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

@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?

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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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@magsmar

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

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After emergency check in, 6/10/19, full of fluid, hardly able to breathe (dumb me), I had the AV ablation, June 11. Having some physical adjustments in recovery. My pacemaker is set for 82 and doctor will lower to 72 in a week then to 62 a week after that. Have a dry cough, PVCs once in awhile, lower back ache (left kidney area), taking lasix and potassium, no beta blockers, taking Xarelto & supplements. Checkiing with PCP Monday. Praying that all (evens out)!

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I am an 82 year old male in good health and condition and have been having afib for about one year and 19 occurances The most recent month I have had 4 occurrences and the last one lasted 17.5 hours. I have been hoping to figure out what is causing it; too many supplements, stress, sleep, diet, etc., but am not having any luck so far. I have heard that a new trend is to use ablation instead of medication. When should I consider medication and/or ablation since afib is probably causing heart damage?

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I'm 67 and was diagnosed with AFib 5 years ago after I received a stent for a blockage. It started when I experienced some fluttering, was put on meds and that has managed the Afib very well. Had a check up 6 months ago no problem, had an exam one Monday with ECG my heart was in Afib, I had no idea I felt great. My cardiologist ordered blood thinners, maintained my normal meds and then suggested Ablation. Seemed like a real jump to me but I let him refer me to the University of Missouri Medical Center. I've never had any major issues even though my heart very infrequently has gone into Afib (haven't experienced any fluttering since I've been on meds) and I'm very active. I'm a little concerned regarding the risks and success rates of Ablation. I'm also concerned about the cost, I'm retired on Medicare + supplement and I'm really leaning towards just maintaining through medication. Looking for everyones thoughts.

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@bikermo

I'm 67 and was diagnosed with AFib 5 years ago after I received a stent for a blockage. It started when I experienced some fluttering, was put on meds and that has managed the Afib very well. Had a check up 6 months ago no problem, had an exam one Monday with ECG my heart was in Afib, I had no idea I felt great. My cardiologist ordered blood thinners, maintained my normal meds and then suggested Ablation. Seemed like a real jump to me but I let him refer me to the University of Missouri Medical Center. I've never had any major issues even though my heart very infrequently has gone into Afib (haven't experienced any fluttering since I've been on meds) and I'm very active. I'm a little concerned regarding the risks and success rates of Ablation. I'm also concerned about the cost, I'm retired on Medicare + supplement and I'm really leaning towards just maintaining through medication. Looking for everyones thoughts.

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I had an ablation in 2014 for aFib at Mayo Clinic ( St. Mary’s Hospital). I had many episodes and cardioversion prior to ablation. I took Flecainide and propranolol. That controlled my PVC’s well, but still had AFib episodes. Most would self convert after a few hours. But the Flecainide after taking just 1 dose, I could feel pauses. I would get light headed. After putting up w it for 5 yrs, my Doctor, ordered a 14 day zio patch and discovered what I already knew..pauses lasting 3-4 seconds. That’s called AV Node disfunction..or Sick Sinus Syndrome. It’s kind of the chicken or the egg scenario. Did aFIB cause it or did I have SSS already & meds brought on symptoms. So Mayo’s gave me a pacemaker and got rid of pauses…I feel so much better. Plus, I was switched to Sotalol. Flecainide made me feel bad all the time. My aFib is controlled much better now. I still have an episode a few times a yr, but they self convert. I will never not have aFib because I had mitral valve repair 25 yrs ago, and when you have scar tissue in your heart, aFib can be result. But I have no complaints…lots of energy…I walk on treadmill 35-40 min. a day.
My advise is if you go ahead w ablation, make sure the Doctor does this procedure many times a month…experience matters. If you haven’t tried other meds, you might ask about Sotalol and Ditiazem..that combo really helped me so far. Hope this info help you move forward w your big decision.

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@bikermo

I'm 67 and was diagnosed with AFib 5 years ago after I received a stent for a blockage. It started when I experienced some fluttering, was put on meds and that has managed the Afib very well. Had a check up 6 months ago no problem, had an exam one Monday with ECG my heart was in Afib, I had no idea I felt great. My cardiologist ordered blood thinners, maintained my normal meds and then suggested Ablation. Seemed like a real jump to me but I let him refer me to the University of Missouri Medical Center. I've never had any major issues even though my heart very infrequently has gone into Afib (haven't experienced any fluttering since I've been on meds) and I'm very active. I'm a little concerned regarding the risks and success rates of Ablation. I'm also concerned about the cost, I'm retired on Medicare + supplement and I'm really leaning towards just maintaining through medication. Looking for everyones thoughts.

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I'm 70. Let me start off by saying that for 45 years I've had every type of PVC, palpitation, skipping, jumping, floundering around, fluttering, hesitating, twinging sensations and on and on known to man and then some, and feel every one of them. Some, very scary. I endured them all at work and at play. Doctors always passed them off as semi-normal and never really told me what they were all about or any explanation for them. Over the years my heart would on occasion kick in and race very rapids for 10-15 seconds but would always go back to normal beat. One of these sensations hit me 8 years ago when I was at work. I felt it certainly, but this time it didn't let up. Lasted for 14 hours at a rate of 200-plus bpm. I let it go and told my family doctor about it. He asked me if I wanted to see a cardiologist and I said no, not at this time. Well, the racing started coming on at about a rate of 30-45 days in between episodes. Finally went to see a cardiologist about it. They gave me the standard tests to see how strong my heart was. Ultrasounds, ekg's, holter monitors. They could see all the palpitations but of course no AFIB was evident. To make a long story short I was finally diagnosed with paroxysmal AFIB after having several more episodes. I don't like a lot of medications so I only took a blood thinner and a beta blocker. Didn't take a couple of the other medications they prescribed because of the possible side effects. Anyway, episodes began to be more frequent. Cardiologist advised me that maybe an ablation was in order. I thought about it and researched it. And decided to have it done, especially since my heart would race way up there and no medication was touching it to slow it down. It always would let up on its own, but the feelings and sensations my heart would give me just before and after I went into AFIB were miserable. I had the ablation done in June of 2019, and in fact, I had a severe episode the night before. They took excellent care of me during pre-op and when I reached the operating room arena there were people coming out of the woodwork to wire me up, prep me and make me comfortable. I had no fears. I'm a Vietnam Veterans so I took it in stride. Procedure took a little over 4 hours and I was going home the next day after spending the night. To date I have had no further episodes except for an occasional burst of speed which is scary because I don't want this to come back. However, I am still left with thousands Palpitations every day but I still get through them. Refused any further medications for it. Maybe down the line. They are still scary sometimes but I just live with it. Depending on your situation, how many episodes and how fast your bpm's are during the episode I would seriously consider having it done. Mine was getting REALLY bad and more frequent and would have eventually worn my heart done.

Liked by robbie1956

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@bikermo

I'm 67 and was diagnosed with AFib 5 years ago after I received a stent for a blockage. It started when I experienced some fluttering, was put on meds and that has managed the Afib very well. Had a check up 6 months ago no problem, had an exam one Monday with ECG my heart was in Afib, I had no idea I felt great. My cardiologist ordered blood thinners, maintained my normal meds and then suggested Ablation. Seemed like a real jump to me but I let him refer me to the University of Missouri Medical Center. I've never had any major issues even though my heart very infrequently has gone into Afib (haven't experienced any fluttering since I've been on meds) and I'm very active. I'm a little concerned regarding the risks and success rates of Ablation. I'm also concerned about the cost, I'm retired on Medicare + supplement and I'm really leaning towards just maintaining through medication. Looking for everyones thoughts.

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@bikermo Hi and welcome to connect, we are a group of patients that have experienced various health concerns and we share our experiences to help others. I did not have afib but i have had quite a few ablations. My more detailed story is in an earlier post on this thread about may of 2019. But in a nutshell I've had some very successful ones and some that were less successful. My particular issue was a condition called VT for short but basically a really fast heartbeat.
So based on the 2 very successful ones and some not successful ones the doctor i found who knew when medication was best and when an ablation was beast. Thru my experience I've seen two types those that think ablation is always the answer and the ones that use a combination of therapies. The one that for me was the most knowledgeable was when they would weight the advantages of Medicine, pacemaker and ablation and not rely on just one treatment plan. I also will add that within the EP arena there are two types those that specialize on afib and ones that are more for my area of VT. I actually was referred once to one that was experienced with afib and refered me to one who was better quilified in vt.
On the Medicare issue i am on medicare with tricare for life secondary and at least for my situation now which is as a heart transplant recipient is working very well. O was on another insurance plan when i was getting ablations but I do know if your working with Mayo Clinic they do take Medicare and im Sure if you get in contact with the facility that would do it they can probably figure out the out of pocket. Ill also hive one more plug for Mayo. Since getting my transplant here i do like there approach to making sure you are advised as to all options available as to treatment options. They use a team approch which with my prior heart they did do my last ablation and due to what they saw were able to help me decide as to where to go next. Please ask any questions you like.

Have a Blessed Day
Dana

Liked by robbie1956

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@danab @bikermo it sounds like both of you have been through so much I can’t even imagine what I’d be like..
I’ve been getting episodes of skips and racing and belching and sometimes it feels like my stomach is right up in the top part of my upper abdomen , today it’s been especially bad…I’ve had episodes like these in the past that can last for weeks into a couple of months…been seen, tested seen and more tested…then they go away…this belching, PPI use and nerves just wreak havoc on my nerves…last EKG showed left axis deviation….normal sinus rhythm, left anterior fascicular block…waiting to see my Cardiologist on the 30th. Anxious, took an extra half of klonopin tonight to quite the nerves…God I hate these episodes, after all these years, you’d think I could cope better…but my hat is off to both of you fellas…..mine seem like small stuff to what you have been through…please good luck and reply if you feel like it ….thanks

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@crashnam

I'm 70. Let me start off by saying that for 45 years I've had every type of PVC, palpitation, skipping, jumping, floundering around, fluttering, hesitating, twinging sensations and on and on known to man and then some, and feel every one of them. Some, very scary. I endured them all at work and at play. Doctors always passed them off as semi-normal and never really told me what they were all about or any explanation for them. Over the years my heart would on occasion kick in and race very rapids for 10-15 seconds but would always go back to normal beat. One of these sensations hit me 8 years ago when I was at work. I felt it certainly, but this time it didn't let up. Lasted for 14 hours at a rate of 200-plus bpm. I let it go and told my family doctor about it. He asked me if I wanted to see a cardiologist and I said no, not at this time. Well, the racing started coming on at about a rate of 30-45 days in between episodes. Finally went to see a cardiologist about it. They gave me the standard tests to see how strong my heart was. Ultrasounds, ekg's, holter monitors. They could see all the palpitations but of course no AFIB was evident. To make a long story short I was finally diagnosed with paroxysmal AFIB after having several more episodes. I don't like a lot of medications so I only took a blood thinner and a beta blocker. Didn't take a couple of the other medications they prescribed because of the possible side effects. Anyway, episodes began to be more frequent. Cardiologist advised me that maybe an ablation was in order. I thought about it and researched it. And decided to have it done, especially since my heart would race way up there and no medication was touching it to slow it down. It always would let up on its own, but the feelings and sensations my heart would give me just before and after I went into AFIB were miserable. I had the ablation done in June of 2019, and in fact, I had a severe episode the night before. They took excellent care of me during pre-op and when I reached the operating room arena there were people coming out of the woodwork to wire me up, prep me and make me comfortable. I had no fears. I'm a Vietnam Veterans so I took it in stride. Procedure took a little over 4 hours and I was going home the next day after spending the night. To date I have had no further episodes except for an occasional burst of speed which is scary because I don't want this to come back. However, I am still left with thousands Palpitations every day but I still get through them. Refused any further medications for it. Maybe down the line. They are still scary sometimes but I just live with it. Depending on your situation, how many episodes and how fast your bpm's are during the episode I would seriously consider having it done. Mine was getting REALLY bad and more frequent and would have eventually worn my heart done.

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I'm a vet too and don't really have fear of doing it but I have concern whether it's actually needed and if I decide to have it done it making things worse. I also want to know what my costs will be, seeing the posts that people have had multiple ablation treatments and being on a fixed income that concerns me. The meds are handling it now and I never really feel fluttering or racing as others here have described so I feel blessed. I worked in healthcare in management 41 years, my wife's a RN running one day surgeries for the hospital I retired from, one of my daughters is a NP and the other is a CNA both working for the VA. I know healthcare and doctors which doesn't cure any anxiety on my part or my questioning the process. I appreciate your response and it helped. I also want to thank Mayo for the support and information they provide to patients, in my 41 years working as a leader in a hospital Mayo was the institution we aspired to be like! Thank you!

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@bikermo

I'm 67 and was diagnosed with AFib 5 years ago after I received a stent for a blockage. It started when I experienced some fluttering, was put on meds and that has managed the Afib very well. Had a check up 6 months ago no problem, had an exam one Monday with ECG my heart was in Afib, I had no idea I felt great. My cardiologist ordered blood thinners, maintained my normal meds and then suggested Ablation. Seemed like a real jump to me but I let him refer me to the University of Missouri Medical Center. I've never had any major issues even though my heart very infrequently has gone into Afib (haven't experienced any fluttering since I've been on meds) and I'm very active. I'm a little concerned regarding the risks and success rates of Ablation. I'm also concerned about the cost, I'm retired on Medicare + supplement and I'm really leaning towards just maintaining through medication. Looking for everyones thoughts.

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Hi @bikermo. I'm a little older (85) than you. Your AFib situation seems a lot like mine — no obvious symptoms as long as I'm faithful to my medication regimen. It's been that way for almost all of my 6 years after AFib was diagnosed by my PCP after an EKG during my annual physical. Three close friends in my age group have AFib, and after troubling physical symptoms, they chose ablation. So far as I know, they're fine with it now, several years after their original diagnosis.

With me, ablation is two or three levels removed from my current therapy — 1) a beta blocker to control BP, soften heart contractions, and stabilize heart rhythm; 2) anticoagulant (Coumadin) to prevent blood clots, and 3) two BP meds (Lisinopril and a diuretic, Amiloride). I chose Coumadin at the outset because an antidote was available for that but not for newer popular anticoagulants. (That's different now — antidotes are emerging for a few more anticoagulants).

I'm blown away by the extent of competent medical advice available within your family; this may be your other most important advantage (in addition to the asymptomatic arrhythmia). Working only with medical professionals at my HMO, I'm otherwise alone scientifically, so I don't have your challenge of organizing a large consulting group to advise you on the question of ablation. I'd give a lot to have your advantage of such a rich collection of medical expertise to guide me. Martin

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