Pulsed Field Ablation

@gloaming, I am leaving for Madison this afternoon for my PFA at 6:15 tomorrow. I'm not exactly anxious, but I am definitely aware of oh-so-many possibilities. I'm first up on the schedule, which I think is excellent. I am also getting a watchman, so I will be spending the night at the hospital. Any last minute advice?

I had PFA in January 2025. No changes to my meds after the procedure...stayed on 50 mg Metoprolol and 20 mg Xarelto, plus 20 mg Atorvastatin every other day. In the 12+ months post ablation I experienced no recurrence of Afib, however occasional episodes of PVCs and PACs, which my EP is not concerned about because the burden is 1% or less. It took me more than a couple of weeks to feel like I recovered from the procedure. Initially, I had a brief bout of pericarditis, which was treated with NSAIDs (even though I was taking Xarelto). That's my post PFA experience...yours and everyone else's will probably be different.

@ltb7 I went for 3 month check up after PFA. They took me off The Flecinide. 36 hours later I was in AFIB! when I told them this they immediately put me back on the Flecinide. My goal was to get off meds. I’m so disappointed! I guess we will see in 2 months. I’ve also never had a heart monitor. They were going to when I came off the med last week. Now cancelled it.

@tomandpatti I’m sorry to hear that. Are you only on Flecainide? When I first got diagnosed in Dec. I was only on Diltaizem and they gave me 150mg. Flecainide as a pill in a pocket. Then I had more episodes so they put me on 300mg. daily. I’m down to 100mg daily. I hope I don’t have the same results after the 3 months but there is no guarantee at all.. will they redo the ablation?

@tekkie50 Yes, eyes open, take it all in, ask reasonable questions, and let them do their work. You can relax. You'll be 'out' anyway, and won't be conscious again until you awaken in your cubicle and tucked-in. The toughest part, for most adults, is lying on your back for the next three/four hours letting the incision begin to heal and to seal. Your nurse will caution to be lie still, try not even to strain by lifting your head. You'll be asked to drink at some point, then eat a sandwich or whatever they offer, and if you can keep it down, they'll ask you to rise and to walk around the ward for several minutes to see if your BP is sound. Then they call your ride and you get wheeled out of the cath lab and taken home. It's a long (at the hospital by request NLT 0730) day in some ways, but you DO get a nap! 😀

@tomandpatti Aw, that's too bad. But it's not conclusive either. The blanking period is three months long for a reason, and even then people report having a lot of ectopy right through the Holter monitor session, and then the next thing they knew they had just gone several months and been clear of any arrhythmia or its familiar symptoms. Now, years later, they're still in NSR all the time. We are all different that way. The literature just covers the middle bulge under the 'standard normal distribution' bell curve, which means it misses the mark on about 33% of all patients.

@gloaming thanks for your reply! I had a wonderfully uneventful PFA and then a Watchman implant, which earned me a night in the hospital just to make sure that all is well. I was worried about the laying on my back thing since I was sure I would have to pee before that time was up. I talked to my doc about that, and she said that they do a bladder ultrasound while you are still under, and if necessary, drain your bladder with a catheter.

I had to check in at 6:15 in the morning and was in my room at about 11. I had a great team. 3 anesthesiologists who listened to my concerns about propofal (sp?) , a cast of what seemed like thousands, and my doc and her associate, who did the best informed consent I have ever heard for any procedure.

Now, I wait for 3 months and see how it goes... so far, so good!

@ltb7 Thank you for your reply. I am on Coreg ( I’ve been in it for many years) for blood pressure and pvc. Also Losartan. Pretty low doses. I’m just over the 3 months now with the ablation. All I have been told is end of April we will discuss a plan

@gloaming thank you for your reply. I guess I really had my hopes up after reading that FPA had an 80% success rate and since I was not in Afib constantly I hoped I would have successful results. So maybe as you say time will tell. Even though I am on 50 mg Flecinide 2x per day they have still ordered a holster for me. Guess we will see

@tomandpatti I hope it turns out for the better. It's early, and if it turns out that you still have runs of tachyarrhythmia, you can always get another ablation...maybe even look for another EP and give that person a go. My first ablation did not work, but the second did. Same EP, same RF energy, and I'm just into my 38th month in a week. Ablations DO work...all the time....but not the first time about 20-25% of the time. It's a bummer, but second ablations have a higher success rate.