More than PACs

I posted here a couple weeks ago that I was having what I thought were PACs 6 months post ablation. Those progressed to what I consider short runs of Afib and what my Apple Watch labels “High Heart Rate”. What I thought were PACs was labeled as “Inconclusive “. Anyways, I could feels things going on. Not nearly as bad as before ablation but definitely more than nothing going on. I decided on Friday to follow my EP’s nurse practitioner and my cardiologist advice and go back on meds I was taking pre-ablation and the few months after. That includes 50 mg metropolol, 100 mg flecainide twice a day and 20 mg xarelto. I also placed a call to cardiologist to start the process of diagnosis again. I have first appointment tomorrow and guessing will get a monitor to wear for a week. Crazy thing is since I started meds on Friday no hint of arrhythmia. Those meds didn’t prevent episodes pre-ablation just made symptoms less. Either way I want to be med free at some point so we will see where this goes. One last thing, is nothing has changed trigger wise that I can think of.

It sounds like your ablation succeeded in reducing symptoms but not eliminating them entirely. The fact that the flecainide works now isn't unheard of at all. It will suppress PACs, and it's possible that's all this is. It's also possible it's short bursts of afib, or a mix of both. Wearing a monitor sounds like exactly the thing to do, though I'm not sure why you're going through the cardiologist. The EP is the preferred person to manage this.

As per Carey, you ought to be seeing your EP for all things related to your Ablation and to your Arrhythmias.
Cardiologists usually are not experienced in electrical problems with the heart, rather they handle the plumbing.
My Cardiologist, (a Professor and very experienced) referred me to my EP who handles everything and anything that relates to my Arrhythmia.

I will end up at the EP but this is the process they seem to prefer. I am in a smaller community with no EP but our cardiologist works closely with an EP in a bigger community an hour away. I trust them both and the process.



Edited 1 time(s). Last edit at 09/05/2022 07:51PM by Rayole4382.

Oh, okay, I get it. Let us know how it goes and what they find.

Let us know what. you find out. Here in the middle of the night wearing my Zio monitor (tape already came off so now taped on with medical tape that isn’t perfect). Only I am at the almost 4 month mark but very similar story.

Really hoping the monitor is getting this. And wishing my doctor used better monitors with extra sticky pads.

Quote
BigBoy2020
Let us know what. you find out. Here in the middle of the night wearing my Zio monitor (tape already came off so now taped on with medical tape that isn’t perfect). Only I am at the almost 4 month mark but very similar story.

Really hoping the monitor is getting this. And wishing my doctor used better monitors with extra sticky pads.

I'm not sure what you mean by your first two sentences. I was addressing Rayole.

I've heard similar complaints about the Zio (and other brands) not adhering well, but what you're doing sounds right. It just needs to be firmly against clean, dry skin without excessive body hair.

A little update-as I thought cardiologist got me an appointment with the EP that did my ablation. Appointment is middle of October. Cardiologist said EP will decide if 2nd ablation is necessary. I haven’t had an episode since Sept.2 when I started back on flecainide and original dose of metropolol. I am also back on Xarelto. I have felt really good other than energy knocked down a notch from the meds. I stressed to cardiologist and will to EP the goal was no arrhythmia and no medicine and I am more than willing to try ablation again. I am wondering if EP will want me to try coming off of meds one more time and see if arrhythmias come back or just say schedule a date and let’s see what is going on in there.

I'll be very surprised if you stopped the meds and your afib remained in remission. That's probably wishful thinking. Recurrent afib 6 months after an ablation generally indicates that it was at best only partially successful. It's not going to get any better from there. From your original description I'd say your ablation succeeded in reducing afib burden but not eliminating it.

Thoughts on a second ablation (if recommended) finishing the job (even if temporary)? I am hoping that what I was told, second attempts are common and even more successful, comes true. I do realize nobody has a “crystal ball” just looking for some experiences close to mine.

Second attempts, often called "touch up" procedures, are common and usually have a much higher success rate. Even top EPs will tell their patients that a touch up may be required. So you're on the right track and you can trust your EP's advice.

It's true, the EP should discuss the risks of AF, and of CA, and that CA has at best a 75% success rate the first go. Mine did mention that there is a good chance a second one will succeed with a success rate of 80%. Combined with whatever the real percentage of burden was accomplished the first time, that second 80% greatly increases the odds of success on the basis of probability. However, a third and fourth might be time to seriously consider ablating the nodes and just living with a pacemaker. I'll be there if the second one fails. I don't want to keep scarifying my heart tissue.

Met with my EP today and a second ablation is on the books 10 months after the first. After listening to my story and me hammering home getting off meds is the goal, she was all about a “touch up “. December 14 is the date and she feels very confident, without promises, that this will workout very well. Gotta admit that I get an ego stroke when she calls me “ young and healthy”! I am in decent shape and 51 (M). She said most of her “touch ups” come in the late 40’s to mid 50’s age group due to a still healthy heart that wants and can repair its self after an ablation.

I know this isn’t anything groundbreaking for the veterans here but I am guessing there are “lurkers” here like I was not too long ago and hope it is comforting to them. I still have been afib free after going back on original dose of metropolol and flecainide (month and a half). She was confident first ablation took care of “most” of the spots but reconnection has probably happened and will be able to isolate those spots.

Glad you're upbeat about it. As I said before, a touch up procedure is common even with very good EPs and usually successful. Let us know how it goes, okay?

Had my touch up ablation this past Wednesday. Everything went pretty much the same as my first one on my end. EP told my wife all 4 veins reconnected and she was able to re-isolate them. Actual procedure time was a little less than the first. I feel like I am recovering easier this time even though the first time wasn’t that difficult. No weird flutters to speak of yet but I had gone 3 months prior to the procedure without any thanks to flecainide doings it’s job is my guess.

Worst part was navigating a weeks long blizzard up here in the northern part of the country! A few extra nights in a hotel and my wife navigating terrible roads on the way home but all is well now!

Glad it went well!