Is it time for an ablation?

I believe it is too soon

by Gemita - 2020-02-28 21:05:21

Lexitoo, you are still recovering from your pacemaker implant and as you say your episodes seem shorter and rates lower, actually it is all pointing to a vast improvement.  I know you are symptomatic and I do understand because I cant bear being in Flutter or AF either.  I feel the chest quivering, I get chest pain, breathless, weak, dizzy and feel totally miserable BUT ...

After my PM and once I got over the trauma of implant and my arrhythmias calmed down (at around 3 months post implant) you wouldnt believe the improvement!  My AF, Flutter, tachycardia, SVT, even NSVT has miraculously stopped occurring.  I still get runs of AF/tachy/flutter maybe weekly but I mean runs and I can certainly live with that and I have been able to stop antiarrhythmic Flecainide and Digoxin and am only on low dose Bisoprolol.  Prior to implant and immediately after (for first three months) I was getting episodes every night lasting for several hours and at high heart rates.  Flecainide I believe caused Flutter (EP even agreed).  Stopping Flecainide and Digoxin was the best thing I could have done. Maybe Flecainide made things worse for you ?

Pacing at higher heart rates (70bpm) paces me out of my ectopics too which were leading to AF, so it is a win win situation.  EP comfirmed I had bradycardia induced arrhythmias and the higher pacing rate takes good care of that.  It may not work for everyone but it certainly works for me.

I have been following an Atrial Fibrillation support group.  Some have had immense success with an ablation but others have needed two or more ablations and are still facing more.  There would be a healing period of up to 6 months or more and with atypical Flutter you might be looking at two ablations to sort AF/Flutter out, which would double your risk for complications.  I pulled out of an ablation last minute and how thankful I am. My EP told me the cut off age for me would be 80.  I am 71, so I still have time but right now there would be no benefit.

Finally, remember too an ablation is just another way of controlling our arrhythmias.  It can be very effective for typical flutter (not so much for atypical flutter or perhaps AF) but an ablation is certainly supposed to be more effective than antiarrhythmic meds, although it is still not a cure as we all know.  Hopefully it would give you some welcome respite for a few years.  

I hope you find the best way forward

Thank you Gemita

by Lexitoo - 2020-02-28 22:15:42

Your experience gives me hope. My events really are much shorter, and my husband really is not comfortable with ablation. And yes he has read everything he can. He just feels I will be using more precious time waiting to heal and perhaps having complications.  I have a few months before I go to our northern home, where I would have any ablation, so you have given me more to think about. I truly appreciate your time and careful thoughts.

Abation

by AgentX86 - 2020-02-28 23:53:53

Ablations for atypical Aflutter are very tricky things.  If you go for it (and I can't blame you at all, BTDT), you really have to find an EP who does this precedure regularly.  It should be about all he does - at least a hundred a year, thousands total. Atypical Aflutter normally comes from the left atrium.  Since the vena cava (the large vein they use to enter the heart) enters the heart into the right atrium, they have to poke a hole in the septum that separetes them.  Then they have to snake the catheter around the left atrium to do their thing.   It's not a walk in the park at all for the EP.  If everythign goes well, and it does in 99% of the cases, it's no harder on the patient than any other catheterization, though perhaps a longer procedure.

I've had three ablations for atypical Aflutter caused by a failed Maze - all three ablations failed.  The third, the EP knew it wouldn't work pretty much as soon as he was done.  I ended up with an AV/His ablation and pacemaker (needed it for asystoles anyway) the following month.

Thanks

by Lexitoo - 2020-02-29 09:26:52

I appreciate this explanation. I have been told this was not an easy fix but never been told why, exactly. It will help in my decision. At this point I will give the PM a couple more months to settle in. So far my episodes since the pacemaker are short, and that is a big difference. I am also going to ask to have my HR upped to 70. I would prefer not to face ablation knowing it likely is not "one and done".  I have read the many stories, and at my age I hate every day I miss "living". Thank you, again for your time and information.

Ablation

by AgentX86 - 2020-02-29 13:53:36

On th other hand...

If you're close to the cut-off date (unless I misread you) that you will no longer be eligible for an ablation, I'd go ahead and do it.  If everything goes right, it's a really easy (for you) surgery.  I did it with only locals at the catheter insertion point, in the leg.  I was fully awake the whole time, except when they had to do a cardioversion (and they forgot that I was awake).

I'd have it done as soon as the EP will do it.  It's commonly said that arrhythmias beget arrhthmias.  The heart gets used to being paced as it is (this include pacemakers).  Afib/flutter will only get worse over time because the heart "learns" that its's the "new normal".