Ablation

[4chickens]

Hi I’ve now had 4 Ablations 1 was terminated due to a haemorrhage. Following a telephone consultation with my EP he has offered me another Ablation but wants me in Arterial flutter so can map effectively, his concerns are that last time whilst mapping he touched something ( his words) and my heart return to sinus rhythm despite many attempts he was unable to put me back into flutter. The last 2 times I have gone in Af that then spontaneously changes to flutter which always requires cardio version to restore to nsr. He is concerned also that it’s not just flutter but fast Afib , it’s usually up to 190 bpm. So his plan is next time I go into AF or flutter to stop the sotalol and put me onto bisoprolol and list for an urgent ablation. I’m unsure why he is more concern re the reappearance of AF than Flutter. I’m also very anxious about the ablation last time it took 6:30 hrs under sedation, I experienced some pain mainly in my neck. I counted the ceiling tiles in the lab to distract myself. and was sick afterwards I also had flash backs and nightmares about the whole thing. He has offered me a pace and ablate but I’m reluctant at the moment. Apparently my heart is perfect apart from the wiring, he describes it as a healthy heart behaving badly. To be frank 11 years of this is getting me down. Sorry for the long rambling post.

[Hidden]

Difficult to comment really 4chickens. If it’s the same EP who has treated you throughout, maybe a second opinion might help. It all depends on confidence in your EP and where the procedures are carried out. It will be interesting to hear what others say…….

[CDreamer]

I wondered why you were hesitant about Pace and Ablate?

I went for that after 2 ablations and it’s the best thing I did. I was hesitant about being Pacemaker dependant but as the Pacemaker helped me so much that I cancelled the AV node ablation.

I suffered long lasting affects from the medications I took, including sedation. PM implant was done under local anaesthesia & IV Paracetamol. Since implant I have only had 3 AF incidents which were virtually asymptomatic and lasted only a few hours and as a result of infection.

It was the best thing I did and the only treatment that I can say improved my QOL, everything else caused more problems.

I think it also depends on age - I was mid 60’s. If you are much younger Pacemaker will need to be removed and replaced due to battery life which is approximately 10-12 years.

[CDreamer]

PS - I think you need to ask your doctor why the concern about AF more than AFl? Could be purely because AFl is easier to ablate and usually quicker - Flutter often results in AF so that could also be a factor. I know when I had both was when I was at my worst symptomatically.

[Ppiman]

Poor you having to have four ablations. My son's colleague has had six if I recall and been told he's at his limit. He is well though and very fit for his age. I haven't heard that atrial fibrillation "changes" into atrial flutter only that one could mask the other. I gather they begin in different parts of the atrium, with afib occurring in the entrance to the four pulmonary veins in the left atrium, and afl occurring in the right atrium. I was warned that afib could occur after the afl has been cured, which it has with me, over two years later, sadly.

I'm sure that the surface of the atrial wall is extraordinarily sensitive, so I can well imagine your doctor "touching" an area with the catheter could easily stop the arrhythmia. Working inside the heart in the way they do simply amazes me. I did get the impression that they need the arrhythmia in progress so they can "see" the areas that need to be ablated, which are, I gather quite tiny.

Steve

[Jmbrph in reply to Ppiman]

I, too, had flutter ablation but then my heart went to AFib instead. Had the new pulse field ablation a month ago. (EP had to reablate the right atrium again, too.)Not a bit of arrhythmia since but time will tell.

[momist]

If you do ahead with this, could you not ask for general anaesthetic instead of the sedation? My EP prefers GA, and I wasn't bothered either way, but at least a GA puts another person in the room who's sole concern is keeping you alive (the anaesthetist).

[Tickerboy63]

I’d get second opinion. I have only been on Apo-Sotalol for 10 months and at lowest dosage (1/2 tab x 2 day). I have complete confidence in my cardiologist who plans to do ablation in next month or so.

[Tickerboy63]

I wasn’t happy with first Doc I saw as he didn’t really listen to my concerns, but he discounted them. Second Doc truly listens; I needed to feel trusting of the one who’s going to mess with my heart’s wiring system.

[4chickens]

I initially had AF which unfortunately I had to wait 6 months for a routine cardio version for, when this only lasted about 2 months I was offered a left side ablation all was well for 18 months then AF returned this spontaneous chances to AFL which has been treated on 2 more occasions with ablation each time it has lasted about 4 months before back to Af then afl in between I have had numerous cardio versions. The biggest issue is I don’t tolerate the medication well I’m on 40mg of sotalol twice daily which I understand is a tiny dose but enough to make me dizzy and spaced out. My EP is well regarded but I do feel he doesn’t necessarily listen to me and tends to tell me that Af isn’t a killer as if I should be grateful. My reluctance to have the pace and ablate is that i was 50 when this started and have now just turned 60. It feels very final and concerns me about my quality of life afterwards. After the last ablation I felt wonderful within a few weeks and once off the meds the difference was amazing no dizziness no low mood no lack of confidence that I could do thing. I really feel that the medical model doesn’t take into account these things. Maybe I need to just bite the bullet and go for the pace and ablate.

[Spud12345]

A fib originates on the left side of the heart and flutter originates at the fr side. There is also act which is alittle different. I bought an Apple Watch and record my dysarrythmias when they happen and record on them how long it lasts and any triggers. Don’t know if this would helpYou but you can always get a second opinion once you have these recordings The watch transfers info to my phone and I print it off on my computer. Not perfect but a pretty great recording

[Katicup]

I have been in afib off and on since 2008. I would go into it every 12 months and was cardioverted 14 times, as I did not often convert spontaneously. I have been on Sotalol. Helped for a time then I went on Dofetilide. That helped for a while also. 2 years ago they figured out I was sleep apneic. So the treated that and things got better for a time. Then I had a cryoablation under anesthesia, which helped the most. I remain on dofetilide which converts me now. The plan on another ablation to clean up the PAC ectopic sites I have. Consider a place like Mass General if you live near Boston. Another opinion is sometimes helpful.