Should I consider ablation?

Posted by jimana @jimana, May 10, 2016

jimana
79-year old male Caucasian
Excellent health and regular exercise with history of hypothyroidism. No history of cardiovascular problems. Vegetarian for 16 years, with excellent diet high in fruits and vegetables. No history of hypertension or cardiovascular issues until Feb 21, 16. Life-long boundless energy, almost never tired even after intense physical activity. Post-prandial glucose levels usually at mid- to upper 90s. Former runner with asymptomatic Bradycardia for 45 years. Resting heart rate has been from upper 20s to lower 40s, but immediately responsive on demand.

Feb 21, 16 - Sudden onset of A-fib after a meal. Ambulance to ER, Cardizem brought it under control.
Mar 3, 16 – Echo-cardiogram and treadmill, went into A-fib at end of treadmill but controlled with Valsalva.
- Echo normal (64% EF) and treadmill normal. Heart structurally and functionally normal.
Mar 25, 16 – A-fib. Controlled with Valsalva. Blood, EKG, X-rays normal.
April 25, 16 – A-fib for 10 minutes but controlled with Valsalva.
April 27, 16 – A-fib immediately following a meal while driving. Paramedics called. Pulse in 220 range. Administered Adenosine twice to stop heart. Paddles used three times before sinus rhythm and transport to ER. Blood, EDK and X-rays normal.
April 28, 16 – Next day cardiologist recommended pacemaker and antiarrhythmic.
April 29, 16 – Pacemaker implant and began 50MG Flecainide b.i.d.
May 3, 16 – ER with irregular pulse and BP 228/95. Clonidine and Ativan administered in ER.
May 4, 16 – Flecainide increased to 100MG b.i.d., and metoprolol 25MG b.i.d. begun.

NOW – Feel fine upon arising but within one hour after taking Flecainide and Metoprolol feel weak, dizzy, shortness of breath for two hours. Anxiety high during episodes. Otherwise can walk several miles on treadmill with no problem and BP goes down significantly with exercise. Can’t stand these chemicals and side effects. Looking for alternatives. Should I consider ablation?

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

Colleen Young, Connect Director | @colleenyoung | Nov 30, 2016

In reply to @jhoffmanj "Reading with interest comments by my fellow heart patients. I have had a rough summer and..." + (show)

@jhoffmanj, I'm sorry to hear that you've had such a rough patch. Are you on the upswing to better health now?
I want to let you know that there is now a specific HCM group on Connect. I hope you'll also join us there https://connect.mayoclinic.org/group/hypertrophic-cardiomyopathy-hcm/

Colleen Young, Connect Director | @colleenyoung | Nov 30, 2016

In reply to @martishka "Hello Jimena, I read the comments attached to your post and would like to weigh in..." + (show)

@martishka

Hello Jimena,
I read the comments attached to your post and would like to weigh in with some thoughts. I had very similar experiences as you in regards to the meds prescribed for AF and SVT. Metoprolol was one that I didn't respond well to. My side effects from the cocktail of PX drugs included anxiety, cramping in my legs, lethargy, dizziness (standing or sitting)

I was diagnosed with a few rhythm problems including: SVT (pulse would go to 220BPM), atrial fib and atrial flutter. I found the meds more and more difficult to deal with so I chose the ablation path. I ended up having 5 ablations, with similar experiences described by @vermontrob. The first 4 attempted ablations failed for a variety of reasons. After each one I would go back on meds, regroup and then come back for another attempt. The reason I was so stubborn about this is because my life on meds was becoming a hardship. I tried many combinations of drugs to control rate and rhythm and they all had their own set of side effects. My fifth ablation was a PVA- pulmonary vein ablation and it was successful. I am off all rate and rhythm drugs and I feel great.

I chose the ablation path because of the extensive research I had done learning about AF and discussing it with my electrophysiologist. I had paroxysmal Afib-the kind that stops on its own after a few minutes, hours or days. There are two other kinds: persistent Afib which needs intervention to stop (medications or electric shock) and permanent Afib that cannot be corrected.

The nature of Afib is that over times it progresses and can become permanent. It is interesting to note that the Paroxysmal Afib has the most symptoms. My rate and rhythm were becoming more challenging to deal with using medication and I was becoming dependent on emergency room visits to get my heart into sinus. I was moving into persistent Afib. I knew that my failed ablations were an anomaly and that statistically I had a very good chance of having a successful ablation. I have a great deal of respect for my electrophysiologist and together we chose this course. I wish you luck and hope that you find a solution.

Jump to this post

Thanks martishka for sharing details of your journey. I appreciate your advice "I would caution not to compare each experience that we read about at this site as the norm, but instead, as a little bit of information to investigate and question."
Spot on! This is exactly what Connect is meant to do. One should always question and get information specific to their situation.

martishka | @martishka | Nov 30, 2016

In reply to @martishka "Hello Jimena, I read the comments attached to your post and would like to weigh in..." + (show)

@martishka

Jump to this post

Thank you for the feedback, Colleen!

Sabrina C. | @charlottemaxine | May 30, 2017

Hello, I am an 80 year old female with A-fib, I have had several cardioversions and one ablation, which works for a few years and/or a few days or months. I am getting prepared for a cryoablation next month, and I am having second thoughts about this procedure. My meds are 150 Flecainide bid, Metoprol 25 mg bid, Warfarin 5 mg, once daily, Memantine 10 mg once daily, Verapramil 3xdaily , Timilol once daily, Methocarbanol (I am not sure of all the spelling of all these miracle drugs.) My cardioligist said it was a "quality of life issue". What are the pros and cons of my situation? Thank you for any information that you can offer.

Teresa, Volunteer Mentor | @hopeful33250 | May 30, 2017

@charlottemaxine Thanks for posting about A-fib and all of the treatments and the meds you have tried. If you look on this page you will see many Mayo Connect members have spoken about A-fib and their treatments as well as meds. I would like to invite some other members into this discussion who have also discussed treatments for A-Fib, @lalton @martishka @twptrustrek @jhoffmanj @irishblueileen @billmichalski @success101 and @nadine66. Also, you might be interested in this Mayo discussion on ablation: http://mayocl.in/28ReaNr. As you read their stories, please remember, however that everyone's situation is different and not all people react in the same way to treatments or meds. Keep in touch with Mayo Connect. We are here to support you! Teresa

Martin Jensen, Volunteer Mentor | @predictable | May 30, 2017

In reply to @charlottemaxine "Hello, I am an 80 year old female with A-fib, I have had several cardioversions and..." + (show)

Hi @charlottemaxine. I too have A-fib, but my symptoms are barely perceptible, and I have not had to consider cardioversion, ablation, or cryoablation. My A-fib treatment is limited to 2 medications -- Carvedilol, a beta blocker that also deals with A-fib and Warfarin to prevent clotting in my upper heart chambers. Another medication (a diuretic) is aimed at my hypertension. Still another (Lisinopril) at a kidney problem. My doctors -- an internist, a urologist, a nephrologist, and a cardiologist -- know about my status and, especially, about my medications and how they interact with each other and with me.

In contrast, it's interesting that you have been treated with two procedures to stabilize your heart rhythm with a third coming up. You are taking 7 medications for a wide range of conditions; dosages you mentioned seem to be modest rather than strong. What is the therapy that your cardiologist refers to as a path to "quality of life?" How many medical professionals have written your prescriptions for these 7 drugs? Do you think it possible to have a detailed conversation with them about your multiple therapies, especially getting answers to how they view your multifaceted treatment and how the various medications can have a positive affect on your special situation.?

As to your impending cryoablation, since I'm not a doctor, I can't give you any advice. Pros and cons of the procedure are fully dependent on 1) the symptoms you exhibit 2) the competence and experience of your cardiologist. I hope you can grill your doctor thoroughly for answers that satisfy your quandaries. For more professional information, you may check out these two web sites: http://bit.ly/2sj5JUl and http://bit.ly/2rRY2ri and search further for "cryoablation for atrial fibrillation". Let us know what you plan to do and how things go for you in the days and weeks ahead!

Sabrina C. | @charlottemaxine | May 30, 2017

In reply to @charlottemaxine "Hello, I am an 80 year old female with A-fib, I have had several cardioversions and..." + (show)

My heart meds came from one EP, the Timilol was for my glaucoma and the Methocarbamol was for muscle cramps. Do you have any information about the cryoablation vs. the normal catheter ablation?

Sabrina C. | @charlottemaxine | May 30, 2017

Thank you very much, your reply did help me to clarify some of the questions I had

Martin Jensen, Volunteer Mentor | @predictable | May 30, 2017

In reply to @charlottemaxine "Hello, I am an 80 year old female with A-fib, I have had several cardioversions and..." + (show)

@charlottemaxine, both web sites I suggested provide information comparing cryoablation with customary ablation. Hopefully you'll find that cryoablation is unusually reliable with relatively low discomfort. However, the University of Iowa Hospital site said two or three cryoablation treatments may be needed to end A-fib altogether.

Larry | @crashnam | May 4, 2018

Age 68, considering ablation for intermittent episodes of AFIB. Been reading up on both RF ablation (burning), and Cryoablation (freezing). Also have plenty of PVC's for 35 years. Able to pretty much cope with them until AFIB episodes began three years ago, and PVC's have gotten worse and more alarming. So, I'm dealing with both. Apparently not enough PVC's to have them ablated but of course Dr's. are more concerned with the AFIB even though the PVC's actually bother me a lot more. I realize ablations are not always completely successful, but sometimes they are. It's like the luck of the draw, but some relief would be okay with me. Anyway, has anyone had the cryoablation (freezing) vs. the RF ablation (heat). In my reading, the cryoablation has less serious consequences should something go wrong. Any input from anyone having this procedure and how you are doing would be appreciated.

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