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Re: Do you ever feel like Afib is just around the corner? March 01, 2019 03:04PM |
Hey DavrosT thanks for the inquiry and welcome back.
It is not uncommon during certain phases of PAF (paroxysmal AFI
for a person to have what appears to be regularly spaced or seasonal-seeming triggering. Over the course of one’s long term gradual progression of the disease it will usually go through a number of such phases over time. That phenomenon you describe can also manifest as this; you have a new AFIB episode and then it seems like your heart has reset and feels rock solid for a decent period of time and you feel almost immune to any hiccups or recurrences of AFIB until gradually you notice an increase in ectopic beats, perhaps leading to short runs of ectopy and the tension waiting for the dam to break seems to build up until ... BAM ... another episode and the cycle repeats itself.
I went through a phase like that for about 7 to 8 years during my gradual progression from rare sporadically short-lived episodes in the beginning of my AFIB ‘career’, toward eventual conversion of increasingly frequent and longer duration PAF episodes until it all suddenly flipped into full time 24/7 aggressive symptomatic persistent AFIB after 16 years of doing my level best at managing the beast naturally and with medications when needed.
But the scenario you describe, DavrosT, maybe a bit different issue and I need to know a little more. Was this your first ABL 20 months ago, and who did the procedurec and what kind of AFIB ABL did you have done? And you mentioned some weekly 2 hour breakthroughs you had post ablation I think you implied. How frequently post ablation have you had any breakthroughs of actual arrhythmia? (I.e. AFIB, AFlutter or ATachy), not just ectopy which does not count in this equation.
Roughly how many, if any, actual recurrences of longer than 30 seconds duration have you had the past 20 months, starting AFTER the blanking period?
If you have had any actual breakthroughs past the blanking period, and even if you had increasing AFIB/Flutter activity during the last month of the three month blanking period, then this sensation of increased ectopic activity with an increasing sense of the dam about to break could just be your signal that you likely may need a follow-up procedure to button down a few loose screws. Even after an elite expert ablation it’s very possible that a few sub-clinical remnant triggers that we’re not quite mature enough during your first procedure to readily reveal themselves to the EP when he or she was trying to elicit any more mischief during the final phase of your index ablation. Not infrequently, a few such immature triggers can remain hidden due to the added suppression effect from anesthesia, or because a less experienced ablationist simply was not looking for them in all the right places.
In any event, if you have had any actual breakthroughs of AFIB/AFlutter since the end of the eighth week of the 12 week blanking period, this increased instability may well indicate a need for one more tune up with an expert ablation EP to solidify durable NSR for you.
If you do get any actual breakthrough in the coming months, then I’d suggest to get this fixed sooner rather than later. However, be very discriminating in your choice of EP to perform this second ABL and don’t automatically assume the EP who did your first ABL is fully capable of putting the lid on the kettle long term during a follow-up ABL. Unless you already chose an elite level operator who performs a good number of persistent and LSPAF cases routinely and with good success, thus indicating he/she should be able to address whatever your heart presents to them.
Chasing down potential atypical left Atrial flutters can definitely stretch the comfort zone of those EPs who typically perform only ... or mostly .... just a standard PVI-alone or PVI + LAPosterior wall-Iso, anatomical-only index ablation ... and who may not be so skilled or comfortable at doing real-time electrophysiological sleuthing tracking down unique active triggers or flutter circuits during an ablation and who, thus may well have missed even obvious Non-PV triggers too during the index ABL.
Best wishes!
Shannon
Edited 2 time(s). Last edit at 03/01/2019 03:45PM by Shannon.
It is not uncommon during certain phases of PAF (paroxysmal AFI
for a person to have what appears to be regularly spaced or seasonal-seeming triggering. Over the course of one’s long term gradual progression of the disease it will usually go through a number of such phases over time. That phenomenon you describe can also manifest as this; you have a new AFIB episode and then it seems like your heart has reset and feels rock solid for a decent period of time and you feel almost immune to any hiccups or recurrences of AFIB until gradually you notice an increase in ectopic beats, perhaps leading to short runs of ectopy and the tension waiting for the dam to break seems to build up until ... BAM ... another episode and the cycle repeats itself.
I went through a phase like that for about 7 to 8 years during my gradual progression from rare sporadically short-lived episodes in the beginning of my AFIB ‘career’, toward eventual conversion of increasingly frequent and longer duration PAF episodes until it all suddenly flipped into full time 24/7 aggressive symptomatic persistent AFIB after 16 years of doing my level best at managing the beast naturally and with medications when needed.
But the scenario you describe, DavrosT, maybe a bit different issue and I need to know a little more. Was this your first ABL 20 months ago, and who did the procedurec and what kind of AFIB ABL did you have done? And you mentioned some weekly 2 hour breakthroughs you had post ablation I think you implied. How frequently post ablation have you had any breakthroughs of actual arrhythmia? (I.e. AFIB, AFlutter or ATachy), not just ectopy which does not count in this equation.
Roughly how many, if any, actual recurrences of longer than 30 seconds duration have you had the past 20 months, starting AFTER the blanking period?
If you have had any actual breakthroughs past the blanking period, and even if you had increasing AFIB/Flutter activity during the last month of the three month blanking period, then this sensation of increased ectopic activity with an increasing sense of the dam about to break could just be your signal that you likely may need a follow-up procedure to button down a few loose screws. Even after an elite expert ablation it’s very possible that a few sub-clinical remnant triggers that we’re not quite mature enough during your first procedure to readily reveal themselves to the EP when he or she was trying to elicit any more mischief during the final phase of your index ablation. Not infrequently, a few such immature triggers can remain hidden due to the added suppression effect from anesthesia, or because a less experienced ablationist simply was not looking for them in all the right places.
In any event, if you have had any actual breakthroughs of AFIB/AFlutter since the end of the eighth week of the 12 week blanking period, this increased instability may well indicate a need for one more tune up with an expert ablation EP to solidify durable NSR for you.
If you do get any actual breakthrough in the coming months, then I’d suggest to get this fixed sooner rather than later. However, be very discriminating in your choice of EP to perform this second ABL and don’t automatically assume the EP who did your first ABL is fully capable of putting the lid on the kettle long term during a follow-up ABL. Unless you already chose an elite level operator who performs a good number of persistent and LSPAF cases routinely and with good success, thus indicating he/she should be able to address whatever your heart presents to them.
Chasing down potential atypical left Atrial flutters can definitely stretch the comfort zone of those EPs who typically perform only ... or mostly .... just a standard PVI-alone or PVI + LAPosterior wall-Iso, anatomical-only index ablation ... and who may not be so skilled or comfortable at doing real-time electrophysiological sleuthing tracking down unique active triggers or flutter circuits during an ablation and who, thus may well have missed even obvious Non-PV triggers too during the index ABL.
Best wishes!
Shannon
Edited 2 time(s). Last edit at 03/01/2019 03:45PM by Shannon.
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