Questions about zio result and possible afib

Hello everyone
I had my 2nd successful ablation in September with Dr. DiBiase who is amazing and connected to Dr. Natale. I’ve been doing great and am considering coming off the blood thinner. Met with doc yesterday and February zio showed no afib, but showed small run of SVT and another small run of VT- neither of which I even pressed the button for. I was surprised to hear this and very upset. Doctor who I greatly trust says neither is a concern. I was shocked and not prepared to ask questions. I made the google mistake and freaked out. He also said it should not lead to afib which is comforting. 24 hours later while on a new zio (luckily) I have an episode this afternoon of racing heart. I felt massive anxiety similar to past afib episodes. I of course fear my anxiety, which is admittedly a constant battle for me, literally caused this as I was worried about the SVT and VT. I have no other heart abnormalities, slightly high bp that is treated and am almost 46 years old. I’m not drinking, smoking, lost a ton of weight and am doing it all correctly. A couple of hours later I gone on to feel worse, can tell I’m tachy and anxious. Apple Watch is inconclusive- I assume because running 98-110. I calm down, feel much better, take Apple Watch reading again and it says afib- which I’ve never seen before on watch (don’t check often). My zio will of course confirm.
1- are apple watches very accurate? Or sometimes err when other arrhythmia are the culprit?
2- has anyone seen these arrhythmias also and found they were nothing to be concerned about?
3- do I need to make an appt with Natale at this point? I am very confident in my doctor, but now we are talking multiple arrythmias which I assume makes this more complicated?
4- will these occasional blips possibly remain that and hopefully not afib?
5- could the ablation procedure be creating additional arrhythmia and problems?

I’m very discouraged and really wonder if I literally caused this with my anxiety. Any input you could provide is greatly appreciated. I’m trying to be optimistic that this is all ok, not a real afib reading, and that these are small blips I can handle (had some all along)- but I’m scared because today was reminiscent of the miserable time I had last summer. Thanks for your support.
Tracy

1 - no experience with Apple watch
2 - SVT I've felt but never recorded in the first few months after my ablation. VT is another story. Are you sure about that?
3 - I think you're fine with you doctor
4 - maybe/maybe not. Time will tell
5 - No

Thanks Wolfpack. Yes he said it showed a moment of VT- but not dangerous for me because I don’t have structural heart disease.

Tracy, a few brief runs of SVT and even v-tach are nothing to worry about. More people have them than probably realize it. The important part is they didn't sustain. If an arrhythmia doesn't sustain more than a few seconds, they just don't even count it.

And that's why you're worrying about it but your EP, who happens to be one of the top EPs in the country, isn't.

Hi Tracy, I ditto all of the above replies you received to your questions! Please do NOT read too much into the very brief SVT or VT from a ZIO patch report. They tend to report all the utterly inconsequential micro blips of literally second in duration, and often what they report as ‘SVT’ that is often a good deal less than 30 seconds long, is just using a more generic label for ‘Supraventricular Tachycardia’ as possibly encompassing any possible atrial arrhythmia originating ‘above the ventricular’. But it would only start to count as an actual Atrial arrythmia once it exceeds 30 seconds in duration ... not before!

As Carey noted, since any activity of less than 30 second durations is not even considered a detectable atrial arrhythmia, and the certainty of these very short blips ranging especially from several seconds to 15 seconds or so are particularly questionable and hard to classify. Thus, the ZIO folks just chose to lump any such micro bursts (for lack of a better term) under the catch-all definition of ‘SVT’ in its broader less specific meaning as any possible atrial arrhythmia such as AFIB, AFlutter or ATachy ... that is, assuming it actually makes it past 30 seconds duration to begin with:-)

Dr DiBiase is right on the money ... not at all surprisingly ... by his not showing a single care in the world about your ZIO report. Therefore, please don’t add any totally optional and equally unnecessary stress and worry over these entirely minor non-events.

Everything sounds fine!

Best wishes to you ...

Shannon



Edited 1 time(s). Last edit at 07/20/2019 03:02PM by Shannon.

Hi Tracy,

1- are apple watches very accurate?

Based on recent FDA approval, Apple watches are as accurate as any Alivecor device in interpreting afib episodes so if the apple watch reading came back as possible afib, I would at least review the ecg it or have someone else look at it.

You should have an instant reading of the ecg saved on your phone in your health app and you can review it there and also export it.

Thanks very much everyone.

Hi Wolfpack, with regards to your answer No.5.

Q. 5- could the ablation procedure be creating additional arrhythmia and problems?
A. No.

After my first AF ablation in Bordeaux (1st in India) I was back in AF within 3 days which then converted to Left Atrial Flutter within 48 hours. I then had an ablation for the LAFL before I returned home to Macau near Hong Kong. Before I got on the plane back home I was back in AF

I then decided I would have to return to Bordeaux again to stop the AF.

I did return and Prof. Hocini, a lovely lady, had to burn my heart to a cinder to stop the AF and only weeks later I was in Left Atrial Flutter again.
My experience with LAFL is that it never stops and is probably worse than AFIB. I returned again to Bordeaux for an ablation of the Left Atrial Flutter as Prof Hocini said the fact that I had LAFL after the ablation by her meant there was a 'gap somewhere' (my wording)

It would appear that an ablation can and does cause other arrhythmias and problems unless I am missing something.

It is highly likely that I will be having an ablation (No 6 overall) for Flutter soon and from my readings on the internet there is surely a possibility that that 'simple' Flutter ablation will awaken AFIB all over again. P.S. AFIB always followed Atrial Flutter when my battle with this illness first started in 2006.

Barry G.

Barry, there's no question that ablation lines can cause flutter. Anything that creates an imperfect electrical barrier in your atria can create a flutter circuit, so a less than perfectly done ablation line that has a gap in it somewhere can set the stage for flutter. I battled exactly that problem for years after foolishly letting my first EP make three ablation attempts on me. The second EP said he counted at least three and possibly four separate flutter circuits that had been created in my heart. It took Natale to finally get rid of all of them.

Hi Carey, thanks for your post. I am guessing your first 3 ablations where for Atrial Fibrillation and also zapping possible Right Flutter 'on the way out' which seems to be the normal practice. That said, to be battling Flutter for 3 years make me guess you were getting Left Atrial Flutter which in my experience is a far more difficult arrhythmia to treat. Prof Jais admitted 'defeat' when ablating my second case of LAFL but did say he believed he had done enough to ensure it should not break out again and that was almost 10 years ago.

May I ask how long ago the first 3 ablations took place as I am hoping average success rates for Right Atrial Flutter ablations have improved dramatically since then.

Barry G.

Quote
Barry G.
Hi Carey, thanks for your post. I am guessing your first 3 ablations where for Atrial Fibrillation and also zapping possible Right Flutter 'on the way out' which seems to be the normal practice. That said, to be battling Flutter for 3 years make me guess you were getting Left Atrial Flutter which in my experience is a far more difficult arrhythmia to treat. Prof Jais admitted 'defeat' when ablating my second case of LAFL but did say he believed he had done enough to ensure it should not break out again and that was almost 10 years ago.

May I ask how long ago the first 3 ablations took place as I am hoping average success rates for Right Atrial Flutter ablations have improved dramatically since then.

Yeah, you've pretty much got it right about the first three ablations. Number 1 was for afib, number 2 was for flutter resulting from ablation #1, and number 3 was for both.

My first ablation was 2010, second 2011, and third 2014. The fourth was in late 2014 by another (better) EP who repeated the entire procedure, PVI and all, because in his words "I found no evidence you'd ever had an ablation." That terminated my afib, but it left me with intractable left atrial flutter that routinely hit rates of 230-250. Dealt with that for two years using some pretty extreme measures with potassium until finally having it fixed once and for all by Natale in 2017.

Hi Carey thanks for your post, seems like your battle with arrhythmias has been at least as frustrating and demoralising as mine.

How you coped with two years of Left Atrial Flutter is beyond me. I had 3 months of none stop LAFL and still worked on a construction site with plenty of climbing scaffolds and high rise staircases, a living nightmare. After that 3 months I finally had the much awaited successful cardioversion and came back to the world of the living. The fear of ever having LAFL again drove me to seek another ablation in Bordeaux even though the cardioversion was still holding solid NSR. I have had nearly 10 years of solid NSR only for Right Atrial Flutter to appear again however it seems like the ablations for AFIB are still holding but that is probably because my last ablation in France was the full and final slash and burn i.e there was no other thing they could do at that time.

Note: On my first of 4 ablations in Bordeaux I made it very clear I wanted the full slash and burn no matter what the dangers,
however Prof Haisaguerre said he would only do the minimum damage possible to clear the arrhythmia. I knew there and then I was in for the long haul :-(

Barry G.