Ablation question

[Sue143]

Hello again. I'm 38, good health. I've had palps. for almost 7 yrs. In July I had a-fib for the first time. It was stopped by a Cardizem drip and I haven't had a-fib since. I had another echo, blood work and Holter monitor. Blood work and echo normal. The Holter shows PAC's and atrial tach. My Dr. thinks the atrial tach. is what triggered the a-fib. I had been taking beta-blockers but they increased my palps and caused my BP to drop too low. so they stopped them.
He sent me to an EP dr. and he said I would be a good candidate for an ablation. He said I could take anti-arrhythmia meds but he didn't recommend them because they may not work and they have a lot of side effects. He said if the PAC's were coming from the same  arrhythmia then they would be gone too if I got the ablation. But he said if my heart was quiet the day of the ablation, then they wouldn't be able to find anything.
He said this won't kill me and I can live with it, but he worries that over time everything will get worse and they'll have a hard time keeping me out of a-fib.
I feel like I have no other options but an ablation. He told me all the risks and I have 2 small children so I don't want to take any risks I don't need to. Are there any other options for me? Is it really possible to get rid of the PAC's? I've read how everyone else still has palps after an ablation.
He told me not rush and think about it and call him if I want to schedule. Is there anything else left for me?

Thanks, Sue

[Cleveland Clinic]

Sue,

I remember your history. Your options are pretty well spelled out for you.

Your options are really meds, no meds or an attampt at an ablation. Each carries risks and benefits. I think the main issue needs to be how well you can live with your symptoms as you are now. An ablation may help with both the SVT and PACs.  
Thus it could impact your palpitations.

It is very difficult to balance the risks and benefits of any procedure, especially when you take into account your family. You should focus on how well you can deal with doing nothing and how that will impact your overall sanity and well being.  If you are miserable all the time from worry about the SVT and palpitations, it might make it easier to reason through to undergo an ablation.

You might talk to others on this forum who have undergone an ablation to get some more insight from those that have gone through it.

good luck

[Sue143]

I forgot to add that the atrail tach episodes only occur from once a week to once a month, and last anywhere from 10 sec. to 10 mins.

[Elrod]

I've got a question for the board. Can a person with chronic A-Fib have success with an ablation. I live near Cleveland and have heard so many good things on this BB about CCF, that I'm ready to talk to my Cardiologist about the ablation. There just seems to be so few that have chronic a-fib. Right now I'm on 180mg of Betapace 2X per day, and Warafin, this is keeping my HR in the 78-98 range. Thank you.

[bubby1]

I am considering ablation at the pittsburgh med center. I am told that I do not need to be in Afib to fine the source any longer. Is this true? I take Amiodorine and coumadin and would like to get off these drugs. My Afib is chronic and I get cardioverted about 2 times a year. Any info would be appreciated

[Sue143]

Hi Alice, I'd love to chat with you. My email is ***@****.
Looking forward to hearing from you.

Thanks, Sue

[Sue143]

Thank you so much for your insight. You are always so helpful. Right now I am in agreement with you. Unless it gets so unbearable to live with I'm willing to just live with it for now. They said the risks are 1 in 1000 of a possible serious complication. I would like it to be better than that if there's no guarantee that it will work in the first place.

Thanks again, Sue

[arthur]

The risks have gone down from about 2-3% complication rate a few years ago, to 0.1% (according to the post above).  If true, I doubt the risk can get any lower...so the question is whether you can put up with the irritation of occassional afib, or if in fact, the afib poses an additional risk by becomming permanent and leading to a greater likelihood of clot formation and stroke.

I understand that chronic afib is much more difficult to cure via ablation than paroxyzmal afib (PAF), because of gradual physiological changes (remodeling) that occur in the cardiac tissue.  The possibility of a cure remains, however, it's not as high a success rate as for PAF.

Some EPs insist on a preliminary procedure which establishes the protocol necessary to induce the arrhythmia.  In this way, on the day of the actual ablation procedure, the EP has a better chance of inducing the arrhythmia for ablation.  Without this preliminary step, you simply take the chance that it won't show up when you're all wired up, which could be disappointing.

-Arthur

[BJo]

Hi Alice,  My husband had successful RF ablation for A-flutter about 4 years ago at a well-known teaching hospital in the east.  At that time he had both A-flutter & A-fib.  The head EP told him up front, "I can cure your A-flutter but not your A-fib."  According to our local cardio, there is now a possible cure for his paroxysmal A-fib.  Would you mind to contact me & let me know about (what I assume) was your pulmonary vein isolation ablation that you had done at CC.  My email addy is: ***@****.
Thanks Alice,
Betty Jo

[Scared in Ky]

I am scheduled for an ablation the tenth of Novemeber.  I had a holter monitor that revealed bigeminy and pvc and a non sustained run of vtach.  I had a heart cath it came back good.  I however do have mitral valve prolapse its moderate to severe with no to mild reg.  I have been on sotalol which made me bradycardic.  I am now on Tambocor it seems to help some but my heart rate sometimes goes up to 153.  I feel so bad I pretty much stay in bed all the time.  I am scared to do the ablation and I am scared not to.  Is there any other medicine that might help.  Maybe I am just overly anxious....I am on xanax and my sister passed away back in May.  She was only 33 and they say she died from a seizure.

[glassheart46]

I just had an ablation for atrial tachycardia and frequent pac's.  My atrial tachycardia would come on only once in a while like youself but my pac's were very frequent and prior to the ablation they were 24/7.  My ablation was a success.  The ep doc got them all as they were very active as it sounds like yours are.  It was not near as scary as I thought it would be and I was only in for 2 hours.  I decided on the ablation because I did not want mine to turn into a-fib which is a much more dangerous arrhythmia.  I hope this helps you decide.  If you wish to email me my address is:
    ***@****

Take care!

[Momto3]

Sue, Count me in on successful ablations (Hi Glassheart-It'sME!)
I had an ablation for frequent pvcs in August and it was considered a success. I am scheduled to go back in November so they can try and ablate another foci as I am multi-focal. The doctors are being conservative and that's OK by me!! I have been on beta blockers and more recently Tambacor and Rythmol, but opted for the ablation rather than the medicine. Good luck...

[Momto3]

Hi Hankstar, Yes, they were able to ablate a foci in the RVOT. After the procedure the Dr. told us that she felt 70% confident that she successfully ablated a major foci. So that would fall right in line with what you have read. I am not certain what percentage my pvcs have decreased. I do know that I am multifocal and that it is presumed that I have (had) 2-3 major foci. I also know that on a previous holter I registered around 22000 ventricular ectopics, 3000 couplets, some runs, and very frequent bigeminy. Subsequent report showed frequent activity as well. This last report (mid Oct) showed about 6000 isolated pvcs, and only 54 couplets...marked improvement! The doctors are being extremely cautious and conservative because of  cardiomyopathy issues. I've had benign pvcs for many years and have been on beta blockers on/off. Some success initially, but eventually seemed to be more problematic. Since the pvcs were benign, I was able to use BB on an as needed basis, and that worked great.

Last year after an annual checkup, my EF had declined enough to indicate cardiomyopathy. That's a very long story, but the bottom line is that the doctors are confident that the CM was a result of the frequency of pvcs. After 3 months on Tambacor this year, EF improved 10%. Although the antiarrythmics appeared to be effective, I did not like the side effects, and knew I would have to take them forever. I also have MVP/MR and there is a possibility that the valve will need repair in the future. With that in mind, it would be ideal to have no CM and good EF.

I am very fortunate because my doctor is extremely conservative and would not recommend the procedure withou very careful consideration. Although the pvcs are annoying, I have pretty much learned to live with them.  Absent the CM issue, my doctor probably would designate them as benign. However, my records have been reviewed by MANY doctos and this seems to be the consensus.

It does take time for the heart to heal. In August,the pvc activity was markedly reduced. About week 6, the activity picked up. Event montitor and holter showed significant enough frequency to warrant further treatment.  Otherwise, I face the RX again...UGH!!! Thanks for asking.

[Momto3]

Hi Hankstar, Yes, they were able to ablate a foci in the RVOT. After the procedure the Dr. told us that she felt 70% confident that she successfully ablated a major foci. So that would fall right in line with what you have read. I am not certain what percentage my pvcs have decreased. I do know that I am multifocal and that it is presumed that I have (had) 2-3 major foci. I also know that on a previous holter I registered around 22000 ventricular ectopics, 3000 couplets, some runs, and very frequent bigeminy. Subsequent report showed frequent activity as well. This last report (mid Oct) showed about 6000 isolated pvcs, and only 54 couplets...marked improvement! The doctors are being extremely cautious and conservative because of  cardiomyopathy issues. I've had benign pvcs for many years and have been on beta blockers on/off. Some success initially, but eventually seemed to be more problematic. Since the pvcs were benign, I was able to use BB on an as needed basis, and that worked great.

Last year after an annual checkup, my EF had declined enough to indicate cardiomyopathy. That's a very long story, but the bottom line is that the doctors are confident that the CM was a result of the frequency of pvcs. After 3 months on Tambacor this year, EF improved 10%. Although the antiarrythmics appeared to be effective, I did not like the side effects, and knew I would have to take them forever. I also have MVP/MR and there is a possibility that the valve will need repair in the future. With that in mind, it would be ideal to have no CM and good EF.

I am very fortunate because my doctor is extremely conservative and would not recommend the procedure withou very careful consideration. Although the pvcs are annoying, I have pretty much learned to live with them.  Absent the CM issue, my doctor probably would designate them as benign. However, my records have been reviewed by MANY doctos and this seems to be the consensus.

It does take time for the heart to heal. In August,the pvc activity was markedly reduced. About week 6, the activity picked up. Event montitor and holter showed significant enough frequency to warrant further treatment.  Otherwise, I face the RX again...UGH!!! Thanks for asking.

Oh, once the first foci was ablated, they did try to identify other foci, but my extra beats settled down. The doctor said the heart settled down immediately after she ablated, what is perceived to be, a major foci....

[Momto3]

Yep, I do believe it is because of the cardiomyopathy that they are being so cautious.  After all those years of benign pvcs, it turned out that I was one of the rare ones : )

[NHS]

I've been reading with interest the comments on the "success rate" of catheter ablations and on post-ablation problems.

I'm a 60 year old female who has been diagnosed as having paroxysmal atrial fibrillation. The episodes began in the year 2000. Holter monitor results and EKGs indicate that I've had ectopic beats, PACs, and occasional SVT. I tried atenolol (with and then without lanoxin). It helped for about two years. Then, I tried Rhythmol, but only took it for two weeks because of the side effects. I've been taking Norpace CR since September of this year, but it doesn't seem to be helping consistently.

Recently, the EP recommended that I have a catheter ablation. I'm trying to get as much information as possible about the best place(s) to have one done and about the best people to perform one.

I already have the EP's point of view on this. But I think sometimes the best information comes from the people who have had the procedure done on them.

Since I live in Southern California, I'd especially like to hear from anyone who has had a catheter ablation preformed in this geographic area. Please let me know your age, what your diagnosis was, where you had the ablation done, who performed it, and how satisfied you are with the results.

I'd like to schedule the ablation soon. So, I'm eagerly awaiting your replies.

NHS  

[PA1472]

I had an ablation done four weeks today.  I was diagnosed with Supraventricular Tachycardia.  I was at a wedding and had an attack.  They called 911 and I passed out after 45 minutes and I was shocked.  That had to have been one of the worse experiences I've ever medically have had!  They normally just inject me with the heart medication to bring my heart back down to normal rhythm, but these guys decided differently since I was passed out and unresponsive.  I was admitted, surprisingly since I'm usually always discharged right after the event.  But, they founds some abnormalities in my EKG.  After all tests were performed, I agreed to have the ablation done. I just turned 50 and felt it's time I put these episodes behind me once and for all.  

After the ablation, I felt pretty good the next day.  As soon as I got home from the hospital, I started to clean my house and I stressed out my heart by over-extertion.  My doctor told me to call 911 and was admitted again for observation.  I'm now having atrial tachycardia caused by POTS.  Postural Orthostatic Tachycardia Syndrome.  My questions are:

Has anyone been diagnosed with this too and how serious do you this diagnosis is?

What was your recovery period after the ablation?  

I wasn't given any restrictions or any recovery period.  I stayed home from work for three weeks.  Any type of exertion seems to stress my heart and beats more rapidly from the atrium.  I have been feeling fatique more quickly since the ablation.  I can only work part time hours until I can get back to normal routine.  My chest has had a burning feeling whenever I breath in.  I also hear each and every heart beat every second.  Is this normal after the ablation?

I appreciate your comments.  THANK YOU EVERYONE!!

[arthur]

I have had a successful ablation for PAF.  It was carried out about 3 years ago at the Univ of Penn Hospital by Dr. Francis Marchlinksi.  At the time, his rf ablation procedure had a 0% complication rate (stenosis, stroke, etc), and he and his group had carried out 50-60 ablations for PAF triggered by PV foci (his group had carried out hundreds of ablations for a variety of arrhythmias).  I found him very knowledgable and extremely conservative (thus accounting for the very low complication rate)...for example, in my case, I spent six hours on the table while he put me in PAF about nine times, basically to confirm and re-confirm the location of the offending focus.  He ablated only this focus, leaving behind several others which he found caused nothing more than occassional PACs (0-5/min, mostly near 0-1/min).  These days, EPs are likely to ablate all suspicious foci, as the technology has advanced to allow this without significantly increasing the complication rate.

I agree with Hankstar that the best place to go is a place that has a huge amount of experience (like the Cleveland Clinic).  I am not familiar with what's available in CA, but if you ask Dr. Natale, perhaps he knows of a few large clinics there.

Good luck!  PAF is curable (as of a couple of years ago, the cure rate was about 60-70% after the first rf ablation, and 80-90% after the second, if necessary).

-Arthur

[PA1472]

Dear Hankstar,

Thank you so much for your prompt response.  I see from your comments to me and others, you're very knowledgeable in the medical field.

I feel better knowing that you can relate to my symptoms.  

Thanks again for your response and well wishes Hankstar!

[NHS]

Thank you both so much for your helpful replies.

Arrhythmia symptoms are indeed distressing and they do interfere with quality of life, if not peace of mind. Like some of the other  folks who posted messages, I wear a heart monitor/wrist watch. At times, I've seen my resting heart rate go from its normal 59 to 65 beats a minute to 188. My heart races and I feel as if I'm about to pass out. Although this only lasts for a very short time, it's scary.

If the meds were helping I might not be considering an ablation. But, since they aren't terribly effective, since the episodes are becoming more frequent, and since(as I understand it)the likelihood of having a successful catheter ablation does decrease as time goes by, I've decided to go ahead.

A doctor who was recommended by the EP told me that I have a 25% chance of experiencing post-ablation arrhythmia(s) and that the likelihood that these would be permanent is very low. I understood this person to say that he's been performing ablations since 1989.

Apparently, my echocardiograms indicate that the arryhthmias are all in the upper region of the heart, in an area that isn't near the pulmonary vein(?).

I like the suggestion to ask Dr. Natale for some information about CA docs/facilities. And, again, I thank you for your moral support and help.

NHS

[NHS]

Hankstar and Arthur --

My husband just reminded me that, after reveiwing the most recent set of echocardiograms, the EP had said I have superventricular tachycardia. As I understand it, this may differ from PAF, but I'm not sure exactly how it does.

Do either of you have any information about this?

Also, I'd like to know if either of you (or anyone else reading these messages) has (or is) taking Norpace or Norpace CR?

As noted in my first message, I've been taking it for about three months. I'm experiencing some side effects and would like to know if anyone else has, too.

Looking forward to replies.  

NHS

[NHS]

Thank you for the information about SVT, Norpace, etc.

The SVT was caught on tracings recorded while I was hospitalized in September. I was hooked up to a portable monitor, which, in turn sent data/tracings to a computer terminal at the nurses' desk, 24/7. Someone was always on duty to watch the tracings and evaluate them from time to time, for the doctors.

As I recall, they referred to the SVT tracings as "runs" which lasted several minutes each. Most of them occurred during a single night, while I was asleep or in a semi-waking state. The PACs were also caught in the tracings taken at the hospital, as well as on some of the EKGs that were done in an out-patient setting, in the past.

I did learn about torsade de pointes, before I decided to take Norpace. When I expressed concern about it to the doctor who prescribed it, I understood him to say that, since I'm taking such a low dose (100 mgs twice a day), and since my heart is otherwise "healthy" (no history of heart attacks and no structural problems), the risk of developing torsades is very low. I decided to take the chance because nothing else seemed to be working and no one was recommending an ablation at that time.

All that's changed. The Norpace has kicked up an inner ear problem and I've learned a lot more about ablations than I knew at that time. The down side to ablation (as I see it) is that it may not "cure" my problem and may, in fact, cause "new' arrhthymias. I understand this, from what I've read in teh messages on this board (and elsewhere) and from other sources.

What do you think?


NHS

[arthur]

Ablations may seem to "cause" a new arrhythmia, only because the original noise (focal signalling) was removed, and now, foci which didn't have a chance to express themselves, can.

Although this sort of thing can occur, my personal feeling is that it's not too common.  For example, I have a number of unablated foci, and these seem to confine themselves to producing PACs.  I believe the secret is in the EP mapping procedure (during your ablation session) which preceeds the actual ablation, which is designed to locate all active foci.  Even after the ablation is performed, the EP should be checking further by attempting to induce further arrhythmia.

As Hankstar has stated, the supraventricular stuff is generally easy to access and ablate, so chances are that things will go ok.

Good luck!

-Arthur

[NHS]

Thanks so much for the clarification/information, as well as your support.

Arthur, what you said about the likelihood of "new arrhythmias" seems to coincide with what was said by the EP and by the specialist the EP recommended. Do you need to take medicine to control/alleviate the PACs you experience?

Hankstar, what you said about having an ablation (or not)is quite true. One needs to weigh the risks/benefits of one's options and go with the option that seems to be the most promising. I understand from you and from the e-mails posted on this board, that the best plan is to have the ablation performed by the most qualified doctor(s), and to have it done at a facility that's a "center" for such a procedure.  

Right now, I'm looking at having it done by two docs (together). They're on staff at UCLA and/or Ceders-Sinai and they seem well qualified. They were recommended by the EP I've been seeing. I looked them up on the AMA website (for qualifications and for disciplinary actions, if any). One of them is included in a "Best Doctors" list.

Both Cedars and UCLA seem to be set up for ablations, because many of them are performed there each year, and because each of these facilities has two "cath labs" -- something which seems to bear this out.

I was hoping to get additional information about other docs/facilities in Southern California from people who have had an ablation and who use this board, but so far I haven't received any replies in this vein.

Unfortunately, I'm not sure how to post an e-mail to Dr.Natale, to ask him for some feedback on this subject.

Meanwhile, hankstar and arthur, I'm looking forward to hearing from you.

NHS

[arthur]

re. PACs after ablation...
In my case, I began by taking some meds in an attempt to alleviate the PAC production which seemed to show at a rate of 3-6 per min each and every day (shortly after the ablation).  The meds were Toprol XL and Tambocor, in order to make the foci less responsive to adrenaline surges and autonomic nervous system fluctuations.  After a couple of months I decided that taking these drugs was not really the answer.  I had become somewhat OCD'd on the topic of my pulse and the PACs, which of course constituted a wonderful self-fullfilling circle of anxiety. BTW, this appears to be a common side effect of such arrythmias as is easily seen by the posts herein. As I read more and discussed the topic with specialists, it became evident that everyone has foci and the ease with which the noise from these buggers travels is controlled by the state of your autonomic nervous system...thus with anxiety, the highway is toll-free, and lots more PACs are bound to show up. (It's the reason that the good doctors on this forum occassionally suggest meditative approaches). My  heightened awareness of these PACs simply led to more.

I stopped taking the meds.  And it took a good year to force myself to stop paying attention to the PAC production.  Spot checking since then has revealed an enormously decreased level of PACs (0-1 per min), more than was ever achieved with meds alone.  I now can claim to be completely cured with the ablation procedure, since the cure was dependent on knocking out the right focus and taking on the right attitude.

At this point I am 56 years old; I participate actively in competitive sports (soccer), which includes very rigorous and regular physical workouts, at the same level as when I was 30.  I am no superman, and I consider myself lucky to have avoided (thus far, knock on wood) any serious injuries.  I just wanted to make the point about exercise, since the PAF I had experienced did threaten to take it away.  Now I can train and play at the highest level and not worry about triggering an arrhythmia.

I am sure that the ablation will do it's thing...the rest is up to you.

-Arthur