Should I cancel Ablation

[smconorm]

Last October I was diagnosed with arrhythmia.  The Holter Monitor indicated 24,608 SVE beats in 24 hours.  Subsequently, there was an Echo-cardiogram and nuclear stress test that indicated my heart was normal and I was referred to an Electro-physiologist.  I was told I have a preliminary A- fib condition and the EP starting me with drugs that are supposedly mild with minimum side effects .  This includes Rythmol SR 325 MG twice per day and Metoprolol Succer 25 MG (a beta blocker) once per day.  With the medication, the condition improved but was still present.  I was told I am a good candidate for and Ablation since I am "breaking through" the drugs and the condition will get worse with time.  The ablation procedure has been scheduled for Mid July.  Next month!

Ten days ago I returned from a two week cruise and started a diet and increase exercise.  I have lost about five pounds and I am averaging 30+ miles per day on my bike.   After a few days, I noticed there was no trace of arrhythmia and I stopped taking the Metoprolol.   Now after 10 days there is still no trace of my prior condition and I have cut back on the Rythmol and started drinking two to three cups of coffee--- ironically hoping for some sign of the condition to justify going through with the ablation.  I am wondering if somehow a change in my body chemistry after the relaxing cruise and new diet and exercise has brought and end to this affliction?  I feel great and I am somewhat reluctant to go through with this but I suspect the condition may be lurking in the background and reappear at a later time.

My question is whether I should cancel or reschedule this procedure. Does anyone know if the success of the catheter ablation is diminished when symptoms are not present?  There is quite a bit of cost and inconvenience as I will be in the electrophysiology laboratory /hospital in a city several hours away from home.


  

[smconorm]

My resting heart rate now, after discontinuing  Metoprolol for 10 days, is 51.  With Metoprolol it was 39 to 41 and with a blood pressure of 90 / 60  .   Every time I stood up I was dizzy.  However, the Metoprolol did provide significant relief for the symptoms by reducing their intensity.  I have been taking 325 MG aspirin per day as advised by both EP's.  I am still taking Rythmol but reducing from 325MG twice a day to 225MG twice  a day.  

I have been unable to correlate activities that bring on the worst episodes of the SVE's with my daily activities.  I suspect there may be some sort of delayed effect.  

[smconorm]

My initial decision to go forward with the mapping and ablation was based on the following I learned from two EP's I have been working with:

--The condition will get worse over time and eventually lead to sustained A-Fib even though there is no immediate risk for up to 10 years
-- All medication will fail eventually
-- Once in A-Fib the condition is more difficult to cure with an ablation--- there is better  success with paroxsmal afib
--If successful the ablation is a permanent cure.  
--There are life style benefits since the Metoprolol has undesirable side effects

Your comments regarding the ability of the lab to instigate the SVE with drugs are helpful since my concern is related to any possibility that the procedure is less effective when I am symptom free.

[Jerry_NJ]

Sounds to me like you've got a case to put of the ablation, maybe for years.

Ablation, especially for AFib, is not risk free, nor is it guaranteed to work/cure.  

If your symptoms are mild all you really need to do is control your HR, what is your rest HR now?  If you don't need to control your HR (a beta blocker has this affect for most of us) maybe all you need is a "safety" anticoagulant, and here a aspirin may be sufficient.

My EP and Cardiologist say no ablation for my AFib, my symptoms are too mild to take the risk.  Then too, I am in persistent AFib and have an enlarge left atrial chamber, i.e., the success rate for ablation for my condition is poor too.

That's my take, and it is based on the understanding that all you have is a lone or occasional AFib condition.

[stutterheart]

What is the purpose of the ablation? Most of the time, the procedure is a 2 for 1: the procedure is at least an electrophysiology study where they shock your heart slightly with the catheter tip and inject chemicals to produce arrhythmia. IF they find something, they'll do an ablation.
If there is a 'screw loose', they'll probably be able to pick it up in the lab. You are probably stress free now and your chemicals are in order. But they can replicate high-stress situations in the lab. I'd go for it. I don't think they'd do anything if they don't find anything.
You are probably a bit like me: it comes and goes. When they are on, I'm scared to death, when they are off, I feel invincible.