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?

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bikermo | @bikermo | Sep 19, 2020

In reply to @crashnam "I'm 70. Let me start off by saying that for 45 years I've had every type..." + (show)

@crashnam

I'm 70. Let me start off by saying that for 45 years I've had every type of PVC, palpitation, skipping, jumping, floundering around, fluttering, hesitating, twinging sensations and on and on known to man and then some, and feel every one of them. Some, very scary. I endured them all at work and at play. Doctors always passed them off as semi-normal and never really told me what they were all about or any explanation for them. Over the years my heart would on occasion kick in and race very rapids for 10-15 seconds but would always go back to normal beat. One of these sensations hit me 8 years ago when I was at work. I felt it certainly, but this time it didn't let up. Lasted for 14 hours at a rate of 200-plus bpm. I let it go and told my family doctor about it. He asked me if I wanted to see a cardiologist and I said no, not at this time. Well, the racing started coming on at about a rate of 30-45 days in between episodes. Finally went to see a cardiologist about it. They gave me the standard tests to see how strong my heart was. Ultrasounds, ekg's, holter monitors. They could see all the palpitations but of course no AFIB was evident. To make a long story short I was finally diagnosed with paroxysmal AFIB after having several more episodes. I don't like a lot of medications so I only took a blood thinner and a beta blocker. Didn't take a couple of the other medications they prescribed because of the possible side effects. Anyway, episodes began to be more frequent. Cardiologist advised me that maybe an ablation was in order. I thought about it and researched it. And decided to have it done, especially since my heart would race way up there and no medication was touching it to slow it down. It always would let up on its own, but the feelings and sensations my heart would give me just before and after I went into AFIB were miserable. I had the ablation done in June of 2019, and in fact, I had a severe episode the night before. They took excellent care of me during pre-op and when I reached the operating room arena there were people coming out of the woodwork to wire me up, prep me and make me comfortable. I had no fears. I'm a Vietnam Veterans so I took it in stride. Procedure took a little over 4 hours and I was going home the next day after spending the night. To date I have had no further episodes except for an occasional burst of speed which is scary because I don't want this to come back. However, I am still left with thousands Palpitations every day but I still get through them. Refused any further medications for it. Maybe down the line. They are still scary sometimes but I just live with it. Depending on your situation, how many episodes and how fast your bpm's are during the episode I would seriously consider having it done. Mine was getting REALLY bad and more frequent and would have eventually worn my heart done.

Jump to this post

I'm a vet too and don't really have fear of doing it but I have concern whether it's actually needed and if I decide to have it done it making things worse. I also want to know what my costs will be, seeing the posts that people have had multiple ablation treatments and being on a fixed income that concerns me. The meds are handling it now and I never really feel fluttering or racing as others here have described so I feel blessed. I worked in healthcare in management 41 years, my wife's a RN running one day surgeries for the hospital I retired from, one of my daughters is a NP and the other is a CNA both working for the VA. I know healthcare and doctors which doesn't cure any anxiety on my part or my questioning the process. I appreciate your response and it helped. I also want to thank Mayo for the support and information they provide to patients, in my 41 years working as a leader in a hospital Mayo was the institution we aspired to be like! Thank you!

Martin Jensen, Volunteer Mentor | @predictable | Sep 19, 2020

In reply to @bikermo "I'm 67 and was diagnosed with AFib 5 years ago after I received a stent for..." + (show)

Hi @bikermo. I'm a little older (85) than you. Your AFib situation seems a lot like mine -- no obvious symptoms as long as I'm faithful to my medication regimen. It's been that way for almost all of my 6 years after AFib was diagnosed by my PCP after an EKG during my annual physical. Three close friends in my age group have AFib, and after troubling physical symptoms, they chose ablation. So far as I know, they're fine with it now, several years after their original diagnosis.

With me, ablation is two or three levels removed from my current therapy -- 1) a beta blocker to control BP, soften heart contractions, and stabilize heart rhythm; 2) anticoagulant (Coumadin) to prevent blood clots, and 3) two BP meds (Lisinopril and a diuretic, Amiloride). I chose Coumadin at the outset because an antidote was available for that but not for newer popular anticoagulants. (That's different now -- antidotes are emerging for a few more anticoagulants).

I'm blown away by the extent of competent medical advice available within your family; this may be your other most important advantage (in addition to the asymptomatic arrhythmia). Working only with medical professionals at my HMO, I'm otherwise alone scientifically, so I don't have your challenge of organizing a large consulting group to advise you on the question of ablation. I'd give a lot to have your advantage of such a rich collection of medical expertise to guide me. Martin

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