Afib eligibility for ablation

Posted by katiekateny @katiekateny, Oct 20, 2023

I am really hoping that I qualify for this ablation surgery. I really like the idea that success means no more eliquis and metoprolol. These drugs leave me with muscle weakness and I am short of breath. Don’t want to have to take these.

What criteria do they look for to be a good candidate? Anything I can do to increase my chances.

I see the surgeon on Nov 1

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

They want someone with few other/unmanaged co-morbidities. Diabetes, COPD, as examples, should be managed before attempting ablation. Usually, the same for mitral valve prolapse...get that fixed first because MVP can bring on AF (atrial fibrillation).

They look for sleep apnea, if diagnosed, or suspected, to be controlled. Ideally, weight lose if BMI upwards of 28, not strictly necessary, and a lot depends on the EP involved (electrophysiologist).

Blood pressure...the same. Etc, etc....

Again, some EPs will help when it's a bit risky, or likely to fail due to other problems, but ya gotta find them. Even so, and this is me personally, I would be averse to risking the catheter ablation while still grappling with other serious problems. Those cause stress on the heart, and if you're already in stress due to hypertension, immune compromised, etc, .....your choice as always, but you have to get it past a busy EP.

The other, more closely relevant matters are to do with the heart itself: minimal to moderate left atrial enlargement. If it's walls are too thick, that will cause valve problems, but also invites fibrosis (scarring), which the ablation will only compound. Also, the longer one is in persistent or permanent AF/Flutter, the more difficult it is for the EP to nip it. So, the wisdom, as with most disorders, is to deal with them as soon as possible. The earlier you get an EP to ablate the pulmonary vein ostia, for example, the less likely you are to see that unwanted atrial enlargement, which happens over time as the atrium fibrillates.

Does that help?

(Edit-added) BTW, few EPs will advise you to cease taking an anticoagulant. Even after a successful ablation, there is still a risk of clot formation which only gets worse over time as we age. Metoprolol, sure, no use in taking a channel blocker when you're nicely in NSR, but the anticoagulant becomes more important over time, just especially so if you have small bouts of arrhythmia. Consult your EP for that kind of advice.

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@gloaming

They want someone with few other/unmanaged co-morbidities. Diabetes, COPD, as examples, should be managed before attempting ablation. Usually, the same for mitral valve prolapse...get that fixed first because MVP can bring on AF (atrial fibrillation).

They look for sleep apnea, if diagnosed, or suspected, to be controlled. Ideally, weight lose if BMI upwards of 28, not strictly necessary, and a lot depends on the EP involved (electrophysiologist).

Blood pressure...the same. Etc, etc....

Again, some EPs will help when it's a bit risky, or likely to fail due to other problems, but ya gotta find them. Even so, and this is me personally, I would be averse to risking the catheter ablation while still grappling with other serious problems. Those cause stress on the heart, and if you're already in stress due to hypertension, immune compromised, etc, .....your choice as always, but you have to get it past a busy EP.

The other, more closely relevant matters are to do with the heart itself: minimal to moderate left atrial enlargement. If it's walls are too thick, that will cause valve problems, but also invites fibrosis (scarring), which the ablation will only compound. Also, the longer one is in persistent or permanent AF/Flutter, the more difficult it is for the EP to nip it. So, the wisdom, as with most disorders, is to deal with them as soon as possible. The earlier you get an EP to ablate the pulmonary vein ostia, for example, the less likely you are to see that unwanted atrial enlargement, which happens over time as the atrium fibrillates.

Does that help?

(Edit-added) BTW, few EPs will advise you to cease taking an anticoagulant. Even after a successful ablation, there is still a risk of clot formation which only gets worse over time as we age. Metoprolol, sure, no use in taking a channel blocker when you're nicely in NSR, but the anticoagulant becomes more important over time, just especially so if you have small bouts of arrhythmia. Consult your EP for that kind of advice.

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Yes…I think I am just about perfect given the criteria you outlined.

I am only 25 lbs over weight. No metabolic issues of any kind. Don’t drink, don’t smoke. Don’t use illegal drugs.
This for sure started 8 years ago…maybe even back 20 years. First time I complained to a Doc was about 2015. But, I have only ever been episodic with periods between from weeks to hours and no pattern as to when. Each episode lasting only several minutes.

I read that my chances of success is pretty good. So, if the doc will have me..I will sign up.

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My story:
Severe left atrial regurgitation, atrial valve not opening properly, no comorbidities:

Everyone is different, but here is my experience for what it's worth. I had mitral valve repair, ablation, and LAAC at 78, over a year ago. No more AFIB (it can work permanently). I exercise and eat smartly (low in calories, sugar, salt, and caffeine). When I walk, I mediate by well-wishing for others. I also visualize my RNA, DNA, and all body systems being in good order. (I love order.) I got off of Eliquis after four months by wearing a heart monitor for 30 days to be sure AFIB was gone. I had to push my cardiologist to put me on the monitor. My last vital stats while sitting were 116/66, heart rate 66. I have also now weaned myself off of 12.5mg metoprolol daily and 81mg aspirin daily. (Read recent JAMA article that said low dose aspirin causes brain bleeding over time. Now it is recommended only for stroke and heart attack victims as I understand it. I have also read that metoprolol interferes with sodium and sugar levels. Too low an amount of sugar or salt can cause dizziness as I read it.) Vitals and alertness are better than ever. Daily, I do take a magnesium glycinate supplement containing 29% of RDA. Pure Encapsulations is the best brand I have found. I have read that magnesium and moderate exercise help folks to stay out of AFIB). I had a great surgeon at WakeMed in Raleigh, Dr. Boulton, who did all of the heart stuff. That was key of course. He also supports magnesium supplements. Overall, I feel extremely fortunate.
More: After a dizzy event about five months ago, where many tests found absolutely no signs of anything abnormal, my cardiologist wanted me to have a loop recorder implanted (standard recommendation I guess). I said no for a host of loop recorder concerns and have been fine as wine ever since. My best research indicated that the probable cause of my dizziness was the metoprolol I took that day. Off that now as I said and doing fine. Hope this helps. Also, everyone should read "Undoctored: Why Health Care Has Failed You and How You Can Become Smarter Than Your Doctor." I'm not saying that doctors are all wrong or all bad, just that you likely have the time to sort things out better than they can for your particular circumstances. Lastly, be sure to read "The AFIB Cure".

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I had this issue of AFIB about 30 years ago and the old cardiologist I went to was one of the pioneers in performing research on this procedure. He told me it was like "killing an ant with a sledge hammer".....in other words the fix is permanent. 30 years later they discovered on a heart catheterization that I had a Myocardial Bridge in my LAD causing my chest pains. Medical research say the two are not "cause and effect" but if you have had a heart cath or have one in the future make sure they rule out a Myocardial Bridge. Not all cardiologist are trained to recognize an MB so many are missed. The heart is an amazing organ with its own electrical system. Hopefully, you will be able to obtain the ablation procedure and stop the AFIB. Best of luck!

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Does anyone have any experience or thoughts with having a bundle branch block.? I was diagnosed with that years ago when taken to the ER because of having a Rx drug reaction. It was an aside comment by the team taking me to the ER. When I followed up with my "then cardiologist" I was told essentially it was not anything to worry about. Now with on again/off again aFib and having a recent exam my new preferred provider told me the bundle branch block at could be impacting my test results. It wasn't in my records that I even had one, I just happened to mention that. Odd timing but the next day I was reading some background history of an MD at one of the major US hospital systems -- one of his specialties was "treatment of bundle branch blocks" this is the first time I ever knew there could be "treatment for that"

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My 93 year old father had a fainting spell four hours after an angiogram to determine if he was suitable for a TAVR (Trans Aortal Valve Replacement). When he was in the ambulance and had been ECG'd, the EMT came out and told us he would need to go back for observation, and he seemed to show a right bundle branch block. He shrugged it off as innocuous, and we picked up our dad six hours later, apparently not likely to have low BP again. Five weeks later, he had the TAVR, and was none the worse for wear. Nobody ever expressed reservations over the RBBB.

It should be understood that AF will not kill a person. It may, often will, lead to atrial enlargement and eventually heart failure, as all the credible websites and posted research states. But, that's well down the road. Additionally, while it will not cause a person to die any time soon, it can bring on other conditions, mainly when the rate is above 100 BPM, the accepted upper limit for 24/7 heart function. If untreated heretofore, a competent physician/specialist would almost certainly prescribe both an anticoagulant to minimize the risk of stroke AND a rate reduction medication such as metoprolol, a calcium channel blocker (Beta Blocker). As suggested two posts higher, one must monitor BP and watch for fainting and dizziness when on metoprolol. When an otherwise healthy and fit heart is on too much metoprolol, it can slow the heart too much, say under 40 BPM, and lead to syncope.

As always, bone up on the various topics, make a list of questions, keep an observation/event log, and discuss what you have learned, or what you need to know more about, with a qualified physician/nurse practitioner with expertise in the associated subject matter.

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My cardiologist sent me to a surgeon for an ablation after one year of episodes and four ER visits. I had it July 12 and now the episodes have decreased after the first three months. But you must take the blood thinner for ever plus the metoprolol too. But the operation was easy, an in and out in 6 hrs and a ten day recovery. Make sure you get a specialist in ablation surgery. Mine was David Strouse in Arlington VA. Good luck.

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My AFIB and getting off drugs story:
I had AFIB, severe left atrial regurgitation, atrial valve not opening properly, no comorbidities.

Everyone is different, but here is my experience for what it's worth. I had mitral valve repair, ablation, and LAAC at 78, over a year ago. No more AFIB (it can work permanently). I exercise and eat smartly (low in calories, sugar, salt, and caffeine). When I walk, I meditate by well-wishing for others. I also visualize my RNA, DNA, and all body systems being in good order. (I love order.) I got off of Eliquis after four months by wearing a heart monitor for 30 days to be sure AFIB was gone. I had to push my cardiologist to put me on the monitor. My last vital stats while sitting were 116/66, heart rate 66. I have also now weaned myself off of 12.5mg metoprolol daily and 81mg aspirin daily. (Read recent JAMA article that said low dose aspirin causes brain bleeding over time. Now it is recommended only for stroke and heart attack victims as I understand it. I have also read that metoprolol interferes with sodium and sugar levels. Too low an amount of sugar or salt can cause dizziness as I read it.) Vitals and alertness are better than ever. Daily, I do take a magnesium glycinate supplement containing 29% of RDA. Pure Encapsulations is the best brand I have found. I have read that magnesium and moderate exercise help folks to stay out of AFIB). I had a great surgeon at WakeMed in Raleigh, Dr. Boulton, who did all of the heart stuff. That was key of course. He also supports magnesium supplements. Overall, I feel extremely fortunate.
More: After a dizzy event about five months ago, where many tests found absolutely no signs of anything abnormal, my cardiologist wanted me to have a loop recorder implanted (standard recommendation I guess). I said no for a host of loop recorder concerns and have been fine as wine ever since. My best research indicated that the probable cause of my dizziness was the metoprolol I took that day. Off that now as I said and doing fine. Hope this helps. Also, everyone should read "Undoctored: Why Health Care Has Failed You and How You Can Become Smarter Than Your Doctor." I'm not saying that doctors are all wrong or all bad, just that you likely have the time to sort things out better than they can for your particular circumstances. Lastly, be sure to read "The AFIB Cure".

REPLY
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