My Time for Considering an Ablation has Arrived

Well, after many years of monthly bouts with afib primarily of the vagal type I am now entertaining the beast every 2 weeks for 4 -5 days at a time so I figure 50% of the time is enough already.

I made an appointment with Dr. Carlos Cuello, (originally from OH) now at Ft. Myers as part of the Lee County Memorial system. He performs a PVI and I am anxious to meet with him. As a person with bradycardia my afib bouts with no meds (other than warfarin) maintains rate in the 60's and 70's at rest. Normally, my resting rate is in the 40's. I am hoping, should I be a good candidate for the procedure I won't require a pacemaker. At age 66 with no major underlying anatomical issues I hope to bite the bullet and go for it.

Recently, to add insult to injury, my thyroid has been throwing off some very low TSH levels indicating hyperthyroidism yet all the other symptoms indicate hypothythroidism so maybe it is Hashimoto's thyroiditis. I am anxiously awaiting an appt. with an endocrinolgist which unfortunately is not until March. My appointment with Cuello is in February. Obviously, the thyroid issues may be the culprit but I won't know for a while.

OK, after all this I am in afib now and would like any feedback on whether anyone has heard of Dr. Cuello, had thyroid problems or bradycardia and also had a successful ablation.

Thanks to all.

Benj,

I have never heard of Dr. Cuello. Why don't you see Dr. Sergio Pinski at the Cleveland Clinic in Weston? It's just a hop, skip and a jump across Alligator Alley to Weston from where you live. Dr. Pinski did a very difficult ablation on our BB friend Bob G from Ocalo, and Bob is doing very well. It's just that Dr Pinski is very experienced and has a proven track record for competence.

How many ablations has Dr. Cuello done? I'm just worried for you because this procedure can be so helpful when done by the right pair of hands, but so damaging in the hands of the inexperienced.

I don't blame you for wanting an ablation. There comes a time when enough is enough. I had a flutter ablation and a PVI by a doctor here in Miami, but I'm still having residual problems two years later, so I have an appt with Dr. Pinski in February, myself.

Blessings,
Marian

Benj:

Yes indeed, a hyper thyroid will throw you into afib. My first episode of afib was brought about by being hyper. You need your free T3, free T4 tested along with TSH.

Has your doctor given you any meds for your thyroid? If you are hyper you should be taking an anti-thyroid med, or at least a beta-blocker to protect your heart. March is too far away, you need something for your thyroid now.

Liz

Benji: As Liz says, a hyperthyroid condition can easily lead to afib.

If you can't get an appointment with and endocrinologist until March, you need to get to someone else that can write script before then. Usually 10 or 20 mg/day of methimazole for several months are prescribed for hyper conditions.

Ask for a Free T4 and TSH blood test. It will take weeks for your TSH to adjust to normal, even with medication, so best you get started ASAP.

Personally, I'd hold off on the ablation until my thyroid settled down if I were you. And, this having been said by one of those who's had an ablation which is successful.

Hang in there and get your thyroid in order. I'd be surprised if an EP wouldn't suggest the same thing.

Gordon

I too would add a voice for going to see Dr. Pinski. See the other guy first if you wish, but also make an appointment in Weston. You are too close to pass up going there. I lived in Cape Coral for six years back in the late 70's and worked at both Lee Memorial and Ft. Myers Community as it was then known. They have grown by leaps and bounds since then, but doubt that they have the track record of Dr. Pinski. I also would work on getting the Thyroid situation cleared up as well. Best wishes to you for good health and NSR.

Cynthia

I should have mentioned the other thyroid values which don't make much sense:

TSH: extremely low: 0.018
Thyroxine, free: 2.3 which is relatively high
Free T3: 4.7 (normal)

A year ago, all the values were normal. I see cardio tomorrow but am very anxious to see an endocrinologist.

As for Cuello, I have the right questions to ask when I see him next month and the number of ablations he has performed.

I agree with Marian an others - Try for Dr. Pinski.

You've certainly done your best to change your pattern but it just keeps on coming. It's time to start thinking about something other than afib and start enjoying life! Good luck.

Hi Benj: bradycardia is defined as a resting heart rate below 60 bpm. Heredity (genetics) plays a big factor with respect to one's resting heart rate. Bjorn Borg (the tennis player) had a resting heart rate of around 35 at the peak of his game, while Jim Ryun had a resting heart rate of 72 at the peak of his running career.

The key thing to talk about is "symptomatic bradycardia". As long as one doesn't have symptoms such as undue fatigue, shortness of breath, light-headedness or fainting, there isn't a problem with a slow heart rate.

I was a vagal AFibber before being successfully ablated. I had problems with bradycardia that was made worse by the Sotalol that I was taking for atrial flutter. My AFib would come on like clockwork. I would sit down before dinner, my heart rate would go down to the high 30's (bradycardia), I would start to get extra heartbeats and then the AFib would kick in.

If you could get in to see the doctor regarding your thyroid issues sooner (before you go to the cardiologist if possible), that would be great, as the thyroid can play a big role in some of these heart problems, and the cardiologist would want to have this sorted out first, if possible.

With such a low rate during AFib, do you feel the irregular rhythm? How did you first pick up on it? Mine was obvious, since it bounced around between 80 and 170.

Just as an aside, in two weeks we are taking our 16 1/2 year old cat in for radioactive iodine treatment for hyperthyroidism. Isn't science woderful?

Good luck...

Benj, If you have a somewhat flexible schedule, you might be able to get in sooner to see the endocrinologist. Try calling their office and asking them to notify you when there is a cancellation of an appointment by another patient. Good luck with everything. Bob

Well thank you all for that sage advice. I now have an appt. with Dr. Pinski on March 1. Amazing I can get to see him before a local endo. doc...go figure.

I found another endo. and have an appt. Feb. 8 so hopefully that can be addressed prior to seeing Pinski.

I will still see the other local afib guy, Cuello in Ft. Myers but I have a lot of questions re: his experience...who knows, now that I have an appt. with Pinksi I might just cancel the other guy. At least I have choices.

As for bradycardia when in NSR I have no symptoms. During afib such as now, with no rate meds, and typing I have a rate of approx. 80 bpm. Since I never really feel the heart beat when in NSR I sure know when I go into afib. The heart races and if asleep I awaken pretty quickly. When exercising or performing some sort of physical activity the rate may go to the low 100's but mostly at rest it remains in the 60's-70's during afib.

Occasionally, I will take a 60 mg. diltiazem tab, once or twice a day which works very well in keeping the rate down.

Benj,

Good for you! I'm so glad you made the appt w/ Dr. Pinski. If we are ever there on the same day, I would be glad to meet you.

Wishing you the best,

Marian

Benj;

I am Bob G Ocala, and I am a great fan of Dr. Pinski. He changed my whole life. with the help of the support and prayers, and the angels from this BB. I have tried many things, many meds, many ways to stop my AFib, and they never worked. I had to be on oxygen constantly in order to even breathe, but he cahnged all of that. And he was so polite, so courteous, so professional, at not at all in a hurry to put me through an ablation. He listened to me, he heard my story, he understood, and we tried several different things that worked briefly. then we came to the place of the ablation as the only other answer. Of course, being from this BB, I naturally wanted to know what his percentage rate was. I was very surprised when he gave me my answer. It was a great response, given with feelings for me, as his patient. He said, what are percentage rates sir, what counts is how much can I help you...what percentage do you want....what would be necessary to give you a better life...25% 50% 75%. I hope I can stop all of your AFib, but at least, because of your very difficult case, if I can do anything to relieve you it is worth it. I sdo not measure myself with how many people are what%, but rather by how I am able to help my patient! ANd how you progress after the abaltion. he has been true to his word, and he has changed my life. I hope to hear the same for you!

God bless you and bring peace to your heart.

Bob G Ocala

Hello,
I am new to the afib club, as I just found out this year after surgery for a triple break in my ankle that I had afib and it has not let up. I have read with interest your experiences, and what a help to see what others are going through. None of my friends have it or know anything about it.
I see that most of you must be from the eastern U.S. Does anyone know of a doctor who is an expert in ablation in Los Angeles. My doctor has sent me to one that does surgery in this area but I do not know his experience as of now. Plan to find out but I do not believe we have any of the best clinics here on the west coast. I seem to get afib every one to two weeks and am on sotolol and an extra dose has worked in abating the afib until today and I cannot get rid of it. It is not extremely fast but out of rhythm. Any advice would be welcome. Thanks.
Joyce

Joyce - I am not sure I can give you lots of answers but can share some thoughts. I have had Lone AF for a couple of years. One cardioversion kept me in rhythm for a year and acupuncture worked three times over the second year. It has now gone out and been out of rhythm for about 2 months. My heart rate is 70-80 and am using Diltiazem for rate control. I feel fine and have not altered anything I am doing.

I am busy learning the language of AF and it has helped me to ask good questions with my docs. I am still trying to get a good call on whether being out of rhythm but at a normal rate, will reduce likely success of a potential ablation. The electrophysiologist I saw pretty much said that things are moving fast in that field and there are likely to be major improvements in the procedure in the near future.

I guess that I would offer to do some reading on the topic. There are a number of decent sites. Next, do some shopping for a cardiologist/EPT that you can talk to and that gives you straight answers and is willing to involve you in the process.

Anyway, I hope that helps a bit. I would take a hard look at rhythm control drugs and the side effects and likely effectiveness in the long run.

Dave