From my 20/08/18 ablation report (not least for HBK re Flecainide)

"After transeptal catheterization, the patient went into atrial
fibrillation. PV isolation was performed using the contact force
SMART TOUCH Catheter with the Carto system. We used high
power (45 watts) short duration (7 to 20 sec) in combination with
apnea. The 1st encirclement resulted in PVI on both sides. As the
patient was still in fibrillation after PVI we also ablated the inferior
LA facing the CS. A shock was then delivered to restore sinus
rhythm. Adenosine challenge identified reconnection at the RPVs
which were successfully ablated resulting in negative adenosine. In
absence of typical flutter the cavo-tricuspid isthmus was not
ablated.
The follow-up showed sinus rhythm with no recurrence and the
absence of complication.
The patient was discharged with FLECAINIDE and
DILTIAZEM for 2 to 3 months after which it should be discontinued
in absence of arrhythmia . ELIQUIS could also be interrupted given
the low CHADS score after 3 months in absence of recurrence."

As regards the sentence I've put in bold, from what I've read my take is that ablating the the inferior LA-CS complex (or the base of the LAA or the anterior LA) increases AF cycle length thus terminating AF and as such presumably assists in preventing AF getting established in the atria in the future? Would you guys who know about such things agree with my conclusion? Any opinion would be appreciated.



Edited 5 time(s). Last edit at 08/08/2019 12:38PM by mwcf.

MWCF, thanks for sharing. I have a questions since my report was a lot different than yours. I'll paste the end part here:

"We recommend that the patient continues with Lanzoprazole and Eliquis for 2 months and Flecainide for 1 month. In case of recurrence an antiarrhthmic drug could be restarted.

We hope the long term result will be favorable. Please feel free to call / fax for any clarification. We would like to be informed of the patient’s condition.

If any fever with neurological signs appear within the 1st month, can you please inform us immediately! (risk of esophageal fistula despite proton pump inhibitors)."


So, all of my anxiety started when I got this report and read about fistula. I actually didn't know that was a risk prior to the procedure. I looked it up on my phone and got kind of freaked out from that point on. They recommended the Lanzoprazole for 2 months. And, they said to be aware of the risk for fistula in the report. I thought maybe this was something standard they wrote in everyone's report. But, I noticed it's not in yours. Do you think this means I did get a lesion or my esophagus got too hot?

:|

I'd be interested to hear what Shannon has to say too as I know he's seen a lot of these reports from Bordeaux and other docs. At this point, I guess I'm past the point of the fistula scare but wonder if any of my issues are related to any esophagus lesions. For one thing my voice has been very hoarse



Edited 1 time(s). Last edit at 08/08/2019 01:21PM by HBK.

HBK,

I’m just about to take off from Phoenix to Dallas for the Stop-AFIB.org patient conference tho s weekend that my friend, Mellanie True Hill’s invites me to attend again.
I’ll answer your question in more detail when I arrive later at the Dallas Hotel regarding AEF (atrial-esophageal fistula) but the short answer is DO NOT fret one moment about that risk, it’s exceedingly rare and especially with highly experienced operators such as at Bordeaux ...Natale and a host of other very skilled ablation maestros who likely have never had an AEF, in spite of many thousands of collective procedures.

There are a near endless list of much greater real world threats than an AEF fir you or anyone else to be concerned with.

Just be aware of the symptoms typically starting 10 days to 3 weeks post ABL with strong fever and neurological effects and immediate get thee to an ER. But it will not happen to you at this stage of the process and your odds werecesssntially nil to begin with.

Go to go flight is taking off!

Shannon



Edited 1 time(s). Last edit at 08/08/2019 03:31PM by Shannon.

Ok thank you Shannon. Have a great time at the conference!

Shannon, also would be interested in hearing your thoughts on what you've seen in your experience in the community regarding more minor GI issues after ablation (ones that can cause issues for a while but then go away).

When I eat sometimes now I'm feeling not pain but pressure below my sternum and at the same level in my back. Also been having a hoarse voice for a while.

This study [www.ahajournals.org] says
"UGI functional abnormalities after AF ablation, as detected by functional studies, are common, occurring in 74% of the patients. These abnormalities are transient and resolved within 3 to 6 months."

I'm seeing a gastro doc at the end of the month to get check up.

Just want to make sure I don't have some type of issue that I'm making worse with my eating habits....or if I need some med to let it heal, etc

HBK,

Don't panic. What Shannon says! My report had exactly the same wording on the end - I just posted the mid section of my report - not the first para and last few short paras.

They've never had an AEF at Bordeaux and they've done 10s of thousands of AF ablations of there from as far back as the early 90s.

I too have read lots of stuff on folks having digestive issues post-ablation for a few months that most always clear up by 6 months at the latest.

Cheers,

Mike

MWCF, thanks for sharing that. That's a big relief. Glad to hear that is standard and was on your report to