in the early days of 2003 that no doubt help set the stage for her long 11 year period of excellent, though not total, success with the help of dedicated nutritional and dietary LSRF improvement as well as a solid first ablation by Dr Natale. Yet like many women she was introduced to the ablation process at a bit later age than the average man , and for good reason back in those early days of ablation beginnings.
With the still comparatively rudimentary tools in hand then and knowledge available in 2003 compared to now needing to have her LAA buttoned down in a one, two and possibly but hoping not three smaller targeted touch ups is very understandable. It's important to to understand the difference between in her case having to address some LAA/CS remnant tachycardia from the more typical recurrences noted in this study in which large parts of a first ablation have to be repeated.
We all know that LAA isolation due to its particular nature has an inherently higher risk for need one or two, and much more rarely three, true limited scope touch ups in expert hands. While no one wants to have tony go any of them, these are a big difference from multiple larger scale repeat ablations.
Would it have been possible to avoid any LAA work at all with an earlier touch up after the first few breakthroughs within the few years after an index ablation? .. As hard as that is to do, as I know first hand, after having had such good combined success for a good period, and it still seemed so easy to be able to quiet it down again by redoubling my efforts?
We'll never know for sure, but in speaking with Dr Natale about this same scenario, and from the bulk of recent research, and based on my own experience as well as careful observation on this board for many years, I do now strongly support for those having had an index ablation, in particular, not to rely only on supplements and dietary changes alone or in combo with drugs, once a bonifide arrhythmia recurrence has occurred more than a couple times and well passed the blanking period as both Jackie and I did at a time when none of really knew any better and it clearly seemed the logical thing to do to continue trying to postpone any follow up procedure as long as possible.
Dr Natake had told me immediately after my big index procedure that I almost certainly would never have AFIB again, but would for sure require coming back once more to finish isolating my LAA tachycardia circuit that he was only able to delay but not cut off entirely in that first ablation when my Left bundle branch block truggered and forcing a quick end to that ablation before the final steps could be done. Even his his assurance that I would half to come back I still stubbornly pressed on for a year longer than Inshould have trying to rediscover that right mix of magnesium and potassium etc that would obviate the need for the LAA isolation... Fat chance! That mistake wound up costing me to have to go through at least 7 additional of the 14 ECV cardioversion during that last 14 months of clock line tachy/flutter ev very three to four weeks and who knows how much extra stress on my heart?
Though Jackies recurrences weren't as frequent as mine , we both quite understandably felt at the time from our own prior successes that we could buy more time by just redoubling our nutritional repletion efforts and it did often help a great deal in buying more time, but was it in hindsight the best decision?
My point is that once one embarks on an expert ablation process with a top EP it's the better part of valor to follow through with that prescribed process until things are truly well buttoned down. That includes making a clear assessment of any repeat recurrences that are well after the blanking period and then realizing that this signifies a new open circuit that is very unlikely to truly be cured, no matter the time or effort at more or less controlling it on our own. And, as such, the best approach is to get that first, and chances are higher to be the last ablation needed at least for a very long time, the earliest rather than later we can return to take care of it while also redoubling our efforts at good dietary and nutrient repletion as well as all the other LSRF improvements that can help our cause.
I learned the hard way that this is an overall wiser approach compared to dragging the 'going it alone' protocol to the bitter end until you just can't take it anymore before throwing in the towel for starting an ablation process with the right doctor.
Embrace all the methods we have at the smart and well considered time in the course of each Individual persons journey with AFIB and don't view having to finally breakdown and accept an ablation as some kind of failure ... That idea is a dangerous one and for the majority is counterproductive long term, no matter how often we hear of he comparatively few who seem to have won the lottery and avoided it all. Every EP can tell you of cases of some folks that have very symptomstic or asymptomatic AFIB for a period of time and then suddenly it disappears and never comes back. That for sure is a distinct small minority, but everyone else is on some continuum of likihood of having better or worse odds of being able to win this game without an ablation with the numbers on the most desired end of the spectrum definitely much smaller at this point than those who will need to cast a wider net for their own success stories to be realized longer term.
For both women and men, start always with the most direct and life style based options and work the rest of the best options in from there in a timely manner as your own condition will dictate without getting too dogmatic about one side to the exclusion of the other.
Finally, it is not only just that women are way underrepresented in nearly all areas of cardiac treatment, especially procedures, even though they get AFIB and some other heart conditions at the same rate as men ( especially after menopause), but there are some additional likely physiological contributions for women such as increased prevalence of isolated atrial amyloidosis found in more women than men which can make one more susceptible to AF with increased chance of recurrence after ablation, and more complex hormonal/endocrine function may play a roll too as to why women may, on the whole, require a follow up or two more ablations than men beyond just the obvious reason that men more often get in earlier when still paroxysmal.
Yet women more often first come to ablation with non-paroxsymal AFIB and with more Extra-PV triggers (likely from the longer delay and older age at time of first ablation). In any event, at least a good part of these differences that seem to contibute a bit longer road for women are addressable with caregivers and women alike being open to changing attitudes and approaches to treating women for AFIB as well as cardiovascular diseases in general earlier in the game.
Apologies for the length and any typos I both dictated and typed this on my IPhone this morning early after waking before jumping into AFIB Report all day and will try to come back to clean up errors when I can in a few days... Hope you can make sense of it.
Shannon
Edited 4 time(s). Last edit at 04/19/2015 04:01PM by Shannon.
Of course, many of us, including me did much the same thing and it seems prudent and reasonable ... and up to a point it is, but the more I've learned about AFIB and the more insidious its nature, the more obvious it is that it's also a timing game in which it makes all kinds of sense to establish risk factor avoidance and life style modification as key initial foundational steps that are adopted as life long changes, but at the same time understand that anything less than near total control .... George or Erling for example ... Via the natural means alone ... Increasingly put you at risk for more advanced disease and greater likelihood of needing one, two or possible even three touch ups tops after fully successfully completing an expert ablation process, where the odds of being one or two and done with a top EP are a good deal higher when the ablation process is added into the mix of a comprehensive treatment program that includes ALL of the best tools in our tool kit earlier on in the overall progression of the condition.
Getting too wedded to the idea that exclusively one side of the coin or the other is the only way to go is, overall and for the vast majority, a far less favorable strategy.
That's the one big concern I have with the very understandable and natural inclination to continue rationalizing postponing starting such an expert ablation process until the AFIB has become totally intolerable and too hard to control at all.
The problem is that our minds are uncannily good at subliminally stretching the degree of AFIB we interpret as 'not yet intolerable' and still hoping against hope we can still find that magic formula to put it all back in the bottle even after years of continued modestly frequent breakthroughs inspite of heroic natural and drug efforts combined. And it is SO easy to slide into that no mans (or woman's) land without realizing it where in spite of doing everything right we are nevertheless still pouring gasoline on the fire, albeit perhaps a little more slowly than when doing nothing for sure, and thus are too often inadvertently fostering further progression and increased odds of a more challenging ablation process to occur by the time even the most ardent of the diehard group who swear "I'll never get an ablation" is finally ready to throw in the towel.
To combat that natural tendency toward excessive caution that thus becomes more reckless and risky when taken too far, we must get rid of the idea that logically assessing when is the best time to go for an index ablation with the best possible EP is considered some personal 'failure' of will power or lacking the smarts and thus are unable to solve our individual AFIB riddle on our own. A kind of premature hubris can often creep in there as well after a good period of a seeming cure-like success as well.
Even the comparatively few who have been so fortunate ., and a wonderful Hallelujah to each and everyone who have worked hard and also
been so fortunate ... to truly gain long term control over the beast without an expert ablation as at least part of their equation for success. Perhaps a good measure of that natural-only success has been baked in for some of these comparatively smaller numbers due to genetic good luck or just jumping on it early enough and with the right choices to nip the progression in the bud. But our experience shows that the numbers who have truly been able to pull this off long term are not high at all to this point of of knowledge and understanding.
Yet everyone who embarks on the highly recommended life style risk factor and life style mods naturally assumes and hopes they will be among the true success stories without an ablation, and yet this very thought when latched onto too firmly can undermine ones chances for real success which is stopping AFIB as early as we can in the process by whatever combined means is necessary ... NSR is the main and only real goal... Not how you got there.
In Jackies case, she was very wise to recognize the value of a truely 'holistic' approach early on and got her index ablation back in the early days of 2003 that no doubt help set the stage for her long 11 year period of excellent, though not total, success with the help of dedicated nutritional and dietary LSRF improvement as well as a solid first ablation by Dr Natale. Yet like many women she was introduced to the ablation process at a bit later age than the average man , and for good reason back in those early days of ablation beginnings.
With the still comparatively rudimentary tools in hand then and knowledge available in 2003 compared to now needing to have her LAA buttoned down in a one, two and possibly but hoping not three smaller targeted touch ups is very understandable. It's important to to understand the difference between in her case having to address some LAA/CS remnant tachycardia from the more typical recurrences noted in this study in which large parts of a first ablation have to be repeated.
We all know that LAA isolation due to its particular nature has an inherently higher risk for need one or two, and much more rarely three, true limited scope touch ups in expert hands. While no one wants to have tony go any of them, these are a big difference from multiple larger scale repeat ablations.
Would it have been possible to avoid any LAA work at all with an earlier touch up after the first few breakthroughs within the few years after an index ablation? .. As hard as that is to do, as I know first hand, after having had such good combined success for a good period, and it still seemed so easy to be able to quiet it down again by redoubling my efforts?
We'll never know for sure, but in speaking with Dr Natale about this same scenario, and from the bulk of recent research, and based on my own experience as well as careful observation on this board for many years, I do now strongly support for those having had an index ablation, in particular, not to rely only on supplements and dietary changes alone or in combo with drugs, once a bonifide arrhythmia recurrence has occurred more than a couple times and well passed the blanking period as both Jackie and I did at a time when none of really knew any better and it clearly seemed the logical thing to do to continue trying to postpone any follow up procedure as long as possible.
Dr Natake had told me immediately after my big index procedure that I almost certainly would never have AFIB again, but would for sure require coming back once more to finish isolating my LAA tachycardia circuit that he was only able to delay but not cut off entirely in that first ablation when my Left bundle branch block truggered and forcing a quick end to that ablation before the final steps could be done. Even his his assurance that I would half to come back I still stubbornly pressed on for a year longer than Inshould have trying to rediscover that right mix of magnesium and potassium etc that would obviate the need for the LAA isolation... Fat chance! That mistake wound up costing me to have to go through at least 7 additional of the 14 ECV cardioversion during that last 14 months of clock line tachy/flutter ev very three to four weeks and who knows how much extra stress on my heart?
Though Jackies recurrences weren't as frequent as mine , we both quite understandably felt at the time from our own prior successes that we could buy more time by just redoubling our nutritional repletion efforts and it did often help a great deal in buying more time, but was it in hindsight the best decision?
My point is that once one embarks on an expert ablation process with a top EP it's the better part of valor to follow through with that prescribed process until things are truly well buttoned down. That includes making a clear assessment of any repeat recurrences that are well after the blanking period and then realizing that this signifies a new open circuit that is very unlikely to truly be cured, no matter the time or effort at more or less controlling it on our own. And, as such, the best approach is to get that first, and chances are higher to be the last ablation needed at least for a very long time, the earliest rather than later we can return to take care of it while also redoubling our efforts at good dietary and nutrient repletion as well as all the other LSRF improvements that can help our cause.
I learned the hard way that this is an overall wiser approach compared to dragging the 'going it alone' protocol to the bitter end until you just can't take it anymore before throwing in the towel for starting an ablation process with the right doctor.
Embrace all the methods we have at the smart and well considered time in the course of each Individual persons journey with AFIB and don't view having to finally breakdown and accept an ablation as some kind of failure ... That idea is a dangerous one and for the majority is counterproductive long term, no matter how often we hear of he comparatively few who seem to have won the lottery and avoided it all. Every EP can tell you of cases of some folks that have very symptomstic or asymptomatic AFIB for a period of time and then suddenly it disappears and never comes back. That for sure is a distinct small minority, but everyone else is on some continuum of likihood of having better or worse odds of being able to win this game without an ablation with the numbers on the most desired end of the spectrum definitely much smaller at this point than those who will need to cast a wider net for their own success stories to be realized longer term.
For both women and men, start always with the most direct and life style based options and work the rest of the best options in from there in a timely manner as your own condition will dictate without getting too dogmatic about one side to the exclusion of the other.
Finally, it is not only just that women are way underrepresented in nearly all areas of cardiac treatment, especially procedures, even though they get AFIB and some other heart conditions at the same rate as men ( especially after menopause), but there are some additional likely physiological contributions for women such as increased prevalence of isolated atrial amyloidosis found in more women than men which can make one more susceptible to AF with increased chance of recurrence after ablation, and more complex hormonal/endocrine function may play a roll too as to why women may, on the whole, require a follow up or two more ablations than men beyond just the obvious reason that men more often get in earlier when still paroxysmal.
Yet women more often first come to ablation with non-paroxsymal AFIB and with more Extra-PV triggers (likely from the longer delay and older age at time of first ablation). In any event, at least a good part of these differences that seem to contibute a bit longer road for women are addressable with caregivers and women alike being open to changing attitudes and approaches to treating women for AFIB as well as cardiovascular diseases in general earlier in the game.
Apologies for the length and any typos I both dictated and typed this on my IPhone this morning early after waking before jumping into AFIB Report all day and will try to come back to clean up errors when I can in a few days... Hope you can make sense of it.
Shannon
Edited 4 time(s). Last edit at 04/19/2015 04:01PM by Shannon.
|
Re: Gender and Recurrence of Afib after Ablation April 19, 2015 05:39PM |
Registered: 11 years ago Posts: 77 |
Shannon,
Thanks for your thoughtful response, and as usual I hone in on one phrase in the middle of your reply. "The near total control via natural means only". What about near total control via medication? When I saw Dr. Schweikert he mentioned there are several more meds I could try if I wanted, since I've had such good success with the propafenone. I'm the one who said, once the propafenone fails I'm off to ablation land, and he said that was absolutely reasonable.
So based on this possible 20% increased likelihood of needing additional ablations (and I understand all the caveats regarding that number), if a med switch (if necessary) can keep me in NSR, you can understand how the decision process just became a little less clear. My echo prior to my appointment in January showed no change in ejection fraction or atrium enlargement, so the propafenone has been very effective in that respect. I have a follow-up appointment with Dr. Schweikert in September, although his staff said if I need to get in sooner, they'll do what they can.
Some people reading this far are probably saying "just get on with it and have the ablation", but if I'm having these internal battles, I'm sure others are as well.
Doreen
Thanks for your thoughtful response, and as usual I hone in on one phrase in the middle of your reply. "The near total control via natural means only". What about near total control via medication? When I saw Dr. Schweikert he mentioned there are several more meds I could try if I wanted, since I've had such good success with the propafenone. I'm the one who said, once the propafenone fails I'm off to ablation land, and he said that was absolutely reasonable.
So based on this possible 20% increased likelihood of needing additional ablations (and I understand all the caveats regarding that number), if a med switch (if necessary) can keep me in NSR, you can understand how the decision process just became a little less clear. My echo prior to my appointment in January showed no change in ejection fraction or atrium enlargement, so the propafenone has been very effective in that respect. I have a follow-up appointment with Dr. Schweikert in September, although his staff said if I need to get in sooner, they'll do what they can.
Some people reading this far are probably saying "just get on with it and have the ablation", but if I'm having these internal battles, I'm sure others are as well.
Doreen
|
Re: Gender and Recurrence of Afib after Ablation April 19, 2015 08:53PM |
Registered: 10 years ago Posts: 1,748 |
Doreen:
This board has changed, if having some AF episodes get an ablation we are told, it didn't used to be that way, people did try many things. Perhaps ablations have become safer, especially with Dr. Natalie, but everyone can't have the good doctor do their ablation.
I remember that one of the top docs who did ablations at U of M Michigan did an ablation on a fellow doctor, the man died, we had a lady on this site whose husband wrote a book about his wifes ablation which left her worse off than before the ablation. There are a few people here lately that have spoken about some of the problems that they are having because of their ablations. Lots are very happy with their ablations, so it isn't just an easy decision.
For me, unless I get worse, I will not get an ablation, I am around Jackies age, so how many years do I have left, maybe 10 or 12 years, would I have to look forward to 2 or 3 ablations during those last years, doesn't sound too great. If people are a lot younger, it would be a different story, they also heal faster, so there are many variables to consider.
Liz
This board has changed, if having some AF episodes get an ablation we are told, it didn't used to be that way, people did try many things. Perhaps ablations have become safer, especially with Dr. Natalie, but everyone can't have the good doctor do their ablation.
I remember that one of the top docs who did ablations at U of M Michigan did an ablation on a fellow doctor, the man died, we had a lady on this site whose husband wrote a book about his wifes ablation which left her worse off than before the ablation. There are a few people here lately that have spoken about some of the problems that they are having because of their ablations. Lots are very happy with their ablations, so it isn't just an easy decision.
For me, unless I get worse, I will not get an ablation, I am around Jackies age, so how many years do I have left, maybe 10 or 12 years, would I have to look forward to 2 or 3 ablations during those last years, doesn't sound too great. If people are a lot younger, it would be a different story, they also heal faster, so there are many variables to consider.
Liz
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Re: How I spent my Spring Vacation April 19, 2015 11:50PM |
Admin Registered: 11 years ago Posts: 2,779 |
Hi Doreen and Liz,
I dont have much time this week just 20 minutes right now, but need to address a few potentially mistaken impressions.
Doreen, I agree with Jackie that you have done everything about as right as you can from all that I have understood from your case by following it here over time. You have had an overall very good level of control with combined nutritional and drug regime and that is perfectly fine ... again while it last and gives a strong level of protection from breakthroughs.
What level of breakthroughs is deemed tolerable will always, as it should, remain an individual decision and my role (as well as the rest of us frequent flyers here) is to share with everyone our own wealth of experiences over many years of trial and hiccups to help each person make a more informed decision at each fork in the road that AFIB will present to all of us over the course of the big picture long term.
You rightly suggest now that if, and when, Propafenone stops working as well as it has in the past you are ready to consider an expert ablation .. smart move ... but with your overall level of low numbers of breakthroughs (at least known one's if you have had not ongoing night time monitoring like a pacemaker which I don't recall?) and that your latest echo shows no atrial enlargement and no signs of distress, are all good indicators that you could also give one more try with another AAR to see if it works for some time as well. Generally AAR drugs tend to stop working overtime and after one or two stop working the odds of a third or fourth working well for long are not high .. though there are exceptions as with every angle of this field.
I do strongly advise Doreen that if you do switch to another AAR like FLEC ( assuming you have not tried it before), that at this stage of the game, assuming your breakthroughs have increased and thus necessitating either the switch in drugs or going for a top level ablation, then do NOT give another AAR trial a lot of rope. In other words, should the new drug start to fail, or fail from the outset to really put the genie under wraps as well as the propafenone did in its hay day for you, then move right on to a truly expert ablation process with the best EP you can manage to arrange for yourself. And good job so far!
And please don't burn that 20% added risk for recurrence into your mind simply because you are a woman. A large percent of that 20% greater risk than men in the excellent study I am reporting on in the upcoming newsletter issue, is largely due to women having waited too long with poorly controlled AFIB, and often not even offered or referred for ablation until they were significantly older than the study cohort of men having ablations.
Plus, the majority no doubt never had the benefit of the many good tips and advice on a site like ours here to fill in the blanks and increase their odds of success whether if be with diet, supplements and better Life style choices.. or all of those things plus a top level ablation process. I think when you read my report on this meta-analysis study in the next newsletter, out hopefully next Sunday or Monday at latest (fingers crossed), you will feel less like you are fated to several ablations just because you are a women which is not what is being said in the study. Much of the added risk detected in this large meta-analysis for women ablates can be avoided now that we know a good deal of the adjustable contributors to that skewed increased likelihood of post ablation AFIB recurrence for women over men. But it is not at all a fait accompli that any given women is doomed to more procedures.
Another significant factor buried and not immediately obvious in the studies data, is that since many more women than men getting ablations across the 20 studies examined in this large cohort of gender studies were both older and referred for ablation much later in their AFIB careers and had more non-paroxysmal AFIB as well as more non-PV triggers found, then it is highly likely that since a majority of these women were not ablated by top tier persistetn AFIB ablationist and no doubt a majority had primarly ONLY PVI/PVAI ablation to begin with, that this factor alone could account for a very significant amount of the 20% increased risk reported for these older and more AFIB progessed women than in the younger men who had a higher percentage of paroxysmal cases to begin with as well!
Do you see why its important to look behind the numbers of these studies, this is a very valuable finding and very well done meta-analysis but its important to understand what it really implies.. Its my fault for even mentioning it here before I published the next news letter... only a glimpse of the information can be more misleading than enlightening.
And Liz, I have never, and in no way, ever suggest that anyone should just run out and get any ole ablation as soon as they have a couple breakthroughs.
What I DO recommend requires several key steps.
1. First doing everything you can and dedicate your self to seeing how far you can get with true rhythm control with the Strategy and other dietary and LSRF medications for a good year to 6 months at least. IF you do very well with that route and have just a hand full of episodes a year... some may think one episode a month is a tolerable level, even though long term that level can gradually slide into 20 or more before you know it. But the point is, each of us will know what we are willing to go with and when it begins to increase and stretch your comfort zone, I am just saying don't then try to rationalize why doing ten more things that still don't really change the level of activity for the better and thus continue solely on that path alone. Instead take your bodies clear warning at that point to include a top level ablation process ALONG WITH all the best healthy living and restoration of missing healthy biochemistry that you can adopt consistently in your life.
2, When it's time for an expert ablation process do everything possible to get the best possible EP with their hands on your heart during those critical few hours of your life. And never settle for less just because it seems more convenient or you, or you are simply not that fond of traveling even when you can afford it etc.
2, And where drugs help for a good while and you seem to tolerate then reasonably well, then hallelujah .. if they help you reduce your AFIB burden significantly Im all for i rt in combination with true risk factor modification and healthy life style choices and changes...
3. Again, though, keep your eye on the long view too and don't get complacent accepting too much activity just because of some fears about an ablation.
4, Always be open to including all the best methods simultaneously for upping your odds of sustaining consistent and unbroken long term NSR. That is how real reverse remodeling can best take place.
And yes, of course Liz an ablation can have dangers and some people have died just as many have died from strokes related to poorly treated AFIB as well... the bottom line is this condition sucks and that is why I am so adamant about moving heaven and earth to put oneself in the very most experienced hands when, and if, the time comes when an ablation is your best chance to get on top of this lousy game.
And that is another reason we so often start with the best many of us know like a Dr Natale, when choosing a truly top notch EP as the role model for excellence around here. With any of the top 30 to 50 likely even the top 100 ablationists in the US, your odds of anything serious happening too you are extremely small and a lot less than the odds of your AFIB becoming much worse or persistent if you don't get back to a stable NSR once your AFIB has become toxic enough to really interfere with your life on a daily basis.
In your case Liz, from all that you have shared with us too, you have been relatively blessed with a not overly serious case of AFIB and you seem to have found a nice niche of comfort with the levels of breakthroughs you now have, and hopefully it doesn't increase markedly the rest of your life. There will always be a fair number of people that can more or less get by with drugs, nutrients or just better living or via good set of genes etc ... the later two which you may have inherited from your mother as well from past reports. So it's understandable why your stance and outlook is as it has been over the years and rightly so, and yet as you noted above, if you were in your early to mid-fifite's with a notably more symptomatic AFIB, I imagine your decision making might well change a good degree with respect to considering an top tier ablation.
It's true too that not everyone can make it to Dr Natale, but we are not trying to address and rescue everyone. We can only address those that find our voice and have the where-withall to listen and understand the many good ideas being shared here. And what I have found is that for so many who at first can not dream of traveling to see someone like Dr N, once they better understand the logic and the scope of the choice, more than a few will find a way to make it happen when its their heart on the line.
And yet for those that simply can't financially afford to travel to see a man like Dr Natale, as rare as such EPs are at that level of stature, there are still a pretty good number of others who are top notch as well by any standard, and can do a great and reliable job for the vast majority who might need a top ablation and who are spread out in different parts of the country too.
Dr Natale is simply the benchmark by which our readers can measure true excellence in this field, and thus better appreciate and gauge those other men and women who strive for that degree of consistent quality as well. EPs that can be sought out and found with a little effort if an afibber really simply cannot make it to see the safest of all choices in Austin, San Fran of La Jolla when factoring in both success with the least amount of overall work required AND overall safety.
But please don't assume I would dare recommend anyone to go rush off willy nilly to get an ablation just because of a few breakthroughs prior to having a first ablation, or for someone who has just a few short recurrences after an index ablation followingr the blanking period.... everything I say and suggest regarding ablation is predicated on choosing a top level ablationist from the outset.
And I always strongly include adopting for life all the best life style and postive healthy dietary adaptations one can consistently incorporate into their daily lives ... and Not as a fad or a part time temporary thing, but by listening to the message of AFIB that something fundamental is out of whack systemically and needs to be addressed first and foremost.
However, unlike the very excited Dr John in the latest new tread about his blog at the top of this page, I have a much more measured assessment of the real world long term benefits for the vast majority via these vital and important steps life style risk factor improvements alone, and yet I fully endorse the effort to encourage both physicians and doctors to adopt those smart and health protocols.
But Im also willing to bet my bottom dollar Dr J will also discover too over time when more than barely a couple hundred overly chubby Australians join the Adelaide bootcamp that what they are suggesting is a very important key step, but only one side of the coin. I just shy away from this virtual throwing the baby out with the bathwater by now suddenly tossing ablations into a little used waste basket before they have really tried their so-called 'new discovery' that previous common sense steps such as losing weight, eating better and reducing risk factors can greatly help reduce AFIB burden for many people ... a mantra we have been chanting for 16 years here .. likely while Dr J was busy defending the status quo for much of his early career during those years.
Nevertheless, we all welcome any increased awareness among doctors of treating the whole patient first and foremost, but I imagine with his zeal now assuming he has found the holy grail to make AFIB little more than an occasional after thought in which ablations are only needed rarely to give a suffering patient enough rope to allow then to exercise more to find their cure ... that he may find before too long that there are some holes in their theory when they recruit some otherwise pretty healthy and slim Afibbers who have been through it all and still have rocking and rolling AFIB and while many likely eat better and are as fit as he is!
I've always had a red flag radar for the messianic types, especially the recent converts to being new true believers in whatever new breakthrough theory. Life has a way of bringing humility to such overzealous views, Even when they include so many extremely good and welcome ideas as Dr J is now promoting along with a hand full of his friends and other EPs from Adelaide. its all good though, as I guess having that zeal might help convince some otherwise older traditionalist docs to give the life style risk factor protocols a closer look, and that can only be a good thing in my view.
I'll be glad though when all the hoopla around this series of Australian studies that for sure have some very worthy messages shared within them, and that I report on too in the upcoming newsletter, resumes its more normal place in the firmament of good ideas and comes back down out of breathless orbit and a little closer to planet earth.
Anyway, I digress again, but the main thing Liz and Doreen in my view is to keep an all inclusive vision here with a disease as complex and insidious as AFIB has proven to be and with as many individual wrinkles and manifestations, it's just not wise to basically rule out any potentially positive method that has shown real results, whether its magnesium and potassium along with a host of good dietary changes, stress reduction, and risk factor improvements and catheter ablation included too by an expert operator.
Sleep well all ... back to the newsletter.
Shannon
Edited 1 time(s). Last edit at 04/20/2015 12:52AM by Shannon.
I dont have much time this week just 20 minutes right now, but need to address a few potentially mistaken impressions.
Doreen, I agree with Jackie that you have done everything about as right as you can from all that I have understood from your case by following it here over time. You have had an overall very good level of control with combined nutritional and drug regime and that is perfectly fine ... again while it last and gives a strong level of protection from breakthroughs.
What level of breakthroughs is deemed tolerable will always, as it should, remain an individual decision and my role (as well as the rest of us frequent flyers here) is to share with everyone our own wealth of experiences over many years of trial and hiccups to help each person make a more informed decision at each fork in the road that AFIB will present to all of us over the course of the big picture long term.
You rightly suggest now that if, and when, Propafenone stops working as well as it has in the past you are ready to consider an expert ablation .. smart move ... but with your overall level of low numbers of breakthroughs (at least known one's if you have had not ongoing night time monitoring like a pacemaker which I don't recall?) and that your latest echo shows no atrial enlargement and no signs of distress, are all good indicators that you could also give one more try with another AAR to see if it works for some time as well. Generally AAR drugs tend to stop working overtime and after one or two stop working the odds of a third or fourth working well for long are not high .. though there are exceptions as with every angle of this field.
I do strongly advise Doreen that if you do switch to another AAR like FLEC ( assuming you have not tried it before), that at this stage of the game, assuming your breakthroughs have increased and thus necessitating either the switch in drugs or going for a top level ablation, then do NOT give another AAR trial a lot of rope. In other words, should the new drug start to fail, or fail from the outset to really put the genie under wraps as well as the propafenone did in its hay day for you, then move right on to a truly expert ablation process with the best EP you can manage to arrange for yourself. And good job so far!
And please don't burn that 20% added risk for recurrence into your mind simply because you are a woman. A large percent of that 20% greater risk than men in the excellent study I am reporting on in the upcoming newsletter issue, is largely due to women having waited too long with poorly controlled AFIB, and often not even offered or referred for ablation until they were significantly older than the study cohort of men having ablations.
Plus, the majority no doubt never had the benefit of the many good tips and advice on a site like ours here to fill in the blanks and increase their odds of success whether if be with diet, supplements and better Life style choices.. or all of those things plus a top level ablation process. I think when you read my report on this meta-analysis study in the next newsletter, out hopefully next Sunday or Monday at latest (fingers crossed), you will feel less like you are fated to several ablations just because you are a women which is not what is being said in the study. Much of the added risk detected in this large meta-analysis for women ablates can be avoided now that we know a good deal of the adjustable contributors to that skewed increased likelihood of post ablation AFIB recurrence for women over men. But it is not at all a fait accompli that any given women is doomed to more procedures.
Another significant factor buried and not immediately obvious in the studies data, is that since many more women than men getting ablations across the 20 studies examined in this large cohort of gender studies were both older and referred for ablation much later in their AFIB careers and had more non-paroxysmal AFIB as well as more non-PV triggers found, then it is highly likely that since a majority of these women were not ablated by top tier persistetn AFIB ablationist and no doubt a majority had primarly ONLY PVI/PVAI ablation to begin with, that this factor alone could account for a very significant amount of the 20% increased risk reported for these older and more AFIB progessed women than in the younger men who had a higher percentage of paroxysmal cases to begin with as well!
Do you see why its important to look behind the numbers of these studies, this is a very valuable finding and very well done meta-analysis but its important to understand what it really implies.. Its my fault for even mentioning it here before I published the next news letter... only a glimpse of the information can be more misleading than enlightening.
And Liz, I have never, and in no way, ever suggest that anyone should just run out and get any ole ablation as soon as they have a couple breakthroughs.
What I DO recommend requires several key steps.
1. First doing everything you can and dedicate your self to seeing how far you can get with true rhythm control with the Strategy and other dietary and LSRF medications for a good year to 6 months at least. IF you do very well with that route and have just a hand full of episodes a year... some may think one episode a month is a tolerable level, even though long term that level can gradually slide into 20 or more before you know it. But the point is, each of us will know what we are willing to go with and when it begins to increase and stretch your comfort zone, I am just saying don't then try to rationalize why doing ten more things that still don't really change the level of activity for the better and thus continue solely on that path alone. Instead take your bodies clear warning at that point to include a top level ablation process ALONG WITH all the best healthy living and restoration of missing healthy biochemistry that you can adopt consistently in your life.
2, When it's time for an expert ablation process do everything possible to get the best possible EP with their hands on your heart during those critical few hours of your life. And never settle for less just because it seems more convenient or you, or you are simply not that fond of traveling even when you can afford it etc.
2, And where drugs help for a good while and you seem to tolerate then reasonably well, then hallelujah .. if they help you reduce your AFIB burden significantly Im all for i rt in combination with true risk factor modification and healthy life style choices and changes...
3. Again, though, keep your eye on the long view too and don't get complacent accepting too much activity just because of some fears about an ablation.
4, Always be open to including all the best methods simultaneously for upping your odds of sustaining consistent and unbroken long term NSR. That is how real reverse remodeling can best take place.
And yes, of course Liz an ablation can have dangers and some people have died just as many have died from strokes related to poorly treated AFIB as well... the bottom line is this condition sucks and that is why I am so adamant about moving heaven and earth to put oneself in the very most experienced hands when, and if, the time comes when an ablation is your best chance to get on top of this lousy game.
And that is another reason we so often start with the best many of us know like a Dr Natale, when choosing a truly top notch EP as the role model for excellence around here. With any of the top 30 to 50 likely even the top 100 ablationists in the US, your odds of anything serious happening too you are extremely small and a lot less than the odds of your AFIB becoming much worse or persistent if you don't get back to a stable NSR once your AFIB has become toxic enough to really interfere with your life on a daily basis.
In your case Liz, from all that you have shared with us too, you have been relatively blessed with a not overly serious case of AFIB and you seem to have found a nice niche of comfort with the levels of breakthroughs you now have, and hopefully it doesn't increase markedly the rest of your life. There will always be a fair number of people that can more or less get by with drugs, nutrients or just better living or via good set of genes etc ... the later two which you may have inherited from your mother as well from past reports. So it's understandable why your stance and outlook is as it has been over the years and rightly so, and yet as you noted above, if you were in your early to mid-fifite's with a notably more symptomatic AFIB, I imagine your decision making might well change a good degree with respect to considering an top tier ablation.
It's true too that not everyone can make it to Dr Natale, but we are not trying to address and rescue everyone. We can only address those that find our voice and have the where-withall to listen and understand the many good ideas being shared here. And what I have found is that for so many who at first can not dream of traveling to see someone like Dr N, once they better understand the logic and the scope of the choice, more than a few will find a way to make it happen when its their heart on the line.
And yet for those that simply can't financially afford to travel to see a man like Dr Natale, as rare as such EPs are at that level of stature, there are still a pretty good number of others who are top notch as well by any standard, and can do a great and reliable job for the vast majority who might need a top ablation and who are spread out in different parts of the country too.
Dr Natale is simply the benchmark by which our readers can measure true excellence in this field, and thus better appreciate and gauge those other men and women who strive for that degree of consistent quality as well. EPs that can be sought out and found with a little effort if an afibber really simply cannot make it to see the safest of all choices in Austin, San Fran of La Jolla when factoring in both success with the least amount of overall work required AND overall safety.
But please don't assume I would dare recommend anyone to go rush off willy nilly to get an ablation just because of a few breakthroughs prior to having a first ablation, or for someone who has just a few short recurrences after an index ablation followingr the blanking period.... everything I say and suggest regarding ablation is predicated on choosing a top level ablationist from the outset.
And I always strongly include adopting for life all the best life style and postive healthy dietary adaptations one can consistently incorporate into their daily lives ... and Not as a fad or a part time temporary thing, but by listening to the message of AFIB that something fundamental is out of whack systemically and needs to be addressed first and foremost.
However, unlike the very excited Dr John in the latest new tread about his blog at the top of this page, I have a much more measured assessment of the real world long term benefits for the vast majority via these vital and important steps life style risk factor improvements alone, and yet I fully endorse the effort to encourage both physicians and doctors to adopt those smart and health protocols.
But Im also willing to bet my bottom dollar Dr J will also discover too over time when more than barely a couple hundred overly chubby Australians join the Adelaide bootcamp that what they are suggesting is a very important key step, but only one side of the coin. I just shy away from this virtual throwing the baby out with the bathwater by now suddenly tossing ablations into a little used waste basket before they have really tried their so-called 'new discovery' that previous common sense steps such as losing weight, eating better and reducing risk factors can greatly help reduce AFIB burden for many people ... a mantra we have been chanting for 16 years here .. likely while Dr J was busy defending the status quo for much of his early career during those years.
Nevertheless, we all welcome any increased awareness among doctors of treating the whole patient first and foremost, but I imagine with his zeal now assuming he has found the holy grail to make AFIB little more than an occasional after thought in which ablations are only needed rarely to give a suffering patient enough rope to allow then to exercise more to find their cure ... that he may find before too long that there are some holes in their theory when they recruit some otherwise pretty healthy and slim Afibbers who have been through it all and still have rocking and rolling AFIB and while many likely eat better and are as fit as he is!
I've always had a red flag radar for the messianic types, especially the recent converts to being new true believers in whatever new breakthrough theory. Life has a way of bringing humility to such overzealous views, Even when they include so many extremely good and welcome ideas as Dr J is now promoting along with a hand full of his friends and other EPs from Adelaide. its all good though, as I guess having that zeal might help convince some otherwise older traditionalist docs to give the life style risk factor protocols a closer look, and that can only be a good thing in my view.
I'll be glad though when all the hoopla around this series of Australian studies that for sure have some very worthy messages shared within them, and that I report on too in the upcoming newsletter, resumes its more normal place in the firmament of good ideas and comes back down out of breathless orbit and a little closer to planet earth.
Anyway, I digress again, but the main thing Liz and Doreen in my view is to keep an all inclusive vision here with a disease as complex and insidious as AFIB has proven to be and with as many individual wrinkles and manifestations, it's just not wise to basically rule out any potentially positive method that has shown real results, whether its magnesium and potassium along with a host of good dietary changes, stress reduction, and risk factor improvements and catheter ablation included too by an expert operator.
Sleep well all ... back to the newsletter.
Shannon
Edited 1 time(s). Last edit at 04/20/2015 12:52AM by Shannon.
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Re: How I spent my Spring Vacation April 20, 2015 09:28AM |
Registered: 11 years ago Posts: 77 |
Shannon,
Thanks for taking the time to respond so thoroughly. I know you're so busy doing the AFIB Report and yet you took the time to craft a thoughtful reply.
Before I went to Dr. Schweikert I had rejected the possibility of moving on to another AAR drug, and thought I was heading for ablation when I had several breakthroughs around Christmastime, but when Dr. Schweikert brought up the possibility of increasing the propafenone or trying another AAR as an equally valid strategy, I've been giving those ideas more consideration.
I will also admit Jackie's third procedure knocked me for a loop. Jackie has been tirelessly and selflessly helping everybody fight this unpredictable afib, and for my first few years on this board, I was convinced she had it licked with an ablation by Dr. Natale, which was performed only after she had tried everything under the sun. It just shows how insidious this disease.
And you're right, Shannon, Dr. John certainly has some valid points regarding lifestyle changes that could change the course of afib, but hopefully his comments don't have the unintended consequences of blaming the afib sufferer when things stay awry. After all, a lot of us were runners, athletes, etc. and would have been considered in "pretty good shape" if we had been lined up for comparison with our peers when our afib first surfaced. Add the total diet tweaking, alcohol avoidance, caffeine avoidance since afib, and our hearts should be like metronomes. And sadly they're not, so it's not an easy fix.
I'll be interested in the results of the CABANA study.
Doreen
Thanks for taking the time to respond so thoroughly. I know you're so busy doing the AFIB Report and yet you took the time to craft a thoughtful reply.
Before I went to Dr. Schweikert I had rejected the possibility of moving on to another AAR drug, and thought I was heading for ablation when I had several breakthroughs around Christmastime, but when Dr. Schweikert brought up the possibility of increasing the propafenone or trying another AAR as an equally valid strategy, I've been giving those ideas more consideration.
I will also admit Jackie's third procedure knocked me for a loop. Jackie has been tirelessly and selflessly helping everybody fight this unpredictable afib, and for my first few years on this board, I was convinced she had it licked with an ablation by Dr. Natale, which was performed only after she had tried everything under the sun. It just shows how insidious this disease.
And you're right, Shannon, Dr. John certainly has some valid points regarding lifestyle changes that could change the course of afib, but hopefully his comments don't have the unintended consequences of blaming the afib sufferer when things stay awry. After all, a lot of us were runners, athletes, etc. and would have been considered in "pretty good shape" if we had been lined up for comparison with our peers when our afib first surfaced. Add the total diet tweaking, alcohol avoidance, caffeine avoidance since afib, and our hearts should be like metronomes. And sadly they're not, so it's not an easy fix.
I'll be interested in the results of the CABANA study.
Doreen
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Re: How I spent my Spring Vacation May 09, 2015 08:43PM |
Registered: 10 years ago Posts: 83 |
Jackie,
So sorry to hear you're in the '3rd time lucky' category. Really hope and pray that this time is the last time. I am so grateful for your kind support - and Shannon's clear advice on my own ablation journey. I'm nearly 6-months down the road from an ablation only supervised by Dr Sabine Ernst and I haven't even got (noticeable) ectopics to report. All is calm. As I've just written, I'm experiencing some internal bleeding issues, but that's nothing to do with the ablation.
It was the best decision I ever made, and I'd happily put myself forward for a touch-up, should the need arise. Your decision to do so will no doubt persuade those who are wondering whether it's worth the discomfort.
Take good care of yourself.
So sorry to hear you're in the '3rd time lucky' category. Really hope and pray that this time is the last time. I am so grateful for your kind support - and Shannon's clear advice on my own ablation journey. I'm nearly 6-months down the road from an ablation only supervised by Dr Sabine Ernst and I haven't even got (noticeable) ectopics to report. All is calm. As I've just written, I'm experiencing some internal bleeding issues, but that's nothing to do with the ablation.
It was the best decision I ever made, and I'd happily put myself forward for a touch-up, should the need arise. Your decision to do so will no doubt persuade those who are wondering whether it's worth the discomfort.
Take good care of yourself.
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