Question for the experts

Hi folks,

I am looking for some advice based on the expert knowledge of this great group. Being in persistent afib for almost 2 years I decided to undergo an Ablation with Dr. Natale in TCAI, this was around 2 1/2 years ago, I do not have the ablation report with me at this moment but in general he ablated a lot (3hrs total procedure time) and he even did some work on the LAA, however what he told me is that he did not performed the complete occlusion cause he thought it was enough with what he did. I went on the blanking period with some flutters here and there and one CV after 6 weeks which put me into an absolute quiet mode for almost two years and a couple months.
I have been following exactly what Dr. Andrea recommended to me, not pushing my limits in anything whatsoever and being completely obedient, I even avoided caffeine and booze all this time although he mentioned to me that one beer or one coffee here and there won´t create any issue. Besides this I am fairly healthy person, practicing sports almost every day and eating quite healthy (50 yrs old)

Everything was absolutely quiet until yesterday morning that a skipped beat (I think it was a PAC) appeared, during the day the skipped beats became more often and during the night I started to have those every 3 minutes or so and this has continue until today now for almost 24 hours. Of course it does not feel even close compared to afib but still the feeling is somehow bothersome because every time I have the skipped beat it feels like a hic-up on the chest.
My iwatch does not show any afib and my HR is very low as usual, I am also doing the neck thing and I am quite sure is not afib. I have been also taking 500mg Magnesium every day and the only med I am on is Babyaspirin 81mg.

My question is how concerned should I be about this, will this be the starting point of the beast coming back again or is something that may disappear in a couple days, shall I increase my Magnesium intake, I am really not sure of what all this means, and in the meantime I am also waiting for my nurse practitioner to give me any advice since I still have my lync in place and properly working.

Thanks in advance for your comments and help



Edited 4 time(s). Last edit at 03/28/2019 08:03PM by fravi.

Can't advise.
My EP told me that Flecanide will reduce/hopefully eliminate them. I've got these what i think are PACs and take 50mg of flec at night. Seems to work for me but it could be placebo as well? I do take Mg, herbal tea and a few other supplements as well - placebo?

My crystal ball is in the shop so I can't tell you for sure, but I wouldn't be concerned. I doubt it's going to lead to renewed afib. You had a Natale ablation, after all.

Since my ablations in Bordeaux in 2003 I have been in sinus rhythm but plagued by many ectopics, up to 8000 on a 24 hour Holter. Although they were very uncomfortable, like being kicked in the chest every few seconds, the EPs said they were a nuisance but not a problem.

I started to take lots of magnesium, then added taurine, and finally potassium. I thought they had stopped, however another Holter showed just as many. But now I hardly feel them at all. I’m happy with that, and I have continued to take the supplements for many years now. Works for me!

Gill

Had 2 Natale ablations (4 overall and 2 hours of burn with Natale); last one April 2018. Off all meds from July 2018-Feb2019, but had ectopics off and on from july-sept, then they essentially stopped until Feb 2019 where they came back significantly. Tried to put up with them but was having trouble sleeping so went to 50mg flec bid and 12.5mg atenolol. It's helped alot but am still visited daily by them. Getting used to it but wish they would go away. also am taking 300 mg mag, no alcohol, try to eat right, etc. At this point you are still in very good shape!

Forget to add that i take Eliquis. i've been taking blood thinners for so long I no longer consider them meds!

Good to hear from you Fravi!

Ectopics can happen even more than 2.5 yrs out but from one’s ablation... though more often they tend to subside around to 2.5 to 3 yr mark. Especially when the proximal triggers for said ectopics are tied to the prior ABL as your EP said, unless you have constant runs of PVCs with well over 20,000+ detected daily ( 40,000 a day seems to be the for sure green light for a dedicated PVC ablation unless they are making the person miserable too, before an EP is likely to offer to do anything about what is typically not an urgent problem, as you have been informed.

However, as Gill’s example plus a handful of others we have seen indicate, it is possible to have longer periods of either frequent or occasional runs of ectopy well past the roughly 2.5 to 3 year post ablation increase in some ectopy that are usually likely to be associated with said Ablation from the zapping or stunning of one’s myocyte pacing cells during the ablation ... especially when said pacing cells are quite young and recent in their appearance in your left or right atria. Such atrial myocytes tend to have a rough life span of around 2.5 yrs. before they undergo typical apoptosis ( cell death) followed by regeneration of those cells with new fresh pacing cells that tend not to be as prone to ectopic hiccups having not be zapped before. ... hence the reason most post ablation increases in periodic or frequent ectopy tends to be a self-limiting phenomenon, if it occurs at all, in the first few years post ablation.

With nearly all things biochemical and biological there tend to be exceptions to the norm, or rule, as well. But for the large majority of Afibbers who experience an increase in post ablation ectopic activity it does tend to be self limiting over time. Using some combo of magnesium/potassium or low dose FLEC/atenolol can certainly help reduce both frequency and nuisance factor of any remaining activity, as Gill has noted even though her experience with long term ectopy falls decidedly under the exception category to the typical limited experience post ablation.

Best wishes to you and it’s great to hear your actual atrial arrhythmia seems to be very quite and not causing any real problems!

Shannon

Shannon

AF recurred 3 days after my initial ablation, so I had a second one immediately. Prof. Haissaguere said he thought he would find a gap in the lines but that was not the case. There was a very toxic focus in the coronary sinus which he said was extremely difficult to find and ablate. He was not sure that he had managed to get all of it.

I have always wondered if this could be the source of my many ectopics.

Gill

Thanks a lot for your replies, fortunately during the last couple days I increased my daily Magnesium dose to 750 mg (my bowels tolerate that amount perfectly) and the ectopics have seen to reduce tremendously and everything is almost quiet again. I also received good news from TCAI that my loop was fine with no afib seen . I think it also can be related to dehydration since I have been travelling a lot during the last couple months with many trans-Atlantic flights and lots of jet lag without proper hydration. Now I am very conscious on the need of proper water intake.

Thanks again to all of you for such great advise and best of luck.



Edited 2 time(s). Last edit at 04/01/2019 09:59PM by fravi.

Quote
Gill
Since my ablations in Bordeaux in 2003

Gill,

I remember your posts stating in Aug 2004, when I joined. The 15 year durability of your ablation, especially given the relatively young technology of that time, speaks volumes about the skill of Prof. Haissaguere (now retired) and the whole Bordeaux team! You had excellent foresight to seek them out from the UK then!

I also remember that it was standard for the Bordeaux team, for international patients, to do a second ablation in short order, if there were issues right after the index ablation. This occurred with our founder Hans Larsen as well as PC (Pat Chambers MD) as well as you. Pat decided to travel to Bordeaux from Hawaii rather than using a US team.

Cheers,

George

Hi George

I spent many many months researching ablations in those far off days, reading articles in scientific journals (of which I understood very little at that time) and asking any EP that I saw if s/he would have it done. They all said absolutely not, it was experimental and dangerous, the results were one third better, one third stayed the same, one third were worse.

In UK only a couple of EPs were just beginning to investigate ablations so that was out. The name 'Haïssaguerre' kept popping up, and Bordeaux wasn’t far away. I speak fluent French so that was another plus. I knew it was going to be a gamble but with 24/7 highly symptomatic AF I felt as though my life was over anyway.

I got lucky with the timing though. During our first consultation the Prof. told me that they had recently changed the way they did the procedure and success rates for persistent AF had jumped from about 40% to 70%. That was good enough for me.

The whole thing, including several trips to France, fares, hotels, taxis etc cost me about £8,000 in total in 2003. It was actually cheaper fo rme to fly to Bordeaux for a TEE (TOE) than to pay to have it done privately in London!

Best money I ever spent. I just wish I had found this forum before I started on the journey, would have saved me so much time and effort.

Gill

Hi Gill,

Your investigations to figure out what to do and who to choose is a good model for anyone.

Cheers,

George

Glad for forums. New here and Afib since September 2018. ER, meds, cardiovenversion failed, Ablation in Feb failed. Currently on Metropinole, and Eloquis and REFUSED AMIODERONE, active on Stop Amioderone group on Facebook. So not sure what is next for me, but one doctor is not happy with my recent refusal on drug.

Researching on supplements, taking Magnesium Oratate and Calcium Oratate, Vit E, Flax Oil etc per Andrew Saul on Arithmia article. It seems to all help. Now learning on Niacin and hopeful

Quote
GeorgeN

Since my ablations in Bordeaux in 2003

Gill,

I remember your posts stating in Aug 2004, when I joined. The 15 year durability of your ablation, especially given the relatively young technology of that time, speaks volumes about the skill of Prof. Haissaguere (now retired) and the whole Bordeaux team! You had excellent foresight to seek them out from the UK then!

I also remember that it was standard for the Bordeaux team, for international patients, to do a second ablation in short order, if there were issues right after the index ablation. This occurred with our founder Hans Larsen as well as PC (Pat Chambers MD) as well as you. Pat decided to travel to Bordeaux from Hawaii rather than using a US team.

Cheers,

George

15 years is outstanding for sure.