Intoducing Myself

Hi, I am a 67-year-old man, a new Atrial Flutter patient, and a new member of this forum. I thought I would briefly tell you how I got here.

Thanksgiving weekend I came down with Influenza Type “A” and really did not get back to normal for 3-4 weeks. During that time I was having work done at my home and went out to watch them finish up. Standing on my driveway watching when I suddenly felt lightheaded and just fell over but did not pass out. Stood up and kind of shook it off, but a few minutes later it happened again. So I went over to the garage and sat down on the bumper of my truck as they packed up and left. Next thing I know I woke up laying on my driveway. Decided I was dehydrated so went in and drank a couple of 16oz cups of ice water and that was it, no more episodes nor did I feel bad. My BP was normal and so was my heart rate which was about 64 beats per minute. Called my family doctor and went in for a checkup, found nothing agreed I was most likely dehydrated, and sent me home.

Felt fine until mid-January and suddenly my heart rate just took off one morning. I went to my family doctor again and had an EKG he had me take additional BP meds based on my heart rate and scheduled a visit with a Cardiologist. My heart rate went down to normal overnight and stayed there. A week later on Thursday I went to Cardiologist, had another EKG and everything checked out fine still had a normal sinus rhythm. They also ordered me a monitor to wear for 14 days. But Saturday night my heart rate shot up again during the afternoon and the med regimen did not help at all. Sunday morning my rate was 150 beats per minute and would not budge so I went to the Emergency room.at 8:30 AM. By mid-afternoon they had me diagnosed with Atrial Flutter but the IV Metoprolol was now slowing my heart rate down. Cardiologist came in around 5:00 PM and told me he was changing over to pill form and stopping the IV. For some reason the ER doctor added the pill but did not stop the IV, instead leaving it running and the smallest drip possible. Around 11:00 PM my heart converted all those meds hit me and I tanked. I suddenly felt lightheaded, cold, and dampish just as my heart monitor took a reading and the alarm went off. I looked over and it said my blood pressure had dropped to 34 over something. Just at that moment, the door flew open and they hit me with Atropine and prepped me for the possible use of the paddles but never did need to use them. I was released on Tuesday with Metoprolol and Xrelto. I also wore that monitor for 14 days and the results were :

Patch Wear Time: 14 days and 0 hours (2023-01-20T09:27:54-0500 to 2023-02-03T09:27:58-0500)

The patient had a min HR of 41 bpm, max HR of 193 bpm, and avg HR of 65 bpm. Predominant underlying rhythm was Sinus Rhythm. 21 Supraventricular Tachycardia runs occurred, the run with the fastest interval lasting 11 beats with a max rate of 193 bpm, the longest lasting 13 beats with an avg rate of 101 bpm. Atrial Fibrillation occurred (4% burden), ranging from 54-173 bpm (avg of 121 bpm), the longest lasting 9 hours 54 mins with an avg rate of 134 bpm. Atrial Fibrillation was detected within +/- 45
seconds of symptomatic patient event(s). Isolated SVEs were rare (<1.0%), SVE Couplets were rare (<1.0%), and SVE Triplets were rare (<1.0%). Isolated VEs were rare (<1.0%, 676), VE Couplets were rare (<1.0%, 18), and VE Triplets were rare (<1.0%, 2).

Atrial fibrillation and atrial flutter noted. Keep appointment with EP as scheduled. Ablation being considered.


I am thinking that the Influenza A virus may have played into and Cardiologist agrees but who knows? I am really not wanting to stay on the blood thinners for long if I can avoid it, so I am scheduled for an Ablation on April 3rd and possibly a loop monitor afterward.

I can sympathize with how you felt during that metoprolol overdose they gave you. I had a similar experience once. Now you know what cardiogenic shock feels like.

If I were you, I would go ahead with an ablation, but not necessarily with the cardiologist you're seeing. First off, are they a board certified electrophysiologist (EP)? If not, do not proceed. Second, how many afib ablations have they done? The answer you want to hear is thousands. Same for the center where it will be performed. It needs to be a large medical center that does hundreds of ablations per year. Seriously, I cannot overemphasize how important operator experience is here. It is absolutely vital. There are a ton of EPs out there doing ablations who really shouldn't be. The fact that you like the doctor, or they have a good bedside manner, or they get good ratings on one of those doctor rating web sites are all utterly irrelevant.

I'll second Carey's comments having also gone into 'bradycardia' when my heart was simultaneously over being in AF and full of metoprolol. It isn't fun, and resulted in an early ER stay for me only six days after my first ablation. HR was bottomed out at 30, and one of the nurses came running in to check on me at one point. When she saw that I was okay, she held her two forefingers about 8" apart and said the monitor went flat that long. It was a series of pauses which my EP was aware of when he called to agree to a second ablation.

IOW, we get it. Not a salutary experience at all.

Some of us have found lists showing the EPs in the USA who have the best reputations and the highest success rates. One post came just two or three days ago, so it's on the front page here. Take such lists for what they're worth, but do go to busy cardiac units where each EP performs between 8 and 12 procedures each week...AND...has done so for about 10 years or so... minimum. That's just a rough guide, but you get the idea. You do want experience, and you want skill.

This is still new to you, and probably more than a little disconcerting, even discouraging. We try to impress upon newcomers that AF is unlikely to be the cause of your demise any time soon. It can be well controlled. If you can control your emotions over this new chapter in your life, you'll be much further ahead. Our medical knowledge has come a long way since the 80's and 90's and new techniques and chemical compounds are coming along each year, or so it seems.

Welcome to the forum.



Edited 1 time(s). Last edit at 03/04/2023 01:37PM by gloaming.

Welcome but, at the same time, I’m sorry you’re here. I lurk more than post. You will find great info and support here. You can learn a lot and I picked up a bit of useful info just in this thread alone! Again, glad you made it here and best of luck.

Thanks, everyone for the response. My general Cardiologist is part of a Cardiology group. He has referred me to another Cardiologist in the group who is a certified EP. He does all the ablations and similar treatments for atrial and ventricular arrhythmia for that group as well as other cardiologists in the area. How many he has done I am not sure but that's a good question and I will ask. Yesterday I was contacted by and scheduled to visit the AFib Clinic at the hospital for some more help as a new AFib patient. They will be my contact for rate/rhythm control and symptom management.

James, don’t settle for how many his group has done. You need some direct answers. How many has he done in the past year as well as total numbers? What have his patients had for complications? Has he had anyone die during the procedure or within a month afterward? Listen carefully to his answers. Remember you only have one heart. It’s not three strikes before you’re out. Best wishes.

Hi!

I just posted for the first time myself. I am sorry James you had a lot to go through since you contracted the flu and now this. Who would have known your experience brought you here. I hope things work out for you and you remain healthy.

I did want to add about Carey's comments and ablations performed by EP's. It seems like doctors are very eager to want to advise the ablation procedure. When I first found out I had Afib last year, the day I had the EKG to confirm it, I was told by the PA (my primary care doctor), who referred me to an EP on the spot, that the EP could do a cardioversion to get my heart back into rhythm without even considering I had just told him I had an issue with my thyroid. I discovered any such procedures were not recommended until my thyroid was properly regulated. Still, how does one find out how many ablations are done if the EP is young? I appreciate now knowing the importance of finding an EP with tons of experience.

Quote
Diana
Still, how does one find out how many ablations are done if the EP is young?

If they're young they haven't done enough. You don't want a young EP for an ablation (two exceptions I can think of who are probably in their late 30s). You want middle age at a minimum just because that's how long it takes to get there. I know, age discrimination in spades, but there you have it. We're not employers so we can do it.

A young EP can manage afib medically just fine, so I'm not saying don't go see a young EP. I'm just saying that when it comes to afib ablations, it's a mix of technical skill and dexterity gained by doing the same procedure many times on many different patients over many years. Think concert pianist. You don't get there by playing the piano twice a week.

How to find out how many afib ablations they've done? The only reliable way I know of is to ask them.

Trying to control AF when underlying and contributory precursors are present is like trying to fill a sink with the stopper lifted. The chances of filling the sink are mighty slim. Fixing the causes is the right thing to do, and when those are put to bed, or at least well-managed, then you can do all the fancy and expensive things to get the heart to behave on its own.

I went into v-tach in the EPs office in 2019. He wanted me on 300mg flecainide a day and after 5 days to take a stress test while he administered it to see if I can handle the dosage. I weighed about 121 pounds and based on flecainide guidelines, one must weigh more than154 pounds to take that dose. His office was in the hospital so while we were waiting for an ambulance (why didn’t they wheel me downstairs to the ER?), he asked me how much Tenormin I had taken that day? I said 25mg. He asked if I brought the vial with and he examined the bottle and told me to take another 25. Then another…then another.

After the ecv, I was in icu with 24 hr for 3 days until it finally went up to 37.

So I sympathize with you…iatrogenic caused Brachy is not fun.