Help with ablation decision

[Quality Woman]

I am being told I need a cardiac ablation & need help to make an educated decision. I am 58 years old female, three generation (maternal side women)history heart disease, triple by-pass (4/01), hospitalized twice (2001, 2002)for a-fib & tachycardia, enlarged left atrial, liver enzymes (62-don’t drink), non-smoker, eat heart healthy, no diabetes, blood pressure 135/73), LDL-71, HDL-51, Cholesterol 139, heart rate 54-56, 1˝ hour gym work-out 3/4X/wk, 15 pounds overweight, recently having sinus bradycardia, supra ventricular ectopy, ventricular ectopy, supra ventricular premature beats, ventricular couplets & triplets, sudden rate increase (55-98), PAC Triplets, interpolated VPB, QRS conduction change & ventricular bigeminy & trigeminy.  Currently on Sotalol,80 mg, AM & 120 mg,PM, Zetia,10 mg,OD, Warfarin Sodium,5 mg,OD,5x/wk. & 7.5 mg.OD 2x/wk, Caduet, 5mg/20mg,OD, Niaspan,500mg,OD, Folic Acid,1 mg,OD, Sertraline Hcl,50 mg,OD, Fexofenadine Hcl,180 mg,OD, Co-EnzymeQ10, 120mg, OD, Omega3's, 1200 mg, OD & Calcium w/D, 500mg, OD.
The arrythmias are fairly constant (more noticeable when still).  I am often fatigued & lightheaded.    
Questions (1)I thought ablations were for irregular heartbeats that are also tachycardia. I only had two tachycardia episodes (last in 2002). (2)Can they “map” and find all of them? (3)What would happen (structurally, physiologically) if I did nothing and the arrythmias continued? (4)General long term effects of ablation? (5)I read ablation (AV node) often results in heart rates that are too slow and a pacemaker is needed. Is this common? (6) Dr. raised the Sotalol (was 80 mg., BID) while I am deciding and I don't feel the arrythmias. What are the dangers of long-term beta blocker use? Mother had kidney disease (one removed at 25). Am I forgetting to ask something?
Thank you so much and I am so grateful that your website and advise forums exist.

[Forum-M.D.-bkj]

QW,

Thanks for the post.

Making a decision to under go any procedure is difficult. Each time you need to ask yourself:  How severe are my symptoms? Will the procedure impact the symptoms? What are the risk of the procedure? And Are the risks worth it?

Im not sure what you are undergoing an ablation to accomplish since im not sure what they are trying to ablate.

(1)I thought ablations were for irregular heartbeats that are also tachycardia. I only had two tachycardia episodes (last in 2002).

They can attempt to ablate foci for ectopy if it occurs frequently. The success rate of this is not as great as other types of arrythmias.

(2)Can they “map” and find all of them?

Usually there are multiple sources of ectopy. An electrophysiologist who has reviewed your case would be able to answer this question.

(3)What would happen (structurally, physiologically) if I did nothing and the arrythmias continued? (4)General long term effects of ablation?

Unless you were having very frequent ectopy or arrythmmias, usually nothin. Again, Im not sure of your underlying arrythmia, so I can't specifically comment.

(5)I read ablation (AV node) often results in heart rates that are too slow and a pacemaker is needed. Is this common?

AV node ablation is a specific kind of ablation that disconnects the atria from the ventricles. Sometimes the AV node can be harmed in an ablation but it depends on what the physician is trying to ablate.

(6) Dr. raised the Sotalol (was 80 mg., BID) while I am deciding and I don't feel the arrythmias. What are the dangers of long-term beta blocker use?

Really none. If you aren;t having symptoms, I would discuss with your physician why exactly they feel you need an ablation.

Am I forgetting to ask something?

We always forget to ask something. It's human nature :)

good luck

[frs87]

I read many people discussing about risks of ablation but I actually always heared it is a very safe procedure. The only problem is the possibility of an AV block, but apart from that I don't see why not choose ablation as an alternative if you have a normal structured heart.

[maggiemag]

It is a very safe procedure, but any time you have an invasive procedure, which it is, there are risks.  You are after all, putting caths in the heart itself.  And it is a VERY expensive procedure!  Unless the abnormal rhythms are sustained/very frequent or cause untoward hemodynamics, or the patient just can't tolerate the symptoms any more, I hope a reputable EP wouldn't even try one, given a structurally normal heart.  Just my opinion!

[Bromley]

Hi.  I agree with the doc.  You need to start by understanding what they are trying to cure, and then assess whether an ablation is the right thing for it.

I dont see anything in your write up that looks like something worth ablating. I'm not saying its not there, I just dont see that you have comprehended it and successfully put it into words.   Like the doctor said, onsies and twosies are't usually candidates for ablation unless you get literally thousands of the suckers everyday.  Also, there are some characteristics that can disqualify people from being good candidates for ablation:  for instance, heart disease.

Having been through an ablation myself, I can tell you that while an ablation is an easy procedure to go through, the effects it has on you can be very profound, and they will last a lifetime.  From your description,  you work out at the gym, and are clearly not debilitated now.  This is something you should not take for granted.

Trust me it is better to play it safe.  Ablations carry a fairly significant risk of stroke, and there are an infinite number of ways to screw them up. So you really really need to go through this carefully, and select a fine doctor, before you sign up for one.  

I suggest asking a lot more questions and doing a great deal of reading on your own. If necessary seek a doctor who can answer your questions in a way you can understand.  

Good Luck.