Dissapointed

somewhat dissapointingly I had an episode of afib this morning,
I’d come home from a night shift, gone to bed then at 8:45 went to use bathroom, got back into bed laid on my left side and felt few strange beats in chest, I felt my pulse and recognised it was irregular, so tried laying on right side, still same,
So I sat up and tried blowing through nose, and standing up, but nothing, I felt fine in myself, so started to get dressed to go to hospital, by the time I’d got half dressed it had gone back to normal at around 8:55-9:00 am.......
I had hoped my ablation had been successful but it appears after 5 years it’s back,

Don't panic yet. After my first ablation, I went 13 years before my afib came back, but during that time, I had 4 breakthroughs scattered over that time period, all short lived. Then finally a big surge and another ablation. Disappointing for sure, but maybe just a small bump in a long road.

I’d only had one episode of afib before my ablation so kind of hoped that it would be caught nice and early and one and done🤷🏻‍♂️🤷🏻‍♂️

I see it as a glass half full. You were symptom free for 5&13 years. It’s a gift.

You may need a touchup. My two ablations lasted 6 months and the second 3 months. I would had appreciated 5 years af free.

I am wondering if you might have gotten into a trigger or two... like caffeine, salt, dehydration, alcohol, msg/flavor enhancers, overexertion? I suspect that even after an ablation one should still consider triggers and general health to stay away from our 'edge'. Just a thought. Jeff

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Jeff W
I am wondering if you might have gotten into a trigger or two... like caffeine, salt, dehydration, alcohol, msg/flavor enhancers, overexertion? I suspect that even after an ablation one should still consider triggers and general health to stay away from our 'edge'. Just a thought. Jeff

Good reminder for those reading Jeff! I haven’t had caffeine, chocolate or even caffeine free (because it’s 3% caffeine), alcohol and I’m very anal about msg since 2004. If I eat out I ask to go inside the kitchen and I inspect the seasoning bottles. They seem to be OK with my request. Many times they say they don’t add msg but my restaurant inspections turned up seasonings containing msg. I don’t add salt, soy sauce or eat foods high in salt (ie a pickle or olives). Sugar and high carbs are my triggers.

I speculate everyone is different and it’s possible for some to get up to multiple ablation touch ups for the rare few to fix it. An example is isolating the LAA which may take up to two touch ups to fix. A few of us who have posted have had a LAA isolation ablation...or two.

I disagree re triggers and ablations. If you've had an ablation and you've been in normal rhythm for over 12 months without the aid of antiarrhythmic drugs (ie, your ablation was fully successful), then your former triggers just don't matter any more. Do what you want without fear. Obviously, that requires a "within reason" caveat because doing things like binging on alcohol can cause AF in anyone, but a fully successful ablation makes AF from your old sources impossible. There should be no problem with caffeine, chocolate, exercise, MSG, alcohol in moderation, salt, sugar, carbs -- whatever it was you think were triggers in the past.

Carey, your post sounds strange. I don't think a successfull ablation may mean "do what you want now and forget about your past triggers".
It does not sound like good advice.
A sure trigger remains a sure trigger, even if it does not trigger afib anymore. It's still bad for the patient. We don't know why some things are bad for some people, but I'd stay away from my sure triggers, ablated or not... if only I could find them !

Think about what an ablation does. It doesn't stop the afib your triggers provoked. It simply contains it with a fence. Think of afib like a little monkey in your heart that goes ape shit when you eat or drink certain things. You spent years trying to keep the monkey calm by avoiding those things, but then one day an EP came along and put the monkey in a cage. That doesn't stop the monkey from going ape shit, but it keeps him contained where he can do no harm. Now he can scream and leap about and throw poop all he wants but you don't feel a thing because he's in that cage.

So why bother avoiding the things that piss off the monkey?

Put another way, I would bet that if you put a catheter into my pulmonary veins or a few other specific places in my heart, you'd find it blazing away with afib right now. But because those areas have a fence around them the rest of my heart doesn't know or care and is happily pumping away in perfect normal rhythm. I would further bet that's true of everyone here who's had an ablation. An ablation doesn't stop your afib, it simply contains it. So what would I accomplish by avoiding triggers other than depriving myself of things I enjoy?

The bottom line is if your triggers cause afib after an ablation, then your ablation wasn't successful.

Let me carry on with your analogy...
Ablation put the monkey in the cage. Okay.
Therefore, why would you still excite the monkey and give him the strong need to find a way to open the jail instead of letting him as quiet as possible in its cage ?

Things that fool the autonomic nervous system don't disappear with burns in the atria.

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Pompon
Things that fool the autonomic nervous system don't disappear with burns in the atria.

Quite true, but that's my point. A successful ablation means that nothing the monkey does in the cage can escape and cause harm elsewhere, so why would I care if the monkey is excited? I bet my monkey has been going ape shit for almost four years now but I've been totally unaware and I see no reason to try to calm my monkey. He does what he does but because of my last ablation he just doesn't matter.

Relax and do the things you enjoy without worry.

I was told by my NP that with age and genetic disposition it’s possible one can get new hotspot firings that were never ablated or exist beforehand and cause an af episode. So how can the cage be monkey proof?

There's no cage. There are fences, at best. And one can't build a fence everywhere.

Everyone is different. So, we're like living on an island. Many people don't even have a monkey on their island. Many other people have a monkey, but the monkey only becomes crazy (or shows it is) once they're old and weak.
There are other situations: the monkey is crazy but the human does not care or don't even see it; and suddenly, he's severely injured and he realizes there's a crazy monkey able to do them arm.

And then, there are people like us. We know we share our island with a crazy monkey. We ask for some help. No one can kill the monkey, but we're given poisons we sow everywhere in the island in the hope they can keep the monkey quiet. We may succeed, but very often, we're as much or even more poisened than the monkey. We always try to know why the monkey is so crazy. We may discover the monkey is drived nuts when we're running everywhere on the island, or when we eat some kind of food or drink alcohol...

So, as we still need help, we trust some guy saying he'll build fences on our island. Us one side, the crazy monkey the other side. Once the fences are built, we may ignore the monkey's crazyness, we may ignore he's furious when we eat or drink or run around. We rely on the fence. But the fence may be fragile, the monkey may be stronger than King Kong or clever enough to find a small path without a fence, or to dig a tunnel...

Islands are not equal. The guy building the fence, repairing or reinforcing it always have to work with his tools, but he can't bring furnitures. He must do with what's available locally.

My island has a sandy ground, there are no big trees, I don't know what drives the monkey crazy about once a week, because what seems to excite him one day let him indifferent the other day. The poisons I've tried against him always land in my own soup.
The fence builders, who know how and have the tools to drive the monkey crazier than ever, have tried all manners to excite the monkey once they've built the fences, but to no avail. My monkey is amazingly clever and vicious, never showing from where it'll likely strike in the future.

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susan.d
I was told by my NP that with age and genetic disposition it’s possible one can get new hotspot firings that were never ablated or exist beforehand and cause an af episode. So how can the cage be monkey proof?

That's true, but in that case it's not that the monkey escaped. It's more like you acquired a second monkey and so now you'll need to add a new cage.

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Carey

I was told by my NP that with age and genetic disposition it’s possible one can get new hotspot firings that were never ablated or exist beforehand and cause an af episode. So how can the cage be monkey proof?

That's true, but in that case it's not that the monkey escaped. It's more like you acquired a second monkey and so now you'll need to add a new cage.

That’s my thoughts too...so if you by chance have a genetic disposition to AF (i.e. a family member who also has AF), then it makes sense to avoid the same triggers after a successful cage installation so the monkey‘s offsprings and Uncle Donkey Kong won’t be tempted to visit.



Edited 2 time(s). Last edit at 03/18/2021 12:07PM by susan.d.

I agree with you, Susan.

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Ken
Don't panic yet. After my first ablation, I went 13 years before my afib came back, but during that time, I had 4 breakthroughs scattered over that time period, all short lived. Then finally a big surge and another ablation. Disappointing for sure, but maybe just a small bump in a long road.

Same experience here following my ablation in 2009. First 4-5 years were perfect NSR. Then an occasion run or two of affib then nothing. Once to the point I thought I was headed for another ablation. But it quieted back down to just occasional short runs.

Carey,
I loved your simplification of the afib ablation situation as building a fence in front of a crazy monkey to stop him from escaping and do whatever he wants of destructions to his host.
How can you describe in the same analogy the effect of anti-arrhythmic drugs especially the famous flecainide.

Ben

Ben, Pompon gave an excellent analogy of arrhythmia drugs —we are given poisons to keep the monkeys quiet but run the risk of the poisons landing in our soup. I understood. Plus some drugs you have to be observed in the hospital during the initial dosing. These drugs have death warnings on the labels.

If you live in Australia they just write you a script for whatever...no hopital monitoring. I've had a few scares, one from a Dr who told me while I was it ER with a nasty episode " Flecainide...you take Flecainide... stop that it will kill you" leaving me puzzled as to who I should have a serious conversation with...my regular Cardio (who I no longer see) or this new one in the ER? You are damned if you do and damned if you don't.



Edited 1 time(s). Last edit at 03/20/2021 09:29PM by JoyWin.

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ben saif
Carey,
I loved your simplification of the afib ablation situation as building a fence in front of a crazy monkey to stop him from escaping and do whatever he wants of destructions to his host.
How can you describe in the same analogy the effect of anti-arrhythmic drugs especially the famous flecainide.

Hmmm... kind of a fun question!

Flecainide works by slowing conduction in the heart, which has the effect of reducing excitability. So flecainide is like giving the monkey a tranquilizer, something like Xanax or Valium.

Carey:

I'm just seeing this post now after two years of you writing about this analogy. I agree with you 100%. I've been telling people this for years, but not in such an easy-to-understand analogy. I love it! It's not a common or popular belief to have in the a-fib circles though.

Travis