Martin Kotlar Posted October 1, 2023 Report Share Posted October 1, 2023 I have been diagnosed with paroxysmal atrial fibrillation. I am scheduled for an ablation procedure. My question is: if I am not in a-fib at the time of the ablation, is the procedure still performed? Thank you. Martin Kotlar Quote Link to comment Share on other sites More sharing options...
Daisy Posted October 1, 2023 Report Share Posted October 1, 2023 1 hour ago, Martin Kotlar said: I have been diagnosed with paroxysmal atrial fibrillation. I am scheduled for an ablation procedure. My question is: if I am not in a-fib at the time of the ablation, is the procedure still performed? Thank you. Martin Kotlar If you go to a really experienced EP with top-notch credentials, it shouldn’t be a problem. They will do mapping to find the sources and also provoke them during the ablation. Quote Link to comment Share on other sites More sharing options...
markflint Posted October 1, 2023 Report Share Posted October 1, 2023 9 minutes ago, Daisy said: If you go to a really experienced EP with top-notch credentials, it shouldn’t be a problem. This is the important part. Really important. Mandatory if you want the best chance for success. There are people here who have had multiple ablations that failed to get the job done. It may take more than one, and in my case, which was complicated, took three. Your EP should have thousands of ablations on the books, and share his success record -- which should be defined as NSR unaided by antiarrhythmic medications after the blanking period. I would be as diplomatic as possible, but do not worry about offending anybody when pushing for this. You have a right to put your future in the hands of someone you trust to get it right. --Mark 2 Quote Link to comment Share on other sites More sharing options...
Martin Kotlar Posted October 1, 2023 Author Report Share Posted October 1, 2023 Daisy, are you saying that I do not have to be experiencing A-Fib just prior to getting the ablation procedure? How does the cardiologist know what to do if I have a normal rhythm at the time of the procedure? Thanks for your comments. Quote Link to comment Share on other sites More sharing options...
markflint Posted October 2, 2023 Report Share Posted October 2, 2023 3 hours ago, Martin Kotlar said: Daisy, are you saying that I do not have to be experiencing A-Fib just prior to getting the ablation procedure? Yes. They can induce AFib. https://www.mayoclinic.org/tests-procedures/cardiac-ablation/about/pac-20384993#:~:text=Sensors on the tip of,where to apply the ablation. Quote Link to comment Share on other sites More sharing options...
Daisy Posted October 2, 2023 Report Share Posted October 2, 2023 5 hours ago, Martin Kotlar said: Daisy, are you saying that I do not have to be experiencing A-Fib just prior to getting the ablation procedure? How does the cardiologist know what to do if I have a normal rhythm at the time of the procedure? Thanks for your comments. No, you don’t have to be in Afib as you go into an ablation, but you do need a very experienced, top notch EP who can both do mapping (an electrophysiology study) and induce Afib with drugs. During the mapping they measure electrical potentials to help identify where the arrhythmias are coming from. Here is a quote from the link Mark gave: “Sensors on the tip of the catheter send electrical impulses and record your heart's electricity. Your health care provider uses this information to identify the area that is causing your arrhythmia and to decide where to apply the ablation. This part of the procedure is called an electrophysiology (EP) study.” Quote Link to comment Share on other sites More sharing options...
Martin Kotlar Posted October 2, 2023 Author Report Share Posted October 2, 2023 Thank you Daisy & Mark - your comments and information are extremely helpful. Quote Link to comment Share on other sites More sharing options...
Daisy Posted October 2, 2023 Report Share Posted October 2, 2023 10 hours ago, Martin Kotlar said: Thank you Daisy & Mark - your comments and information are extremely helpful. P.S. one (of many!) why it is so important to have the best of the best EPs is that, not some but actually many, will not do mapping but simply go in and ablate around the pulmonary veins (PVI ablation) as this area is the most common source of Afib. This will often be enough but it is also the cause of many failed ablations as there are many other areas where Afib can arise. For instance, in my case, isolating the pulmonary veins had no effect on my Afib and Aflutter. I was with a top notch EP and he traced all the sources of arrhythmias until each area tested as “electrically silent” and he could not induce any more arrhythmias. But, yes, it is helpful if you are actually in Afib when you get in the table, but not necessary if you are with an excellent EP. 1 Quote Link to comment Share on other sites More sharing options...
Afiber Posted January 25 Report Share Posted January 25 Hi. I just had an ablation (Jan. 4). I am very concerned because after about 10 days post ablation, I started having in and out afib and tachycardia episodes and had to go back on my original medications, Flecainide, Metroprolol and Elliquis. Unfortunately, the afib ended up stopping for a couple of days and then coming back with a vengence and has been nonstop for 7 days now. Dr. changed my medication to Multaq 3 days ago. No change at all. Before the ablation, I had Afib maybe 3 times a year and taking an extra 1/2 dose of my meds always stopped it within hours. I am way worse off now. Most likley going in for Cardioversion in the next few days. I am in Texas and I believe I have a very good, experienced Electrophysiologist, but I am still concerned. Does anyone have any comments or similar experiences? Quote Link to comment Share on other sites More sharing options...
markflint Posted January 25 Report Share Posted January 25 It's understandable to be upset, but those symptoms probably don't mean your ablation was a failure. You are in what is known as the blanking period, and your heart is well and truly pissed off about being messed with. During the blanking period scarring will form and close off the ability of misbehaving cells to cause AFib. The unknown is whether the EP got all of the miscreants. In the meantime, if the AFib is intolerable, they may try a stronger antiarrhythmic med, such as amiodarone or Tikosyn (dofetilide). These drugs can have serious side effects, and tikosyn requires hospitalization for a few days to monitor to make sure it doesn't have the side effect of QT interval elongation, which can be serious. I would only take drugs on that tier if the AFib was intolerable, or I were in AFib after the blanking period -- and I'd be scheduling a follow-up ablation ASAP to get me into NSR to minimize time on them. Your EP should have given you information about the blanking period as part of your discharge, and you also should have been told to stay on the Eliquis. Not having you on anticoagulants is a pretty serious error. Mark Quote Link to comment Share on other sites More sharing options...
Daisy Posted January 25 Report Share Posted January 25 2 hours ago, Afiber said: I am in Texas and I believe I have a very good, experienced Electrophysiologist, but I am still concerned. I agree with Mark's comments. However, if it were me and this didn't stop after the 3 month blanking period, I would not go back to the same EP for a second ablation. The biggest predictor of success is who does it and while "good and experienced" is good, better is someone with a track record of 85 - 90% success and there are a very limited number with those stats. I traveled (to Texas) for mine and it was certainly worth it. Quote Link to comment Share on other sites More sharing options...
markflint Posted January 25 Report Share Posted January 25 3 hours ago, Daisy said: However, if it were me and this didn't stop after the 3 month blanking period, I would not go back to the same EP for a second ablation. I kind of thought the same thing as Daisy, but was going to wait before coming right out and saying your guy doesn't sound like he's a big dog when it comes to treating AFib. If I lived in Texas and needed another ablation I would go to Austin and have it done by Natale. I don't like the man, and he pushes the boundaries, which means he takes risks, but he's a savant with the probe. Mark Quote Link to comment Share on other sites More sharing options...
Daisy Posted January 25 Report Share Posted January 25 3 minutes ago, markflint said: If I lived in Texas and needed another ablation I would go to Austin and have it done by Natale. Yes, I went to Natale. In my case I don’t think that he took any risks as he only ablated areas that were showing up generating arrhythmias. Main thing, it worked. Quote Link to comment Share on other sites More sharing options...
markflint Posted January 25 Report Share Posted January 25 7 minutes ago, Daisy said: In my case I don’t think that he took any risks as he only ablated areas that were showing up generating arrhythmias. Main thing, it worked. I may remember this wrong, but around a month before I got mine somebody else on this forum got a pericardial effusion during a Natale ablation. He only ablated areas showing up generating arrhythmias for me, too, but that meant going into the LAA, and that's a place most EPs don't dare to go. My EP, who was fine with me seeing Natalie and considers him one of the best, did comment that he, in his words, "ablated the sh** out of you." He wasn't saying that was a bad thing, just a big thing. Quote Link to comment Share on other sites More sharing options...
Daisy Posted January 26 Report Share Posted January 26 1 hour ago, markflint said: He wasn't saying that was a bad thing, just a big thing. Yep, a big thing! He also had to ablate my LAA in order to end my flutter, and yes few dare to go there! Quote Link to comment Share on other sites More sharing options...
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