Pulmonary Vein Isolation (PVI) for Afib with Complete Heart Block and PM in place

Pulmonary Vein Isolation Ablation to treat Atrial Fibrillation

by Gemita - 2023-10-22 18:46:40

FG, It is lovely to hear from you but I am so sorry you are still battling Atrial Fibrillation (AF) and I wish you all the very best for your pulmonary vein isolation ablation in a couple of days.  The procedure sounds alarming I know, but actually for an experienced EP with the right tools, it is a straightforward procedure and generally safe, so no bad thoughts, please.

I am surprised your EP quoted you 50% response rate for the first ablation.  I was quoted something like 70-75% first attempt.  I hope your EP is experienced and has a good success rate and above all that you have confidence in him.  We need the best, most experienced EP for a successful outcome with AF.  

You should allow up to 6 months for healing following an ablation, although most patients notice improvements after 3 months.  Short runs of AF can be normal following an ablation, or even longer periods of AF but these episodes should end without intervention. 

I was told that I would need two ablations to fix my several arrhythmias, when I could expect something in the range of 80-85% success rate.  The thought of two ablations though did not appeal FG and I declined, choosing medication (Flecainide and Digoxin) and my pacemaker instead.  It has worked well for me.  I am now off all meds except Bisoprolol for rate control.

Please don’t concern yourself about a stroke.  They will no doubt prepare you well with pre procedure anticoagulation to ensure that no blood clots have formed in the heart before the ablation is undertaken.  Eliquis is one of the best FG.  Are you going to have a general anaesthetic and did they tell you approximately how long the procedure might last?  I was told anything between 2-4 hours.

So as already mentioned, it takes about three months for the heart to get the full benefit from the procedure. You may experience atrial fibrillation and palpitations (skipped heartbeats) whilst in hospital and in the first two to three months after the procedure. This does not mean the procedure has failed. If this happens your doctor may need to review your medication to stop your arrhythmia whilst continuing your anticoagulation.

Following your ablation, you should not strain or lift heavy objects for a few days or as recommended, so that the groin incision site can heal.  You should be able to go home the same day if you had light sedation, or the next day with a general anaesthetic.  

So please move forward with confidence.  You have nothing to lose and a great deal to gain.  Good luck FG.  I will be keeping my fingers crossed for you

Thank you!

by FG - 2023-10-22 23:18:13

Gemita so nice to hear from you! I had been gone for a while as I was doing fine and working a lot. But now this...

My EP says he does 130 ablations a year. He speaks with confidence and said he will be cautious and not over burn anything so its possible we may have to repeat the procedure but the second time his rate is 85-90%. So we will see. Thank you for the follow up discussion on what to expect following the procedure. I need to be careful about both groin incisions and no heavy lifting. They want me to stay the night. I am already on Eliquis.

So glad to hear you are doing well! Will you ever get the 2nd ablation? How is your husband doing?

Thanks, FG

I like the sound of your EP's safe approach

by Gemita - 2023-10-23 04:04:48

FG, I had an Electrophysiological Study (EP Study), not an ablation since my doctor wanted to establish whether I had Atrioventricular nodal reentrant tachycardia (AVNRT) and to have a good look round first before proceeding with either a pulmonary vein isolation procedure or an AV Node ablation which was originally scheduled for some 6 weeks later.  AVNRT is a type of paroxysmal supraventricular tachycardia due to the presence of a re-entry circuit within or adjacent to the AV node.  

They used four catheters for my EP Study. Each catheter had two or multiple electrodes, and for each pair of consecutive electrodes, a distinct intracardiac electrogram gets recorded.  Standard intracardiac electrograms are collected and recorded from the high right atrium, His bundle, the apex of the right ventricle, and coronary sinus.  

Fortunately I was in AF at the time of my Study, so they could quickly locate the main trigger sites.  Although I hadn’t consented to an ablation at the time of my Study, they were able to stop my AF using intravenous Flecainide after 3 cardioversions failed to stop it.  I got chest burns as a result of the cardioversions.  My EP Study confirmed "in AF with very rapid fractionated signal in the distal coronary sinus with the Right Atrium relatively organised.  No evidence of pre-excitation during AF".  Hope you get some answers too.

I note they are using both your groins as access sites for your catheters.  They only went through my right groin for the EP Study.  Extensive bruising was a problem afterwards when I developed a pseudo-aneurysm, but I was unlucky.  You will need several hours of bed rest in the hospital after your procedure, to help protect your groin area.  This will help keep the wound closed and prevent bleeding. The prolonged bed rest can be difficult with an overactive bladder I recall, so don’t be afraid to ask for assistance!

I will get an ablation when my AF increases in frequency and duration, but I will probably go straight for an AV Node ablation rather than face multiple ablations, since I have AF with a rapid ventricular response rate that isn’t easily controlled with medication.  In the meantime, 100 % atrial pacing in AAI mode (since I have sick sinus syndrome) has been extremely effective in helping to reduce my AF episodes and all my other atrial tachy arrhythmias and therefore symptoms overall.  I believe this is why I have been able to successfully stay off anti arrhythmic meds.

Hubby is doing okay, but we are still battling to keep his glucose levels stable with daily insulin injections.  His kidney function has deteriorated so there is lots of work to do.  Otherwise he is fairly mobile, still smiling and always happy.  I am sure his happy nature (and two great grandchildren) are keeping him going.  So please go to your ablation with a happy, optimistic frame of mind.  It can certainly do no harm.  Remember you have a lot to live for too.  Please let us know how it goes

recovery

by godrew - 2023-10-23 09:41:06

Hello FG, I had an ablation a few years back.  I actually though what I was told and read was a bit understated on the recovery.  Obviously all people are different.  The dr went through both sides of groin like you are mentioning.  It is a bit uncomfortable for about 5 days(lets be real, its a sensitive area).  I had my procedure on a thursday and took the following week off.  I was also told 50/50 success rate after 1st procedure.  I did actually go back into AF but the recourse was to cardiovert and change meds at this point.  

Every patient has different history and so would the results be. I previously had Myectomy and a Maze procedure so from what the Dr said was the there was a lot of work to do because of extra scare tissue, you probably do not have that issue.  The stroke thought is always in your mind because they tell you about it, but the team will constantly be monitoring your blood.  This is also why you will be pretty bruised up at the incisions post procedure.

Recovery was not bad just a bit slower than i mentally prepper for. Just take it slow and keep wound clean.  Sounds silly but I was most nervous to have a bm after.  

FG

by Gemita - 2023-10-30 09:35:27

When you are able, please let us know how you are?  I hope you have benefitted from the ablation or at least that you have not had any complications.  I send my best wishes and hope that you will feel stronger as each day passes

Post Ablation Report

by FG - 2023-10-31 16:49:16

Thank you guys for asking!

Well the procedure was one week ago. The first 4-5 days was constant palpitations and heart jumping around but I never felt faint, just a slight bit dizzy from time to time but no fainting. Like godrew said lots of bruising around both groins but little pain. Dr. said no jogging for a week so I went 1 mile this morning and felt fine. The palpitations are about half what they were initially so I am relieved about that! I almost went to the hospital ER over that. Anyway, no faint feelings now but heart stll irregular even with the pacemaker. I was told the Afib may not go away for 2 mos or so - not a real pleasant thought. But no control over that! 

We'll see how it goes. I've done the next best step to try to fix my Afib. Just a waiting game now. Well I hope that's all it is!

Healing period

by Gemita - 2023-10-31 17:02:56

FG, thank you for responding.  You are in the healing period and unfortunately anything can be expected in the first few months and it may get worse before it gets better, but from your remarks it seems to be getting better, especially as you have felt like jogging this morning?  That sounds amazing.  I would just try to relax and believe this is the storm before the calm.  Your heart is angry and has been purposely scarred, so it is not happy.

I am confident that this will get better.  Try to stay calm and confident too.  You will give yourself the best chance of a happy outcome that way.  Go easy on the jogging and don't push more than you can comfortably manage.  I send my best wishes for a good recovery and respite from your AF