PAC's/PVC's post pvi ablation

[Donald7252]

On 11/8/2008 I had a PVI ablation for a-fib. I am a 55 year old male with no heart damage. I had had a-fib episodes for nearly 20 years. About 5 years ago I was put on flecanaid, 150 mg twice daily. I was already taking atenolol 50MG 1 per day. As I had gotten older I had more episodes, more frequently, of A-fib. I went for the ablation at NYUMC in New York City. I had the normal healing process, some bouts of a-fib, some skipped beats, etc. After 3 months I stopped the Flecanaide. Within 48 hours I was having skipped beats, lots of skipped beats. In fact they were so frequent that I could not function. I went back to the NYUMC doctor and told him the problem. Because during one of these episodes I reverted to A-fib for about 8 hours, he recomended a second ablation for a-fib. He also told me to take the flecanaid as before. Since back on the flecanaid I have had no a-fib, very few and infrequent skipped beats. Is the second ablation really needed if I am OK on medication? My problem is that if the ablation does not cure/reduce dramatically the skipped beats, I will still need the medication. Therefor, my mind tells me, if I am controlled on the drugs, and the ablation is not fixing the skipped beats, what's the sence of having the second ablation. The ablating doctor says he doesn't think I will remain controlled for long on the medication. What is your opinion of this mess.

[Michael J. McWilliams, M.D.]

If it were me as the patient, I would continue taking the medication until it failed on several occassions, then reconsider the ablation.  The ablation has a low risk of stroke.  If the symptoms are controlled on medications, I agree with you.

[heart2]

My cardio doc is sending me (44 female) to an EP doc to discuss ablation for my recently diagnosed PSVT.  I am fairly well controlled on Lopressor but I can only take 25mg / daily.  I split the dose and take it during waking hours because my heart rate at rest (even before I started the beta blocker) is 48-52 BPM.  My cardio is afraid that one day I may no longer be controlled with 25mg and won't be able to tolerate a higher dosage.  She wants me to check out having an ablation done.  If that is not an option, she'll try me on the flecanaid.  Aside from stroke as MD mentioned, and of course, failure to rid me of my PSVT, what could the other complications of an ablation be?  Is it worth the risk?

[Donald7252]

The EP that is treating me at NYUMC told me that the longer I wait for the second ablation, the lower the chance for success. I still have the PAC?PVC's occasionally, and in large numbers for a few hours from time to time. I don't know if spicy food is a contributing factor, but it seems to follow the day after a very spicy meal. I am worried because the ablation, by design damages parts of your heart, and no one seems to know how this effects you 30 years down the road.

[Donald7252]

I don't know anything about your condition, but It seems that "ablationist" seem to specialize in one type of problem. In my case it was a-fib. The result od my ablation, although maybe not the normal result, was alot of skipped beats. My EP that did the ablation is from a well respected Med Ctr in NYC. But it seems that in my case he is more concerned with the a=fib and not even giving a second thought to the PVC/PAC issue I have. I think as this field is relitivekly new, statistics are the goal. I think they look for patients that have a high possibility of success to "pad" their stats. If they want to ablate you, the EP must feel that you have a high likelyhood of success. The ablation itself is nothing. You wake up and within 8 hours your walking, gingerly, and the next day you go home. The staff in the recovery area, and the staff for your overnight stay are very usually attentive. I personally nad an episode of my blood pressure droping to an extremely low level. I was almost unconsious but my wife said that there were three doctors on me like a hawk, and they had me up and running in 15 minutes. I was very happy about the staff. When I got home I had some episodes of stuff that I never had before. I actually went to the emergency room once and was admitted overnight. You will have chest pressure for a couple of days, but it is not severe. The worst part is the healing of the sheave sites, where the insert the cathaters. Your groin area will not be happy for a couple of weeks. My other advice would be to shave your groin area. This sounds stupid, but in my case, they really didn't shave everywhere, but the bandage you with some unbelivably sticky tape, which eventualy must come off. In my case I can honestly say that that was the most painfull part of the whole process. Jabing the Lovenox needle twice a day for 5-10 days will be easy, removing the pressure dressings, OH MY GOD! All in all, if you only have to do it once, and it works, it will be a great thing. If it doesn't work that well, like in my case, and you must do it again, well you can read my post, I'm trying to make sure it is absolutely needed before I go through it again.