Hi Brian, your research and analysis is impressive and that sets you up for good therapeutic outcomes. If it would be easy for you to be prescribed a “pill in the pocket,” that might be an interim step to get you out of this miserable cycle. Flecainide is the most common one—no more than 200 mg if you are under 154 lbs. no more than 300 is you are over. And if that doesn’t work, you might consideby Daisy - AFIBBERS FORUM
Hello, I am a 24 year old male living in Vancouver BC, Canada. I have had symptomatic paroxysmal a-fib since 2022, and I am a professional weight lifter and boxer, so you can imagine how much it has affected my athletic career. (Exercise is a big afib/PAC trigger for me). I feel that each time I get an episode now, it lengthens every time greatly. I fear that my next episode will last over 12-24by Brian - AFIBBERS FORUM
Thanks KingFizzy. I agree with you about the brute force aspects of RF and cryo ablation. It's great that three science and engineering are progressing. Re. working in the Middle East, I'm not in the oil and gas sector, so the cost of the ablation is not going to be chump change for me. I definitely need the insurance coverage in order to be able to afford this.by MarionGlenn - AFIBBERS FORUM
Sidenote, I've been offered employment in the Middle East several times and the salaries were outrageously high (300-500k) 20+ years ago but the conditions were equally outrageous. Live in a compound, 14+ hour days, 6 days a week, no 'vices' (you know what I mean) and 2 weeks off shore to what seemed to be Las Vegas style oil rigs where anything and everything goes. Bottom line,by KingFizzy - AFIBBERS FORUM
MG, You're lucky you were able to put this off until better technology came along. As good as some EPs can be with the tools of the last 20 years, I believe one day this period of "you had someone burn the inside of your heart with a f'ing soldering iron???" will be a WTF medical embarrassment equivalent to frontal lobotomy. You and everyone else are fortunate to be ablby KingFizzy - AFIBBERS FORUM
Thanks Carey for your prompt response, which makes good sense. I'll proceed and see what happens. Worst case I'll just have to wait until next year when (presumbably) FDA approves Farapulse. Thanks again!by MarionGlenn - AFIBBERS FORUM
I would think that if you have a plan that will cover procedures outside the US, they would use the host country's approval rather than the FDA's. Using the FDA to determine what a non-US doctor can do would lead to all sorts of sticky problems. I don't think calling them and asking is going to have any negative consequences, and I think ultimately you're going to have to anywby Carey - AFIBBERS FORUM
I'm a U.S. citizen living and working in the Middle East; 69 years old with lone Afib (paroxysmal) since 2005; largely asymptomatic until 2019. I'm an amateur (non-competitive) endurance runner (one marathon or ultramarathon per year), and in 2019 the Afib started to affect my training. It's gotten progressively worse over the past four years, so I've decided to take my EP&by MarionGlenn - AFIBBERS FORUM
Pulsed field ablation (PFA) and Maze procedures (including a convergent procedure) are kind of apples and oranges. A PFA is just an ablation, nothing more. It uses a different technology that seems to be safer, but the end result is the same. But a Maze procedure is surgery and comes with all the attendant risks and a long recovery time, even the minimally invasive mini-Maze. A convergent is justby Carey - AFIBBERS FORUM
Hey Susan, thanks for the response. There is nothing I can find that either of my parents or grandparents had any heart issues at all, let alone with the Mitral Valve. Unfortunately, they have passed all due to different circumstances, but nothing related to heart. I do know that in many cases the Mitral Valve Prolapse is hereditary, but in my case it doesn't appear to be the case.by cornerbax - AFIBBERS FORUM
After about a year it appears that my Afib has actually been caused by Mitral Valve Regugitation. I have Mitral Prolapse (Of the Posterior Leaflet). Many doctors totally disregarded my Echo's which showed this moderate to Severe mitral regurgitation. Those cardiologists/EP's only stated to get an ablation. Fast forward to now, my current Cardiologist and EP state they believe myby cornerbax - AFIBBERS FORUM
Thanks, Susan. So, it's a modest gain at best, nothing to shout about. Still, it's early days, and refinement of the techniques...both of them...over time might still yield some gains.by gloaming - AFIBBERS FORUM
Another trialby susan.d - AFIBBERS FORUM
I know Dr. Natale is the most recommended EP here on this forum. But I'm in Canada and for financial reasons, I really need to stay within my health system. So I've been trying to find the best in Canada. Specifically, one that will be on the cutting edge for pulsed field ablation. Who I'm considering is Dr Atul Verma at Mcgill (7 hour drive for me). He did a previous PFA trialby SamIAm - AFIBBERS FORUM
Hi Lynne, I am a recent "graduate" of Natale ablations -- Index November, 2022, Touchup and Watchman--April, 2023. My initial ablation was extensive (because I had put it off on the advice of my EP) and he had to isolate my LAA on the first go-round but the put in a Watchman during the touchup. All went very well. He has perfected some of his techniques in difficult areas and is remarkaby Daisy - AFIBBERS FORUM
QuoteLynn Penner 1.Is there a place on the forum describing Natale's current ablation technique? His technique wouldn't be a lot different than it was when he ablated you. He still uses RF exclusively, although he has been using pulsed field ablation (PFA) in clinical trials. But there have been huge changes in the technology, and PFA is one example. Although not approved by the FDAby Carey - AFIBBERS FORUM
Oh, oh!! We'll keep a close eye on this artefact. It would be a huge disappointment to all concerned if this turns out to be the case.by gloaming - AFIBBERS FORUM
Interesting. Here is a paragraph that got my attention though: QuoteThose initial studies showed, however, that among patients who returned for repeat ablation due to symptomatic recurrences, the rate of renewed pulmonary vein conduction was “unexpectedly high,” raising questions about the durability of the ablations, Sørensen said. That is referring to PFA.by Daisy - AFIBBERS FORUM
by Yuxi - AFIBBERS FORUM
Sorry to hear this. You had a pulsed field ablation if I remember correctly? Did Dr. Natale ablate non-pulmonary areas with RF as well? If not sometime down the road a touch up might be necessary unless you are okay with staying on medication. Hope the meds get you in NSR soon though in the meanwhile.by Daisy - AFIBBERS FORUM
So I think I finally figured out what the wierd rythym I've been getting is called. I think it's a type of electrical alternan, where I have alternating RR-intervals. One slightly slower beat, then one slightly faster beat, repeat. It happens when I exercise without a very, very gradual warmup. I triggered an event on my latest holter monitor, but the report said it was just a high hearby SamIAm - AFIBBERS FORUM
I am unclear, yes...sorry. I guess I assumed that at some point an ECG was done and they found that you had intermittent AF or PACs and that you could either revert or take something, and that has worked. For some reason I had it in my mind that you had had a procedure, and I thought a Holter would have been assigned to you later.by gloaming - AFIBBERS FORUM
I am not in afib as long as I take the dofetilide. I went back into afib after trying to stop the dofetilide. Went back into NSR after resuming the dofetilide. Sorry if I was not clear.by FibberMcGee - AFIBBERS FORUM
Okay, so your history is fairly straightforward...no Holter because all indications were that you were still in AF. It must have been bitterly disappointing.by gloaming - AFIBBERS FORUM
Stopped the dofetilide after 90 days. Went into afib after holding 2 doses of dofetilide. My kardia said i was in afib and I could definitely tell I was in afib. Never had a holter monitor assessment.by FibberMcGee - AFIBBERS FORUM
Fibber, did you suspend any heart medications, whether rate or rhythm, for about 10 days prior to the Holter monitor? Did you have a Holter assessment a couple of weeks past the blanking period?by gloaming - AFIBBERS FORUM
I started dofetilide on 5/10/21 for persistent afib. I went into normal sinus rhythm after 2 doses. I remained in sinus rhythm for about a year and then started having breakthrough episodes of afib. I had an ablation on 6/28/22. The breakthrough episodes of afib stopped, but when my EP tried stopping the dofetilide after the blanking period, I went into afib after holding 2 doses. So now I remainby FibberMcGee - AFIBBERS FORUM
Quotegloaming Agree with Jim. At least, as far as I have seen on YouTube, the 'wand' is a six-loop 'sink stopper' that must be rotated and applied repeatedly for a few seconds, but the shape is best suited for the PV ostia. Maybe there's another series of loop applicator....? Not yet, at least according to the ep I was in contact with, but hopefully in the future. Bothby mjamesone - AFIBBERS FORUM
Agree with Jim. At least, as far as I have seen on YouTube, the 'wand' is a six-loop 'sink stopper' that must be rotated and applied repeatedly for a few seconds, but the shape is best suited for the PV ostia. Maybe there's another series of loop applicator....?by gloaming - AFIBBERS FORUM
The current PFA instrument is best suited just to ablate the pulmonary veins. Might have some use elsewhere in the left atrium, but too blunt for a typical right-sided aflutter ablation. So, unless they are going to be working on the pulmonary veins for your flutter/tachy, no reason to wait for PFA, because they probably won't use it and will just use RF or perhaps RF and focal Cryo in someby mjamesone - AFIBBERS FORUM