I am a 68-year-old male that was diagnosed with a fib about five or six years ago. First it was a flutter that went into a fib. Had one ablation for a flutter and two ablations for a fib. They did not work this is when I lived in New York. I want to Dallas 4 years ago and instead of going the ablation route the doctor put me on Tykosyn. Had really good results for about four years had a couple of a fib episodes had a cardioversion or two. But it was going well. Then I had a serious episode of heart failure and they diagnosed me with 100% electrical block from my AV node. They rushed me to the hospital and gave me a pacemaker. Once they put in a three lead pacemaker I felt great! My heart right now is set to go no lower than 70. And I felt really really good..About a month ago I had a hernia operation while in the hospital the doctors noticed that my QTC was over 500. So my EP immediately took me off Tykosyn. And then about a week later I went back in a fib. I recently had a cardio version to get me out but it lasted about three hours and I’m back in a fib. The difference now is they have me on metoprolol twice a day and my heartbeat doesn’t go above 80 very rarely. It may jump up to 100 but it comes right down. I actually feel pretty good but Since I had a pacemaker put in about three months ago because of 100% heart block I am being monitored 24 seven.
My problem is I feel pretty good I have not exercised since the hernia operation so I’m not sure if exercise is gonna get me winded or not. I am set to meet a top top EP guy in Austin and get an ablation to get rid of the a fib. But I’m almost having second guesses because I feel pretty darn good my heart does not jump up to 130 any more. Nor am I having any symptoms of series a fib attacks.
So should I go for another ablation and get rid of the a fib or just live my life the way it is in A fib but no real issues.
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jsanta
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I had 3 lead PM inserted 2018. Last year I was in AF for 1% of the time. I’ve had 3-4 episodes of not very symptomatic which lasted 3-4 hours max. Prior to that I was incredibly symptomatic & in AF 75% of the time.
I would question your doctors further as to the benefits of having attempting 3rd ablation after the first 2 failed? What’s different this time? What would be the risks?
I think this is one of the most difficult questions to answer because everyone’s tolerances differ, their circumstances and their medical history. You obviously have concerns so as a lass from the north of England I’ll quote the vernacular- If in doubt, do nowt (nothing). In other words watch & wait may serve you best for now or until at least you are convinced it’s the best option for your circumstances. Doesn’t sound like you are there yet.
I couldn’t possibly say that but your experience would suggest it. I asked the same question of my EP who replied that he had a reasonable number of people who had similar experiences but didn’t work for all.
3 lead Resynchronisation Therapy Pacemaker kept my AF at bay except for when I have severe chest infections - I had COVID with pneumonia and had a one serious, very symptomatic AF episode and a few other much less symptomatic and shorter episodes for the following 3-4 weeks - now back to nothing.
Don’t poke the beast though is my suggestion - go slow and steady.
PS - my PM is now reduced to 60 before it kicks in - really feel that is good for me.
Thanks CD.. feeling good except that I am in a fib all the time. Still ticking about 80 and double dose of Metperal really helping. Haven’t done any exercise since hernia op 3 weeks ago. Cardio version 2 weeks ago didn’t work. So not sure if I will be out of breath. Going for a fast walk tomorrow have no clue what to expect except feeing good right now.
Not a EP specialist but I can’t help but think that e lead pacemaker is helping me. I have 100% heart Eletical Bloch which I feel that Covid induced. I was vaccinated but no booster. So who knows. Stay tuned. Will see how walk goes. Thanks for getting back to me..
I'd be guided by the EP's opinion and hope that he's not too swayed to giving out ablations just because that's how he earns his living! Many people with PAF are living happily and safely with a PM and the higher dose of beta-blocker that that allows, I understand.
I would consider this dietary protocol. Although it is no overnight cure, if followed more or less, I think it would slowly help, and more and more over time. carrafibdietinfo.com/
Many of us have quite good diets, a healthy lifestyle, get enough exercise, etc, however the main problem is calcium intake. Calcium plays a role in heart rhythm, contraction, blood pressure as well as other bodily functions. Too much can wreak havoc.
Pacemaker never cures Afib. We all know of it. Go to Austin, the top top ep will cure your Afib. I read it here people have many ablations and still did not resolve their issues. With NHS they cannot choose their EP, in US we can choose our EP and go with him. He is doing PFA too. If you meet criteria of the study, he might use it on you if you are willing to participate with it. It is safe and very effective. The skills set of the EP is critical. The tip of the catheter needs to ablate the tissue at the pulmonary vein. Imagine It doing it on a moving target which is our heart and the heart is still beating during the ablation. If you leave a gap between two points of ablation Afib will come back. So you see the skills set of the Ep is critical here. He is well known of finding other sources of Afib as the posterior wall of the left atrium and the coronary sinus among other places in the left atrium. He might find sources of the Afib on the right side too and will ablate it too in the same ablation. Same thing applies for atrial flutter too. Rarely we will need a second ablation with him.
Thanks Sean my tele appointment with Doc in Austin is may 6 I met him 4 years ago and he said “you’ll be back”., he was right. Feeling really good right but in Afib 100% ticking about 80 BPM with no fast ticking. Been 3 weeks since hernia op and 2 weeks since unsuccessful cardio version. So will start exercising and see if I’m out of breath. Stay tuned!!
Whilst I would agree that a specialist EP is the only person who can evaluate whether or not ablation would be useful, I would just like to challenge you on several points. Firstly we in the UK CAN choose which specialist we want to see. It’s written into the NHS Charter and we also have a private system and many people take out Health Insurance which operates in exactly the same way as in the US. Many people aren’t aware of that fact and may not want to challenge their referring doctor or prefer to be led by them, but I decided who I want to see both through NHS and privately and I’ve never had any seeing the person I wanted to. Sometimes I’ve had to travel but as long as it’s within the country ie: England, Scotland, Wales or N Ireland, there is rarely a problem. Getting specialist treatment outside of your country can be more problematic.
The other problem which many countries, not only UK, have is that EP’s are very thin on the ground and that is often the real difficulty in getting to see one through the NHS - too many people wanting an appointment and too few EPs. If you live near the big specialist Centres you will stand a much better chance, otherwise you will need to be persistent and be prepared to travel and therein lies the difficulty - very sadly a lack of resources of both NHS and patient which leads to an equitable system.
Secondly although Pacemaker is never a ‘cure’ for AF - there is a Medtronic Pacemaker especially designed to stop AF and I have a Pacemaker which has been more affective in stopping my AF than 2 ablations and all of the drugs. And those ablations were performed by top EP. No matter how good the EP, there are many people for whom ablation tends not to last for more than a few years or will need more than one procedure.
Actually, if you live in Wales we can’t choose to go anywhere other than Wales. Some people who live in North Wales are sent to Liverpool as it is nearer than going to Cardiff and there are no ablation centres in North Wales. If you live in England you can opt to go to Wales if the English NHS will pay for the treatment . However, if you live in England you wouldn’t be likely to opt for Wales as the best centres are in England. No idea about the system in Scotland and Northern Ireland.
It is brilliant that your pacemaker has helped so much Dreamer, you deserve the best. Long may it continue. X
May I ask the name of the “ top top guy in Austin”?I’ve been thinking about Cleveland Clinic and a recommendation by my dentist of an EP at Penn Lancaster.
Hi! I would definitely speak with top EP in Austin first. I’m slowly discovering my own Dallas/Austin Doctor journey. I would love to know who you first saw in Dallas and who you are scheduled to see in Austin. Is it with the Texas Cardiac Arythmia group? I am going to see Dr Horton in that group. But like others have said pacemaker does not affect AFib. Personally I’m considering a Watchman or Lariat procedure and living with my minimal AFib. Unless it becomes a constant issue. Always working on life style changes too to reduce episodes. Dr Horton may have different thoughts but that is what I’m hoping for.
Dr Horton is the best of the best when it comes to LAA devices in the nation. Usually they ablate first if you still have Afib because LAA is a big source of Afib and or flutter on top of the four pulmonary veins. Once you have the device it would be difficult to ablate it. When it comes to ablation Natale is still the best of the best. Both are close colleagues . They will work in tandem to make you the best you can be.
Wow thanks Sean.. very reassuring!! Thank you so much! I really needed that!! What does LAA stand for? Is Horton in Austin as well? The pacemaker is a little wrench thrown in but it did save my life being I am 100% electrical heart block.. Was having 2nd thoughts because feeling ok at rest. The fact is I am in Afib all the time and once I start to exercise will be out of breath. I am an active ex college football player and I refuse to be a lump on a log. Will keep you posted!!! Thanks again. Jimmy
LAA stands for left atrial appendage. It is like a pouch of the left atrium where blood clots can be formed when the atrium is quivering during the episode of Afib. When you are back into sinus rhythm the blot clots can be pushed out and can go to the brain or some other parts of the body. So the devices are used to fill in the pouch. So go back to the expertise of the EP. He has to pick the right size and form of the device to match your appendage. And when he puts it in the pouch, he cannot leave a space between the device and the wall of the LAA. Blood clots can escape from there despite the device. Imagine you have to hold the device and do it when the heart is beating. Usually the procedure of the watchman device lasts less than 20 minutes to talk about their expertise. Go back to your permanent Afib, most likely the source is LAA. Dr. Natale will let you know all of it and with his advanced medical equipments will detect all the sources of your permanent Afib and he will take care of all of it. Once your Afib is dealed with you can resume your life as you wish.
With cryoablation or radio frequency ablation the tip of the catheter needs to be in contact with the cardiac tissue for a short period of time at each point of ablation. Too short it will not burn the tissue, too long it will cause damage to the surrounding tissues. All of it on a beating heart.
Dr. Natale started using PFA catheter since December 2020 to ablate and I guess the study is still on going. With PFA , pulse field ablation, the contact is short and instantaneous and the electric shock only burn the cardiac tissue and very selective given the frequency the electrical wave used by catheter. With the same catheter he can switch between RF and PFA. So if you can pick which techniques I would go with PFA.
Such great advice thank you. Need to absorb and will discuss with Natali. I do have a 3 lead pacemaker. I really feel it is preventing me from going into traycadiia (sic). Will keep you posted after my consultation with Natali. Again Thank You Sean!!
Dr Horton and Dr Natale are in Austin, however, Dr Horton comes up to Dallas and does procedures here once a month. Unless it is the Lariat procedure that is only done in Austin.
Hey Sean just want to let you know that I’m having my ablation with Dr. Natale next week. I’m actually feeling pretty good except when I do any type of exertion or exercise I go automatically into a fib and lose my breath. But the pacemaker does help on the low end I have not gone into any tachracrdia. And my resting rate is 60 when I sleep so the pacemaker is doing its job hopefully Natale will get me going again!
Thank you, SeanJax, very encouraging words! Though I am in Dallas, Dr Horton comes up here once a month. Sounds like if I have to do an ablation though that I will want to go to Austin. I would prefer, overall the Lariat, just because it gets me off of blood thinners sooner. I am miserable on my blood thinner!! I would think with the Lariat since it pretty much gets rid of the LAA, that it might also put an end to any AFib stemming from the LAA. But I guess I will find out about that when I meet with Dr Horton.
No question in my mind that the three lead pacemaker I have recently put in his helped my a fib. I don’t go into tachycardia as much anymore. Smooth 80 most of the time. I have a 100% heart eletical block on the left appendage. I still get out of breath the same as before when walking fasr but I’m not having the a fib high pulse rate when I am resting usually like I had before.. Hope it lasts. Still getting an adulation…
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Many people with PAF are living happily and safely with a PM and the higher dose of beta-blocker that that allows, I understand.
Advice needed please …
Advice greatly needed please
My pulse feels really weak.
Help! Back in a fib again
Thanks for advice more needed!
