← Return to Seeking advice about Paroxysmal Afib before seeing cardiologist

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@gloaming

Hi, and welcome Canuck AFers Anonymous!
I'll address each of your comments: (BTW, windyshores is no slouch...she's been around the block once or twice and is well-read):

In a way, you are lucky that your fibrillating rate has remained low. My own, and for most others, is upwards of 140, and was at 180 while I was 'strapped in' on the operating table awaiting for my workup angiogram a month before my first ablation (I had to have two, more later...). I do appreciate that you are like a great many of us who are symptomatic, often debilitatingly so. There is a slow erosion of well-being the longer one is in any level of AF, whether paroxysmal, persistent, or permanent.

Alcohol is a wise thing to avoid because it is a toxin, no matter what anyone says, and as a toxin it must be hard on the heart and on enervation and proper electrical function.

Some patients swear that passing their noses over a cup of coffee sets them off. Maybe they're right. However, all the recent research suggests that caffeine is good for the heart, even a diseased heart, in moderation (and herewith is the proverbial fly in the ointment; some people don't understand that caffeine AND OTHER STIMULANTS like it are found in a wide variety of common consummables. They add up! Especially inside of five or six hours because 5 hours is the approximate half-life of caffeine (as it is for your bisoprolol and my metoprolol, BTW). If you have a second cup of coffee or a Mountain Dew five hours apart, you still have about 40-60% of the non-metabolized caffeine from the first coffee, and now you're adding the same amount.

I had my first run of AF at Km 8 of a 10 K maintenance run. It was a typical run, but suddenly something changed and my legs became sluggish and heavy. I sat on the curb and took my pulse, and it wouldn't come down under 130. Long story short, my cardiologist told me I have an irritable heart. He thought it might be due to my history of running races where I was red-lined much of the time. Three months later, an overnight polysomnography showed that it was 'severe' sleep apnea that had made my heart throw in the towel. I hadn't a clue. But, if exercise sets you off, then for now you should probably slow down. I know, it sucks, but the alternative is to make your heart want to enter the 'persistent' phase of AF, which you should want very much to avoid. AF begets AF, and a heart spending a lot of time in it will slowly remodel itself, including enlarging the left atrium. An enlarged left atrium encourages mitral valve prolapse...yet another problem. The gift that keeps on giving. 🙁

Your cardiologist might be speaking about his own success rate, which is about as low as someone certified to carry them out might be allowed. The actual success rate, except for him, apparently, is more like 75%, with a subsequent 'correcting ablation', or touch-up for missed gaps, running about 80%.

The normal process, whether you're paroxysmal or worse, is to perform a simple PVI (pulmonary vein isolation) by drawing a bunch of burn lesions around the ostia of the pulmonary veins where they empty oxygenated blood returning from the lungs into the left atriums' rear wall. The issue is that, for some hearts, the lining of the atrium, the endothelium, migrates into the mouths of those four veins. The endothelium is what propagates the electrical signal from the SA Node nearby. There are no nerves. Just a broadcast charge of voltage that spreads over the endothelium and it causes all the myocytes to contract in sequence as the charge spreads over them. Trouble is, there are two signals. One from the SA, but another that enters the PVs and spreads a second wave emanating from the ostia. This causes chaotic and irregular double-beats of the atrium.

There's a lot more, including the left atrial appendage, the Vein of Marshall, the coronary sinus, and other places that might also be the foci or 're-entrant' points for the unwanted extra signals. It gets complicated. The point is that a 'good' solid EP doesn't need you to be in AF during the ablation. They can 'challenge' your heart using adenosine, isoproterenol, or even good ol' caffeine if they wish. They can apply voltage to the heart and watch for places where the signal travels. This is the 'mapping' process you may have heard about. Or, if they simply can't manage to get the AF to turn up, they'll just do a PVI (pulmonary vein isolation) and see if that takes care of it. You may have to return for another ablation. Happened to me, and my gentleman EP got it all the second time.

If you can get referred to a really busy, very highly regarded, and highly skilled EP, try to get a referral to that person. You want an EP with a good rating, a good rate of success in ablations, and one who performs at least 10 of them each week (they also have rounds, meetings, prep, and meeting both new patients in their offices and discharging others over the phone...they're BUSY! They won't ask you to their next backyard barbeque...they're professional and busy).

The USA, if you have the resources, has some excellent EPs. Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin is top-rated, as is Dr. Pasquale Santangeli at Cleveland Clinic.

Finally, and I regret ending on this note, but my ethical code forces me to be square with you: Your cardiologist is going to be a liability to you on the basis of what you have shared. Find another. Travel. Whatever you must do, this person is not going to do right by you. If you feel you deserve a fair shot at overcoming this problem, you will have to be more active and assertive than you have been. In the end, don't expect a skilled physician whose estimate of your success rate is as low as 30% to be the answer to your problems.

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Replies to "Hi, and welcome Canuck AFers Anonymous! I'll address each of your comments: (BTW, windyshores is no..."

What about the watchman procedure

Does anyone know about the watchman procedure is it better then ablation and dam drugs