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?

Liked by catmom777

My advice is don’t take ablation lightly- it is becoming more common, when it works it is fabulous, but my husband has had nothing but very serious complications after ablation in a high volume center. When the risk was 1 in 100, he was the one. Had perforation of his heart, bleeding into pericardium with tamponade, pericardial tap (one complication) and also fevers, elevated white blood cell count, cough, resting pulse up to 100 with almost no exercise tolerance ( a different complication). It has been 8 weeks and he is finally starting to feel better, but has been a nightmare.

Hello Jimena,
I read the comments attached to your post and would like to weigh in with some thoughts. I had very similar experiences as you in regards to the meds prescribed for AF and SVT. Metoprolol was one that I didn’t respond well to. My side effects from the cocktail of PX drugs included anxiety, cramping in my legs, lethargy, dizziness (standing or sitting)

I was diagnosed with a few rhythm problems including: SVT (pulse would go to 220BPM), atrial fib and atrial flutter. I found the meds more and more difficult to deal with so I chose the ablation path. I ended up having 5 ablations, with similar experiences described by @vermontrob. The first 4 attempted ablations failed for a variety of reasons. After each one I would go back on meds, regroup and then come back for another attempt. The reason I was so stubborn about this is because my life on meds was becoming a hardship. I tried many combinations of drugs to control rate and rhythm and they all had their own set of side effects. My fifth ablation was a PVA- pulmonary vein ablation and it was successful. I am off all rate and rhythm drugs and I feel great.

I chose the ablation path because of the extensive research I had done learning about AF and discussing it with my electrophysiologist. I had paroxysmal Afib-the kind that stops on its own after a few minutes, hours or days. There are two other kinds: persistent Afib which needs intervention to stop (medications or electric shock) and permanent Afib that cannot be corrected.

The nature of Afib is that over times it progresses and can become permanent. It is interesting to note that the Paroxysmal Afib has the most symptoms. My rate and rhythm were becoming more challenging to deal with using medication and I was becoming dependent on emergency room visits to get my heart into sinus. I was moving into persistent Afib. I knew that my failed ablations were an anomaly and that statistically I had a very good chance of having a successful ablation. I have a great deal of respect for my electrophysiologist and together we chose this course. I wish you luck and hope that you find a solution.

I have had afib for over a year took meds for it gone into afib several times had to stop working i am 59 a female i decided to have ablation surgery 3 wks ago 1 wk later went into afib plus got sick with lung infection from breathing tube still dont know if it helped yet been rough recovery dont think i would try again still on medications blood thinner beta blocker flecinie of some side effects see my doctor on fri see what happens next.

Thanks for sharing the seriousness of an ablation. Hope that your ablation strategy works out in the long run. More than one ablation may be necessary to solve your afib

@martishka

Hello Jimena,
I read the comments attached to your post and would like to weigh in with some thoughts. I had very similar experiences as you in regards to the meds prescribed for AF and SVT. Metoprolol was one that I didn’t respond well to. My side effects from the cocktail of PX drugs included anxiety, cramping in my legs, lethargy, dizziness (standing or sitting)

I was diagnosed with a few rhythm problems including: SVT (pulse would go to 220BPM), atrial fib and atrial flutter. I found the meds more and more difficult to deal with so I chose the ablation path. I ended up having 5 ablations, with similar experiences described by @vermontrob. The first 4 attempted ablations failed for a variety of reasons. After each one I would go back on meds, regroup and then come back for another attempt. The reason I was so stubborn about this is because my life on meds was becoming a hardship. I tried many combinations of drugs to control rate and rhythm and they all had their own set of side effects. My fifth ablation was a PVA- pulmonary vein ablation and it was successful. I am off all rate and rhythm drugs and I feel great.

I chose the ablation path because of the extensive research I had done learning about AF and discussing it with my electrophysiologist. I had paroxysmal Afib-the kind that stops on its own after a few minutes, hours or days. There are two other kinds: persistent Afib which needs intervention to stop (medications or electric shock) and permanent Afib that cannot be corrected.

The nature of Afib is that over times it progresses and can become permanent. It is interesting to note that the Paroxysmal Afib has the most symptoms. My rate and rhythm were becoming more challenging to deal with using medication and I was becoming dependent on emergency room visits to get my heart into sinus. I was moving into persistent Afib. I knew that my failed ablations were an anomaly and that statistically I had a very good chance of having a successful ablation. I have a great deal of respect for my electrophysiologist and together we chose this course. I wish you luck and hope that you find a solution.

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Five ablations- WOW. My husband is stable right now on Tikosyn, metoprolol and blood thinners at 3 months post ablation. He will be taken off tikosyn at 6 months to see if afib comes back, which he would hate. But another ablation? I can’t picture it, this experience was a nightmare. Fourteen days in the hospital, both of us frightened that his active and healthy life would be ruined.

Anyway, I can see that lots of people here have arrythmias that impact their lives more that my husband’s afib did, so make your choices just don’t think for a minute that it is a minor procedure.

@martishka

Hello Jimena,
I read the comments attached to your post and would like to weigh in with some thoughts. I had very similar experiences as you in regards to the meds prescribed for AF and SVT. Metoprolol was one that I didn’t respond well to. My side effects from the cocktail of PX drugs included anxiety, cramping in my legs, lethargy, dizziness (standing or sitting)

I was diagnosed with a few rhythm problems including: SVT (pulse would go to 220BPM), atrial fib and atrial flutter. I found the meds more and more difficult to deal with so I chose the ablation path. I ended up having 5 ablations, with similar experiences described by @vermontrob. The first 4 attempted ablations failed for a variety of reasons. After each one I would go back on meds, regroup and then come back for another attempt. The reason I was so stubborn about this is because my life on meds was becoming a hardship. I tried many combinations of drugs to control rate and rhythm and they all had their own set of side effects. My fifth ablation was a PVA- pulmonary vein ablation and it was successful. I am off all rate and rhythm drugs and I feel great.

I chose the ablation path because of the extensive research I had done learning about AF and discussing it with my electrophysiologist. I had paroxysmal Afib-the kind that stops on its own after a few minutes, hours or days. There are two other kinds: persistent Afib which needs intervention to stop (medications or electric shock) and permanent Afib that cannot be corrected.

The nature of Afib is that over times it progresses and can become permanent. It is interesting to note that the Paroxysmal Afib has the most symptoms. My rate and rhythm were becoming more challenging to deal with using medication and I was becoming dependent on emergency room visits to get my heart into sinus. I was moving into persistent Afib. I knew that my failed ablations were an anomaly and that statistically I had a very good chance of having a successful ablation. I have a great deal of respect for my electrophysiologist and together we chose this course. I wish you luck and hope that you find a solution.

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Hello vermontrob,

I think I should qualify that statement of “5 ablations”. I had 4 attempted ablations- since they weren’t able to complete the procedure (for a variety of reasons) they are not actually “ablations” – more of a mapping of the heart. These 4 were the simpler kind, they made a small incision in my groin and snaked up to the heart and I was awake, sedated but awake!. In two of these attempts they were unable to find the origin of the rogue electrical impulse that was setting off my heart rate and in turn heart rhythm. Because of this the assumption was that the rogue signal(s) were originating in one of my pulmonary veins and it was recommended that I have a PVA (pulmonary vein ablation) I think that this is becoming the gold standard to cure aFIb. I would caution not to compare each experience that we read about at this site as the norm, but instead, as a little bit of information to investigate and question. I was born with a heart rate problem. As a child, when I was playing hard my heart rate would shoot up. I struggled with this throughout university, particularly in stressful situations (where I was presenting ) I was diagnosed in my mid 20’s with the electrical rate problem which was treated with drug therapy. And I had my first ablation in my late 40’s (I am 66). In my 50’s I developed AF, which is not uncommon at that age. My problem was that my heart rate problem was exacerbating the heart rhythm problem. I was becoming a regular guest at emergency and when I entered was often greeted by a nurse or knew exactly what to do for me- a slow verapamil drip, a little ativan, and no one threatening to “paddle” me! The symptoms, with all kinds of drug cocktails were becoming unbearable and life limiting- I sail and it was difficult to take off to remote areas under those conditions. I would like to caution that my experience was complicated and yes, emotionally difficult to deal with when procedures kept failing. But , as I mentioned before, I have great respect for my electrophysiologist who has been my doctor for over 20 years. We came to this decision after many conversations and questions on my and my husband’s part. I am delighted that I did!

I wish your husband luck and hope that he finds a solution soon.
best,
martishka

Reading with interest comments by my fellow heart patients. I have had a rough summer and fall. Hospitalized twice for afib. Second time I was taken to hospital by ambulance. I had been in Dr.office, unrelated to my heart condition and the nurse informed me that my pulse was 160 and she was having trouble finding my blood pressure. Fast forward; my Dr. told me that my HCM does not lend itself to another ablation procedure. I have had two and each one gave me two years of freedom from afib. I was cardioverted to get back in syn and am now on a drug call Norpace. In addition I have been taking .20mg of metoprolol and .20 of a water pill. I am now and have been in sync. However this drug gives me terrible stomach gas, makes me constipated and I do not have much energy. I have also lost about 10 pounds. From 182 to 172. I am 80 plus. Have been physical active all my life. Is anyone taking this drug and do you have similar symptoms. Thanks.

@colleenyoung

Welcome @jimana,
Thanks for the details of your very recent events. I can imagine that your anxiety is high. This is all so very new. A number of members have asked about ablation and others have shared their experiences. Check out this discussion https://connect.mayoclinic.org/discussion/i-was-just-diagnosed-with-svt-and-cant-seem-to-find-any/ where you’ll meet @martishka, @topaz @gonefishinmt.

Also see this discussion thread where @billmichalski @twptrustrek @jhoffmanj are discussing AFib issues https://connect.mayoclinic.org/discussion/good-morning-im-almost-66-years-old-with-infrequent-afib-and-on/

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jimana, I learned a great deal from your experiences. However you did not elaborate on the hyper thyroid aspect. My wife had an afib bout and was diagnosed as having an over active thyroid. She is being treated by a cardiologist and an endocrinologist. On the ablation issue, you may see from other comments I have made that my two procedures went well. That is I was two years between having afib issues. It is really discouraging sometimes to have to live with the spectre of your heart goinh out of whack and the very unpleasant side effects these meds produce. Good luck.

@colleenyoung

Welcome @jimana,
Thanks for the details of your very recent events. I can imagine that your anxiety is high. This is all so very new. A number of members have asked about ablation and others have shared their experiences. Check out this discussion https://connect.mayoclinic.org/discussion/i-was-just-diagnosed-with-svt-and-cant-seem-to-find-any/ where you’ll meet @martishka, @topaz @gonefishinmt.

Also see this discussion thread where @billmichalski @twptrustrek @jhoffmanj are discussing AFib issues https://connect.mayoclinic.org/discussion/good-morning-im-almost-66-years-old-with-infrequent-afib-and-on/

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Thanks for your comments @jhoffmanj. We’re always learning and if we’re not, we might as well go out and eat grass with the cows one one of my teachers often said. Since you mention the thyroid gland, my wife’s experience may be of benefit to someone. After having a heart attack in 2003, she had a recurring A-fib problem and as we travelled around the country in our motor home, we would find ourselves in some ER in the middle of the night from the east coast to the west coast. She was taking Synthroid at the time and a cardiologist who was filling in for her doctor said that too much thyroid hormone might be the problem. We stopped it and she was A-fib free for several years. This fact may help someone: a doctor later on said she needed to take something for her thyroid and prescribed an unusual form – Tirosint – which uses an oil-based delivery system. She tolerated it well and it worked like a charm. Two more bits of info from my situation: (1) I learned some months after my repeated A-fib episodes that excessive vitamin D levels can bring on A-fib. I had been taking 10K units a day and that may well have triggered my A-fib. (2) I learned from my old friend, Mr. Google, that older men who have been using men’s progesterone cream for prostate help for more than five years can send them on an A-fib journey. Needless to say I reduced my D3 and cut out the progesterone.

@nadine66

Hi. I had cardiac ablation 10 days ago to try to elimi ate my A- fib. Im still scared it wont stop. Ive had two small episodes since that lasted 2-4 hours. Im afraid somehow ill set it off.

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We were told that the ablation cannot be judged re: working or not working for months- I recall 3 months and 6 months, so not sure which. The ablation I believe cauterizes multiple sites around pulmonary arteries and veins, and it is the scar tissue that prevents pathways for afib to pass. So until the burns caused by ablation have healed and formed scar tissue, you can’t tell if afib will return. It is scary, but you need to give it time. Hope this helps.

@jhoffmanj

Reading with interest comments by my fellow heart patients. I have had a rough summer and fall. Hospitalized twice for afib. Second time I was taken to hospital by ambulance. I had been in Dr.office, unrelated to my heart condition and the nurse informed me that my pulse was 160 and she was having trouble finding my blood pressure. Fast forward; my Dr. told me that my HCM does not lend itself to another ablation procedure. I have had two and each one gave me two years of freedom from afib. I was cardioverted to get back in syn and am now on a drug call Norpace. In addition I have been taking .20mg of metoprolol and .20 of a water pill. I am now and have been in sync. However this drug gives me terrible stomach gas, makes me constipated and I do not have much energy. I have also lost about 10 pounds. From 182 to 172. I am 80 plus. Have been physical active all my life. Is anyone taking this drug and do you have similar symptoms. Thanks.

Jump to this post

@jhoffmanj, I’m sorry to hear that you’ve had such a rough patch. Are you on the upswing to better health now?
I want to let you know that there is now a specific HCM group on Connect. I hope you’ll also join us there https://connect.mayoclinic.org/group/hypertrophic-cardiomyopathy-hcm/

@martishka

Hello Jimena,
I read the comments attached to your post and would like to weigh in with some thoughts. I had very similar experiences as you in regards to the meds prescribed for AF and SVT. Metoprolol was one that I didn’t respond well to. My side effects from the cocktail of PX drugs included anxiety, cramping in my legs, lethargy, dizziness (standing or sitting)

I was diagnosed with a few rhythm problems including: SVT (pulse would go to 220BPM), atrial fib and atrial flutter. I found the meds more and more difficult to deal with so I chose the ablation path. I ended up having 5 ablations, with similar experiences described by @vermontrob. The first 4 attempted ablations failed for a variety of reasons. After each one I would go back on meds, regroup and then come back for another attempt. The reason I was so stubborn about this is because my life on meds was becoming a hardship. I tried many combinations of drugs to control rate and rhythm and they all had their own set of side effects. My fifth ablation was a PVA- pulmonary vein ablation and it was successful. I am off all rate and rhythm drugs and I feel great.

I chose the ablation path because of the extensive research I had done learning about AF and discussing it with my electrophysiologist. I had paroxysmal Afib-the kind that stops on its own after a few minutes, hours or days. There are two other kinds: persistent Afib which needs intervention to stop (medications or electric shock) and permanent Afib that cannot be corrected.

The nature of Afib is that over times it progresses and can become permanent. It is interesting to note that the Paroxysmal Afib has the most symptoms. My rate and rhythm were becoming more challenging to deal with using medication and I was becoming dependent on emergency room visits to get my heart into sinus. I was moving into persistent Afib. I knew that my failed ablations were an anomaly and that statistically I had a very good chance of having a successful ablation. I have a great deal of respect for my electrophysiologist and together we chose this course. I wish you luck and hope that you find a solution.

Jump to this post

Thanks martishka for sharing details of your journey. I appreciate your advice “I would caution not to compare each experience that we read about at this site as the norm, but instead, as a little bit of information to investigate and question.”
Spot on! This is exactly what Connect is meant to do. One should always question and get information specific to their situation.

@martishka

Hello Jimena,
I read the comments attached to your post and would like to weigh in with some thoughts. I had very similar experiences as you in regards to the meds prescribed for AF and SVT. Metoprolol was one that I didn’t respond well to. My side effects from the cocktail of PX drugs included anxiety, cramping in my legs, lethargy, dizziness (standing or sitting)

I was diagnosed with a few rhythm problems including: SVT (pulse would go to 220BPM), atrial fib and atrial flutter. I found the meds more and more difficult to deal with so I chose the ablation path. I ended up having 5 ablations, with similar experiences described by @vermontrob. The first 4 attempted ablations failed for a variety of reasons. After each one I would go back on meds, regroup and then come back for another attempt. The reason I was so stubborn about this is because my life on meds was becoming a hardship. I tried many combinations of drugs to control rate and rhythm and they all had their own set of side effects. My fifth ablation was a PVA- pulmonary vein ablation and it was successful. I am off all rate and rhythm drugs and I feel great.

I chose the ablation path because of the extensive research I had done learning about AF and discussing it with my electrophysiologist. I had paroxysmal Afib-the kind that stops on its own after a few minutes, hours or days. There are two other kinds: persistent Afib which needs intervention to stop (medications or electric shock) and permanent Afib that cannot be corrected.

The nature of Afib is that over times it progresses and can become permanent. It is interesting to note that the Paroxysmal Afib has the most symptoms. My rate and rhythm were becoming more challenging to deal with using medication and I was becoming dependent on emergency room visits to get my heart into sinus. I was moving into persistent Afib. I knew that my failed ablations were an anomaly and that statistically I had a very good chance of having a successful ablation. I have a great deal of respect for my electrophysiologist and together we chose this course. I wish you luck and hope that you find a solution.

Jump to this post

Thank you for the feedback, Colleen!

Hello, I am an 80 year old female with A-fib, I have had several cardioversions and one ablation, which works for a few years and/or a few days or months. I am getting prepared for a cryoablation next month, and I am having second thoughts about this procedure. My meds are 150 Flecainide bid, Metoprol 25 mg bid, Warfarin 5 mg, once daily, Memantine 10 mg once daily, Verapramil 3xdaily , Timilol once daily, Methocarbanol (I am not sure of all the spelling of all these miracle drugs.) My cardioligist said it was a “quality of life issue”. What are the pros and cons of my situation? Thank you for any information that you can offer.

@charlottemaxine Thanks for posting about A-fib and all of the treatments and the meds you have tried. If you look on this page you will see many Mayo Connect members have spoken about A-fib and their treatments as well as meds. I would like to invite some other members into this discussion who have also discussed treatments for A-Fib, @lalton @martishka @twptrustrek @jhoffmanj @irishblueileen @billmichalski @success101 and @nadine66. Also, you might be interested in this Mayo discussion on ablation: http://mayocl.in/28ReaNr. As you read their stories, please remember, however that everyone’s situation is different and not all people react in the same way to treatments or meds. Keep in touch with Mayo Connect. We are here to support you! Teresa

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