ablation for afib?

[CFS56]

I have had a couple of afib episodes that I'm aware of, episodes of SVT, tons of PVCs and runs of PACs.  Been to ER a lot.  Been taking bystolic for 5 years and did fine for the first four.  The last year I have been having episodes of both regular and irregular tachycardia as well as going into bigemy and trigemy with the pvc thing.   The PVC episodes seem to be more of a reaction to stress and I know that beta blockers don't do a whole lot to stop them, so though disconcerting, I have not been overly concerned.  But the tachycardia episodes have seemed to be happening more than they should.  Friday, I noticed my heart skipping and just figured it was pvcs but within a minute or two, the tachycardia started up..it was irregular.  I was able to stop it with vasalva.  I set down for a while and as soon as I stood up it started again, was able to stop it.  This kept happening..about 5 times I think over a period of several hours.  Finally I took double dose of beta blocker and an ativan and it stopped.  Went to my cardiologist today and he's running some blood test and said to see what happens at the higher dose of bystolic and if it continues to happen we need to consider an antiarryhthmic, which totally freaks me out and I don't want to do or ablation.  He went on to explain that if the tachycardia I experience is afib that is harder to ablate and has higher complication rate.  Has anyone had an ablation for afib?  I am really scared.  I'm probably going to cause my heart to do something weird just by stressing about it.  Neither of my options seem particularly good to me.  Does SVT or afib, whichever it is, just keep getting out of control?  Would it do any good to just switch beta blockers..do you develop a tolerance to them?

[CFS56]

Thank everyone so much for taking the time to share advice and experiences with me.  It has helped, and I think I have pretty much decided what I'm going to do. I have had long standing SVT, since I was in my 20s and I'm now 60.  The afib has only been a recent development and it hasn't happened as much as the SVT has.  So, antiarrhythmics are something I really would like to avoid unless it's short term after an ablation.  Tom H., I had about the same reaction to sotolal as you did...horrrible PVCs and SVT.  Dr. took me off of it within a couple of weeks.  So...I'm going to check around hospitals and see who has done the most ablations for SVT.  I think I will start there as long as my doctor thinks that's a reasonable way to go.  Just getting rid of that would be such a huge relief.  If anyone has any recommendations as to hospitals, I am in Virginia.
Delta Dawn, I hope things go well for you.  I really appreciate everybody's input.  Thanks!

[DeltaDawn23]

I did have an ablation for afib February 3, went to the ER on the 5th, had a pacemaker placed on the 6th, as I had tachy-brady syndrome and it was dangerous because I was having several second pauses.  The pm is just to assist my sinus node and only kicks in when my pulse goes down to 60.  I went into aflutter, which surprisingly, was far easier to tolerate than afib, but now am in afib.  I have another ablation scheduled for the end of April.  I would not rule out anti-arrythmics totally -- investigate them.  My ep put me on Norpace which reduced my afib paroxamal episodes to one or 2 a year for 4 years.  I went for the ablation after lung surgery last summer changed the dynamics of my afib and I was ending up in the ER and needing cardioversion every few weeks.  It was suggested to me by several cardiolgists.  I was told it might take 2-3 times to get rid of the afib and there was an 85% chance of being cured and on no meds after.  It seems like they ought to be able to tell you what your problem is.  Have you been on an event monitor?  Afib only gets worse as you age.  I wish I had done it sooner rather than later.  I am hopeful that my next ablation will work.  The ablation was no big deal.  I have sleep apnea, was sedated also and wore the machine throughout the procedure and woke up with it in the recovery room.  I don't believe I would have done anything different, given my frequent visits to the ER.  The ep said my heart was scarred from all the episodes. Do your research, find a hospital/doctor that does a lot of ablations and has a good record.  U of M Hospital has lost one patient in 5,000 over a 4 year period and that was early on from an esophageal burn.  They have corrected the way they do the burns in that area now.  Cleveland Clinic claims no fatalities at all over a similar number of procedures.  The risk of complications is 2 percent. All things considered, I think those are pretty good odds when compared with an ER visit every few weeks.  Also ablation often makes afib less troublesome (fewer events) even if it does not completely cure it.  Everyone has to make this decision, but it was easy for me at this point because I did not see going to the ER every few weeks as a way to live.  One time it had to be done by the paramedics on a Saturday night!  People tend to gravitate to this board when they have problems, looking for insight and information, so it may have more reports of trouble.  I have read many accounts of good results from afib ablations and got 4 opinions -- all concurring that I should have an ablation sooner rather than later.  Not sure where you live, but check out the stats at the hospital and see what they have to offer.  Wishing you good luck with this.  It can be managed, hang in there.

[SDalb]

My experience has been with afib.
I have had 2 pvi ablations.  The first one in 2010. It lasted two years with infrequent afib episodes.  They became more frequent and i had the second ablation December 2012.  I have been symptom free ever since.  I had been diagnosed with proximal afib.  I have a more detailed journal entry if your interested.  I was not doing well with the meds. Flecanide and metoprolol. I was upgraded to rythmol after the first ablation.  The ablation seemed like the only alternative to drug therapy.  It seems to have worked this time.  Only time will tell if its permanent.  If not I will do it again.  The ablation is the only thing that has given me any type of relief.  But I know it is not successful for everyone.  Hope this helps.

[MichelleP_3811]

If you have an svt that is caused by extra muscle tissue like in avnrt or avrt I would highly suggest getting that corrected first and seeing if the afib clears up as a result.  Afib is harder to ablate and the success rates aren't as good as well the reoccurrence rates are pretty high.  Extra pathways however are easy to ablate with high success and super low reoccurrence.  I understand your trepidation about ablations but your svt may be stressing out your heart causing the other rhythm issues.  Clear that up and you may give your heart a chance to recover and correct itself from any afib issues.  I was terrified to do the ablation but when it is all said and done it really turned out to be not a big deal.  Of course there is no guarantee with any procedure but it is my opinion that over time your svt will wear out your heart and if you are having daily occurrences then things have escalated to the point where intervention may be your best option.  It is your heart and your decision but doing nothing it is very likely things will continue to get worse.  But again, I would not focus on afib if you have an svt that is highly treatable.  Focus on correcting that first.  But if you only have afib and not an extra pathway svt then I have read that ablating that sooner rather than later is the best bet as the heart can get too use to the afib making it permanent.  Best of luck sorting it out.  

[tom_h]

It's "DeltaDawn".  Here's a recent thread started by her:

http://www.medhelp.org/posts/Heart-Rhythm/Ablation--Pacemaker--Cardioversions--Oh-my/show/2479517

[tom_h]

I think Delta_Dawn had an ablation for afib, and I think it was pretty recently.  Perhaps you can message her.

I too have sleep apnea.  I use CPAP to correct it.  I had general anesthesia and was partially intubated for the procedure.  I was instructed to bring my CPAP with me, and the bag was actually sitting on my legs when I awoke in the recovery room, but it was never actually needed.  I come out of whatever they use, Propofol or Versed very quickly, so was alert within 5 minutes of waking up.  I made sure they knew of my severe OSA, so they planned for the intubation ahead of the procedure and monitored my pulse O2 carefully (so they say!)  But I was fine.

Within a day of taking Sotalol, I began experiencing clusters of severe PVC's and one SVT event that was nearly impossible to convert to NSR.  I was about to head to the hospital when my wife asked time to try one more time, and fortunately I got it back into NSR.  I had the self sustaining form of SVT.  Once it started, it would run on without ever dropping out.

[CFS56]

I think they would use anesthesia rather than sedation for me because I have sleep apnea.  My doctor mentioned that yesterday.
I know the ablation for SVT is pretty straight forward and has a good success rate.  But the afib I think is not so much.  I seem to remember somebody here had it done but can't remember any details.  And from what I understand, they don't really know what areas cause your arrhythmia until they actually start the procedure and induce it?  So I wouldn't know for sure it it's afib or SVT or both.
What happened with Sotalol?  That actually sounded like the lesser of the evils when I was reading about antiarrhythmics.  

[tom_h]

Speaking for SVT, I think most people who've had it for a long time will all agree that it gets worse as you age.  It's not that it gets out of control. It slowly becomes more frequent..  Mine also seemed to occur while doing nothing as opposed to doing something strenuous.  I could be driving home from work on the interstate, eating a meal, or just watching TV, and it would start.  So yes, I think it becomes increasingly frequent as you get older.

I've seen you on the forum for a long time, so I'm sure you are aware of the procedure itself.  Results aside, the procedure itself is really not a big issue, especially if you can get anesthesia during it.  I'm sure that the methods and equipment used during mine in late 2010 have been surpassed with newer technology.  Antirhythmics freak me out too, and it was a major factor in deciding to undergo the electrophysiology procedure. That little pill carries serious potential side effects and risk when taking it.  After my not so pleasant encounter with Sotalol, my cardiologist practically pleaded with me to look at the procedure and give it a chance.