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Persistent Afib

Posted by Dini 
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Dini
Persistent Afib
February 15, 2024 06:00AM
Recently I have gone from paroxysmal Afib to persistent Afib. I am scheduled for an ablation and am wondering if now that the Afib is persistent does the success rate of the ablation decrease?
Also, when they use general anesthesia for the ablation are you intubated.
Thanks!
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Carey
Re: Persistent Afib
February 15, 2024 02:36PM
The success rates for persistent afib are lower. Using a top-tier EP improves those chances significantly.

You will most likely be intubated for general anesthesia, but some anesthesiologists may use what's known as a laryngeal mask airway (LMA) instead. The difference is an LMA fits over your trachea but doesn't go into it. As a patient you wouldn't be likely to notice any difference between the two.
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Dini
Re: Persistent Afib
February 15, 2024 06:03PM
Thank you so much for the information!
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gloaming
Re: Persistent Afib
February 15, 2024 06:29PM
Some EP's use what is called a trans-esophageal echocardiographic endoscope (TEE) which is like the device they put up your bottom for a colonoscopy. This goes into the trachea and helps to keep the catheter burner away from the trachea while they watch its movement It's an imaging device.. So, you are generally not intubated, although they'll place a mask over your face initially to get you to sleep, but after you are testably unconscious they may insert the TEE.
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Daisy
Re: Persistent Afib
February 15, 2024 07:57PM
Quote
Dini
As a patient you wouldn't be likely to notice any difference between the two.

Though you are likely to feel much less throat irritation with the LMA. Some EPs, however, want their patients to have an endotracheal tube as there are some advantages such as protecting against aspiration.
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Dini
Re: Persistent Afib
February 16, 2024 05:22AM
My EP said they are not doing a TEE. So it must be one of the other two.
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Carey
Re: Persistent Afib
February 16, 2024 03:24PM
Quote
gloaming
This goes into the trachea and helps to keep the catheter burner away from the trachea while they watch its movement It's an imaging device.

You're mixing up two different things. TEE stands for transesophageal echocardiogram. The catheter is placed in the esophagus, not the trachea. It's an ultrasound transducer on a flexible catheter, not an endoscope as used in a colonoscopy. The heart rests right against the esophagus, particularly the left atrium, so this gives a much better view of the heart than an external ultrasound. What you're describing is the wand used by some EPs to move the esophagus away from the left atrium during the ablation to avoid esophageal injury. This has largely fallen out of favor since moving internal body parts around has its own risks. For a standalone TEE you're right that you won't be intubated, but you might be if the TEE is done as part of an ablation.
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gloaming
Re: Persistent Afib
February 16, 2024 07:15PM
Oops,. I see that I did type trachea. My bad. Sorry for the confusion, and thanks for the correction, Carey. I had intended esophagus, but..well...there ya go.
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Carey
Re: Persistent Afib
February 16, 2024 08:29PM
No worries; we all do it. If I had a dollar for every boneheaded thing I've posted over the years, I could take a nice vacation.
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Dini
Re: Persistent Afib
February 17, 2024 01:08AM
Another question:
I’m trying to keep my HR down (under 100) until my procedure in April. My dr only wants me to take metoprolol, (because of multiple drug allergies) which really saps my energy and has all these other effects. I’m wondering if you know of any natural supplements that may help lower the HR? Does anyone know of how bad it is for the HR to be in the 110 range for long term?
My EP does not want to do another cardioversion as the last one only lasted 1 day.
Thanks again
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Carey
Re: Persistent Afib
February 17, 2024 02:12AM
It's bad to be over 100 for a long period of time. Bad as in heart failure bad. Don't do that.

Ask you doctor to prescribe diltiazem instead. It doesn't suck the life out of you like metoprolol does.
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Dini
Re: Persistent Afib
February 17, 2024 03:17AM
I was on diltiazem last year, but it made my blood pressure skyrocket like in the 170/115 range. Had a really hard time getting it back to normal.
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Carey
Re: Persistent Afib
February 17, 2024 04:22AM
That's pretty weird. Diltiazem is used as a BP med. I take it for that purpose. Are you sure it was the diltiazem that upped your BP and not something else you didn't recognize at the time?
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Dini
Re: Persistent Afib
February 17, 2024 05:32AM
Yes I’m sure. I have paradoxical reactions to a few different meds. Do you know if all beta blockers have the same impact, or if it’s just metoprolol?
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Carey
Re: Persistent Afib
February 17, 2024 06:29AM
No, they don't all have the same impact. You need to talk to your doc and get them onboard with finding a solution that works for you.
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Daisy
Re: Persistent Afib
February 17, 2024 06:29PM
Quote
Dini
Yes I’m sure. I have paradoxical reactions to a few different meds. Do you know if all beta blockers have the same impact, or if it’s just metoprolol?

Metoprolol is contraindicated for people with a fairly common genetic variation—CYP2D6. My EP did genetic testing and I do have that variation so she prescribed propranolol instead. So, yes different beta blockers have different effects on different people.
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Dini
Re: Persistent Afib
February 18, 2024 12:44AM
That’s very interesting. I will have to look into the testing! Thanks for that info.
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Daisy
Re: Persistent Afib
February 18, 2024 01:09AM
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Dini
That’s very interesting. I will have to look into the testing! Thanks for that info.

My pharmacogenetic report says of Metoprolol when you have this variation: Poor metabolizer resulting in significantly increased sensitivity to Metoprolol.Compared to a normal metabolizer a poor metabolizer may require a 75% dose reduction. Consider alternate beta-blockers. If Metoprolol is prescribed, be alert to adverse events.

But, this sort of testing is not standardly done by cardiologists though a growing number of labs are offering it.
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Dini
Re: Persistent Afib
February 18, 2024 10:15PM
Do you have the specific name of the genetic test that your EP/Dr. ordered?
Thank you
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Daisy
Re: Persistent Afib
February 19, 2024 12:54AM
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Dini
Do you have the specific name of the genetic test that your EP/Dr. ordered?
Thank you

Pharmacogenomics testing. Many labs now offer it and you can find a lot of choices with an online search. Here is an article from Mayo on this testing: [www.mayo.edu]
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