My heart keeps the rhythm of a bad jazz band. I had an ablation procedure performed in 2014 and just recently the missed beats have come back.
Testing showed that my occurrences were twice as frequent as the recommended threshold for acceptable.
I find out next week whether my new meds are working. If not I’m scheduled for my next ablation procedure set for the end of October.
Same here. No symptoms (still, from my last post a year ago.) I can walk for miles in San Francisco and it does not affect me.
I got diagnosed when I was trying to donate blood and got rejected because of a racy pulse. I get a Holter Monitor and ultra sound every couple of years. I only see my cardiologist every other year, and get my INR checked every 6 weeks.
No quality of life issues at all.
Quite possibly related. The development of atrial fibrillation can sometimes be an early, if not the earliest, manifestation of disease of the heart’s electrical conduction system. ‘Degenerative’ disease of the conducting system is very common, especially in older people. It can also develop for other reasons such as scarring from heart attacks or from heart inflammation.
Although a fib is characterized by a rapid and irregular heart rhythm, people with disease of the conduction system may also have times where no electrical impulse is generated by the atrium (upper heart chamber). This is called ‘sinus arrest’ and may require insertion of an “artificial pacemaker” (with the sinus node, sitting at the top of the atria, being the natural default pacemaker that we’re born with).
In addition, people with conduction system disease often have blocks in the conduction of electricity from the sinus node through the atria (upper heart chambers) to the ventricles. These blocks can be transient or permanent. If such a block becomes permanent or is deemed to be at risk of persisting, a pacemaker is often inserted and will directly stimulate the ventricle when required, i.e. when no impulse from above has been detected*.
*there are much fancier options as well
Thanks for the informative discussion.
Based on what I’ve read here, I just set-up my Apple Watch 4 to do A-Fib checks on me. I’ve had the watch (and the ability) since Christmas and never bothered using that feature.
My first test showed “No Signs”.
Depends on your species. A guy we know owned a racehorse that repeatedly was first out of the gate, ran beautifully, then slowed down in the stretch. The horse was certified as a bleeder, so got Lasix to race. Tests showed he had bouts of a-fib exacerbated by potasium depletion from receiving Lasix.
The horse was put down. Racehorses that don’t/can’t win are a poor return on investment. Selling/giving away the horse was considered, but a horse with heart disease could collapse and injure humans.
My late grandmother had several rounds of A-Fib. Her pulse would race to 150+ with a very unstable rhythm. We could not get a BP reading during those episodes. However most of those episodes of A-Fib would settle on their own, and her heart would return to its normal rhythm in a few hours time. She did not seem uncomfortable or in any way affected by the incident. Her oxygen saturation would remain normal - as measured with a pulse oximeter after the episode was over. She was prescribed a small dose of Sotalol which kept it under control until she passed away, years later. I think it is ventricular fibrillation that is considered serious / possibly fatal.
ETA: She was also on Clopidogrel and Aspirin.
Indeed. Unlike ventricular fibrillation which is often lethal, atrial fibrillation is seldom an emergency or acutely life threatening. And that’s a good thing since almost 10 percent of people over the age of 65 have it.
And although blood thinners are usually mandatory, its very high prevalence suggests that the abnormal rhythm itself, once the stroke risk has been addressed, may not confer much harm to many people. In fact, there seems to be no difference in outcomes (including death) whether you simply control the heart rate in atrial fibrillation or convert (‘cardiovert’) the person out of atrial fibrillation. (Here is a systematic review of the issue with basically the same conclusion).
Yes. I am. What’s up?
I received the ‘zap’ and it didn’t take. I went to another dr. who said I needed ablation. I managed to get into Emory to see the Chief of Cardiology; and I’ve been very happy.
I’m on Diltiazem and Eliquis.
Atrial fibrillation is pretty common and has many causes. It bothers some patients a lot, with symptoms like breathlessness or discomfort. And others don’t really notice it.
The original goal of treatment was to return to sinus rhythm, and some cardiologists still prefer this. Some large studies suggest just getting the rate under control offers the same benefits in terms of mortality, and is much easier to do. At best, maybe 60% of patients given stronger medicine or cardioversion might be in sinus rhythm a year later. Ablation might increase this to 85%. But 25% of people on strong medicines like amiodarone can’t tolerate it.
If it bothers you, more aggressive approaches might work. But they don’t always work, and don’t always stay effective.
I’m not bothered about if I know it’s not going to cause a heart a attack. However, It caused a massive blood clot in my heart post heart surgery.
The Cardiologist said it would always be a risk going forward and to stay on blood thinners.
Had the ablation on Thursday, and was released Friday afternoon. It seemed to go well and everything looked good in the echocardiogram afterwards. Still a bit sore at the catheter insertion site and have some epic bruising around the area. They reduced the dose of one of the medications and I’ll stay on anticoagulates for at least 3 months when I’ll have a follow-up with the cardiologist.
Same here. My afib was treated pharmaceutically for 15 years, but worsened. Jumpstarts didn’t help much. Ablation changed everything. Continued sinus rhythm is wonderful!
Cardiologist here. Not electrophysiologist (specialized cardiologist who would do afib ablation or Watchman implantations). As others have mentioned, afib treatment is not a one size fits all. For most people a rate control method, where we just treat with medications to keep the heart from going too quickly, is good enough. Many people are “fortunate” and don’t feel the fibrillation. Plus, the risk of developing afib rises with increasing age, and thus even though an ablation or cardioversion may be successful now, there is no guarantee it will continue to stay that way. The first line of treatment is generally to restore normal heart rhythm with the idea that everyone deserves a shot, but there are certain characteristics like age, left atrial chamber size, chronicity of the afib, does the afib come and go (paroxysmal) or is it persistent, are there other comorbidities like sleep apnea, hypertension, heavy alcohol use, etc, that go into the decision process. They may try antiarrhythmic medications (some have been mentioned, like flecainide, propafenone, or amiodarone) to maintain a normal heart rhythm but they tend to have more negative effects and are usually only used if there is a really good reason for wanting the heart to stay in a regular (sinus) rhythm.
The Watchman device is a relatively newer device that occludes the left atrial appendage, which is the funny little hangy thing off the left atrium where most clots form. It looks sort of like a bottle cap and it basically plugs into the opening of the appendage and anchors itself in there with small hooks. The device eventually endothelializes (gets covered in a layer of cells) that makes it nice and smooth to the blood, and plugs off the opening leading to a lower risk of blood clot forming. It’s reserved for people who really can’t take blood thinners for long periods of time, usually because of a past history of bleeding or need for frequent procedures that would interrupt the time on blood thinners to the point that they are essentially ineffective. Definitely not for everybody.
I could go on for pages and pages but it gets boring pretty fast.
I should also add, generally speaking because of the relatively high rates of recurrence even after ablation, most electrophysiologist/cardiologists recommend continuing taking blood thinners to prevent stroke even if the ablation is successful. Assuming that the risk/benefit is there, I mean.
Any RCTs on this?
A quick search showed a meta analysis that showed continued OAC use after ablation therapy was associated with a decreased rate of thromboembolic events although as expected an increased risk of bleed.
https://www.ncbi.nlm.nih.gov/pubmed?term=31257677
I believe that the most recent 2019 update by ACC/AHA/HRS mentions that it’s a discussion to be had but no hard recommendations for continuing indefinitely.
I’m not at work right now so I can’t access the journals outside the abstracts, but talking to my colleagues it has generally been the consensus that due to the high rates of recurrence as well as the oftentimes decrease in symptomatic afib thus leading to silent afib, the benefit is to reduce the risk of stroke.
I treat it like I would perioperative afib. Many people post-CABG or other CT surgery will have afib in the post-op phase and likely never have it again. But many have a lot of risk factors for afib and the stress of cardiac surgery likely just unmasked an underlying predisposition.
I’ll see what I can dig up tomorrow and ask some of my EP colleagues.
Here’s another meta analysis that shows the opposite, that stopping after successful ablation is associated with similar risk of VTE but lower rates of bleeding.
https://onlinelibrary.wiley.com/doi/abs/10.1111/jce.13822
Much obliged, but I would be embarrassed dumping more of a search onto you.
Mostly I wanted to be sure that I hadn’t missed any key trials - where I work, a lot of rhythm stuff, even atrial fibrillation, is the purview of the EP people and frankly I’m not sure what they do post ablation when sinus has been restored. On the other hand, I tend to see a very skewed, older population with lots of comorbidities where we almost always anticoagulate and simply assume they’re in (or in-and-out of) a fib forever.
Thanks,
Why isn’t it for many more than get it?
Anticoagulation is itself risky, and not just for active people. My sedentary father-in-law slipped backwards in his chair and died from a brain bleed which I doubt would have happened if he wasn’t on anticoagulation. The device seems comparable for stroke reduction and lowers overall morbidity and mortality, and I am led to believe even cost over a fairly reasonable time frame (the high cost of stroke and bleeding complications care).
Am I wrong in my belief that it is likely underutilized with many reasonable candidates for it not being offered it? (Honest question to which I would not be surprised by an answer that yes I am wrong.)