Choice of another ablation or meds

Posted by bobcat763g @bobcat763g, 5 days ago

Hello everyone,
I am a 59 yr. old male with previous heart surgery.
I had my first ablation on Feb 2 for a high heart rate and a flutter that was a complex ablation due to scar tissue from a heart surgery in 1966 and was doing great until May 15 when my heart rate went to 130 for 18 hrs. and had the cardioversion to correct it.
On June 21st the same thing happened again and another cardioversion was done.
I spoke with my cardiologist yesterday and was informed that my choices are to go on tikosyn…if that doesn’t work then another ablation…. If it is still not corrected than an av node ablation and a pacemaker.
My question is should I just do the second ablation and skip the tilosyn?
I am asymptomatic and show no symptoms except for a bit of tiredness and notice for heart rate from my Fitbit.
Any info would be appreciated.

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In my non-medical reading expertise (cough), medications can, and often do, do a good job for a great many people who are in the early stages of disordered cardiac rhythm. This may be the case for months, even years. However, the heart seems to have a mind of its own and is preferentially looking to advance its state of disorder. Eventually, all patients, or very nearly all, will have to change medications, up their current medications to higher doses, or submit to another form of 'therapy', or even surgery such as ablation.

You have an undefined tachy-arrhythmia that is intermittent. Or just tachycardia...you haven't said which. But this is after both invasive heart surgery and a recent ablation. It seems, on the face of it, that your heart's condition is evolving, and that the electrophysiologist did not manage to stem your rhythm problem...whatever it is. Quite apart from your original surgery many years ago, you have had an ablation, and approximately 25% of all index ablations (first ablations) do not stop the arrhythmia. IOW, they fail. I'm an unhappy example...or was until my EP agreed to try again seven months later. Happily, the statistics for second ablation success is somewhat higher at 85% across EPS globally, but remember that the first ablation got a lot of the job done. So all the EP has to do is to tidy up, usually, by improving the stockade of scarring lesions around the pulmonary veins, or he/she might need to ablate the left atrial appendage, or the coronary sinus, or even parts of the septum. The point is that, as much as it might be a bummer to find yourself in that unhappy 25%, some of us have to fall there or the statistic is meaningless! 😀

Second comment from me/or a question: why tikosyn? And not Sotolol, or Multaq, or diltiazem, or propafenone, or metoprolol, or........why just tikosyn?

Last comment: if you have an arrhythmia, you may need to be on a DOAC (Direct Oral Anti-Coagulant). Certainly with atrial flutter or fibrillation, you must be prescribed an anti-coagulant. With simple tachycardia, I don't know that it's that important...but I'm not an expert.

Challenge your expert caregiver. Learn as much as you can so that you can make an informed decision. I'm just guessing for you.

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When I was first diagnosed with the arrhythmia back in November I was put on digoxin and diltiazem...after 1 month the rate was back in normal range but was still in a flutter.
After the ablation I was good for 3 months ,then 140 heart rate and cardioversion...good for 6 weeks then again 140 rate and cardioversion.
Once the arrhythmia starts it doesn't seem to stop until the cardioversion.
Tikosyn is what the cardiologist and heart rythem specialist are suggesting...am also on eliquis.

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@gloaming

In my non-medical reading expertise (cough), medications can, and often do, do a good job for a great many people who are in the early stages of disordered cardiac rhythm. This may be the case for months, even years. However, the heart seems to have a mind of its own and is preferentially looking to advance its state of disorder. Eventually, all patients, or very nearly all, will have to change medications, up their current medications to higher doses, or submit to another form of 'therapy', or even surgery such as ablation.

You have an undefined tachy-arrhythmia that is intermittent. Or just tachycardia...you haven't said which. But this is after both invasive heart surgery and a recent ablation. It seems, on the face of it, that your heart's condition is evolving, and that the electrophysiologist did not manage to stem your rhythm problem...whatever it is. Quite apart from your original surgery many years ago, you have had an ablation, and approximately 25% of all index ablations (first ablations) do not stop the arrhythmia. IOW, they fail. I'm an unhappy example...or was until my EP agreed to try again seven months later. Happily, the statistics for second ablation success is somewhat higher at 85% across EPS globally, but remember that the first ablation got a lot of the job done. So all the EP has to do is to tidy up, usually, by improving the stockade of scarring lesions around the pulmonary veins, or he/she might need to ablate the left atrial appendage, or the coronary sinus, or even parts of the septum. The point is that, as much as it might be a bummer to find yourself in that unhappy 25%, some of us have to fall there or the statistic is meaningless! 😀

Second comment from me/or a question: why tikosyn? And not Sotolol, or Multaq, or diltiazem, or propafenone, or metoprolol, or........why just tikosyn?

Last comment: if you have an arrhythmia, you may need to be on a DOAC (Direct Oral Anti-Coagulant). Certainly with atrial flutter or fibrillation, you must be prescribed an anti-coagulant. With simple tachycardia, I don't know that it's that important...but I'm not an expert.

Challenge your expert caregiver. Learn as much as you can so that you can make an informed decision. I'm just guessing for you.

Jump to this post

I did ask why not diltiazem and digoxin again and was told that they are rate drugs.
Tikosyn is supposed to control rythem....if my rythem stays good ,the heart rate is good.

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Okay, that's clear now...thanks. So, like Amiodarone, tikosyn is meant to be stand-alone. I was told to cease metoprolol immediately when I was put on Amiodarone. Once it was working, overnight in my case, there was actually some danger in having metoprolol also in my system. So I had to stop immediately.

Personally, I would use the tikosyn for the time being, but consider getting in line for a second ablation. If your second ablation works, you won't need anything, except apixaban or equivalent.

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Please google the side effects of that med. I just did. When donkeys fly I would take it.
I have a different attitude towards doctors and meds than most people do. Most people have a health
problem, run to the doc, and swallow whatever he says. Then have horrible side effects and run to him again
and take something else with side effects.
You live in your body, and what you put in it is your responsibility. That includes diet and everything you
put down the hatch. Most everything we do, eat or deink has a positive or negative consequence. These doctors have salespeople bringing new meds and giving them for people to try as a guiney pig. Let's try this, and let's try that. I am old as dirt. And with experience, one becomes opinionated. So take it with a grain of salt, but not too many grains or there goes your blood pressure! LOL

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@gloaming

In my non-medical reading expertise (cough), medications can, and often do, do a good job for a great many people who are in the early stages of disordered cardiac rhythm. This may be the case for months, even years. However, the heart seems to have a mind of its own and is preferentially looking to advance its state of disorder. Eventually, all patients, or very nearly all, will have to change medications, up their current medications to higher doses, or submit to another form of 'therapy', or even surgery such as ablation.

You have an undefined tachy-arrhythmia that is intermittent. Or just tachycardia...you haven't said which. But this is after both invasive heart surgery and a recent ablation. It seems, on the face of it, that your heart's condition is evolving, and that the electrophysiologist did not manage to stem your rhythm problem...whatever it is. Quite apart from your original surgery many years ago, you have had an ablation, and approximately 25% of all index ablations (first ablations) do not stop the arrhythmia. IOW, they fail. I'm an unhappy example...or was until my EP agreed to try again seven months later. Happily, the statistics for second ablation success is somewhat higher at 85% across EPS globally, but remember that the first ablation got a lot of the job done. So all the EP has to do is to tidy up, usually, by improving the stockade of scarring lesions around the pulmonary veins, or he/she might need to ablate the left atrial appendage, or the coronary sinus, or even parts of the septum. The point is that, as much as it might be a bummer to find yourself in that unhappy 25%, some of us have to fall there or the statistic is meaningless! 😀

Second comment from me/or a question: why tikosyn? And not Sotolol, or Multaq, or diltiazem, or propafenone, or metoprolol, or........why just tikosyn?

Last comment: if you have an arrhythmia, you may need to be on a DOAC (Direct Oral Anti-Coagulant). Certainly with atrial flutter or fibrillation, you must be prescribed an anti-coagulant. With simple tachycardia, I don't know that it's that important...but I'm not an expert.

Challenge your expert caregiver. Learn as much as you can so that you can make an informed decision. I'm just guessing for you.

Jump to this post

I had a radio frequency ablation in 2008 for pvc’s and a fib. It has lasted 16 years. This was done after massive heart attack and quintuple bypass in 2004. I went to Mayo Clinic in Scottsdale and they said I would need it to save my life. My local hospital couldn’t figure that out what was going on. Since I lived in a northern suburb of Chicago I wanted to have it where my family was. Mayo sent me to Loyola University medical center. Had it done there. 7 hour surgery no sedation. 16 years later still working.

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Sounds like a great success story, jefck. I hope you continue in NSR for many more years.

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At st marys now...while on the c dosing if tikosyn my heart came down from 120 to 38...it also stopped for 14 seconds.
I now have a pacemaker to jump start the sinus node when it gets lazy...felling better and looking forward to going home.

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Great, and you can put that drug behind you now. Many of us find that a rising dosage of the 'rate control' drugs eventually puts us in danger when we slip out of arrhythmia and into normal sinus. I had the same thing happen, but I was close to the ER and they saw it all on their monitor. The nurse came running into my room in a panic, but was relieved to see me chatting with the missus. She held out her fingers 10" apart and said they watched my heart stop beating for 'that long' on their desk monitor.

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Still have to take the drug...at least for now...will know more afterv3 months

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