Atrial tachycardia and PAC burden and urgency of ablation question

[Iamfuzzyduck]

So I finally found the report from my 14 day holter monitor and it showed a PAC burden of 4% and 141 episodes of atrial tachycardia originating from the pulmonary vein and the longest stretch being 30 beats (I guess that is what the EP meant when he said i was having mini afib episodes, maybe he was trying to make it so I'd understand). This measurement was taken 3-5 weeks after my big afib event, so my heart was probably very sensitive. The reason I am writing is that does it mean I shouldn't wait for an ablation, or would it be ok to wait for the best EP and have it completed in June/July this year, as opposed to next month? I do feel that my heart has calmed down considerably over the past couple of weeks to the point where I am drinking two cups of coffee a day and a glass of wine 3 days a week- but now that I have just read the report I am in a panic!! Also when I sleep on my left side at night my heart quivers, but it is ok on my right-I don't know if it is in my head. I have been working out and doing some intense rounds of high cardio but if I push it as hard as before my episode I can sometimes feel like I am skipping a beat and feel light headed, again, I don't know if I am imagining it! I am now scared again :(...

[mjames1]

So essentially your monitor showed no afib, some very short runs of atach and very few PACs. Based on that alone, I wouldn't want anyone poking around my heart with heat or cold

The question seems to me seems to be what exactly is your afib burden, i.e. how is afib affecting your life and not what some arguably sub clinical events on a monitor say. If afib is impeding your life, then ablation or anti-arrhythmic meds make sense. If not, they don't to me.

That said, if you do decide to ablate, waiting for the best ep possible makes the most sense. Ideally, you want someone who has not done hundreds, but hundreds PER YEAR and thousands in total.

Jim

[Iamfuzzyduck in reply to mjames1]

Thank you! It is so confusing! I shall wait then!

[CDreamer in reply to Iamfuzzyduck]

I don’t see what you are confused about? James has given you a very clear answer but it is an opinion.

If you have virtually no AF, some tachycardia (different ablation) and a few ectopics (which everyone has to a greater or lesser extent) then unless AF is very symptomatic and HR cannot be controlled - what would your reason be for wanting an ablation?

Bearing in mind that many EPs in US will recommend if you have good insurance as ablation makes them and hospital a lot of money, I would tend to agree with James. Don’t poke the beast. My 1st ablation made things a lot worse, second helped and left me AF free for about 3 years but I took a long time to recover and had a high ectopic (PAC’s) burden for about 12 months after. Now that was 10 years ago and equipment and skill levels and success rates have improved but only with the very experienced and very skilled EPs.

It is your decision - do your homework on treatment options and do everything you can - Lifestyle wise - then you may find a big difference anyway and you are going to give yourself the best chance possible for recovery from ablation and of it actually lasting.

Hope that helps.

[bean_counter27 in reply to CDreamer]

We're understandably focused on the issue of AF and ablation is one of the key treatments for AF. However, just because Atrial tachycardia isn't AF doesn't mean ablation isn't also a suitable treatment for Atrial tachycardia. This is a question for the medical professionals and/or people experienced with Atrial Tachycardia as a primary condition.

[Iamfuzzyduck in reply to bean_counter27]

The EP thinks afib is the primary condition here…

[Iamfuzzyduck in reply to CDreamer]

James didn’t confuse me, it is the different types of arrhythmias i have that confuse me, and when my apple watch shows an afib burden of 8%. James’ answer is helpful. The PACs only started after the afib, not before, I don’t know why ..

Thank you for your answer

[Ppiman]

Only your doctor can advise, but these AT events are similar to AF, I suppose. I was told similarly. The ectopic rate is low. I would guess mine is far higher but variable. It sounds as if you are being properly looked after.

Steve

[bean_counter27 in reply to Ppiman]

I agree, only your doctor is in a position to appropriately respond to your questions and concerns. He/she will have the "full picture" of your results any other medical conditions, medical history etc and be well versed in treatments. What you need to do is ensure you ask him/her all the questions you have and make sure he/she knows about your anxiety/concerns.

If it was me, I'd want to know my options (including do nothing) and the pro's and cons of each. After discussing it, I would also normally ask "if you were in my position, what would you do?"

If you are not confident enough to engage in depth with your doctor, take someone with you who can do it for you, with your assistance or vice versa.

Your health is paramount so don't think you're being over the top by wanting to know all of the above. If you're still concerned about whether you're doing the right thing then seek a second opinion.

[Ppiman in reply to bean_counter27]

Well, that was clear and very well put. Sage advice.

Steve

[Iamfuzzyduck in reply to bean_counter27]

He made it very clear he would have an ablation in my shoes. I am having a second opinion but it is whether i should wait for that. I think i will as no one seems to think I am having a high burden of arrhythmias. Thank you for your advice …

[bean_counter27]

See my reply to Ppiman above

[Cangelo629]

From what you wrote your story sounds similar to my path to AFIB I am very pleased that I took the step to have a ablation I hesitated at first made my life miserable exspecally when Ivwoukd hit the gym. Now I sleep better even on my left side that's a common issue with Afib it acts up when you do. As time goes on AFIB begats AFIB its not going away and usuall ends up getting worse. The procedure has made a world of difference in my life I have much more energy was able to cut and eliminate some of the meds I was taken I simply feel better over all im 65 and have more energynow then I did 5 years ago.. If your in the US you know we don't have to wait to have the procedure provided your a candidate for it just make sure you find a electrophysologist who has some years under there belt doing the procedure. I would at this point cut your coffee and alcohol consumption along with the other food triggers that can affect your hearts rythem. Read up and ask questions learn all you can about AFIB it will help make better decisions as you travel your own journey.

[Iamfuzzyduck in reply to Cangelo629]

Thank you! I am glad to hear it improved your afib. I think what you are saying is along the lines of the treatment protocol here…

[bassets]

I feel the same asCangelo629. I a loads better after my ablation and have been able to cut down on my meds. I saw a private electro physiologist and went back on the NHS to have my ablation under him. The Afib did come back but it was nothing like as bad as before so I am glad I took the chance. You will be better to discuss the pros and cons with a doctor before you make up your mind to ablate. Good luck.

[Iamfuzzyduck in reply to bassets]

Thanks! I am glad it improved your afib!