AFIB

[TrvlBug]

DH had his first ablation about 6 years ago after 3 cardioversions. He was on meds prior but had some serious side effects with one. Almost 5 years to the day, his heart began racing uncontrollably. Off to the ER during Covid height, not fun. They had lots of trouble getting his Afib under control with meds and actually called his cardiologist because they wanted to do a cardioversion then and there. They were told no, get it under control with meds.

His cardiologist recommended a second ablation which he had a month later. So far so good with Afib rearing its ugly head only a couple of times. Initially we were worried that it didn't take as he had some scary heart rates. Don't recall how long, but it does take some time to see if the ablation is successful. Thank goodness for the Apple watch . If this one doesn't take, his cardiologist recommends a pacemaker.

 

[firemediceric]

I had my A-Fib ablation procedure a little over 4 years ago at age 48. Although my resting heart rate is considerably higher post the ablation, it is still well within normal limits running 75-80 BPM. Prior to the ablation, when not having an episode of A-fib, my resting heart rate was in the high 40's. Other than that my only comment is that I have not had an episode of A-fib since having the ablation. I hope that continues.

 

[Murf2]

[I know this is an old thread but it is fairly specialized and therefore I didn't want to start a new thread.]



I consulted with an electrophysiologist today. Many things were discussed including the ablation option.



He did say the jumbled up electrical signals inside the heart that cause afib can be caused by heart tissue that has been scarred by strenuous athletic activity over the years. It is kind of sadly ironic that vigorous athletic activity can lead to a heart condition like afib.



In February I wore a Zio heart monitor for two weeks. It showed I was in afib for 18% of the time (about 59 hours), however afib occurred primarily in a stretch of 6 days and mostly on 2 days within that stretch. For example, on those 2 days I was in afib for over 6 hours each day. For 7 consecutive days there was absolutely no afib.



I'm leaning toward having the ablation procedure. I don't like treating symptoms if I can (hopefully) eliminate the problem altogether. Thinking of not being a daily slave to Sotalol and Xarelto sounds liberating to me. The thing is, my cardiologist is advocating the medicine route and the electrophysiologist is touting the ablation procedure. The EP says I'm an ideal candidate, since I am paroxysmal afib and relatively young (63). He says the afib burden, or percent of time I'm in afib, will only increase from 18% as I get older. The cardiologist makes it sound like ablation is a somewhat risky procedure and the EP makes it sound routine.



I ask again, for those that got the ablation procedure, what was the turning point that clinched the decision for you?

Well, I’ve had two ablations and am doing well after the procedures. The operation was not a big deal to me.

I do have a couple questions for you though.

Did your EP assure you that you wouldn’t need drugs after the procedure? I know everyone is different but I am still a slave, as you say, to Xarleto, flecenide & diltiazem.

Did he tell you it was 85% effective after just one ablation? My EP told me it was 85% effective generally after two or possibly three procedures.

I’m not trying to be argumentative. Just some things you should look into. I am definitely not trying to say you shouldn’t get the procedure. It has made a great difference in my quality of life.

Good luck to you!
Murf

 

[Alan]

Well, I’ve had two ablations and am doing well after the procedures. The operation was not a big deal to me.

I do have a couple questions for you though.

Did your EP assure you that you wouldn’t need drugs after the procedure? I know everyone is different but I am still a slave, as you say, to Xarleto, flecenide & diltiazem.

Did he tell you it was 85% effective after just one ablation? My EP told me it was 85% effective generally after two or possibly three procedures.

I’m not trying to be argumentative. Just some things you should look into. I am definitely not trying to say you shouldn’t get the procedure. It has made a great difference in my quality of life.

Good luck to you!
Murf

Good questions to ask the EP.

My EP told me that there was an 85% chance of it being successful without the need for a follow-up ablation, and we would not know if it was successful until 3 years after the procedure. Got a few months to go before hitting the 3 years mark.

No drugs at all since the procedure. Long may that last

 

[ivinsfan]

Good questions to ask the EP.

My EP told me that there was an 85% chance of it being successful without the need for a follow-up ablation, and we would not know if it was successful until 3 years after the procedure. Got a few months to go before hitting the 3 years mark.

No drugs at all since the procedure. Long may that last

If it didn't come back after the last two months, you are probably golden. Hopefully you won't go through that much stress again for a long, long time.

 

[Alan]

If it didn't come back after the last two months, you are probably golden. Hopefully you won't go through that much stress again for a long, long time.

So very true

I take my BP every day and it was well up for a while, dropping back to normal levels only after our son was released from hospital and living with us. We certainly don’t need or want those levels of stress in our lives.

 

[Qs Laptop]

Well, I’ve had two ablations and am doing well after the procedures. The operation was not a big deal to me.

I do have a couple questions for you though.

Did your EP assure you that you wouldn’t need drugs after the procedure? I know everyone is different but I am still a slave, as you say, to Xarleto, flecenide & diltiazem.

Yes, he said I could quit Xarelto after 60 post-op and Sotalol right away.

Did he tell you it was 85% effective after just one ablation? My EP told me it was 85% effective generally after two or possibly three procedures.

He said the success rate was between 60% and 85%, depending on the candidates condition. Since I have paroxysmal afib I fall into the favorable camp, or into the 80%+ group. But he stressed there were no guarantees a second procedure might be necessary. And he said I might go years without any Afib and then suddenly, there it is again. Told me about one of his patients that had gone 9 years completely free of Afib and then it started up again this year. She's getting the second procedure.

I’m not trying to be argumentative. Just some things you should look into. I am definitely not trying to say you shouldn’t get the procedure. It has made a great difference in my quality of life.

Well, "quality of life" difference is what I'm kind of struggling with. Most times I don't even know I'm in Afib. I was shocked to find out I was in Afib 18% of the time I was wearing the monitor. When you wear the monitor you are supposed to press a button on the device when you feel you are in Afib and jot down notes related to each incident. I only pressed the button 6 times in 2 weeks of wearing the monitor. All 6 times I pressed the button I was in Afib.

But after the monitor was removed and the data collated and when I saw the full report showing I was NOT in Afib for 7 consecutive days and most of the Afib occurred over 5 days and was really concentrated on only 2 days, and even then, I barely noticed, well, should I get the ablation?

Then I hear that continuing without ablation means my Afib "burden" will only increase with age, my body gets accustomed to being in Afib and resists going into it less and less, it makes me want to get the ablation.

The thought of taking Sotalol and a blood thinner the rest of my life is not appealing. I would like to have "real" coffee (with caffeine), maybe have a couple of beers once in a while, get rid of this need to take a 20 minute nap every afternoon (caused by the beta blocker Sotalol), not feel my heart palpitations when I lay on my left side in bed, exercise without my heart rate spiking from 100 bpm to 175 bpm, etc. But are these things significant lifestyle improvements? Debateable.

Compared to Alan's improvements, mine seem somewhat trivial.

 

[marko]

I haven't read all the 81 posts here, but FWIW: Even at age 62 my brother was an elite level athlete; in amazing shape.

Five years ago he developed AFIB and within a few weeks suffered a massive stroke that has left him without speech and with no use of his right side. He essentially lost half of his brain and is lucky to be alive; most of the experts didn't think he'd make it.

So....my point is for anyone taking this lightly: DON"T. This is one serious issue with truly horrific consequences.

 

[bmcgonig]

Among other things mentioned here the success rate of ablation is highly dependent on the skill and experience of the Electrophysiologist doing the ablation.

There are some that are very experienced in only cryoablation of the pulmonary veins (where most of the problems occur apparently). But you need someone that also is very experienced in RF just in case other areas of the heart are causing the problem.

The most important question to ask your EP is how many ablations has he performed. It’s best if he’s done thousands. For instance one EP you talk to might say he’s done 100s which sounds like a lot , but there are some that have literally done 10000. There’s one guy in Austin called Natale that I think has done 11000 or more. In my opinion if you turn out to not be a simple case then someone like that is preferable.

Ask around to find the most experienced one, even if you have to travel.

 

[Alan]

It was cryoablation that I had done with the knowledge that if it wasn’t fully successful then RF ablation would be needed in a 2nd procedure.

The vegas(?) nerve runs close by and there is a small possibility of damage during the freezing process so periodically the nerve was stimulated to check it was working. The procedure was very quick and the only sensation I had was my stomach “flipping” each time they tested the nerve. There are 4 veins coming into the heart where the surgeon inserted and inflated the cryo balloon to freeze the surrounding heart muscle.

With aging I expect AFib to return at some point, I just hope for as many years as possible to be free of it.

 

[Exchme]

Hi- My first post. I know I need to fill out a profile/intro and will do so soon.

IMO, if you have A Fib, it's better to know about it and manage/treat it than not (and just hope it doesn't lead to a stroke). One of the issues here is that A Fib may be intermittent. Also, how does one know that little flutter feeling was A Fib? Do you make a Dr appointment, show up and say "two weeks ago, I felt something funny in my chest"? The doc needs to actually observe it to diagnose.

My Mom (88) has A Fib. She's had a (successful, so far) cardioversion. Using this little gizmo (and an Ipad or smart phone), she can take her own EKG at home. She does so every morning before and after coffee as well as times she doesn't feel right. It's unfortunate she wasn't doing this over the past couple years-- she had a stroke last year and they can be caused by A Fib.

The software/app seems to give you 3 possible outcomes after the 30 second reading.
1. Possible A Fib-
2. Unclassified
3. Normal

I have zero personal interest in this company and I believe there are now other outfits making similar contraptions. I'll try to post a link, if not you can google "KARDIA".

https://www.alivecor.com/

You can get them through Amazon for around 100 bucks. Also, you don't have to buy the monitoring service. You will need a smartphone, ipad or something to receive the signal from the device. My Dad emails each EKG to their inbox after it's taken with a descriptive comment in the title. (ex...Morning Before Coffee Unclassified). If you keep the labeling consistent you can then search for a specific reading later.

I realize that a first post that mentions a product could raise some eyebrows. Here are a few articles I found on another website that's run by a cardiologist (of course everyone is a 6 ft 4, 190 lb cardiologist on the internet or something like that!!)

https://theskepticalcardiologist.co...fibrillation-potential-for-stroke-prevention/

https://theskepticalcardiologist.co...ng-atrial-fibrillation-at-home-and-in-office/

I hope that is of some assistance and look forward to participating more on this board in the future.

Thank you!

Got an AFIB diagnosis after falling from a ladder and getting an EKG prior to surgery to repair my elbow back in May. But the general conversation with the hospital cardiologist was to follow up in a few months, it was probably intermittent or from worry about the elbow surgery, etc. So as a typical indestructible male, I wasn't too concerned.

But figured that for $100 bucks for the monitor, what the heck, I would check. (well actually I bought the 6 lead $150 model cause it's awesome to get something about the length of a stick of gum that does that). Oops, it showed I was in AFIB all the time. Now I wonder how long that's been going on, I recall for the last couple of years that I would sometimes check my pulse and seem to "miss" one of the beats, figured it was bad technique.

So the monitor results pushed me to actually go to the cardiologist. Wore the heart monitor for a week, I gave them an accidental stress test by exercising on my treadmill and throwing 205 BPM, also they found I couldn't take the beta blockers to slow the heart as that created pauses between beats of 3.5+ seconds while asleep. So they immediately scheduled me for ablation, though it will take a week or so to get the various pre-op tests they want.

Anyway, the knowledge and wonderful folks on this forum gave me the nudge to get me into treatment.

 

[Alan]

Thank you!

Got an AFIB diagnosis after falling from a ladder and getting an EKG prior to surgery to repair my elbow back in May. But the general conversation with the hospital cardiologist was to follow up in a few months, it was probably intermittent or from worry about the elbow surgery, etc. So as a typical indestructible male, I wasn't too concerned.

But figured that for $100 bucks for the monitor, what the heck, I would check. (well actually I bought the 6 lead $150 model cause it's awesome to get something about the length of a stick of gum that does that). Oops, it showed I was in AFIB all the time. Now I wonder how long that's been going on, I recall for the last couple of years that I would sometimes check my pulse and seem to "miss" one of the beats, figured it was bad technique.

So the monitor results pushed me to actually go to the cardiologist. Wore the heart monitor for a week, I gave them an accidental stress test by exercising on my treadmill and throwing 205 BPM, also they found I couldn't take the beta blockers to slow the heart as that created pauses between beats of 3.5+ seconds while asleep. So they immediately scheduled me for ablation, though it will take a week or so to get the various pre-op tests they want.

Anyway, the knowledge and wonderful folks on this forum gave me the nudge to get me into treatment.

Good to get more positive feedback on the Alivecor device. AFib with no symptoms is dangerous because of the possibility of blood clots with no prior indications.

I still use mine several times a week, and I will add another outcome it sometimes displays. Bradycardia - which I have had for many years.

 

[marko]

Thank you!

Got an AFIB diagnosis after falling from a ladder and getting an EKG prior to surgery to repair my elbow back in May. But the general conversation with the hospital cardiologist was to follow up in a few months, it was probably intermittent or from worry about the elbow surgery, etc.
Anyway, the knowledge and wonderful folks on this forum gave me the nudge to get me into treatment.

This was my brothers case. He was an elite level athlete and started feeling funny. Wore a monitor for a few weeks and was found to have intermittent Afib. Cardio doc said "let's keep an eye on it"....A few weeks later he had a massive stroke. Touch and go for a week, two years in rehab. Five years later, he's now semi independent but can't talk and has no use of his right side.

 

[chassis]

+1 for AliveCor Kardia Mobile ECG devices. I have the Kardia Mobile 1-lead device, it was $89, ordered online from the AliveCor site. It has a free app, and taking your own ECG is the easiest thing in the world.

Yesterday for the first time I tried the consultation service. For $25 you can send your ECG to a "board certified specialist" and get an interpretation. 20 minutes after ordering the report, I received it via the app. On a holiday weekend Sunday. Very impressive! Result was normal btw.

I did some digging about the "board certified specialist" and the service is offered by CompuMed. They claim to use US-based, licensed and insured specialists. A cardiologist in this case. It seems legitimate to me.

I plan to purchase the AliveCor Kardia 6-lead device. It is $149, still very reasonable in my view. It gives higher fidelity data which can also be sent to a cardiologist for a near-instant online review and report. I'm a gadget person, so this tickles my technology fancy and also gives me health information, a double benefit for me.

Separately, ablation and PCI procedures are coming under scrutiny, potentially being viewed as unnecessary and not improving outcomes (reducing all cause mortality). Read about the PAUSE, COURAGE, ORBITA, ISCHEMIA and CABANA studies. The procedures improve the appearance of the ECG but may not have other benefits. Pharmacologic and lifestyle modification therapies may be the way forward.

https://www.forbes.com/sites/larryh...rst-big-trial-of-af-ablation/?sh=10dfec363989

 

[Montecfo]

Thank you!

Got an AFIB diagnosis after falling from a ladder and getting an EKG prior to surgery to repair my elbow back in May. But the general conversation with the hospital cardiologist was to follow up in a few months, it was probably intermittent or from worry about the elbow surgery, etc. So as a typical indestructible male, I wasn't too concerned.

But figured that for $100 bucks for the monitor, what the heck, I would check. (well actually I bought the 6 lead $150 model cause it's awesome to get something about the length of a stick of gum that does that). Oops, it showed I was in AFIB all the time. Now I wonder how long that's been going on, I recall for the last couple of years that I would sometimes check my pulse and seem to "miss" one of the beats, figured it was bad technique.

So the monitor results pushed me to actually go to the cardiologist. Wore the heart monitor for a week, I gave them an accidental stress test by exercising on my treadmill and throwing 205 BPM, also they found I couldn't take the beta blockers to slow the heart as that created pauses between beats of 3.5+ seconds while asleep. So they immediately scheduled me for ablation, though it will take a week or so to get the various pre-op tests they want.

Anyway, the knowledge and wonderful folks on this forum gave me the nudge to get me into treatment.

Seems bizarre to say you are in AFib bit no concern by Drs.
Perhaps it was a different arrythmia at first?

I've had AFib a few times. When it did not clear quickly once I was sent to ER immediately for a cardioversion.

 

[Qs Laptop]

Separately, ablation and PCI procedures are coming under scrutiny, potentially being viewed as unnecessary and not improving outcomes (reducing all cause mortality). Read about the PAUSE, COURAGE, ORBITA, ISCHEMIA and CABANA studies. The procedures improve the appearance of the ECG but may not have other benefits. Pharmacologic and lifestyle modification therapies may be the way forward.

https://www.forbes.com/sites/larryh...rst-big-trial-of-af-ablation/?sh=10dfec363989

To summarize the results of the study it was found that there was no difference between drug therapy and ablation in the "all cause mortality composite" (disabling stroke, serious bleeding, or cardiac arrest), which occurred in 9.2% of patients in the drug group and 8% of patients in the ablation group.

However, among people that received ablation there was a "significant reduction in the recurrence of atrial fibrillation." This is what was cynically called "making the EKG 'look better.'"

Furthermore, previous drug therapy patients that subsequently received ablation had the "all cause mortality" rate drop from 7.5% to 4.4%.

Not mentioned was the fact that ablation gives the patient the potential to quit taking the drugs for AF and quit taking blood thinner medications.

 

[Qs Laptop]

I got an Android smartwatch for Christmas, a Tic Watch Pro 2020. The health monitoring apps that came with the watch are tied to the Tic Watch apps on my phone and are OK to decent. A couple months ago I installed an app on my phone called Cardiogram which also gets data from my watch and gives more detailed data.

This is not necessarily a good thing. Previously, before I got my smartwatch I would exercise by using my rowing machine in relative ignorance of what my heart rate was doing. Now, however, I can't avoid it.

When doing a rowing machine exercise session you would expect a graph of your heart rate to start from a resting heart rate of around 70 bpm and slowly build up to a faster and faster heart rate as the exercising progressed. Something like this, which is from my rowing session on Monday, July 5th. (Click on graph to enlarge.)



Seems reasonable, right?

Now look at what my graph looked like the next day, the 6th.



Would you feel like exercising knowing your heart rate is jumping all over the place?

Then there is this session on the 8th, where I quit out of frustration, fear, worry, I don't know what, just that I didn't want to continue.



How can a person's heart rate start out at 110, drop down to 60, then slowly ramp up to 80, drop back down to 60, then climb to 120, all while maintaining a steady pace of exercise?

I also have heart rate data for when I'm sleeping. You probably do not want to see those graphs! This crazy fluctuating rate heart is becoming the main driver when contemplating getting an ablation.

 

[Alan]

I can only speak for myself but ablation almost 3 years ago instantly improved my life. Prior to ablation I had symptomatic AFib such that it caused a slight dizziness and extreme breathlessness when climbing hills out hiking. AFib would be triggered by having more than 1 alcoholic drink in an evening or by the stress of watching a football match I was emotionally invested in.

If my life expectancy is not improved then at least the remaining years are likely to be much more pleasant. With AFib gone with the ablation I am also on no drugs at all.

 

[bmcgonig]

To summarize the results of the study it was found that there was no difference between drug therapy and ablation in the "all cause mortality composite" (disabling stroke, serious bleeding, or cardiac arrest), which occurred in 9.2% of patients in the drug group and 8% of patients in the ablation group.

However, among people that received ablation there was a "significant reduction in the recurrence of atrial fibrillation." This is what was cynically called "making the EKG 'look better.'"

Furthermore, previous drug therapy patients that subsequently received ablation had the "all cause mortality" rate drop from 7.5% to 4.4%.

Not mentioned was the fact that ablation gives the patient the potential to quit taking the drugs for AF and quit taking blood thinner medications.

Here’s a nice discussion regarding the CABANA study. He’s an EP so he does ablation but emphasizes lifestyle changes first.

Successful Ablation patients feel better and have no side effects from drugs.

https://drjohnday.com/cabana-study/

Also a discussion of new HD technology making ablation more successful.

https://drjohnday.com/how-successful-are-atrial-fibrillation-ablations/

 

[bmcgonig]

I can only speak for myself but ablation almost 3 years ago instantly improved my life. Prior to ablation I had symptomatic AFib such that it caused a slight dizziness and extreme breathlessness when climbing hills out hiking. AFib would be triggered by having more than 1 alcoholic drink in an evening or by the stress of watching a football match I was emotionally invested in.



If my life expectancy is not improved then at least the remaining years are likely to be much more pleasant. With AFib gone with the ablation I am also on no drugs at all.

+1. Exactly.

 

[Qs Laptop]

Among other things mentioned here the success rate of ablation is highly dependent on the skill and experience of the Electrophysiologist doing the ablation.

There are some that are very experienced in only cryoablation of the pulmonary veins (where most of the problems occur apparently). But you need someone that also is very experienced in RF just in case other areas of the heart are causing the problem.

The most important question to ask your EP is how many ablations has he performed. It’s best if he’s done thousands. For instance one EP you talk to might say he’s done 100s which sounds like a lot , but there are some that have literally done 10000. There’s one guy in Austin called Natale that I think has done 11000 or more. In my opinion if you turn out to not be a simple case then someone like that is preferable.

Ask around to find the most experienced one, even if you have to travel.

Here is a part of the "About Me" section for the electrophysiologist I am considering to do my ablation:

"My major area of expertise is using complex ablation procedures to eliminate troublesome symptoms, especially in the treatment of atrial fibrillation. I was the first in Minnesota to do radiofrequency ablation. I have been doing ablation procedures for over 30 years and have done thousands of procedures. My patient outcomes for these procedures exceed national reports. "


Would you look further or just go with this doctor?

 

[Z3Dreamer]

Qs Laptop - I wish to respond to post #92. IMHO those watches that have the sensor on them are not accurate. For years I had a chest strap and a watch (SUUNTO) that recorded the data. Spot on! Then I got an arm band monitor as the chest strap is uncomfortable. My watch still recorded the data. This first generation of arm band monitor was totally inaccurate. I would get wild readings. Then I purchased the next generation. Works fine, as long as the monitor is clean. A few month ago I purchased an all in one SUUNTO watch. Back to wild inaccurate readings. I am not trying to diminish AFIB, just saying that you might want to invest in a Schoshe arm band monitor and a watch that records the data.

 

[bmcgonig]

Here is a part of the "About Me" section for the electrophysiologist I am considering to do my ablation:



"My major area of expertise is using complex ablation procedures to eliminate troublesome symptoms, especially in the treatment of atrial fibrillation. I was the first in Minnesota to do radiofrequency ablation. I have been doing ablation procedures for over 30 years and have done thousands of procedures. My patient outcomes for these procedures exceed national reports. "





Would you look further or just go with this doctor?

He’s the type of person I would be looking for, yes. Assuming he’s still doing as many as he used to. I’m in the same situation as you i.e., contemplating the ablation.

 

[Qs Laptop]

Qs Laptop - I wish to respond to post #92. IMHO those watches that have the sensor on them are not accurate. For years I had a chest strap and a watch (SUUNTO) that recorded the data. Spot on! Then I got an arm band monitor as the chest strap is uncomfortable. My watch still recorded the data. This first generation of arm band monitor was totally inaccurate. I would get wild readings. Then I purchased the next generation. Works fine, as long as the monitor is clean. A few month ago I purchased an all in one SUUNTO watch. Back to wild inaccurate readings. I am not trying to diminish AFIB, just saying that you might want to invest in a Schoshe arm band monitor and a watch that records the data.

I was hoping my new watch was giving inaccurate readings. However, I wore a heart rate monitor on my chest that my cardiologist suggested (iRhythm brand) for two weeks. I've got the data from the chest monitor and I was able to correlate the heart rates it was reading as corresponding to the same readings on my smartwatch. The watch was not perfect but I would guess it lined up with the chest monitor about 90% of the time.

 

[Qs Laptop]

He’s the type of person I would be looking for, yes. Assuming he’s still doing as many as he used to. I’m in the same situation as you i.e., contemplating the ablation.

Turns out it appears he went to my high school, although he graduated a couple years earlier than me. I think I'm going to schedule a consult with him.