Zio patch monitor & FIRM ablation

Today I had an appointment with a new EP who had been recommended and is highly regarded, but I was unable to see for my 2nd ablation in 2017 for insurance reasons. They recently started accepting my insurance, and so I was very happy to be able to consult with him.

My 2nd ablation in 2017 didn't work, and while I know that EP is quite skilled and is personable, I have never felt fully supported in this AF adventure by him. He didn't really advise a 3rd ablation unless I got tired of Flecainide, basically left it up to me to contact him if I felt like it, and it always felt odd to me.

Some of the Kardia readings I showed him apparently weren't actually AF. He wants me to get a Zio Patch monitor so he has more data. Has anyone heard of this? It was new to me. Very interesting!

You wear the patch attached to your skin for 14 days, then mail it back to them and the EP downloads the data. Here's info on it: irhythmtech.com/products-se...

I noticed that it is available in the UK and through the NHS, too. If you scroll down and look in "International," you can find it.

The other interesting thing I learned about is the FIRM ablation, which is done locally at Stanford by an EP who helped create it. The jury is still out on it, I'm told, in terms of it being widely embraced as the standard for care for everyone, but for someone like me, it could be just the right thing, according to my EP. Very interesting.

My quite rudimentary understanding of it (we didn't discuss it at great length, just a mention of it) is that this type of ablation looks in places for the origination of the erratic impulses that typical ablations don't take into account.

Next step is the reading from the Zio patch.

What I really liked is this guy's approach. The other guy left me with "we may never know" what causes your AF. This guy seems to take the approach that we can keep looking and it's definitely possible to find it. I feel more hopeful and encouraged. He was also supportive of the metabolic cardiology information and took a picture of Dr. Sinatra's book so that he could get it to read.

I can see why he's in demand and feel fortunate to have been squeezed in his schedule. We'll see what unfolds!

[Ceelos81]

I just sent mine in today. I’ve been dealing with pvcs on and off for about 6 years. Recently for the past 2 months I feel them more aggressive and feel them everyday. So I had my GP refer me to a cardiologist. My quality of life has took a toll. I don’t want to go out my job performance has gone down as well

[greencrop]

Nella, it's wonderful that you've found an EP and an ablation procedure that appear to have a good possibility of being successful for you. I'd never heard of Irhythm Technologies and the Zio patch monitor or the FIRM-guided ablation. I looked at the Stanford arrhythmia website and see that they've been using the FIRM procedure for ten years and it has shown a lower incidence of needing a second ablation. Perhaps your good news was enough to cause the 7.1 Ridgecrest earthquake tonight! I had my first ablation a month ago in a Bay Area hospital and so far all is fine. I hope you're able to arrange the ablation without too much delay and finally be able to say goodbye to your Afib.

[Hidden in reply to greencrop]

Thanks, greencrop, for your support and kind words.

Do you mind sharing which Bay Area hospital? You can PM me if you prefer. It would be interesting if we've had ablations at the same place. I've been to 2 different hospitals in the area.

On that note, one thing I've been thinking lately is that in spite of the imperfections in the US health care system, I do feel incredibly fortunate to have the wealth of choices that we have here in the area for quality doctors, hospitals, and any kind of holistic practitioner you can imagine.

A couple of years ago, it was a big step for me to leave my first EP, but now I'm so glad I did. I wanted to find someone with whom I could truly feel supported. Last night it hit me that some docs just don't seem to want to look beyond the protocol they are used to working within. I hadn't realized that with ablations there is a template used basically with all patients. I had thought and hoped that it would be a matter of course that the EP or cardio would keep looking for solutions for the reality of my situation. Instead I was basically lectured on the general ineffectiveness of meds, but that I needed to just get used to it. Or, I could have a 3rd ablation if I wanted to, with no real explanation to put me at ease, just "we may never know..." with no sense of "but I'm willing and eager to look!"

It's so easy to get swept up in all the different opinions about treatment, meds, etc. It was nice to encounter a doc with quiet confidence, the ability and willingness to really see me, get me, and respond with treatment suggestions that would be a good fit for me, and who was willing to answer my questions.

Ultimately, that's what each of us needs, isn't it? An approach might not be right for every single person with AF, but how refreshing to encounter a doc willing to look at it that way instead of looking at me as if there's something wrong with me because I don't fit their concept of how a patient "should" have AF.

On the FIRM ablation....yes, it's controversial, but for me, it could be exactly the right approach. I also like that it's rather short - only like 18 minutes!

It will take several weeks before I'm able to complete the Zio patch monitoring, but in the meantime, I will do some investigating with Stanford on the FIRM ablation. I need to see the EBV protocol first anyway, so I'll just keep going, step by step.

[CDreamer]

Sounds very positive, it’s always a relief when you actually relate to your doctor and they listen and take you seriously.

Yes, the Zio patch has been around for a few years, hardly ever gets offered in UK on the NHS though from what I can gather - cost I would imagine. Dr Gupta did a video on different types of monitoring devices and said it was the Rolls Royce (at that time) and he explained why some monitors were used and the benefits and limitations of each.

[Hidden in reply to CDreamer]

Yes, feels very positive, CD. I can see why this doc is in demand. It's a very interesting mixture of qualities - brilliance, kindness, compassion, and a down-to-earth way of relating. I didn't feel condescended to at all. No signs of arrogance or dismissiveness. I didn't know how he'd respond to my sharing the Metabolic Cardiology book, which I offered to give it to him. He insisted that he didn't want to take it from me, but took a photo of it so he could get it and read it. Said I was the first patient to ever mention it to him. I appreciate his open-mindedness and sense of "if it's working, keep doing it!" in response to the Sinatra micronutrients and the EBV protocol.

It was as if my entire body got to be in the room. Imagine that! 😹 🤓

[CDreamer]

Dr Gupta on benefits and shortfalls of various monitors

youtu.be/_uJG9pDu_is(Not working as expected?) He talks about the various patch monitors like the Zio about 8 mins in. It’s a 2 year old video so probably not completely up to date but useful information.

[meadfoot]

FIRM ablation has been around for some years but I don't know anyone who has had the procedure, I don't know if it's used in uk or if it is not widely. The monitor sounds interesting. Pleased you have found a medic you have trust in and good luck moving forward to a healthier heart future.

[Hidden in reply to meadfoot]

Thanks, meadfoot!

I read one article that included some European EPs, so my sense is that it's used some places there, but it's not been fully accepted as standard practice, is my very basic understanding.

I find it very encouraging, actually, that this method is there and seemingly designed for the folks for whom a standard ablation didn't work. We'll see what unfolds.

[Hidden]

Pretty sure that my ablation was using this system but under a different name.

from what I have read it's 3D rotor mapping of the heart and targeting the hot spots.

My procedure was 2.5 years ago at Glenfield Hospital in Leicestershire UK and so far has been a great success, I'm still in NSR

www2.le.ac.uk/offices/press...

[Hidden]

Hi Mikee69, that's very interesting! It does sound like the same system, as Topera is the name of the company that licensed the patent. Happy to hear that it was a success for you!

I'm quite intrigued and plan to call Stanford in a bit to gather information. I think that the EP who headed the development of the system does these ablations; if it turns out to be a good option for me, it would be fantastic to be able to have him do it. I will see what I can discover.

It sounds like it's easier on the body overall. Did you have to stay overnight in the hospital? Was this your first and only ablation?

Curious to hear more about your experience. Thanks for posting!