Ablation and the long game

I need an excellent-as-possible heart in order to keep up my very active lifestyle, which is essential to my life goals, not to mention mental health. And it means often being no where near healthcare/cellservice/roads/etc. I'm leaning heavily towards ablation ASAP. EP is on board with my request, pending preliminary tests.

But why might I not want to pursue an ablation at this point? New research/techniques in the making? Long term consequences of ablation showing up, say 20 years down the road?

I'm 50's, very fit & healthy active lifestyle. Self correcting asymptomatic afib bouts <12hr every other day or so. Little to no signs of sawtooth flutter on kardia 6L. Very low stroke risk, not put on thinners, but just started flec and card twice a day.



Edited 1 time(s). Last edit at 09/11/2022 03:52PM by Kwilk.

An echocardiogram is scheduled, so I've no knowledge of atrial dialation. Otherwise, my HEAL-AF score is 2, one point for being asymptomatic and one point for being female. Well, exercise-wise i'm fairly weak when in afib, so maybe I'm not asymptomatic medically speaking.

[pubmed.ncbi.nlm.nih.gov]

2020: A novel and simple scoring system for assessing the indication for catheter ablation in patients with atrial fibrillation: The HEAL-AF Score

J Arrhythm
2020 Sep 2;36(6):997-1006.
doi: 10.1002/joa3.12429. eCollection 2020 Dec.



Edited 1 time(s). Last edit at 09/11/2022 04:27PM by Kwilk.

Weakness is definitely a symptom, so you're not asymptomatic.

If I could change that scoring system I would add one more item: the number of afib ablations the EP has done. Under 1000 would give you 1 point, under 500 would give you 3 points, and under 100 would give you 5 points.

The only major technology in the making is pulsed field ablation (PFA). It's in clinical trials now and will probably come into general usage in about 2 years, though it will take more time after that for EPs to obtain training and experience in it. What PFA mainly brings to the table is improved safety. Whether it improves success rates remains to be seen, but I think that will only happen with less experienced EPs.

I would not wait. You've actually got a pretty high afib burden with episodes every other day, and afib is progressive. It doesn't get better on its own. It only gets worse, and it can progress to persistent afib quickly. This is due to what's known as remodeling. The more time you spend in afib, the more your heart will electrically remodel itself to favor afib, and the more your left atria will increase in size. Ablation is now considered the front line treatment. Also, you're not going to like the drugs, especially given your lifestyle. The flecainide and diltiazem will cap your heart rate at a fairly low number, and diltiazem causes fatigue in many people.

As I alluded to above, experience of the EP is everything with afib ablations. It's more important to the chances of success than any other factor -- by far. Finding an EP with extensive afib ablation experience is worth traveling if necessary, so don't restrict yourself to locals. And don't even consider a middle-sized or smaller hospital. You want to be in a facility that does hundreds of afib ablations per year. So don't tie yourself to your current EP until you know what his experience level is. And other types of ablations don't count for much because afib ablations are the most difficult of all. Just because they can ablate SVT and install pacemakers doesn't mean anything when it comes to afib ablations.



Edited 1 time(s). Last edit at 09/11/2022 05:59PM by Carey.

At the moment I'm trying to figure out the NSR remodeling that occurs after CA. And also there seems to a standard of ablating the PV. From there, ablating more areas during initial procedure, or during follow up. Scaring only the proximal PV seems to allow remodeling to improve LA structure/function, but ablating more does not. EP, who is a talker, but also a good listener, says 20 years, since the get-go, thousands. I'd like to see his CV. Read about laser-balloon III ablation in France giving superior outcomes and shorter procedure times compared to radio-frequency and cryo.



Edited 1 time(s). Last edit at 09/11/2022 05:42PM by Kwilk.

Quote
Kwilk
I need an excellent-as-possible heart in order to keep up my very active lifestyle, which is essential to my life goals, not to mention mental health. And it means often being no where near healthcare/cell service/roads/etc.

I second everything Carey says. Especially about picking the right EP!

On a slightly different tack, you may wish to read this thread on exercise & afib. Over 18 years ago, at age 49, I came to afib and chronic fitness was my path. Starting 2 months after my first episode, I had an episode that lasted 2 1/2 months and converted with a loading dose of flecainide. Pretty quick progression. My EP suggested I just stay out of rhythm as I was doing well (afib HR was <100 BPM). I suggested a "plan B" which included detraining and electrolytes, along with a script for on-demand flecainide to convert when I went out of rhythm. He accepted the plan.

I worked out what detraining meant for me as well as my electrolyte program. In the case of detraining, empirically my trigger was the product of duration times intensity. I learned that long duration exercise at Zone 2 was not a trigger & I could do very short duration high intensity without issue (i.e. 8 cycles of 20:10 Tabatas on my fan bike). It took me two years to combat my denial and decide that competing in high altitude races was a bad idea for me.

I've followed my basic plan successfully since (a couple of episodes a year converted pretty quickly with flec). I've had two "bad" years with a lot more afib. 2012, which I finally figured out was caused by an electrolyte disturbance associated with too much calcium from food. Also the first 10 months of 2021 which included 15 episodes of afib, many associated with C19 vaxes (association is not causation). Subsequent to Oct 27th 2021, I've had one episode of 1.5 hours in the nearly 46 weeks since. I did add in low dose flecainide (two months of 50 mg/day, 4 months of 25 mg/day, a month of titrating to 0 which preceded the episode, went back to 25 mg for a month, dropped to 12.5 mg/day for six weeks and 10 mg since). Since before this episode, I've been repleting iodine per a specific protocol to avoid potential negative issues of high dose iodine. I'm guessing very few EP's would suggest this dosing & I'm not suggesting it for others.

I bring up the exercise as, if it is an issue, it may make sense to consider it, even with an ablation.

Quote
Kwilk
At the moment I'm trying to figure out the NSR remodeling that occurs after CA.

Well, it's the same process that occurs during afib, just in reverse. Your heart wants to keep doing what it's been doing, which is where the saying "afib begets afib" comes from. Well, the reverse is true that NSR begets NSR. It's also pretty common for the left atrium to reduce in size after successful ablation puts it back in NSR, and that contributes to the desirable remodeling. But you may as well quit trying to figure out the mechanism because even the doctors studying this field haven't figured it out yet.

Quote
Kwilk
And also there seems to a standard of ablating the PV. From there, ablating more areas during initial procedure, or during follow up. Scaring only the proximal PV seems to allow remodeling to improve LA structure/function, but ablating more does not.

That's a bit of an over-simplification. Ablating the pulmonary veins themselves was the initial approach used in the 1980s and 90s, but that led to high incidences of pulmonary vein stenosis and the resulting pulmonary hypertension. So in 1998 Dr. Haissaguerre in France developed the pulmonary vein isolation (PVI) procedure, in which the veins themselves aren't ablated but a circle around them is, which electrically isolates the veins from the rest of the heart, thus preventing the afib from "escaping" the pulmonary veins. That is the standard procedure used today no matter what sort of technology is used (RF, cryo, etc).

The over simplification is that part about ablating more than the PVs doesn't produce better results. Virtually all top EPs ablate more than a standard PVI procedure, and that's where the real difference between average EPs and top EPs comes in. Anyone talking to you about cryo or laser balloon techniques will do nothing more than a basic PVI, which will work for many patients, but will not suffice for many more, upwards of 40%. That's because the PVs often aren't the only sources of afib. If you have afib originating from, say, the coronary sinus, a standard PVI of any type won't stop your afib. It might even make it worse. A top EP knows how to locate and ablate other sources, and that's absolutely vital for a successful ablation. This is the major reason I emphasize EP experience. If they don't know how to find other sources and ablate them, then they are only an average EP, at best.

Trust me, you're not going to find a better solution than a top EP with an RF catheter. There is no technology now or on the horizon that can beat that.

Quote
GeorgeN
I bring up the exercise as

Thank for the details. I'm not into any competitive sports. But for the next 20-30 years want to regularly be able to do, say, 15 miles with 5000 ft elevation gain at 2-3 mph.



Edited 1 time(s). Last edit at 09/11/2022 07:51PM by Kwilk.

Quote
Carey
The over simplification is that part about ablating more than the PVs doesn't produce better results.

Depends on how outcomes are measured. For the vast majority of patients, i presume the metric is simply the degree of reduction in afib burden. For them, it doesn't make sense to stop with PV. Sure go ahead and isolate it, but keep going. I'm investigating a more nuanced metric that includes restoration of LA function/structure, given my life goals/style.

On other fronts:

Quote
Carey
Haissaguerre

History of AF Ablation per UCSF: [ucsfhealthcardiology.ucsf.edu]

FWIW, afib101 [learn.afibbers.org] is a blank page in my browser

Laser Balloon for Paroxysmal Atrial Fibrillation Ablation Compared to Radiofrequency Ablation: A Matched-Cohort
LBA half as much recurrence: 14% vs 28%
"At the one-year follow-up, AF recurrence was diagnosed in 7 (14%) of the LB group vs. 14 (28%) of the RFA group (p = 0.14)."
[www.ncbi.nlm.nih.gov]

Quote
GeorgeN
I worked out what detraining meant for me .

you've probably read this, but in case not:

Atrial Fibrillation in Competitive Athletes
Aug 16, 2019
[www.acc.org]

Quote
Atrial Fibrillation in Competitive Athletes
Aug 16, 2019
[www.acc.org]

We direct the reader to the following references that provide an overview in support and against catheter ablation for AF in athletes, respectively.31,32

31. McNamara D, Link M. Ablation of atrial fibrillation in athletes: PRO. [www.acc.org]. Mar 8, 2017. Accessed Nov 16, 2018. [www.acc.org].

32. Madamanchi C, Chung E. Ablation of atrial fibrillation in athletes: CON. [www.acc.org]. Mar 8, 2017. Accessed Nov 16, 2018. [www.acc.org].

Edited 1 time(s). Last edit at 09/11/2022 09:15PM by Kwilk.

Quote
Kwilk
For the vast majority of patients, i presume the metric is simply the degree of reduction in afib burden.

Whoa! That's a bad presumption and that's not the metric at all. Most paroxysmal afib patients are highly symptomatic. It's literally torture for them, so they would view simply reducing afib burden as a failed ablation, and that's exactly what it would be. An ablation should render you 100% free of all atrial tachyarrhythmias without the use of antiarrhythmic or rate control drugs. If you're coming into this expecting nothing more than a reduction in afib burden but having to remain on maintenance drugs, then you're coming into it with expectations far below current medical standards and what you should expect in 2022. I would recommend less focus on new emerging technologies (they're all just variations on the same basic procedure), and more focus on the disease you actually face. I don't think you've quite grasped it yet.

And I must say that if that's all you aim for and that's all you get, I predict you'll be back in an EP's office a few months or years later because if you don't stop it completely, then it will simply continue to progress and worsen. That's not going to be how you achieve your goals.

Kwilk,
my burden over a number of decades, included, fainting, chest pain, arm pain, nausea, shortness of breath, heart rates over 200 etc etc.
I stopped going anywhere because of the fear I may have an episode or end up in an ambulance or stuck in hospital.

Bad advice initially meant I just put up with it. I wish I knew back then what I now know.

Thank goodness I found this site. Common sense advice was a bonus. It took me a while to change how I perceived my condition, and I put that down to the brainwashing of my original Cardiologist who just didn’t get how difficult it was for me…and didn’t really listen to what I was saying. The light came on when I presented him with around 50 read outs from my Kardia device. He was taken aback to say the least.

I won’t go on about it but I could write a book.

As Carey said, it doesn’t usually go away, it just lurks inside your chest, waiting to surprise you, just when you think you’ve beaten it.
People do suffer with this condition, physically and psychologically.

Quote
Kwilk
you've probably read this, but in case not:

Atrial Fibrillation in Competitive Athletes
Aug 16, 2019
[www.acc.org]

I've not read it.

Quote

The position paper from the European Society of Cardiology recommend a total detraining period of up to two months for restoration and maintenance of sinus rhythm. However, this is rarely well received by the athlete and may be unacceptable at the elite level. By contrast, the American Heart Association and American College of Cardiology recommend athletes with well tolerated, self-terminating low-risk AF may participate in all competitive sports without therapy (Class I; Level of Evidence C).

I personally think that detraining for two months and going back to the same level as before is unlikely to be effective. I also think that contintinuing to compete will likely lead to progression.

Quote

But for the next 20-30 years want to regularly be able to do, say, 15 miles with 5000 ft elevation gain at 2-3 mph.

At least in my part of the world (Colorado) the grade is rarely constant, so this would be material. The question is how your body responds to it. In the 2nd paragraph of this post I link info on three methods I use as metrics: Zone 2, MAF heart rate & nasal breathing (all giving about the same result). The data on Zone 2 is that it can increase mitochondrial density and allow one to do more at the same heart rate over time. Also what Phil Maffetone has observed in those who follow his MAF program (nominally limiting long duration exertion to 180-age heart rate). My simple approach is to always breathe through my nose. My hypothesis is that long duration exertion above these rates increases ROS (reactive oxygen species).

Following this approach, I remain fit at 67. Daily I ruck with a 60 # pack for 2.5 miles. I can alpine ski off piste all day hard at 12-13,000' fasted. However if I add hiking to each lap, it becomes a delayed vagal afib trigger. When I climb with a 35 year old friend, she commonly is breathing hard on the approach hike with a 6 pound pack and I'm not with my 60# pack. When climbing, I lead the routes and never breathe hard, she breathes hard climbing on top rope. I do a lot of resistance training as well as one or two HIIT sessions a week.

Quote

Self correcting asymptomatic afib bouts <12hr every other day or so.

Nominally a 25% AF burden. During the first 4 months of afib, 18 years ago, my burden was 57%. During 9.5 months of 2021, a bad time for me, it was 0.56%. During the subsequent 46 weeks, it has been 0.019%. The bad year was 29 times greater than the subsequent 46 weeks, but still relatively modest.



Edited 1 time(s). Last edit at 09/13/2022 02:08PM by GeorgeN.

Kwilk,

Better advice and information on this site than you will find reading various studies. As for success from an ablation - I have had two, the first lasted 13 years with NO afib or the need to take any meds. Then it was back, and the second ablation is now over 2 years with NO afib and taking no meds.

I went for 11 years with afib before my first ablation (6 years diagnosed and 5 years undiagnosed). During the last 6 years when I knew what was happening, I was on meds for control, but recorded over 200 episodes. I ALWAYS knew when I was in afib, and lead pretty much a normal life, but I would not work out (run, do weights, windsurf, hike, ski) when in afib. Tried that with O2 debt being a problem.

Ablation success is varied, but it isn't a success unless afib is totally gone for an extended length of time. What "extended" means is debatable.

It doesn't mean between two weeks and two years. Unless an ablation frees the bearer for something like eight to ten years, it can't have been successful in my view. Something that gives relief for an extended period can have an exalted status in a bag of tricks, but I still think it is only a poorly understood trick if it is so often a merely temporary abeyance that lasts a few short years.

Quote
Carey

Quote
Kwilk

Quote
Carey

Quote
Kwilk
And also there seems to a standard of ablating the PV. From there, ablating more areas during initial procedure, or during follow up. Scaring only the proximal PV seems to allow remodeling to improve LA structure/function, but ablating more does not.

The over simplification is that part about ablating more than the PVs doesn't produce better results.

Depends on how outcomes are measured. For the vast majority of patients, i presume the metric is simply the degree of reduction in afib burden.

Whoa! That's a bad presumption and that's not the metric at all. Most paroxysmal afib patients are highly symptomatic. It's literally torture for them, so they would view simply reducing afib burden as a failed ablation, and that's exactly what it would be. An ablation should render you 100% free of all atrial tachyarrhythmias without the use of antiarrhythmic or rate control drugs. If you're coming into this expecting nothing more than a reduction in afib burden but having to remain on maintenance drugs, then you're coming into it with expectations far below current medical standards and what you should expect in 2022. I would recommend less focus on new emerging technologies (they're all just variations on the same basic procedure), and more focus on the disease you actually face. I don't think you've quite grasped it yet.

And I must say that if that's all you aim for and that's all you get, I predict you'll be back in an EP's office a few months or years later because if you don't stop it completely, then it will simply continue to progress and worsen. That's not going to be how you achieve your goals.

We've a communication problem, which I'll take responsibility for. At least as expressed in the threads I've read on this forum, reduction in afib burden and what it takes to maintain that reduction is largely all that is talked about. I use afib burden in the manner GeorgeN does, percent of time spent in afib.

On the other hand, seen discussed here is the following. In general terms, the more extensive the ablation, the less reversal of atrial cardiomyopathy. Besides the benefits of having a higher functioning left atrium, the more reversal you achieve, it seems the lower your stroke risk. This is particularly important since afibbers are at 5X risk for life, even if becoming AF free.

This is where I'm at, so to say:
2022: Atrial cardiomyopathy: Pathophysiology and clinical implications
Antonella Tufano 1 , Patrizio Lancellotti 2
Eur J Intern Med
2022 Jul;101:29-31.
doi: 10.1016
j.ejim.2022.03.007
[pubmed.ncbi.nlm.nih.gov]



Edited 4 time(s). Last edit at 09/13/2022 08:06PM by Kwilk.

Quote
GeorgeN

Quote
Kwilk
]
But for the next 20-30 years want to regularly be able to do, say, 15 miles with 5000 ft elevation gain at 2-3 mph.

At least in my part of the world (Colorado) the grade is rarely constant, so this would be material.

Same terrain here. I should have written: 15 miles with 5000 ft elevation gain in 5-7 hours, which means for us that the entire time we can chat back and forth as if sitting, never really being out of breath, but being tired afterwards for a few hours. I'm guessing that effort is well below 180-age for all but the rare short steeps offtrail. I hope that an effort level that low won't be a trigger. I'll need to look up Zone 2, MAF, Nasal Breathing, thanks for those clues. I don't really do any training per se except for low level free weights with the idea of limiting osteoporosis and age-related loss of muscle mass.

Quote
GeorgeN
During the first 4 months of afib, 18 years ago, my burden was 57%. During 9.5 months of 2021, a bad time for me, it was 0.56%. During the subsequent 46 weeks, it has been 0.019%. The bad year was 29 times greater than the subsequent 46 weeks, but still relatively modest.

I've read a few of your detailed posts in other threads here, but don't remember you mentioning having had an ablation. I'd ask about trends in your atrial cardiomyopathy, but will start a new thread for that.

Quote
Ken
As for success from an ablation - I have had two, the first lasted 13 years with NO afib or the need to take any meds. Then it was back, and the second ablation is now over 2 years with NO afib and taking no meds.

That's great. Hope my path is similarly successful. So it started in the late 90's for you. Are you, or were you, considered a Lone AF case?



Edited 1 time(s). Last edit at 09/13/2022 04:08PM by Kwilk.

Quote
Kwilk
I've read a few of your detailed posts in other threads here, but don't remember you mentioning having had an ablation. I'd ask about trends in your atrial cardiomyopathy, but will start a new thread for that.

Correct, no ablation. To my knowledge, no cardiomyopathy. I last had an echo 18 years ago with an EF of 54 & I'd been in afib for two months (and was in afib during the echo). I assume it improved when I went back in rhythm.

I do high intensity intervals on my 90's Schwinn Airdyne fan bike. One of its metrics is instantaneous calories/hour. When I do 13 seconds as hard as I can go and easy (50 watts) for 17 seconds and repeat for 8 times, I can do it without opening my mouth. Heart rate max is around 144 BPM. Max cal/hour is 2750 (which I can hold for 8 or 9 seconds). I can jump rope for 60 seconds on an exhaled breath hold. I never breathe hard on my strength training. Last Dec I decided to do a max isometric deadlift with my bar that has a load cell and records max load. I pulled 524#'s. Not the same as with free weights, but still a big pull at my age. I have other thoughts on osteoporosis prevention. Will post more on that later.



Edited 1 time(s). Last edit at 09/13/2022 05:12PM by GeorgeN.

Quote
Kwilk
At least as expressed in the threads I've read on this forum, reduction in afib burden and what it takes to maintain that reduction is largely all that is talked about.

I think you've been badly misled by the sample of posts you've read. The vast majority of posts like that are from people who haven't pursued ablation, or they're waiting for an ablation, or they've had an ablation that failed and they're trying to figure out what to do. Believe me, anyone here who undergoes an ablation and then still finds themself managing afib considers that ablation a failure -- and it is. So when you see success rates quoted, those number don't mean those people came away with afib reduction only. Those number mean only 100% success. Specifically, the accepted medical criteria for "success" is complete freedom from all atrial tachyarrhythmias one year post ablation without the use of antiarrhythmic or rate controlling drugs. Anyone calling an ablation successful that didn't meet that criteria is being less than honest, or at least inaccurate. (And yes, I've seen journal articles where the authors claimed success even though their patients still required drugs to maintain NSR. Such articles are downright deceptive and shouldn't have been accepted for publication as written.)

Although there's an occasional person who comes away with a reduction that's less than 100% who's satisfied enough to just live with it, that's a rare individual. Almost everyone who comes away with only a reduction in burden will pursue a second procedure (or more -- six in my case). And even though they might choose to live with it, calling it anything other than a failure is wrong. No one goes into an ablation expecting only partial success, and no EP does either. The only accepted metric is binary: an ablation either eliminates afib completely without the use of drugs, or it's a failure. Mere afib reduction can be called a partial success, at best.

So what's the true success rate for first-time ablations of paroxysmal afib? Across all EPs worldwide, it's about 75%. However, top EPs commonly achieve 90% and better. And the very top tier EPs can achieve numbers like that with longstanding persistent afib.

So you need to adjust your thinking about ablations. The expected outcome is complete freedom from afib without drugs indefinitely. I had my last ablation in August 2017 and I've been in 100% NSR ever since. Should that ever change, I won't waste 1 minute trying to manage it. I'll be on a plane to Austin, TX ASAP.

Quote
Carey
I <snip> ASAP.

Quote
GeorgeN

Quote
kwilk
I'd ask about trends in your atrial cardiomyopathy, but will start a new thread for that.

To my knowledge, no cardiomyopathy.

To my knowledge, I don't either. And there is some reason to believe I don't, but also some reason to believe I do. It will be interesting to see the echo results. It's ordered, not yet scheduled.



Edited 1 time(s). Last edit at 09/13/2022 08:05PM by Kwilk.

A little clarification of terms here....

The term is atrial myopathy, not atrial cardiomyopathy. The term cardiomyopathy means disease of the entire heart, aka structural heart disease. If you have afib, then you have atrial myopathy, which is the term adopted in recent years to describe the underlying disease that causes afib, atrial flutter, atrial tachycardia, and SVT. Unfortunately, atrial myopathy isn't fully understood, so there's no accepted way to formally diagnose someone with atrial myopathy other than just saying they have one of the atrial tachyarrhythmias. It's more of a theoretical disease, actually.

So I think what both of you are saying is you haven't been diagnosed with cardiomyopathy, which is a good thing, but you still have atrial myopathy because you have afib, which isn't good, but definitely not as bad as having cardiomyopathy.

Quote
Carey
The term is atrial myopathy, not atrial cardiomyopathy. The term cardiomyopathy means disease of the entire heart, aka structural heart disease. .

I actually took her question at face value as long duration, high rate afib (meaning high ventricular rate during afib) can lead to cardiomyopathy.

Quote
GeorgeN
I actually took her question at face value as long duration, high rate afib (meaning high ventricular rate during afib) can lead to cardiomyopathy.

Okay, simple miscommunication on one of our parts, probably mine.

nah. I meant atrial cardiomyopathy, as defined in the literature, such as the reference I cited above.

Okay, so looking around I see that older sources did use the term atrial cardiomyopathy and even a few newer ones still do. My mistake. But the generally accepted term now is atrial myopathy (because the cardio part is redundant). In a few years I figure it will become the single word atrialmyopathy and my spell checker will stop flagging it.

Quote
Kwilk

As for success from an ablation - I have had two, the first lasted 13 years with NO afib or the need to take any meds. Then it was back, and the second ablation is now over 2 years with NO afib and taking no meds.


That's great. Hope my path is similarly successful. So it started in the late 90's for you. Are you, or were you, considered a Lone AF case?

Yes, Lone AF. My athletic history as a competitive swimmer culminating in the 1968 Olympics (not exactly endurance training, but not far from it) likely was a factor in my susceptibility to AF. Also, for a couple of decades, my wife and I trained and competed in dozens and dozens of 5K runs, plus a few 5 milers and one, half marathon. I am now 77 and work hard at staying fit, but a hip replacement put an end to the jogging. After a 50+ year vacation from swimming, I am now back to it again for aerobic conditioning,



Edited 1 time(s). Last edit at 09/15/2022 02:48PM by Ken.

Quote
Ken
Yes, Loan AF. My athletic history as a competitive swimmer culminating in the 1968 Olympics (not exactly endurance training, but not far from it) likely was a factor in my susceptibility to AF. Also, for a couple of decades, my wife and I trained and competed in dozens and dozens of 5K runs, plus a few 5 milers and one, half marathon. I am now 77 and work hard at staying fit, but a hip replacement put an end to the jogging. After a 50+ year vacation from swimming, I am now back to it again for aerobic conditioning,

My parents were at those games as spectators! I don't know much about pool swimming. With even the longest event lasting less than 20 minutes, pool swimming is far from endurance, but the training is grueling hours of non-stop HIIT, daily, and breathing isn't at-will, it's entrained to stroke. That might play into GeorgeN's (effort x duration) hypothesis. I've heard nothing but positive things about masters pool swimming and the folks in it. Hope you enjoy it.

Per PubMed, "Atrial Cardiomyopathy" was first used in 1972. But there were only 3 additional uses until the first appearance in 1994 of "Atrial Myopathy". And it is not clear that those 4 early uses were consistent with modern usage. The modern use of atrial cardiomyopathy began 3 years after atrial myopathy, but has been used 25% more often. "Atrial Cardiomyopathy" has been used in 186 papers, of which 82% (152) also use the term "atrial fibrillation". "Atrial Myopathy" has been used in 149 papers, of which 77% (114) also use the term "atrial fibrillation"

According to an Expert Consensus paper in 2016 (cited below), "a definition and detailed analysis of ‘atrial cardiomyopathy’ is lacking from the literature." That paper goes on to use atrial cardiomyopathy 20 times, and atrial myopathy 4 times, so both seem to be acceptable in the field to some extent, but atrial cardiomyopathy seems to be the preferred term amoung experts. I didn't find in that paper a discussion distinguishing the two terms. Neither term is in MeSH. The working group proposed a definition for atrial cardiomyopathy as 'Any complex of structural, architectural, contractile or electrophysiological changes affecting the atria with the potential to produce clinically-relevant manifestations’

The use of atrial cardiomyopathy seems to be growing exponentially: graph

.... but atrial myopathy does not: graph

In fact, use of atrial myopathy as a title word is now falling, having peaked a couple years ago: graph

however, atrial cardiomyopathy as a title word is growing exponentially: graph

215,168 myopathy
144,566 cardiomyopathy
220,532 atrial
 10,647 atrial cardiomyopathy
    935 atrial myopathy
    190 "atrial cardiomyopathy"
    149 "atrial myopathy"

EHRA/HRS/APHRS/SOLAECE Expert consensus on Atrial cardiomyopathies: Definition, characterisation, and clinical implication
J Arrhythm. 2016 Aug; 32(4): 247–278.
[www.ncbi.nlm.nih.gov]

LOL... You're really going to rub that one in, aren't you?

Personally, I think atrial cardiomyopathy is redundant. The word atrial already identifies the heart, so the cardio prefix is redundant, but clearly the cardiology world doesn't agree with me.

[www.ncbi.nlm.nih.gov]

Atrioventricular Nodal Catheter Ablation in Atrial Fibrillation Complicating Congestive Heart Failure

“ Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular entities with high comorbidities and mortality and severe prognostic implications. ”

Too many ER’s on-call EPs, and my local EP tell me I am getting too many episodes, too many ablations, drugs are not successful etc and that I need to get an AV node ablation. However for some that causes cardiomyopathy unless I get another pacemaker and a third lead to my ventricles to lessen the burden of my heart getting paced 24/7 at a set heart rate with no more tachycardia and no more drugs. However I will still get afib and assorted arrhythmias and I will feel every afib but at 55hr, dizziness and symptoms will still be felt.

I’m posting because this thread was branching out to cardiomyopathy which is a subject I think about recently with swollen ankles and daily in and out, in and out 133-145 tachycardia. Usually they last minutes to 45 minutes but then return minutes to hours later. I think the total burden still can’t be good. I’m scheduled for another ablation (4) in November but until then my heart maybe taking an accumulative toll.

I feel the same way. Every minute my heart is in arrhythmia it is remodeling. I don't know how much AF it takes to undo 18 hours of NSR, but it seems to me that the 'AF begets AF' syndrome likely means that even 15 minutes in AF once a day keeps the heart on the 'back foot', and hastens the remodeling.

Personally, if my now-complex case can't be resolved with a second ablation, this time taking a better look at the right atrium and the atrial appendage, I would ask if they can still the AV node and direct-link a pacemaker so that the timing of each contraction works better. They've been using pacemakers for donkeys' years, presumably to reasonably good reviews. I would rather accept only being able to walk each day than to struggle perpetually with AF and a faint hope that it won't lead to congestive heart failure.

An AV ablation is a permanent nuke to your heart. It’s a last resort measure.

If you don’t mind a pacemaker, you may need 3 leads to lessen the chances of cardiomyopathy. I recommend Metronics. Although I was upset getting an emergency pacemaker after my ablation, it does convert me in the 80% range due to its boost therapy programs. The downside is one has to be very careful not to bang into things because the pacemaker is just inserted into a pocket under the skin and has no muscle/fat protection. In April, a bus door slammed into me. Unfortunately the door hit my pacemaker. Although it still works (interrogation) it was painful for a few months. Last week an elevator door slammed into my PM. Not my fault, overcrowded elevator and I couldn’t get out fast enough with little kids lingering in front of me.

.

Quote
susan.d
The downside is one has to be very careful not to bang into things because the pacemaker is just inserted into a pocket under the skin and has no muscle/fat protection.

You can have them “buried” in the pectoral muscle. I know that yours is already in place but it is something to keep in mind for the future. Mine is buried and thus more protected from bumps.



Edited 1 time(s). Last edit at 09/15/2022 07:53PM by Daisy.

Quote
Daisy
You can have them “buried” in the pectoral muscle. I know that yours is already in place but it is something to keep in mind for the future. Mine is buried in those more protected from bumps.

I had a female relative who at 94 needed a PM replacement. She selected the "buried" approach as she didn't think the skin pocket approach looked good in a bathing suit! Then she was unhappy as the buried approach hurt more and had a longer recovery. She lived in an assisted living facility, but was still aggressively going after the boys

I wasn’t given a choice nor did I know anything about pacemakers or even that two leads are snaked inside my atrial and ventricular veins. Clueless.