Quick history. Previous electrophysiologist had suggested flecainide + beta blocker and/or consider ablation earlier this year. Experienced lots of episodes September and October and a short episode of what was deemed possible VT end of November. Had Stress echo, positive for inducible ischemia.
Finally saw new EP today. He says I don't need an ablation now. He is putting me on sotalol (starting with a very small dose) and says he thinks stress echo may be a false positive. Still have cardiac MRI scheduled for February just to double check.
This EP confirmed all of the things so many of us talk about, and exactly what other EP completely brushed me off about. He says it is definitely my vagal nerve and autonomic system triggering my arrhythmias. He says I would be better served putting off the ablation and continuing to work on getting digestive symptoms under control. He is also going to have me tested for sleep apnea, even though I don't snore, just to cross out that possibility. He simply says an ablation is not needed, at this time, at my age, with the low frequency of my episodes. He says getting a handle on digestive symptoms, I will likely see even more success and do not need to do an ablation so soon.
I want to note I was in there completely resigned to talk to him about the ablation, and it was he who stopped the subject. I was not protesting at all at this point, so I did not steer him here. This was his genuine opinion.
I am elated that everything I've been saying has been validated at this point, and a little disoriented because I had thrown in the towel and now I'm instead encouraged to go back to the other frame of mind. Goes to show, we should always get a second opinion.
Is this EP right? Who knows. I am going to put my trust in him and try it. The facility I am visiting is very well regarded, along with the doctors themselves. I feel I'm in good hands.
Will update on the sotalol. I have to get an EKG in a few days after starting it to make sure it's ok.
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ChasMartin
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Well your post was a breath of fresh air .... fancy, an EP who understands the role of the vagal nerve and autonomic nervous system in heart electronics. And preaches his understanding. So, I now quote your telling paragraph ...........
"This EP confirmed all of the things so many of us talk about, and exactly what other EP completely brushed me off about. He says it is definitely my vagal nerve and autonomic system triggering my arrhythmias. He says I would be better served putting off the ablation and continuing to work on getting digestive symptoms under control. He is also going to have me tested for sleep apnea, even though I don't snore, just to cross out that possibility. He simply says an ablation is not needed, at this time, at my age, with the low frequency of my episodes. He says getting a handle on digestive symptoms, I will likely see even more success and do not need to do an ablation so soon. "
I went this route back in January 2010 after I was first diagnosed. I didn't get my guidance from an EP but from BobD and MarkS who touched the blue light paper with comments on vagal nerve. Then came my research. Then came a Nutritionist an examination of FODMAPS. Then came diet and that was followed by success .... this year has been my best year ever with only 1 AF event which was bad enough to put me off work for a few days.
You have been very fortunate to meet such a guy in your AF journey. In your case he is spot on, dead right ........ but TBF, such a fortunate diagnosis would not always be appropriate for all sufferers.
Hallelujah to that, my EP said the same thing after I transferred to him for a second opinion here in the UK. Eight years on he has kept me safe. The gastric element took longer for him to accept but he and the gastroenterologist he referred me to are now in agreement. What to actually do about it though has proven more tricky. The debate goes on how to resolve or at least control it.
So pleased you have found someone you trust. Go with it and be glad.
Good luck Chas, and thank you so much for this post. I'd be interested to know what your symptoms were to have the vagus nerve involvement taken seriously. My gut doesn't appear to have a problem, but I suspect vagus nerve involvement due to neural symptoms I've experienced (sometimes after exercise or neck/shoulder massage) where there is vibration right across the chest, not just the buzzy of Afib. It's certainly something I'll be discussing with the cardio department when I get that appointment.
He seemed to base it on the digestive connections along with the fact that my episodes have always been evening and middle of the night only. He asked at least 3 times for me to confirm the timing of episodes.
This all sounds very positive. Do you know about the Zoe Programme for digging into your gut health - personal microbioomes etc? The tests also assess your blood sugar response and blood fat absorption. A few of us have done it here and found it helpful. You do have to pay for it but it's worth the money to get customised advice on how your individual digestive system works.
Great to hear, just when you have given up on medics narrow viewpoint up pops an example like this to restore faith. Hope all goes well, it will no doubt be a long road but I found it worth it. A few key factors I have adopted: No alcohol, no fizzy drinks, 80% less gluten & sugar, early light last meal of the day, less red meat, listen to your stomach more, spend x2 as normal on high quality local food & less red meat. I also think not eating between 5pm and 7am (intermittent fasting) helps the whole body not just the digestive area.
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