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A-Fib
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A-Fib

Dear Dr:

Do you think there will ever come a point when A-Fib will become a routine problem to fix, such as angioplasty fixes a clogged artery or a bypass fixes a multitude of blockages? When I had my one and only episode of A-Fib three years ago my cardiologist said to wait two years and let the EP's perfect the ablation procedures before I considered ablation myself. Needless to say I haven't had any more trouble so I wouldn't have needed it anyway.

However, it seems even three years later that ablation for A-Fib isn't any more routine  than before, unless I'm missing something. It seems many ablation recipients are having to go back and have second or third ablations and some still aren't cured.

I am a 36 year old male and am a life-long sufferer from PVC's and PAC's and the smart money says I will be back in A-Fib at some point and I would like to know there will be a cure waiting for me when it happens. Thanks for yout time.


Erik
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Erik,

A fib ablation (PVI or pulmonary vein isolation) is relatively routine for people with recurrent AF.  As a 36 year old with one episode of AF, I wouldn't offer you a PVI until it became a frequent recurrence.  For example, if you as a 36 year-old had one episode of AF every couple years and you were easily converted to sinus rhythm, I would start you on aspirin 325 mg and maybe a beta-blocker and deal with it from episode to episode.  If you had multiple episodes per year and were symptomatic, I would offer you an ablation now.  The quoted success rate of the Cleveland Clinic PVIs is about 80% for the first try and it recurs about 90% after the second try.  This means 90% of the original population, not 90% of the 20% who failed the first procedure.  The technique is improving and takes about 2 1/2 to 3 hours--the older procedures were much longer.

We will never be able to cure everyone with AF, but not everyone with AF needs cured.  For some people, stroke prevention with aspirin or coumadin and heart rate control is all you need to do.  

The techniques are always improving.
11 Comments
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Avatar_n_tn
Eric, I'm sure we would all like a cure 'waiting' for us with every rhythm out there..  But get real..  A-Fib is not anywhere near as bad as it was years ago..  They've made huge strides on curing this rhythm as the doctor indicated.  

I hate to sound 'insensitive' but if I only had 'one' event - I hardly doubt I would be screaming for 'justice' and a 100% cure -RIGHT NOW..  Get real !!!   Do you know how many millions of people deal with this rhythm and suffer with symptoms EVERY DAY !!!

Best Wishes
Marilyn (runner)

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Avatar_n_tn
I have been plagued with Atrial Fib/Flutter and have been cardioverted 9 times over the past year and a half.  I have had two maze procedures in the time as well as PVI.  Finally, I had an AV node ablation and am now permanently 100% pacer dependent.  There are people who have one episode of Atrial fib and don't experience it again...at least not for a very long time.  Beta blockers and aspirin are a good idea if it occurs again.  But if you only had one - two episodes a year, I would opt for the cardioversions with either drugs or Cardioverter.  I am sure it was an uncomfortable experience for you.  It certainly has been very difficult for me.  Good luck to you.
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Avatar_n_tn
Not to sound naive on this subject, but I guess I am, what exactly does A-fib "feel" like when it is occuring?
Thanks-Jerry
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Avatar_n_tn
I've suffered from bouts of a-fib for over 14 years and have been in constant a-fib for the past six.  Once you get past the thought of a "sudden death" scenario, I have not found a-fib to cause any decrease in the quality of life, in fact I feel much healthier know.  The only time I think about it is when my cardiologist stops the stress tests because my heart rate passes through the 190's after two minutes of walking.  Yet I run twenty miles a week and look forward to participating in the NYC marathon in November.  

I would imagine the  doctors won't focus on making major strides against a-fib, which is an treatable annoyance,  when there are still so many types of heart problems that cause death,

good luck
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Avatar_n_tn
Since you are a runner that suffers with A-fib, I'm curious as to what level are your bpm when you train?- is it constant, or is it irregular during sustained exercise.
Thanks.
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Avatar_n_tn
Eric, if you only had the one episode of afib three years ago then I think the good doctor's advice is exactly the right prescription.  Cross one bridge at a time.  I've put up with off and on for 35 years.  I was first hospitalized 10 years ago with it when I couldn't "cough" myself into regular rhythm.  When you have you are convinced you will die and it is quite noticeable.   I equate it with pulling the spark plugs off an auto engine.  I'm 61 in December and am on Betapace.  I will continue this regimin and the aspirin therapy until I am convinced the ablation is necessary.  In any event the Cleveland Clinic is the gold standard for treatment.  If I were going to have an ablation that is where I would go.
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Avatar_n_tn
Eric, if you only had the one episode of afib three years ago then I think the good doctor's advice is exactly the right prescription.  Cross one bridge at a time.  I've put up with off and on for 35 years.  I was first hospitalized 10 years ago with it when I couldn't "cough" myself into regular rhythm.  When you have you are convinced you will die and it is quite noticeable.   I equate it with pulling the spark plugs off an auto engine.  I'm 61 in December and am on Betapace.  I will continue this regimin and the aspirin therapy until I am convinced the ablation is necessary.  In any event the Cleveland Clinic is the gold standard for treatment.  If I were going to have an ablation that is where I would go.
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Avatar_n_tn
Eric,

I think PVI's are very successful.  I had one and I have been AFIB free since.  I think that ablation doesn't work for everyone because for some the focal points are not as precise, and for that reason ablations will never work for some.  

It's kind of like the "cancer cure".  We do have treatments that are much better today than ever.  But for some a certain treatment will work and for others it won't.  Same cancer, same treatment, but different results. Go figure.  The body is simply too complex for easy answers.

Ablations will probably get better but not perfect.  Perfection is a tall order.  I'm just grateful for 90%.  I'll take those odds to the race track any day.

By the way, hope you never have to have an ablation.
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Avatar_n_tn
I want to respond to the question about how an A-fib feels. I tried to write a description for myself several months ago, prior to my ablation, as I was hoping that soon I would not be able to remember. That has not happened. I am 8 weeks post ablation, and although they generally have gotten shorter, they are not gone, and last Friday my EP said "get an appointment to discuss a second ablation".

I'm having a fibrillation right now. The closest description I have been able to come up with is to compare a Fib to running a vibrator on your chest, but inside. We have one of those Homedic body vibrators with two soft round "nodes" on it. If you can imagine placing that on your sternum, and running it in an irregular mode (bump bump TA BUMP, bump THUMP, thump BUMPY, bump, etc.) but inside your chest, that may give you some idea. Other than the pounding inside your chest, you can also have pain (for me centered around my spine below my shoulder blades), shortness of breath (new for me since the ablation), and if your heart rate exceeds 160 or so, diziness, and at 190 BPM or higher, tingling in your arms and legs (because you are not pumping blood any more, you're just stirring it), and passing out at 200 or higher (same reason, not pumping blood). Obviously, you want to control the rate so it doesn't go to 190 or higher, but I have experienced that twice now, and it not any fun.
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Avatar_n_tn
Hope you check back in here after the NYC marathon. As a former runner trying to get back into it, but can't because I apparently have Afib when I run (get dizzy after a mile and a half) could you expand a little bit about how you have coped with your problem to be able to keep to a 20 mile/week schedule? Are you on any meds? Do you run through your high bpm periods or do you stop and recover? Thanks.
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