Pulse field ablation

@drherm Yes, I must confess that I have no life. My wife is ailing and requires me to be close by, and I'm done with endless shows about emergency rooms and cops on TV. Additionally, my Dad is 95 and slipping quickly, including falls, crushed vertebrae, poor balance, limited mobility, etc, and I have been to the local ER with him three times in the past twelve days. So, I lurk here and offer what I can to those who are new and seeking help or advice...not that I give advice, but....sometimes advising people to read more, take more control of their circumstances, and to actually listen to a specialist's concerted advice might be a good thing. 😀

Thank-you for your comment, I appreciate it.

@drherm The heavy preponderance of EPs and initial, or 'index' ablations involve the simple PVI....pulmonary vein isolation. This is because almost all patients still paroxysmal, with their AF coming and then self-correcting inside of a full week (yikes, a full week in AF?), have their problem signaling emanating from the ostia of the pulmonary veins....their mouths, where they empty oxygenated blood returning from the lungs, on the rear wall of the left atrium. But the conscientious EP will not release a patient from the cath lab until he has done one, or both of the following: challenged the heart and done a parting cardioversion. The challenge can be done with adenosine, isoproterenol, and even caffeine. The idea is to stimulate the myocytes and electrical system enough that an undetected re-entrant ignites and causes the heart to lurch into arrhythmia. If this happens, the EP knows to keep looking, to keep mapping the endothelial lining of the left atrium, septum, and coronary sinus for that elusive focus. The electro-cardioversion prior to release is like a 're-start' of your computer. Some of us leave our computers on for many days with them in 'sleep' mode. This is fine, but you must do a 're-start' every five/six days to refresh all the files the computer uses for operations. After all the stress of being punctured, probes, cauterized, and then challenged over 120 minutes or so, cardioverting restores the heart's normal state. At least, that's the idea.

@gloaming I wish you and your family the best. It is great to share insights and research you have done. Always helpful to learn. Much appreciated.

@gloaming that is why he shocked me twice at the end!

@drherm
Dr. Eric Pena, Southern Oregon Cardiology in Medford.

@wews I found your experience very helpful and I wanted to tell you that I had my ablation on 11/24. On my 6 week follow-up, I had not had any A-fib episodes but the PACs that I thought I was experiencing fairly frequently are, in fact, premature supraventricular complexes! Now I have a new "diagnosis" and have traded one form of arrhythymia for another! The APRN was rather blase about this; she said it wasn't soon enough to call the ablation a "failure" which really did annoy me! I told her that my B/P was steadily going back up in the morning when I check it and shouldn't I possibly be back on Amlodipine (vs. Cardizem which is more for rate than for B/P control) and my pulse was still on the low side. She said that might help, BUT she couldn't order that; I had to go back to my medical cardiologist to get that ordered! Like when isn't a cardiologist a cardiologist! Needless to say, I was a little ticked! I am a nurse and I know how to advocate for myself, so I sent a message to my chart cardiologist and they did order the Amlodipine. At least I have no A-fib for now and the PVC's are not as annoying as PACs which I could feel every time; still, I am wondering if I would ever have another ablation unless I was really out of control. I had long months of no A-fib before the ablation and I thought this would cancel out my chances of it "spreading" but now I am about convinced that it is just because I am old and it doesn't much matter what I do to prevent these arrhythymias. I don't drink, smoke, have sleep apnea, exercise every day for 90 minutes, am at a low normal weight, eat right, take my meds, try to be positive, advocate for myself and still I have to deal with this variation in NSR about 30% of the time. I wish you luck with your results. I truly feel your frustration! I too found the recovery from the ablation was not bad, but I was bruised from knee to hip at the femoral vein sight and it took nearly 3 weeks for the bruising on my hands from the IV sites to disappear! Please let us know how you make out; I am anxious to hear what they tell you when you go back for a follow-up!

It is frustrating for sure. I am sorry you are going through this with your providers. I am going to live in atrial tachycardia I think. Fortunately, I take metoprolol for rate control and eliquis and I am able to live without issues mostly. I also eat well, exercise and avoid all caffeine, alcohol, gluten and only eat a little sugar. I have been told my arrhythmia issues are most likely genetic since my older siblings all had or have afib. I have come to accept it. Honestly I didn’t have good results with drugs. Sotalol caused pauses and didn’t keep me in sinus rhythm. My sister almost died from taking Tycosin so I won’t take it and the only other two meds are for end of life afib. The side effects of the drugs are potentially worse than the afib. Learning to manage arythmia is important as is being your own advocate. I know what to do if my heart rate goes up and stays up - take a little more metoprolol. My blood pressure and cholesterol are good. I had breast cancer i. 2025 and three surgeries and on hormone therapy for that for 5 years so I trying to find a good balance and staying positive for my heart and my body. I just turned 71. Stay strong and positive and keep your outlook a good one. Do some gentle yoga and deep breathing and keep your body strong and your heart muscle strong. We can only do what we can do and then embrace life and live every moment happy.