Is there Ablation for PAC / Ectopics?

[Moose09]

Hello fellow rhythm buddies! I’m 62, and I’ve had afib for 6 years now. I’ve had 3 ablations, 1 for flutter, a pulmonary vein isolation, and a coronary sinus ablation (Nov 2024). But I still have either afib or PAC 16-20 hrs a day. When I’m awake I believe the majority of it is PAC’s (from Kardia readings) but it does go right through the night so I don’t know if that’s afib or PAC.

I have my follow up with my EP in Feb and I want to be prepared and fully informed as to possible options. When I saw him last, he said our centre isn’t doing PAF yet, so if things didn’t improve I’d be looking at another traditional ablation, which I’ve read may be making the PAC’s worse, or I’ll start taking amiodarone, or “living with it”. So I’m trying to do some research to prepare for another option. And you have been such a wealth of information and so helpful! I will ask him for a Holter to find out how much of my arrhythmia is afib vs PAC. If it is primarily PAC, I expect the burden to be high - at 16-20 hrs a day it will be in the order of 20,000 beats. It affects my condition - 2 years ago I was going to the gym regularly on an elliptical, now I can’t do 2 flights of stairs, and I NEED a nap every day. I’m on 200 mg flecainide, and I’ve tried both beta blockers and calcium channel blockers but they lower my heart rate too much (I ended up in ER with a resting HR in the high 30’s). So finally my question: is there a centre anywhere that specifically performs ablation for PAC’s / ectopics?

[Cliff_G]

Yes, there are EPs who will look at ablating ectopics. They need mapping first, and you'd need to do your homework to find a suitable centre/EP with not only the capability but also the track record; sorry, no idea where in Canada.

Is your reference to "PAF" a typo (not PAC)? Ablating Paroxysmal A-Fib using cryoablation (PVI) is usually the first approach, so it seems odd any centre would not be doing that.

Ectopics can be easy or difficult to ablate. They are easier if they are unifocal, i.e. all coming from the same place. If multifocal, that can be difficult, and it's also more difficult (but not impossible) to reach and ablate PVCs in the ventricles.

[Moose09 in reply to Cliff_G]

Thank you for your reply Cliff. You are right, I do have a typo, that should read PFA (pulsed field ablation) which we don’t have here yet in my province. My 2nd ablation was PVI by cryoablation.

I would prefer to stay in Canada for obvious reasons, but if there isn’t an EP here that does this type of ablation or who won’t take out-of-province patients, I might be willing to travel for a procedure. I’m thinking Europe, UK, Japan.

[Cliff_G in reply to Moose09]

Sorry, my brain didn't make the leap to PFA!

I'd be very surprised if there weren't a number of good EPs in Canada, though I guess it does depend where you are. If you really needed to travel, I've sent a personal recommendation to you as a private message.

[Moose09 in reply to Cliff_G]

There absolutely are great EP’s in Canada, but in researching have found they are often restricted in taking patients from out-of-province, so my choices may be very limited. I believe my own EP is very good, but his centre doesn’t have the resources to perform PFA or ablation of PAC’s / ectopics. I’ll continue to investigate but in the meantime would like to know all my options. Thanks so much for your personal message!

[Karendeena in reply to Cliff_G]

I think the PAF was supposed to be PFA (pulse field ablation)

[Moose09 in reply to Karendeena]

Yes, you are right Karendeena! 😁 Thanks for catching that.

[DawnTX]

amiodarone was the first medication I was put on. I wish I could tell you something good but for me, it was not however, there are many people on here who have been on it for years we are not all the same as you know. I apparently had an allergy to it on top of everything else which included a rash. I stayed on it for several months, but I was miserable the whole last thing they were going to try on was Ticosyn I am not sure of the spelling FYI to go on it. I was going to stay in the ICU at least five days and be monitored around the clock. I don’t remember now what the reasoning it is a serious drug, but I’ve also heard good things. They really need to find out exactly what’s going on with you. Will they do a implant Heart Monitor? The was a pain to me and told us nothing. The implant takes less than an hour. in the doctors office. I feel a thing is smaller than a pencil eraser where they make a pocket. Within two weeks we had answers. Unless you are having a fib during an ECG, it will not pick it up. This will be constant and see exactly how many episodes you have etc. It’s good for about five years. They removed mine when I got my pacemaker. It came out the same way it went in. I had both atypical flutter and atypical a fib. All chambers are involved for as my doctor referred to me lol I’m unique, including the pacemaker he designed strictly for as he was putting it in. It was the best thing I ever did, but you still have options

you have a lot of people on here with experience with amiodarone as a positive. See what they advise but at the end of the day it’s between you and your doctor.