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?

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I had an ablation for a-fib and it has been great

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@johndl

I posted my story just a few hours before yours - see JohnDL. I'll add to this additional information based on what I understand is your situation (please understand I'm not a doctor). I had one ablation before the one that worked. The one that worked for me required the ablation to be performed in the left chamber. Since the doctor enters the heart thru the right chamber he "poked" a hole between the two chambers (it is something this group developed as I understand it). Check around as one must find a doctor who can do what you need done.

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Thanks so much for the info. All Ive had to listen to has been Doctors who seem to take forever to come up with a plan, then not giving me info on the plan. Ive had 2 episodes since the ablation but very short and not as intense. But no word of a plan going forward. I guess i will have to insist on some answers. I have several other problems going on butt I can't go into them right now I'll get back to you as things move along thanks again for your help.

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Never heard of an episode after the ablation think I willbe more observant the episodes are not fun

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Thanks for the reply and my problems. I also have COPD diabetes and that seems to have an effect to what the doctors want to do and getting them to get together to discuss what the next plan of action should be has been a real trip. I've had two small episodes A-fib since I had the ablation. They have been less intense and shorter an hour or so. My problem is getting all the specialized doctors together to decide on the next plan of action if we should do nothing and see if it completely stops or if I'm going to have to do the ablation again. Once again thank you for your input.

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@1pepper2

Never heard of an episode after the ablation think I willbe more observant the episodes are not fun

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Hi thanks for your comment I on the other hand have received a lot of<br>comments about people having to have the ablation two or three times. Until<br>they find the correct path whatever that means anyway they're not too<br>forthcoming with information that's why I got on the website and ask a few<br>questions I appreciate your comments and if you have anymore please I need<br>all the information I can get I have also COPD and diabetes and these<br>specialized doctors getting together to come up with a plan is a real job.<br>When they were going to do the operation they discovered I had an iron<br>deficiency. So that means another doctor in the mix. Wish me luck thanks<br>again.<br>

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@johndl

I posted my story just a few hours before yours - see JohnDL. I'll add to this additional information based on what I understand is your situation (please understand I'm not a doctor). I had one ablation before the one that worked. The one that worked for me required the ablation to be performed in the left chamber. Since the doctor enters the heart thru the right chamber he "poked" a hole between the two chambers (it is something this group developed as I understand it). Check around as one must find a doctor who can do what you need done.

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Thanks for your comments. I have heard from several people of that it has<br>taken more than one ablation to stop the AFib so I am talking to my Dr<br>about the whole situation I also have COPD and diabetes and late discovery<br>of iron deficiency so things have gotten complicated with Dr and getting<br>them all together to decide on a course of action. You are right I have to<br>be aware of the things going on and that involves asking questions and<br>hopefully getting answers. Thanks again for your comments I'll let you know<br>how things go.

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Sorry to learn of your episodes since the ablation. Again my second ablation was centered in the left chamber where It seems there were cells causing the heart to pump at the wrong time. The right chamber is where the equipment to kill cells must enter the heart.. Only by going thru the heart wall between the two chambers and entering the left chamber was the doctor able to get to the cells causing the problem. Last point, not all doctors get into the left chamber (my first doctor did not). But of course, I have no idea where or why your problem continues.

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Thanks for your reply and your honesty about your experience with A-fib. I have no idea whether my doctor has considered going in on the left or the right of my heart but it is something I will bring up and ask about and the only way we learn about what's going on is to ask questions. My other conditions have done nothing but complicate the matter. Getting all the doctors together to agree on a plan of action seems to take quite a bit of time. The only problem with that is that it makes me very nervous as time goes by and I don't know what anybody is going to do about anything it's a little scary. But I do thank you for your information I will bring it up to my cardiologists and see what he says in fact that I see him tomorrow so thank you again have a good night..

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@johndl

Sorry to learn of your episodes since the ablation. Again my second ablation was centered in the left chamber where It seems there were cells causing the heart to pump at the wrong time. The right chamber is where the equipment to kill cells must enter the heart.. Only by going thru the heart wall between the two chambers and entering the left chamber was the doctor able to get to the cells causing the problem. Last point, not all doctors get into the left chamber (my first doctor did not). But of course, I have no idea where or why your problem continues.

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Hello , I too, had an ablation on the left side of my heart. The accessory pathway is nothing more than a small muscle fiber about 1-2 mm in size that crosses from the upper chambers (atria) to the lower heart chambers (ventricles) About 65% of these connections are located between the left atrium and left ventricle. The other 35% or so are located on the right side of the heart between the right atrium and right ventricle. It is my understanding that all EP doctors can ablate on either side of the heart. Since 65% of these problems occur on the left side it makes sense that they would be able to. I had two ablations where the doctor did not perform a transseptal approach. . One was because they were not able to locate the site of the accessory pathway and the 2nd time because I had experienced a sustained episode of SVT and AF prior to the ablation and they didn't want to dislodge a clot if there was one. My point is that a transseptal approach does not require a "specialist" electrophysiologist. They should all be able to do that. Hope that was clear! Martishka

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It was interesting to read the comments from @martishka and I did not wish to indicate that a "specialist" electrophysiologist was required. Only that the doctor who did my first ablation was unable to correct my AF by working on the right side. So he shocked me back to regular pulse and told me to take meds for the rest of my life. That is when I went looking for another doctor.

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