6 years post ablation follow-up

Hi all! Libby here! I had an afib ablation with Dr. Natale in May of 2018. The first 5 years were perfect! The 6th year I had short runs (like 7 beats) of atrial tachycardia or SVT now and then and this past October I had a 45 minute episode of a-fib. When I went into it I took 30 mg of a calcium channel blocker and like I said, converted after 45 minutes. . I wore a monitor for two weeks after that and had 6 very short episodes of atrial tach/SVT and 1 10 beat run of VT. Most of them were in the middle of the night. I'm 66, my calcium score was 0, chamber sizes and valves normal, so they didn't seem too worried about the VT, but it all gives me anxiety. I often feel like it's going to start, but if I get up and move around it goes away. When does one push to do another ablation? I'd like the perfection of the first 5 years, but reading people's realities maybe I should count my blessings. I felt in good hands in TX, but it's been a tough year at home for my folks and there are risks to procedures. I have good feelings about my care in Minnesota, but having been an echo tech for 36 years, I want the best odds. I'm not inherently a risk taker. What's a gal to do? I appreciate your thoughts, thanks!

You're gonna have to choose your poison...or in this case, your risk. What's the risk that you have AF and do nothing but take medications? Maybe little risk if the drugs work well and you're in NSR 99% of the time. What's the risk of having AF and you do nothing....at all? Just let 'er rip. See what happens. I think you must be aware of what can happen if your AF persists, gets worse, becomes permanent, and you develop severe atrial enlargement, mitral valve prolapse, lots of 'remodeling' with collagen deposition in the substrate and more fibrosis...except it isn't the 'good' kind that an ablation does? You could develop cardiac insufficiency...heart failure.

Or, you accept the minor risks associated with a highly experienced and adept practitioner like Natale or Santangeli, and get the right kind of fibrosis where it counts, and where it gives you perhaps another three or four years of bliss. I can tell you where I'd put my time, money, and effort...if you ask.

Thank you for your comments. The problem with drugs, for me, is that I have some lung issues from chronic histoplasmosis when I was younger so there are drugs that are out of the question, like beta blockers and there's another, I can't think of the name at the moment. And, drugs have side effects too. I have "pill in a pocket" of Diltiazem, but my heart rate is 38 at night and in the 40's or 50's during the day without drugs, so taking it regularly might not work. I took Flecainide in the past, but my flutter pathways in the RA weren't ablated and I was told taking it could be at risk for a very fast flutter. That scares me.
I understand what can happen, be it stroke, atrial enlargement, remodeling... I don't plan on letting it get that far. My contemplation is: Ablation in Minneapolis or TX? and sooner vs wait a little? It could be a year before it happens again. I have an appointment with a naturopath to see what I can do to support my body/heart. I feel everything! I feel from some docs here that the amount of ectopy I have doesn't excite them yet, but I sometimes feel anxious and/or traumatized by past experiences. Could a touch-up solve things forever? I guess I'm a planner and I want to make a plan to reduce my stress.

Libby, you are like a great many AF sufferers who just wants peace of mind, if that can be purchased even, and to slow or to stop a slide into more serious condition. You are doing all the right things, inquiring, asking for anecdotes and advice, reading, going to meetings with qualified people...and you should expect nothing more reasonably. Your orientation is reasonable...you want to improve your circumstances, and you need help.

I used the word 'touch-up' when flat on my back, looking up at bright lights in a cold room, and my EP asked me the usual questions, where are you, why are you here, and who is performing the procedure? When he asked why I was present, I responded that it was for a touchup ablation. Dr. Novak didn't bristle at my response, but he said aloud, 'a pulmonary vein isolation via catheter ablation'. So, my point is that most/all EPs don't look at it as a 'touch-up' of a previous attempt. It's an entirely new procedure, complete with anesthetic, intubation if necessary, TEE if doing RF ablation, and then the typical mapping and cauterization of tissue. In Dr. N's case, he already knew where my foci were, and he knew he needed to go back to the pulmonary vein ostia and zap again, hopefully to close the gap he'd left open the first time. And he did just that.

Thanks, I appreciate the support, gloaming!! One last question, how long does one need to be on Eliquis before an ablation? Was it a month? I think I'll make an appointment to check in with Dr Natale.

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libby
One last question, how long does one need to be on Eliquis before an ablation?

Three weeks is the usual number cited, but it can be as short as 1 dose. If it's less than the time the EP deems necessary, they'll just do a TEE before beginning the procedure.

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libby
Thanks, I appreciate the support, gloaming!! One last question, how long does one need to be on Eliquis before an ablation? Was it a month? I think I'll make an appointment to check in with Dr Natale.

For my angiogram, different surgeon, they went through my wrist. In prep, I was to discontinue apixaban the previous morning, take five (5) 81 mg 'baby' aspirin starting at supper and ending with one before leaving for the hospital that morning. I was asked if I had done as directed, yes, and then she said she would give ma Plavic to swallow prior to the surgery...and she did. While lying on my back on the table, they injected heparin. I swear I was bleeding out of my ears by then! Or thought I should!

for both ablations, Dr. Novak each time, just discontinue apixaban the morning before, and no metoprolol after midnight. Nothing about aspirins, and no Plavic or heparin were administered while I was still conscious (bur I wouldn't be at all surprised if they injected some while I was unconscious).

By the time I got to where I needed workups for an ablation, which included the angiogram, I had been on Eliquis for four years, and they did ask me to answer honestly how careful I was about following the prescription. I don't dick around with such things, so I was able to answer truthfully that I had faithfully taken it for several years by then.

Thanks!!