Ablation

I’m wondering if this raises a red flag with anyone else.
A last minute opportunity came up for a PFA at Mayo. I was supposed to go there for testing Thursday-Friday and have the procedure done on a Monday. They said I do not get to talk with the Dr until the morning of the procedure, but will meet with a CNP 5 days before the procedure. And now they have just changed the dates of my testing to 3 days earlier, I thought the CT had to be done 48 hours before the procedure? Also is it bad to have a procedure done the day after DST begins?
I really need an ablation and scheduled one a month ago elsewhere, just curious if all of the things I’ve mentioned are cause for concern where maybe I should just go with the original RF ablation scheduled a month ago.

I would go through with the earlier date, but that's just me. I didn't have a CT 48 hours before, they did all my stuff the day of the procedure. Just get as much rest as you can beforehand and try to organize things so you won't have to do as much when you get back.

You have checked as to whether they will also be prepared to do parts of the ablation with RF as needed as PFA is only pulmonary veins? And is the Mayo EP someone you have personally chosen for their level of competence and experience? The specific EP is more important than the hospital.

If the EP is at all a bit concerned that there might be changes over three or four days, you'll get instructions to come in for yet another imaging, so don't worry about that...that's their department. In my case, for my second ablation, the MRI was not available and my EP, an excellent one, seemed fine with, if you can believe it, a simple chest X-ray. I think it was because I had had two MIBI stress tests, an MRI, an CT scan, AND an angiogram within the past year and they had all shown little progression. It was because my AF was still paroxysmal and my heart had plenty of rest between bouts of AF.

I can't advise about accepting an ablation with an unknown EP, but that was the case for me. None of us 'knows' our EP when first meeting them, but most turn out to be decent folk, well educated, skilled, and very much wanting to improve your existence. Also, apparently this hospital likes to keep their EPs working and busy, and that is why you were called, and why they're hoping you'll continue to be flexible as they give you changes. I wanted an ablation like nobody's business, and was glad to have one. Mine didn't work, unfortunately, but the same gentleman performed my re-do which did work, and I've live a normal existence since then...Deo Gratias.



Edited 1 time(s). Last edit at 03/01/2024 08:28PM by gloaming.

It's not that time critical. A few days won't matter. And no, it's not bad to have a procedure following the DST change. Remember, that happens on Saturday night so everyone gets a day and a half to adjust. I wouldn't be the least bit concerned about any of that.

I echo Daisy's question. I wouldn't do the procedure if you're just getting an unnamed EP. It could very well be the least experienced EP on staff.

I have met with this EP a couple of times, and I do know he has performed many traditional ablations and has been at this facility for at least 15-20 years. He does have good reviews. So did I specifically choose him a few years ago? No. He was the one who was “assigned” to me, as at the time he was the only one accepting new patients. O recently did ask about other EPs, and was told that they all have the same amount of experience and are all very good. I did wonder though he has MBBS and not MD after his name, does anyone know what that means?
The EP I have been seeing for years is only doing traditional RF ablations, and I very much wanted to have the PFA.
I will only be able to ask the NP questions, so I will ask at my appt next week.

MBBS is an international medical degree awarded in some other countries. It's equivalent to an MD and someone with an MBBS can practice in the US after completing the same requirements a foreign MD would have to complete (usually passing the graduate medical exam and completing a residency). So he's as much an MD as anyone else in the building with an MD after their name.

That’s good to know.

Does anyone know of a good rate control medication that has the fewest side effects? I have many drug sensitivities and had my PFA yesterday. My doc wants to put me on amiiodarone, but I thought someone on this forum had talked about the side effects being bad.
Thanks!

Amiodarone is an antiarrhythmic, not a rate control drug. Amiodarone is very effective, but it does have serious side effects if used long-term. It also has a very long half-life so it takes weeks or even months to get out of your system after you stop taking it.

So what does your EP actually want? A rate control drug or an antiarrhythmic? Since you just had an ablation I would imagine it's the latter. There are other less toxic choices. The usual first choice is flecainide.

I agree with Carey in that amiodarone is a 10 pound sledge hammer where maybe a two pounder will do. Or a five pounder. If is an effective anti-arrhythmic drug, but it is highly potent and can have serious side effects on the lungs and kidneys, as examples. Even so, when I had some trouble after my index ablation, and metoprolol was putting me into bradycardia at times, but also did nothing for renewed AF, amiodarone was what I was told I was gonna get...period. I did question them about alternatives, but that was their prescription. Fortunately, the regimen was only for six weeks to get me to the end of the blanking period, so it's not like it was going to be a lifetime prescription.

In the end, you have to trust your prescribing expert....I guess.

Sorry, I didn’t not mean rate control I meant antiarrthymic.
He did tell me it your only be for 1 month. But I thought I remembered it was a powerful drug. Is multaq a better choice? I’ve had issues with flecainide.

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Dini
Sorry, I didn’t not mean rate control I meant antiarrthymic.
He did tell me it your only be for 1 month. But I thought I remembered it was a powerful drug. Is multaq a better choice? I’ve had issues with flecainide.

Multaq is about the mildest of the antiarrythmics with few side-effects. It took it for two months after my ablation with no problems. It hadn’t worked well for me before the ablation but was sufficient afterwards. It is often given after an ablation.

My PFA was a week ago and I was wondering how long fatigue lasts and also the femoral puncture site. It’s not red or irritated but I have noticed a bump when I press on the area, is that normal and if so how long before the bump goes away?
Thanks!

Fatigue is a very individual thing. I never experienced fatigue at all after ablations, but others do. So it's hard to say how long it will last but a week or so is usually the limit. I think most of it is due more to anesthesia than the procedure itself. Some people walk away from anesthesia like it's nothing but it affects others for days.

Yeah, the bump at the insertion site is normal. It will eventually go away but it could take weeks or even months. It's just a small hematoma (collection of clotted blood under the skin) and it's utterly harmless. Remember this if you undergo an exam for other reasons in the near future and a doctor feels that bump and stops and wonders what it is. That happened to me and when I told him it was just an insertion site for the ablation, he seemed relieved and moved on. I think he probably would have ordered an (unnecessary) ultrasound if I hadn't said that.

Perfect, thank you so much for the clarification of the bump at the insertion site. Anesthesia does have a huge impact on me, so hopefully that will improve in the next few days.
Is yoga too much strain on the insertion sites? I’ve been holding off on it, and am not sure how long I have to wait.

Thank you very much

If it's been a week you're good to do with the yoga.

I am still experiencing fatigue 6 weeks after PFA. Have recently (4 days) cut back and eliminated caffeine so not sure if that’s some of it, but still have so much fatigue. I thought maybe cutting back/eliminating caffeine would help, but still feels the same. Is it normal to feel so tired for so long after ablation?
Thanks!

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Dini
Is it normal to feel so tired for so long after ablation?

No, it's not. What meds are you on?

Just Xarelto.
I don’t feel any shortness of breath or other symptoms. And I do know that quitting caffeine can cause fatigue, but as I said I thought maybe quitting would at some point improve the symptoms. Maybe it’s just too soon after stopping the caffeine to know?

I can't imagine why you thought eliminating caffeine would improve fatigue. I would expect quite the opposite.

Have you spoken to the EP about this fatigue? If you have and they didn't offer anything useful, go see your PCP and get checked out. Could be something completely unrelated to the ablation. Fatigue shouldn't last more than a few days after an ablation, and for some people there's none at all.

Ok, thanks I will contact my primary.

Update: I tested positive for mono. I’m so confused as I always wear a mask, and it’s also kinda unheard of in people 50+

Wow, how unexpected. But good that you saw your PCP and got diagnosed. Now at least you know what it is and it will pass.