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Ablation or not?

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Ablation or not?

Post by twal on Fri Dec 26, 2014 8:49 am

As some of you know, I had an atrial flutter event in November that required cardioversion to get me back in sinus rhythm. (I had an atrial fibrillation event to and a half years ago) My cardiologist sent me to an electrophysiologist to discuss options. Anti-arrhythmia drugs don’t sound promising and have a lot of potentially bad side effects and I’d only consider a pacemaker as a last resort life-and-death response. Which leads me to the choice of watch-and-wait or catheter ablation.

Right now, I’m in the middle of a three week period wearing a CardioNet monitor 24 hours a day to get a better feel for the extent of my electrical problems. For background, I had valve repair surgery 12 years ago and have a first degree AV block. I am on a blood thinner and a beta blocker.

Ablation is relatively low risk (considering it consists of frying the nerves inside your heart) and has a pretty good success rate, although it is more difficult for people who have had valve repair and I do know a guy who had to go through it five times.

I’ll get the doctor’s opinion in a few weeks. But I’m wondering if you folks have any experience/advice on the decision. I’m inclined to wait until these events become more frequent but the success rate goes down the longer you wait. Any thoughts?

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Re: Ablation or not?

Post by marathonman60 on Fri Dec 26, 2014 3:06 pm

CUT OUT ALL CAFFEINE.
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Re: Ablation or not?

Post by echoguy on Fri Dec 26, 2014 8:08 pm

It seems like your situation would be one that could benefit from an evaluation by a sports cardiology program like at Cleveland Clinic or Mayo. Have you considered a consultation there?

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Re: Ablation or not?

Post by Guest on Fri Dec 26, 2014 9:38 pm

I am with Echo, check with Cleveland Clinic for sports cardiology.  Now, I do know of a gentleman who had ablation after years of medication, no known heart issues prior that I know of, the meds stopped working.  He opted for the ablation a couple years ago and has done great! He is no longer on meds, his afib is a thing of the past. In some patients, it takes more than one procedure, don't give up hope if you take this route.  Us folks who have heart issues and prior surgery are a different breed.  My cardio said that the fact that I had heart surgery can create those alternate pathways.  I did not have PACs before surgery, now I do.  
You have to weigh the benefits of the ablation and the impact of the flutter and afib have on your ability to exercise now.  It comes down to what you want to do in the form of exercise, how the ablation effects that part of your life, and the quality of life you have now, only you know what that is.

Brutus needs to weigh in on this as he is part of our gang and has afib that effects his exercise.  None of the decisions we make with our hearts is easy, having the HEART gang to bounce things off of is a blessing for us all.

Keep us posted on your decision.  We are with you!  Smile

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Re: Ablation or not?

Post by Dave Tuttle on Sat Dec 27, 2014 5:52 am

You seem to have a lot of faith in your local cardiac team Tom but if you're the slightest bit uncomfortable with what you're getting there I would head to the Cleveland Clinic's Sports Cardiology Dept. for an evaluation... If you do go that route talk to Mike. He has a good contact there who would likely be very helpful.

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Re: Ablation or not?

Post by RoadKillBill on Sat Dec 27, 2014 6:37 am

No personal insight on this, Tom, but I've always gone to the ACC/AHA guidelines when I've wanted a deeper understanding of my own heart condition. Have you seen:

AHA/ACC/HRS Practice Guideline
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

It addresses Aflutter in addition to Afib. Perhaps there is something of use to you in there.

Best of luck to you.

http://circ.ahajournals.org/content/130/23/e199.full?sid=a1f51ed7-870b-4e07-8265-8e9702e2224e

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Re: Ablation or not?

Post by Gary E on Sun Dec 28, 2014 1:38 pm

LMRun wrote:Brutus needs to weigh in on this as he is part of our gang and has afib that effects his exercise.  None of the decisions we make with our hearts is easy, having the HEART gang to bounce things off of is a blessing for us all)

It is solely up to the individual. I have a hiking friend (he even competed with us and helped the team to a gold medal in their age group in Corning) who has gone the ablation route very successfully. He even spends up to five months (while hiking the PCT from Mexico to Canada) where he is entirely on his own for all but a few days (when he nears civilization for re-supply purposes).

Myself, I'm perfectly fine with the minor inconvenience of going into afib. Whether I'm in the pool, on a trail, or running on a bikepath, I typically either slow down and continue at a lesser pace, or I will resort to walking until the normal rhythm is established. I guess I'm just so used to it, that I consider it almost natural by now.
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Re: Ablation or not?

Post by Gary E on Sun Dec 28, 2014 2:02 pm

"I’d only consider a pacemaker as a last resort life-and-death response"...Twal's quote at the beginning of this thread.

Tom, I just re-read your initial posting and was curious as to why you would only consider the pacemaker as a last resort? I've had mine for over seven years now, and will soon run out of battery life and have a newer version implanted. I'm certainly going to "re-up" as I consider the alternative (not having one) as much more problematic than existing with a little metal device under my skin. In fact, the newer ones have an even longer battery life and they no longer have to have lead-wires* into the heart chambers. I can't wait for that, because I can then start working on shoulder strength to develop that "body-builder's physique" that I've always known was in my genes.

*"clavicular pinch" can occur with older models of pacemakers that rely on leads which pass between the articulating bones of the shoulder during over-head motions.
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Re: Ablation or not?

Post by twal on Sun Dec 28, 2014 7:23 pm

Gary, did you try ablation and it didn't work or did you go directly to pacemaker?

Aren't there sometimes issues with getting the pacing right and working around electrical items?

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Re: Ablation or not?

Post by Gary E on Sun Dec 28, 2014 8:53 pm

twal wrote:Gary, did you try ablation and it didn't work or did you go directly to pacemaker?

Aren't there sometimes issues with getting the pacing right and working around electrical items?

My G.P. actually noticed my irregular heartbeat and referred me to a specialist. I had my backpack in the car and was going to just stop in and see what this guy thought before picking up two other friends for a week-long trek through the Adirondacks. He said "no you're not, your going to need a pacemaker right now" and the very next day it was implanted. Three months later heading up Huron Peak (a 14'er in Colorado) I experienced my first and only angina pains. When I got back to Columbus, I had a heart attack* but the pacemaker kept me going until I was stented the following day.

*that is a whole 'nother story...as I drove myself to the hospital because I really wasn't sure what all that "heaviness" in my chest meant.

Back to your second question about "getting the pacing right". Every four months I get my data downloaded from the pacemaker and the tech's always tinker with the settings and the rate (with approval from my EP, of course). The recording show all the events, time of day, and duration. In my case there is really no distinct pattern. When it occurs at night I just sleep right through it, during the day I sometimes feel it and sometimes not. It is only when exercising that I really take notice (or rather, the afib determines how hard I'm able to push and without adequate bloodflow to the muscles one just can't perform well at all) and I slow down or stop altogether.
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Re: Ablation or not?

Post by twal on Mon Dec 29, 2014 11:06 am

Thanks Gary. Your situation must be different from mine.

Whenever I've talked with doctors, their comments are usually along the lines of "We can do... or, if all else fails, we could use a pacemaker."

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Re: Ablation or not?

Post by HerbW on Thu Jan 22, 2015 9:03 pm

I was diagnosed with Atrial Flutter and tachycardia in May of 2009. Had the shock treatment where they knocked me out and hooked up some jumper cables. When I came to the Doc said guess what? It worked. Anyway, I stayed in sinus rhythm for about 7 weeks then back to AF. I took some meds at the time Beta Blockers I think and then got real serious about diet and supplements. Lost 30 lbs and cut out the meds. My blood pressure was normal and so was my heart rate. That lasted about a year till changes at work messed with my mind and my diet has sucked since. Consequently the AF is back and I now take meds again. Some folks have real good luck with Magnesium supplements. It helps me but doesn't stop it. I suggest reading "Is your cardiologist killing you" by Dr Sherry Rogers. I am not a candidate for ablation, due to artificial mitral valve so I would not be one to advise. I'm not sure I would consider it even if I were a candidate, but every situation and every person is different. The only advice I would give is thoroughly research all the options. Good luck
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Re: Ablation or not?

Post by twal on Mon Feb 02, 2015 6:05 pm

I had my follow up visit with the EP to discuss the results of my three of monitoring.

The good news was that even though I had a lot of arrhythmias, there was nothing to indicate that I needed ablation in the short run. We would revisit if I started getting flutter or afib.

On the other hand, he suggested that my electrical system was weak and I would be a candidate for a pacemaker before too long, maybe even within the year. I don't really a device planted in me (even if it may qualify me as a Medtronic hero).

As I recall, Mike had some bad experiences with his pacemaker and Gary kinda like his. Any good success stories or horror stories?

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Re: Ablation or not?

Post by Gary E on Mon Feb 02, 2015 6:53 pm

twal wrote:
As I recall, Mike had some bad experiences with his pacemaker and Gary kinda like his. Any good success stories or horror stories?

That's right Tom, I love mine so well that I even sleep with it!
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Re: Ablation or not?

Post by LMRun on Mon Feb 02, 2015 7:30 pm

twal wrote:On the other hand, he suggested that my electrical system was weak and I would be a candidate for a pacemaker before too long, maybe even within the year. I don't really a device planted in me (even if it may qualify me as a Medtronic hero).

Sorry to read this Tom. Technology is fantastic, even in the pacemaker area. Research them, ask all of your questions, make an informed decision.

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Re: Ablation or not?

Post by Dave Tuttle on Tue Feb 03, 2015 3:33 pm

I hope you can avoid the pacer Tom but if you do end up a Global Heroes candidate due to having one implanted you'll be in very good company. Gary and Don both seem to do very well with theirs and I think Philip too... Mike may not see this for a while but you should talk to him. I have his e mail address, if you need it I can PM it to you.

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Re: Ablation or not?

Post by twal on Tue Nov 10, 2015 6:57 am

As some of you know, I've had two atrial flutten episodes in the past two months. For one of them, it took three tries to have a successful cardioversion. It looks as if my body is telling me it's time for ablation.

My research showed that the Univ. of Pennn Hospital in Philly is one of the best places to go for ablation. Yesterday, I met with Dr. David Callans there and we're going to do the procedure, hopefully next month.

My last few episodes were flutter and we need to decide whether to treat me for flutter or do the more complex procedure for flutten and afib at the same time. Once we resolve that, we'll proceed.

I'll keep you folks informed.

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Re: Ablation or not?

Post by Dave Tuttle on Tue Nov 10, 2015 8:29 am

Well, it sucks that the cardioversions aren't working out Tom and it does sound like it's time to try something else... Good luck with this, I hope it gets you back to where you should be once and for all.

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Re: Ablation or not?

Post by LMRun on Tue Nov 10, 2015 5:54 pm

Good Luck with your ablation Tom! We'll be thinking of you and wishing you well.

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Re: Ablation or not?

Post by echoguy on Tue Nov 10, 2015 8:59 pm

Keep us posted Tom. Sounds like you are making smart, well informed decisions.

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Re: Ablation or not?

Post by Rachel August on Wed Nov 11, 2015 7:15 am

Thinking of you Tom!!!!

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Re: Ablation or not?

Post by mikenall on Wed Nov 11, 2015 4:26 pm

Good luck with this. I suspect the cardioversions are no picnic either. I've never had flutter that I know of, but did have fibrillation during a triathlon last spring. Found out during a pacemaker download. I don't know if it will detect flutter or not.

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Re: Ablation or not?

Post by twal on Mon Jan 11, 2016 6:46 pm

We're driving down the Univ. of Penn Hospital tomorrow for catheter ablation on Wednesday.

If I don't make it through the surgery, it's been great knowing ya'll. Most likely, I'll be back on line by Friday and you'll have to keep putting up with my posts.

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Re: Ablation or not?

Post by Dave Tuttle on Mon Jan 11, 2016 7:31 pm

twal wrote:We're driving down the Univ. of Penn Hospital tomorrow for catheter ablation on Wednesday.

If I don't make it through the surgery, it's been great knowing ya'll. Most likely, I'll be back on line by Friday and you'll have to keep putting up with my posts.



"If I don't make it through the surgery, it's been great knowing ya'll"
That's not an option Tom, we expect a report Friday!!

Seriously Tom, good luck Wednesday. I hope the ablation goes better than well and with 100% success.

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Re: Ablation or not?

Post by Gary E on Mon Jan 11, 2016 7:41 pm

We will definitely hear from you when you get back...I just hope that procedure doesn't make you too much faster than you already are...because then I'll never be able to keep you in sight.
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