PAF - When to re-ablate

[arthur]

In 2000 I underwent an rf ablation (9 burns directed at a single focus) of PV foci which were found to be responsible for periodic PAF due primarily to adrenaline surges. Such surges were generally due to extreme physical activity.  Several un-ablated foci were noted and found to primarily produce PACs, with some possibility of leading to PAF.  No more PAFs until 2003, when a total of 2 showed up. In the subsequent couple of years, 3-4 have shown up per year.  All were due to extreme activity (soccer game play), all self-converted 10-20 hours post onset.  

Given that I work out/play soccer at extreme levels about 100 times a year, the onset of 3-4 PAFs/yr seems to be a pretty small problem, but it's certainly troublesome, as I cannot function at a competitive level while in AF.  

(1) I am under no medication, but have taken Toprol XL in the past with no adverse effects.  Would taking a single dose of a beta-blocker like Toprol before a game be expected to blunt the adrenergic spikes during game-play sufficiently to reduce the likelihood of a PAF episode?  (In other words, is this a reasonable first step?)
(2) I am now up to 3-4 PAF episodes a year.  At what point should I consider a second ablation procedure?
(3) This is a non-sequitur, however, I have always and continue to be able to feel the focal source(s) vibrating in the center of my chest. These twitterings feel the same as PACs (but are not due to PACs).  The PV ostia, esophagus, vagal and phrenic nerves all seem located close to each other...has this phenomenon been observed by others?

Thanks,

Arthur

[arthur]

Tantric, huh?
Sounds a bit philosophical.
The stomach brain can play havoc with the rest of you, and I'm sure it's through the vagus system, as that system pretty much runs through everything.  Meditation over medication is what the deal is, and to a large part, it should do wonders for those of us with hidden foci, ie, the situation where foci are shooting off ions, but generally don't connect with anything.  When you're anxious, the ions can travel through cardiac tissue more easily, when you're not, they don't, they stay hidden.

Happy Tantra to you!

-Arthur

[Ianna]

Interesting..

http://www.psyking.net/id36.htm

The Enteric Nervous System: The Brain in the Gut

ENTERIC BRAIN~SOLAR PLEXUS
The enteric brain is the key to navigating, enduring and succeeding in a tantric relationship and life in general. Willpower, power, peace, presence, devotion, compassion

[Ianna]

..it found me well... thank you.

Yeah, anxiety and strong emotional ups and downs are the motor. Or better, the fuel. I found that out too. Nothing serious .. but very annoying and sometimes scary.

Anyway, stay well too, Arthur.

See ya,
Ria

[arthur]

Nice to hear from you.  Yup, I occassionally visit this forum.  I found that you need to be careful about forums such as these, as they tend to become addictive (feeding the anxiety).  I've beaten the anxiety by avoiding paying too much attention to skips and vibes, basically the trick being to avoid thinking about arhythmias.  I still play soccer.  With care, I can avoid AFib, but I am not always careful.  The vibes have changed over the years, to the point of almost not being noticable (again, I think this is a side-effect of anxiety, where your nervous system is so tuned-up that tiny electical noises get amplified).

I hope this message finds you well.

Take care,

Arthur

[Ianna]

Hi Arthur.. one post up..

[Ianna]

Arthur hi!

Was I surprised to see you're still here.
Well, not really -- I visit this forum too, very sporadically.
Was just thinking of you while scrolling down.
And there ya were..

This is Ria ..(The Netherlands -- remember?)
Every now and then looking for solutions to this internal vibrating that drives me crazy sometimes.. never found out what/where it originates from (although I suspect it's the diaphragm - and stress etc worsening things)

I see yours are still there. The buzzers.. and you never found an answer either. Nothing...?

Still playing socker, I read.
Still going strong.
Good for you!

Regards, Ria

[runnertom]

I guess I would agree that our advancing age doesn't mean the end to athleticism. I did histograms of all the age groups from a large 5 mile running race last year. I found that the times of the top runners didn't deteriorate all that much with the older groups. There were just far fewer fast runners and many more people in the slower tail of the distribution. I attributed a lot of this to the almost universal weight gain with advancing age and corresponding speed loss. It seems that those who are truly committed to fitness will find a way to stay near the top.

[tickertock]

Hey Fred, Just want to wish you the best of luck with your upcoming ablation. PLease let us know how it turned out. I hope you will finally get relief and be free of the pain the PVCs have caused you. Take care and Best wishes.

[arthur]

Good luck with the ablation!  PVCs are a tougher target (thicker tissue, and as you indicate, in your case the source may be external)...perhaps the EP examination will confirm or deny this hypothesis.

Do you have any experimental verification that the vibrational feeling you are getting may be coming from the phrenic and/or vagal nerves (or some other plexus nearby)?  (ie, was there a specific test or technology used to map out a possible source?)

Sorry to hear the PVCs are still painful.

-Arthur

[arthur]

Thanks for the advice.  I am pushing 60 (actually will be 59 later this year).  Although I have given up trying to keep up with the over-30 bunch, and am considering the same with the over-40 team, my ego doesn't want to let go quite yet.  Don't be alarmed, they only let me play about 1/4 to 1/2 of the game, and I found an over-48 league that I fit into quite well.

When I was taking half-tablets of Toprol XL I felt as you did.  BPM seemed to top off at about 160, resting BPM went to about 35-45 (pretty low, but asymptomatic, as my normal resting BPM is about 45-50).  I would also get winded easily after sprinting...but, I agree that maybe this recourse is safest considering my age (although I have come up against players well into their 60's that can run).

Glad to hear the Toprol is working out for you!

-Arthur

[runnertom]

Arthur,
   Good to hear you are still kicking around! (pun intended). I think we conversed a bit a couple years ago. I am an avid cyclist/runner who at age 54 was found to have blockage in LAD that was subsequently bypassed.
   In the last four years, I have gotten pretty much back to my former level of exercise, riding with old buddies at pre-CABG levels. However, in the last three months, I have become aware of being in AFib after difficult rides. Long rides at a fairly high sustained effort didn't cause a problem so much as those including longer bouts of intense effort. It happened perhaps 6 or 7 times over a 2 month period. Similar to you, I tend to self-convert in about 24 hours.
   My cardio put me on Toprol XL, 25 mg. For the most part, it has been effective. I have been in fib only once while on Toprol and it converted about an hour after I got home.
   At first, I had trouble tolerating the side effects. My exercise capacity is/was definitely decreased. Normal max heart rate is about 175 or 180 and that is reduced to 160 or so. I notice that I had trouble riding a sustained 20 mph as I would without the Toprol I understand stroke volume is also reduced for a double whammy. Interestingly, the effect seems to be reduced perhaps 90 minutes into a ride. I suspect I may be metabolizing what is in my system faster than the time release system can re-supply it. At this point, I am quite happy with the Toprol. I really am not ready to get into an ablation if I can help it, particularly when I can avoid AF by moderating my activity somewhat. That does not sound like an acceptable option for you.
   I would suggest you give Toprol a try and stick with it for 6 weeks or so to get past the noticeable side effects. As you know, ablations do have the potential for irreversible complications. If I remember correctly, you are pushing 60 and don't have that many years of competitive soccer left and the risk may not be worth it.

Tom

[CCF-M.D.-MJM]

Hi Arthur,

(1) I am under no medication, but have taken Toprol XL in the past with no adverse effects. Would taking a single dose of a beta-blocker like Toprol before a game be expected to blunt the adrenergic spikes during game-play sufficiently to reduce the likelihood of a PAF episode? (In other words, is this a reasonable first step?)

Yes, that is a reasonable first time.  If exercise frequently triggers the AF you should get a good idea if this will work for you.

(2) I am now up to 3-4 PAF episodes a year. At what point should I consider a second ablation procedure?

When you think the degree to which atrial fibrillation affects your lifestyle out weighs the risk of the procedure.  Ablations have risks.  If you decide to accept the risk of ablation, your symptoms should be significant enough to justify this. The risk of major complicatons is about 1-2%.  I think it is a very difficult decision.

(3) This is a non-sequitur, however, I have always and continue to be able to feel the focal source(s) vibrating in the center of my chest. These twitterings feel the same as PACs (but are not due to PACs). The PV ostia, esophagus, vagal and phrenic nerves all seem located close to each other...has this phenomenon been observed by others?

People describe sensations like this -- I have no idea what causes them.  You are not alone though.

I hope this helps.  Good luck and thanks for posting.