Seemingly successful ablation at Duke

I wanted to let folks know that I had an ablation on August 4 at Duke with Tristram Bahnson, MD. I have had highly intermittent afib for more than 15 years that has always converted in less than 24 hours with liquid magnesium and chips of Cardizem. I load on Chelated Magnesium (4 250 mg delayed release capsules) daily, along with Taurene, and Potassium (2 when playing tennis). Hard competitive tennis in the heat can bring a spell on, as well as stress, vagal issues, and coughing excessively. I am 70 but very active with 4-5 tennis matches weekly and walking 1-2 miles daily. I broke my ankle playing tennis on 6/22 and was laid up with a cast and then a boot. Within 5 days my afib broke through as though this lack of movement shook up my electrical system. I expect a new avenue because I had afib two days, then a sinus day, then another long afib day and called my EP as it had been since 2/22 since I had any afib. I had not been taking Eliquis but started immediately on the third day because I knew this was different and in fact, I had afib for 74 hours two days later. I started Multaq two days in and converted after the fourth dose to sinus which lasted until the day before the ablation when I had to stop the Multaq the night before. Just missing that one dose let this new afib through.

I had a 1.5 hours cardiac MRI and blood work of course. The ablation was longer than expected because the pulmonary veins were apparently pretty easy to ablate but Dr. Bahnson said he was "stubborn" and noticed a fairly rare (I think he said 10 plus/minus percent) feature of my heart in which the muscles on the outside of my heart went into the heart (? I still don't fully understand this!) and were sources of afib or potential afib so he took another 1.5-2 hours to map and address this! The notes said

1) Antral pulmonary vein isolation with entry and exit block documented
2) After the initial lesion set (or at baseline for repeat procedure) the following veins demonstrated persistent or recurrent conduction: RSPV with persistent connection; pace-capture along ablation line showed intact line. Early activation at carina
just within vein with isolation with carinal abaltion. LS and LI PV ADO sensistive reconnection, also with intact ablation at antral line proved with pace-capture but connection via carina consistent with epicardial connections. ADO - resistent
entry-block, but ADO - sensitive exit conduction noted requiring mapping with multiple doses of ADO..
3) There was ADO sensitive PV reconnection at the following PV's: yes, see above.
4) No inducible AF/AT/AFL was noted, and PV entry- and exit-block PV's was confirmed +/- ADO and bust pacing.
5) Multi-polar high density voltage mapping of the LA was done and showed low amplitude fractionated regions at the L PV posterior carina to antral region.
6) Significant vagal responses were seen during abaltionaty left and right pulmonary veins
7) Phrenic nerve pacing was not done during lesion delivery.
8) Multiple rounds of ADO guided remapping required to achieve exit block from LS and LIPV with robust dissociated ER's and PVP's at baseline after the initial lesion set.
9) No dual AVN physiology or inducible SVT with programmed stimulation.

I expect many of you brilliant compatriots might understand this better than I can but I gather from reading that maybe a fifth of us require a carina ablation in concert with the PV ablation to fix afib as well as possible! I had not read about this in our forum so thought I would share this.

I have not had any pain in my chest, no esophagus issues, and since I am on Multaq for 2 months (maybe because of all the extra burning since that was not the plan originally) no afib and blessed sinus, even when I neurotically check my Kardia machine because I feel "weird"! I am extremely grateful to live 8 minutes from Duke and to have had Dr. Bahnson successfully ablate my husband for afib and flutter and his experience (2500 ablations). He is called "Dr. Rhythm" at Duke and teaches ablations to students. He is also a concert pianist like my husband, who he loves, so I figure I am also lucky because he takes good care of me as well!

Wow that was complicated to the lay person.

Your lucky to have such a top notch EP working on you.

I suspect a very large % of reg. EP's would not have been able to complete this successfully (hopefully for you...time will tell) in 1 fall swoop + then you would have been destined for 1 more at least visit to the EP table in a few months but that is just my guess as the above description of your procedure is about 90% Greek to me.

GL

This is an example of what distinguishes a top EP from an average EP. He didn't just do a PVI and call it a day, which would have left you calling it a failure 2 months from now. He went looking for other sources of afib, found them, and ablated them.

That was my thought, Carey! The ablation took about a total of 6 hours and then I had to rest my two catheter incisions for another 3-4 to assure they healed well (which they did)! I stayed overnight which was fine with me as it was 6:00 p.m. when I woke up in the recovery room (I had been in there about 1.5 hours I think). He uses 4 catheters with one being an ultrasound one. And Dr. Bahnson had an emergency after mine which he took, having done one procedure BEFORE mine starting at 6:00 a.m. And he came to my room at 7:30 this next morning to talk! He really is amazing.