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

Hi Cat Mom, I cured my Afib with exercise 6 days out of 7 for months.,.. so there's hope that you can at least control it better on lower doses of meds and feel better. It's those damned meds that make us feel lousy.
You say you are pre-diabetic. I am wondering if you are on statins for high cholesterol…which cause diabetes.
To my thinking, Afib is constant. At least for me it was. 24 hours a day my heart was wonky…not just rare episodes.
I wouldn't worry about your sodium level dropping. It's normal to happen especially in runners who drink too much water…or in your case drinking like crazy. Live and learn.
Are you no longer drinking coffee, tea, stimulants of any kind, chocolate, sugar, alcohol, smoking etc…? If I touch any of these things I will start to feel skipped beats and thumps and there is NO WAY I ever want to go back to Afib and beta blockers. Believe it or not, I have a friend with Afib and he would rather take drugs to control it than give up his wine and coffee…

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@afrobin

Hi Cat Mom, I cured my Afib with exercise 6 days out of 7 for months.,.. so there's hope that you can at least control it better on lower doses of meds and feel better. It's those damned meds that make us feel lousy.
You say you are pre-diabetic. I am wondering if you are on statins for high cholesterol…which cause diabetes.
To my thinking, Afib is constant. At least for me it was. 24 hours a day my heart was wonky…not just rare episodes.
I wouldn't worry about your sodium level dropping. It's normal to happen especially in runners who drink too much water…or in your case drinking like crazy. Live and learn.
Are you no longer drinking coffee, tea, stimulants of any kind, chocolate, sugar, alcohol, smoking etc…? If I touch any of these things I will start to feel skipped beats and thumps and there is NO WAY I ever want to go back to Afib and beta blockers. Believe it or not, I have a friend with Afib and he would rather take drugs to control it than give up his wine and coffee…

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Hi @afrobin. I tripped over your final sentence about a friend with Afib who doesn't want to give up his wine and coffee. I wish him well, given my experience. My Afib was diagnosed four years ago by a EKG in my annual physical, but I have never felt any symptoms. Nevertheless, I had a small stroke almost a year ago as a result of a blood clot formed in my heart. Since then, I have religiously obeyed the FDA-approved label on my Coumadin anticoagulant — no liquor at all and reduced consumption of coffee. Hated to abandon my vintner, but I don't want another stroke from alcohol thinning my anticoagulant into the danger zone.

I also appreciate your other observations, especially the one regarding statins. A friend has SVT and was experiencing periods of dizziness and lethargy, so her doctor took her off Simvastatin (because it conflicts too much with her antiarhythmic meds), transferred her to Lipitor and — in short order — cut that dose from 20mg a day to 10mg per day. As a result, less threat of intensifying her Diabetes-2 and, more important, no more dizzy spells for over a week now.

Martin

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@afrobin

Hi Cat Mom, I cured my Afib with exercise 6 days out of 7 for months.,.. so there's hope that you can at least control it better on lower doses of meds and feel better. It's those damned meds that make us feel lousy.
You say you are pre-diabetic. I am wondering if you are on statins for high cholesterol…which cause diabetes.
To my thinking, Afib is constant. At least for me it was. 24 hours a day my heart was wonky…not just rare episodes.
I wouldn't worry about your sodium level dropping. It's normal to happen especially in runners who drink too much water…or in your case drinking like crazy. Live and learn.
Are you no longer drinking coffee, tea, stimulants of any kind, chocolate, sugar, alcohol, smoking etc…? If I touch any of these things I will start to feel skipped beats and thumps and there is NO WAY I ever want to go back to Afib and beta blockers. Believe it or not, I have a friend with Afib and he would rather take drugs to control it than give up his wine and coffee…

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My cholesterol is average, not high. There was no reason for my afib except difficulty breathing (chronic bronchitis & mild asthma) or drinking wine with dinner. I have pretty much given up wine and coffee. I have tried them both since my diagnosis and they don't seem to trigger afib, but I'd rather be safe than sorry. I gave up chocolate, don't smoke, and am otherwise doing everything I used to do. I've always been active–biking, hiking, walking, and doing yard work, and eat a good Mediterranean diet that's mostly veggie with occasional fish or chicken. So yeah, I was in EXCELLENT health before all this heart garbage started.
My goal is to live long enough to see my grandchildren grow up (the youngest is 10 months) and to be able to travel to see them. That's it. Thanks for response.

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@catmom777

My cholesterol is average, not high. There was no reason for my afib except difficulty breathing (chronic bronchitis & mild asthma) or drinking wine with dinner. I have pretty much given up wine and coffee. I have tried them both since my diagnosis and they don't seem to trigger afib, but I'd rather be safe than sorry. I gave up chocolate, don't smoke, and am otherwise doing everything I used to do. I've always been active–biking, hiking, walking, and doing yard work, and eat a good Mediterranean diet that's mostly veggie with occasional fish or chicken. So yeah, I was in EXCELLENT health before all this heart garbage started.
My goal is to live long enough to see my grandchildren grow up (the youngest is 10 months) and to be able to travel to see them. That's it. Thanks for response.

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Hi @catmom777. Just to be clear, a wine or two a day didn't trigger my Afib. Instead, it neutralized my Coumadin anticoagulant medication so that my risk of bleeding went to the ceiling. To deal with that, my medical team had me drop my Coumadin for two days. When I went back on, a clot had already formed during those two days; it traveled up to the hippocampus in my brain, causing a "small stroke." Thankfully, the stroke symptoms have been been minor — slight imbalance when erect and walking, slight loss of memory, slight problem forming words. With physical therapy, my brain is learning again how my parts should work when I call on them, so the months-long recovery has begun. Martin

Liked by catmom777

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@predictable

Hi @catmom777. Just to be clear, a wine or two a day didn't trigger my Afib. Instead, it neutralized my Coumadin anticoagulant medication so that my risk of bleeding went to the ceiling. To deal with that, my medical team had me drop my Coumadin for two days. When I went back on, a clot had already formed during those two days; it traveled up to the hippocampus in my brain, causing a "small stroke." Thankfully, the stroke symptoms have been been minor — slight imbalance when erect and walking, slight loss of memory, slight problem forming words. With physical therapy, my brain is learning again how my parts should work when I call on them, so the months-long recovery has begun. Martin

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If you google The Nature of Things 'Cholesterol', the documentary bottom line is, "only a man in his forties who has had a heart attack should be on statins." https://www.cbc.ca/natureofthings/episodes/the-cholesterol-question
Very few of us were considered to have high cholesterol 15 years ago. But Big Pharma lowered 'normal' twice so that most people over 60 are according to them, statin candidates…and doctors toe the line. They have no choice. How can that be that ?… However, now cholesterol no longer seems to be the big deal Big Pharma would have you believe it is. It's CRP (c reactive protein) which is a marker of inflammation in the body. My husband who has had very high cholesterol since his twenties, (and refuses to take statins after watching the documentary) has normal CRP. He is a big walker, a good weight, doesn't smoke or drink and he eats plenty of vegetables.
Big Pharma declared that nearly all men over 60 and women over 75 are eligible for statins.
My elderly sister in law who at age 76 was a vibrant, big personality, younger than her years was put on statins for high cholesterol, lost weight from 140 down to 110 pounds, developed diabetes as a result of statin use, lost so much muscle mass and became very weak, fell and broke both hips and died last month…at age 80. Damned statins! And damned Big Pharma!

Liked by catmom777

REPLY
@predictable

Hi @catmom777. Just to be clear, a wine or two a day didn't trigger my Afib. Instead, it neutralized my Coumadin anticoagulant medication so that my risk of bleeding went to the ceiling. To deal with that, my medical team had me drop my Coumadin for two days. When I went back on, a clot had already formed during those two days; it traveled up to the hippocampus in my brain, causing a "small stroke." Thankfully, the stroke symptoms have been been minor — slight imbalance when erect and walking, slight loss of memory, slight problem forming words. With physical therapy, my brain is learning again how my parts should work when I call on them, so the months-long recovery has begun. Martin

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Wow. I didn't know that. My docs here haven't told me very much. I am taking Eliquis. I don't know if that's the same thing as Coumadin or not. The warning on the label says not to take aspirin and that daily drinking of alcohol can cause stomach bleeding. I only have about four ounces now occasionally–no more often than once a week. If I go out to dinner and someone else is driving I may have a little more. Some restaurants serve more wine than others do, but I always drink the whole glass. I'm sure it's never more than eight ounces and is usually six, so I haven't worried about it. I keep track of my heart rate after having wine and have noticed no change. It seems getting very tired or very anxious are the things that set me into afib, and usually not for long. Need to learn to meditate and do yoga I think. A lot of people have told me that. I'm kind of an anxious person by nature.
I'm glad your stroke wasn't worse. A guy I know here had no idea he was at risk and had a major stroke. If his GF hadn't been home (she's a nurse–his good luck) he would have died. He said his vision went black, he called to his GF, then he said he doesn't remember anything. He was in ICU for five days and doesn't remember any of it. I don't know if his vision ever came back fully. I know it did partially, but he had to quit his teaching job for a long time, like two years, and couldn't drive. He is the luckiest person I know though, aside from the stroke. So lucky to have survived it.
I hope you get back to full function after your rehab. I've heard stories some people get back to where it's like they never had a stroke.

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@kanaazpereira

Hi @1943,

Here’s some information from Mayo Clinic about AV (atrioventricular) node ablation:
https://www.mayoclinic.org/tests-procedures/av-node-ablation/pyc-20384978

You may also notice that I moved your message to this discussion as I thought it would be beneficial for you to connect with members who’ve discussed ablations for various cardiac conditions.
If you click on VIEW & REPLY in your email notification, you will see the whole discussion and can join in, meet, and participate with other members talking about their or their loved ones' experiences.

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Hi @kanaazpereira @1943
Thanks for posting the link. I clicked through but was a little disappointed that it offered very basic information. Years ago, my EP recommended this procedure which involves permanently removing the pace-making ability of your heart and replacing with a mechanical one. It is typically a last resort option and being in my early 60s then not something I wanted to consider seriously. The pacemaker he would use is something called a dual chamber Advisa DR MRI made by Medtronic. I was hoping someone on this forum has experience with this particular model. Another option for me now would be another ablation. I've already had 2 ablations (2017) which I thought worked really well but am starting to have more episodes that require cardioversions to convert. I am quite happy to go through another ablation if It will get me another couple of years. I have a particularly challenging case of left atrial flutter and the key is obviously have someone who is extremely skilled and experienced to perform the ablation. My second ablation took 11 hours, that's how difficult it was.
I still feel that I am too young to have a permanent pacemaker and would rather consider other options first. The thought of destroying the AV node just scares me — despite all assurances that the pacemaker does a great job and is entirely safe, etc. Then there is the hope that EPs will get even better at ablations and of other medical breakthroughs.
Mary

REPLY
@sayaboleh

Hi @kanaazpereira @1943
Thanks for posting the link. I clicked through but was a little disappointed that it offered very basic information. Years ago, my EP recommended this procedure which involves permanently removing the pace-making ability of your heart and replacing with a mechanical one. It is typically a last resort option and being in my early 60s then not something I wanted to consider seriously. The pacemaker he would use is something called a dual chamber Advisa DR MRI made by Medtronic. I was hoping someone on this forum has experience with this particular model. Another option for me now would be another ablation. I've already had 2 ablations (2017) which I thought worked really well but am starting to have more episodes that require cardioversions to convert. I am quite happy to go through another ablation if It will get me another couple of years. I have a particularly challenging case of left atrial flutter and the key is obviously have someone who is extremely skilled and experienced to perform the ablation. My second ablation took 11 hours, that's how difficult it was.
I still feel that I am too young to have a permanent pacemaker and would rather consider other options first. The thought of destroying the AV node just scares me — despite all assurances that the pacemaker does a great job and is entirely safe, etc. Then there is the hope that EPs will get even better at ablations and of other medical breakthroughs.
Mary

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Hi Mary, i can really relate to your concern. Ive had a total of 9 Ablations and had a pacemaker also. I was not Afib bur ventricular Tachacardia. I will say i truly had 2 very successful ablations i the early years. I then due to my EP dr moving tried a new one. I still believe to this day as i found out after the ablation that i did not need that one he was convinced he could get me off my meds with another ablation. I think he was something of a Maverick and tried to do to much. Well that was 2015 and by November 2017 i did not leave the hospital until. I received my new heart in jan 2018. They tried 5 more ablations but without success and i was getting shocked so much to keep me in rythum . So what im basically saying is if you have had great success with your current dr then trust him. Im still in contact with the dr i originally had for the first 2 ablations and after the fact i was talking to him and he never would have recommended an ablation since honestly i was doing great. With me if my first dr would have suggested it i would have trusted him and he was a type to only do what was needed. I learned a lesson. So my advice is if you have a great history with your current dr go with his or hers advice. If its a new dr i would get second opinions. Btw the dr that did the third ablation is not a Mayo dr. I personally trust all of the drs at Mayo i have worked with. Good luck and were here to help.

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I can give you my perspective, since I have had SVTs and Afib since my 20s when I eat gut intolerant foods. Certain foods set up systemic inflammation throughout my body giving me muscle ache, IBS, fatigue, and serious arrhythmias. Dairy products are a huge trigger. I had ablations in 2001, 2011 and Jan./2019, all unsuccessful. Since January's ablation, I am left with Mast Cell Activation Disorder, being since intolerant of most foods and meds. I react even to Savaysa, my anticoagulant that has no lactose filler. I believe that for the 5 hr procedure, I was given massive doses of broad spectrum antibiotic which in turn did no favors for my digestive system by killing off my microbiome. My heart is now recovering from Afib and arrhythmia, and my lifestyle is changed for the better. If you are experiencing any connection between eating and heart arrhythmia, I suggest you find a metabolic cardiologist. They will, among other things, check you for a genetic condition called MTHFR (40% of the U.S. population) and use an approach other than one so questionable for success. http://www.afibbers.org/resources/strategy.pdf

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Your situation is very familiar including the Afib…which thank God is cured.
How are your triglyceride levels, Lifewisemap?…an indication of how much inflammation is in the body.
I suffer from recurrent UTIs (bladder infections) with 32 rounds of antibiotics in 3 years…and have to be on a low histamine diet to reduce inflammation and I have to take particular supplements including powerful probiotics. As my various bacteria have become resistant to some antibiotics, I have to focus on mending my gut biome.

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@danab

Hi Mary, i can really relate to your concern. Ive had a total of 9 Ablations and had a pacemaker also. I was not Afib bur ventricular Tachacardia. I will say i truly had 2 very successful ablations i the early years. I then due to my EP dr moving tried a new one. I still believe to this day as i found out after the ablation that i did not need that one he was convinced he could get me off my meds with another ablation. I think he was something of a Maverick and tried to do to much. Well that was 2015 and by November 2017 i did not leave the hospital until. I received my new heart in jan 2018. They tried 5 more ablations but without success and i was getting shocked so much to keep me in rythum . So what im basically saying is if you have had great success with your current dr then trust him. Im still in contact with the dr i originally had for the first 2 ablations and after the fact i was talking to him and he never would have recommended an ablation since honestly i was doing great. With me if my first dr would have suggested it i would have trusted him and he was a type to only do what was needed. I learned a lesson. So my advice is if you have a great history with your current dr go with his or hers advice. If its a new dr i would get second opinions. Btw the dr that did the third ablation is not a Mayo dr. I personally trust all of the drs at Mayo i have worked with. Good luck and were here to help.

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@danah Thanks for sharing your story. I don't have the same problem you did but 9 ablations seems like a bit much. I know there are some EPs out there who have no problem with doing one after another and disagreement about how many is too much. I really don't think doctors can predict any outcomes, they can only hope for the best. I have been told that I have multiple circuits and another ablation will not help much. It is all subjective of course. The resident EP who did my cardioversion thought a 6 month frequency was too much! I am on the other hand quite happy that it has kept me in sinus for 6 months and will be thrilled to get another 6 before having to make a decision about what to do next since the choices aren't great. My current EP is not too keen on another ablation but then again he did not perform the two that I've had since he was not available. In my case ablations are not a permanent fix, just to buy me some time so if it gets be another couple of years it would be great. I might just stop at 3 though. I can always get another opinion and if necessary will seek one at Mayo. Mary

Liked by danab

REPLY

I am a female, 89 yrs. old in good health except have experienced tachycardia since 37 yrs. old. Now have Afib and have had medications from digitalis to now Metoprolol succinate 50mg. and having horrible time breathing, so have cut dose in half & calling doctor. I have decided to have an AV ( July1, 2019) depending solely on the pacemaker. I am so tired of all the meds and nothing is working especially the Metoprolol. This medicine has not given me quality of life. I hope that the AV will give me back some quality. Anyone have a similar condition?

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Hi:
If you are in great shape then I would definitely go and have it done. I am like you, I wouldn’t want to take all that medications. Take care

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@redhead63

Hi:
If you are in great shape then I would definitely go and have it done. I am like you, I wouldn’t want to take all that medications. Take care

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Dear Redhead63, Thanks. I dislike all medications and try to avoid them. magsmar

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@magsmar

I am a female, 89 yrs. old in good health except have experienced tachycardia since 37 yrs. old. Now have Afib and have had medications from digitalis to now Metoprolol succinate 50mg. and having horrible time breathing, so have cut dose in half & calling doctor. I have decided to have an AV ( July1, 2019) depending solely on the pacemaker. I am so tired of all the meds and nothing is working especially the Metoprolol. This medicine has not given me quality of life. I hope that the AV will give me back some quality. Anyone have a similar condition?

Jump to this post

hello magsmar, the reason, why the cardiologist gave you digitoxin, was , that the betablocker metoprolol alone didn't reduce the atrium fibrillation enough.. digitoxin inhibits the transport of the electric pulses through the AV-node, apart from other effects. especially for older people, like you, who might have a heart failure. you wrote that you are suffering from difficulties with breathing. this is maybe a symptom of heart failure. digitoxin needs time, the half-time is 6-7 days.

My situation is a bit different, 15 months ago I had AV Block -third degree. therefore I needed a pacemaker. the rate of the A-Fib's increased constantly. My heart deteriorated, most probably due to the influence of the fibrillations on the the right chamber (ventricel).
my cardiologist added digitoxin to the betablocker – bisoprolol. I was very "impressed", after 10 days no heart failure symptoms anymore. I'am 73 years old. a control echo of the heart confirmed. I was surprised to read, that digitoxin is also used in the US. it is very old (1885 painted Vincent v. Gogh his French doctor with a branch of digitalis purpurea) , it seems there is a renaissance. I'm very glad that it worked so well.

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