A-Fib, need adivce for our Lorraine.

Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.

LUVMyBirman

Well-known member
Joined
Jun 16, 2001
Messages
3,340
Location
Chicago, IL
Hello all,

Lorraine asked me to post for her. She is in the hospital after a 6 hour bout of A-Fib. Once reaching the hospital..she was given a cocktail of meds. One of which I recall to be lopressor. She soon retunred to normal sinus.

I asked her how oftern she goes into A-Fib. Used a 2 year marker as a gauge. She stated roughly 15 times in the last 2 years. She eventually returns to sinus each time. Will be a number of months in-between episodes.

Electrophysilogist on call was quick to offer her an ablation. Without conversing with her cardiologist. The card has been unreachable today. They will keep her overnight and she has decided to wait on her cardiologist to ask more questions. Meaning she will discharge tomorrow. Based on a few other comments she made, it sounded like she was being pressured into the ablation. She asked my opinion and I suggested unless she was in obvious distress...she needs to make that treatment call with her card. Which she has been in close contact with previous to this new episode. Don't you think her card would have recommend the ablation if he thought she really truly needed it?

So my question for seasoned veterans of A-Fib. Would you jump into an ablation without all of the facts? No EP study to date.
Thank you!
 
I don't know how relevant this is to you, but I had radio ablation along with my valve replacement, 'while they were in there'. I asked around a little about the procedure. One of the people with whom I shared a mutual acquaintance, was the head of Cardiology at a major Toronto hospital. His take on a maze procedure was simple. They have very few risks (admittedly, slightly more when done transcather) a very high rate of success, and virtually no side effects. I elected to have the procedure, and apart from two fairly intense post surgical episodes which lasted hours, I've had no A-fib that I was aware of since. I used to have at least one significant (half hour plus) episode per month, with many, shorter bouts, lasting 5-10 minutes. I twice took myself to emerg and was admitted over it in the past.

To my limited knowledge, the small additional danger when the procedure is done transcatheter, is of burning things which weren't meant to be burnt, or burning them more, but that may not be true anymore since all heart procedures seem to improve faster than we can learn about them!
 
She needs to be seen by an electrophysiologist, referred by her cardio. If she is not on any meds, the EP can prescribe based on her condition and outline her options going forward (ablation). I work with a guy who had the transcatheter ablation done because he quit responding to the medications. Three hour procedure, on coumadin as a preventative for clots, for three months, now afib free. No history of valve problems, I think he had an MI several years ago.
 
I had bouts of A-Fib before my operation as part of my array of symptoms of severe aortic stenosis. The last episode put me in hospital for 2 days before the IV medication returned me to normal sinus mode. The cardiologist was about to resort to shock treatment when, thankfully, the chemical route worked. We all then decided it was time to have the valve replaced.

Immediately after surgery while still in ICU I had a number of A fib episodes, all sorted out with medication. This seems to be par for the course due to the stress the poor heart suffered during the surgery. Since then, now nearly 3 years, normal sinus rythm with the occasional PVC during very strenous exercise.

So I am not an A fib veteran but I would certainly not rush into (or be pressured into) any heart procedure unless "my team" of cardiologist, original surgeon, family doctor, wife, daughter, and my own research on the internet, agreed that it was required and it was time to have it done.
 
Last edited:
Lorraine and Gina,

My experiences with afib were few and occurred just after valve surgery, so I can't comment on the technical side of things. The advice I would give a dear friend (that's you, Lorraine!) is that as long as she is not in any pressing current danger, she should consult with the cardio she knows and trusts. They, together, should be able to develop a game plan of specialist consults and treatments. I view this one like buying a car -- if they are telling her that she's in no danger but she has to decide quickly anyway, I'd opt for caution and wait.

Please keep us posted.
 
Hi all,

Thank you very much for your feedback! I will pass the info on to Lorraine...if she does not get here first!

Steve, I agree with your thoughts. She asked my opinion. Told her the same! Hope you are well. We are long overdue for a meet-up! Hope you are well!
 
I would try everything before going that direction. There was a trial at Vandy using 4mg of Lavasa as a therapeutic dose to reduce a fib. I was not in the trial because I didn't want to risk being in the 1/3rd taking vegetable oil. I did begin the therapy at that level under the supervision of my cardio, and my rhythm issues went away. This could be a coincidence, but I still take the 4mg a day and hope to never see amioderone again.:eek2:

I like to remember that doctors recommend what they know; the right answer for you may be something another doctor knows.:confused2:
 
Last edited:
That's very interesting Todd. Thank you for the information on the Lavasa. Happy it's working for you.

Lorraine is home and weighing options. One of which is a second opinion. I am sure she will be along soon to post an update.:)
 
Yes, medication route first, many good ones to help with Afib, but, I would still seek out an electrophysiologist to provide council. The Bisoprolol that I am taking for AT is working beautifully, thank goodness. Best of luck to Lorraine.
 
I had A-Fib with what seems like the same frequency. I had ablation along with my AVR and I would not hesitate to have another if if needed it but I don’t expect to need another. I have had NO reoccurrence and don’t expect any. It does not work the same for everyone but for me it has been wonderful not to have to go back and forth to the ER pesky A-Fib. Good luck on what you decide!!
 
Hi All,

First I want to thank my good friend Gina for posting. I really appreciate your help Gina.

Yotphix: I agree that should you really burn body parts that weren't meant to be burned? Just the thought scared me. :eek2: I had never heard of the maze procedure but since I got home yesterday I did some research. It seems that wouldn't be of first preferred option after trying meds. But since I am in the unknown right now about it all, what do I know.

LucyLou: It was a electro physiologist that came to my room to see me. He was called in by the Cardio on duty, for my regular cardio.(I found out later from my cardio, that would not have been the electro physiologist of his choice.} I just met both doctors on Thurs in the hospital, so I was not very confidant or comfortable having the electro physiologist wanting to do a EPS with Ablation that quickly (the next afternoon). I mean he's standing there talking to me about something I had never heard of. I'm like WHAT????????????? I couldn't even absorb everything he was saying that quickly. I told him I would prefer to talk to my cardio about all this before I did anything. He quickly pointed out my cardio wouldn't be available until at least Monday (I found out later, my cardio had shoulder surgery the morning I went into Afib, which is why he wasn't available.) He also said if I went home before I had this done, he did not want me to drive, or be alone until I had this done. He then told me to think about it and meanwhile he would schedule it. If I decided not to have it done, I could cancel. I was stunned and so go ahead and schedule it but to be honest with you, I more than likely am not going to have it done. At that time I still thought I may still be talking to my cardio, who may very well have agreed with this electro physiologist. My gut reaction was to call Gina since I couldn't get a hold of my cardio. She reaffirmed my feeling that I should get a second opinion. I told her my decision would depend on a lot of things. Finding out more about the procedure, what my cardio thought, the risks of course and was there anyone I knew that may have had this done. I thought Gina may have had it done, but when we talked she said she hadn't. I said it seemed someone I had read on vr had it done, so she said she would post for me.

I do have a history with having two mechanical valves from March of 2001. I am also already on coumadin. These episodes of Afib didn't start happening until about 2 years after I had my heart attack in Oct of 2007. At that time I was put on linsinopril, norvasc and lopressor. In fact until Thurs, I didn't know the exact name for it. I always called it palpitations or rapid heartbeats. In the medical world though, those terminologies mean something different than Afib. At least that is what this nurse told me Thurs.

I never heard of Bisoprolo Is that a betablocker too, like Metrolopol? That is what I am currently on at 25mgs.

Johan: I agree that should you really burn body parts that weren't meant to be burned? Just the thought scared me. :eek2: I had never heard of the maze procedure but since I got home yesterday I did some research. It seems that wouldn't be of first preferred option after trying meds. But since I am in the unknown right now about it all, what do I know.


Hook: I never heard of Lavasa, but it may be discussed when I go for my second opinion. Thanks for your input.


Steve: My dear friend. Oh I totally agree with you. I found out later when I did talk to my cardio that Afib is not normally dangerous. Because I’m already on Coumadin, I was not at risk of stroking, versus someone who went into Afib and wasn’t on blood thinners. About an hour after I got home on Friday, my cardio called me. We had a long discussion about what went down and how uncomfortable I felt having this procedure practically forced on me, not going who the heck this other guy was etc. He agreed that I did the right thing by telling this electro physiologist I would not do the procedure. My cardio discussed it and see said he did not believe the procedure would hurt me but, 1st, that wouldn’t have been his electro physiologist of choice, 2nd there are other options out there. He referred me to different a electro physiologist that he know who he says is very good, who will explain all of my options to me. He also does Aterial Fibrillation ablations, but he uses a freezing method to zap erractic electrical impulses. I have a appointment with him on Thurs. I will meet with him and then confer again with my cardio.

Cooker: Thanks for your info. This was the first time I actually broke down and went to ER for my Afib. Mostly because my episodes only lasted a half to forty five minutes and then my heart went back into normal rhytyhm. The cardio had told me if we could get an EKG of what was happening, then we would know what was happening to me. I had already worn a halter monitor for 48 hours,, a Ziopatch for a week, and had a sleep apnea test done. So Thur was the first time I had a name.

What scares me is I’m on the beta blocker already. I was taking 50mg for the last two years and last month we lowered it to 25mg because my heart rate was in the 40’s. I was having episodes of light headness, usually following a few hours after the palpitations(Afib) At 25mg it still is only in the 50’s. I could be looking at a pacemaker if we can’t get my normal heart rate up. Of course we don’t want it back up to 150!

I want to apologize because I logged in yesterday, started typing. It takes me a while to think and type what I want to say. This site must have a time out on it after writing a reply for so long. When I went to post my reply, vr said I wasn’t logged in. While I had been typing I saw it had been saving, but then I thought I lost the whole post. I relogged in and part of my post came back. I decided to copy and paste what was there into a word document, and finish and repost it today.

I will keep everyone posted as to the next plan of action. Thank you everyone.
 
Hi Everyone,

I have not had a chance to write. I've been busy with doctor appts another MRI. I saw the neurologist a week ago Wed and then saw Electrophysiologist for a second opinion on Thurs.

The neurologist had the result from my Brain MRI I had done. My Pituitary gland is slightly swollen so she asked me to get another Brain MRI done with and without contrast. I have another visit with her this coming Wed.

The EP visit was about 1 1/2 hrs. He was very thorough in explaining everything. My nephew came with me and we asked the EP if we could record the conversation, and he said that was not a problem. That was good, because I have been able to go back and listen to answers to the questions I had. He explained what I have at the present is Atrial Flutter, not Atrial Fibrillation. I also have a very low heart rate, which since I lowered my beta blocker dose to 25mg, it has come up a little, but not much. He would recommend getting an ablation done for the Atrial Flutter on the electical impulse that he could see on the EKG. What he was seeing on the EKG was a continous loop of one erratic electrical impulse. He would like to go in and zap that. He would not put in a pacemaker at that time, because he feels that the Atrial Flutter and conversion pause may correct itself. The success rate for this particular Atrial Flutter, in 90%. His concern is that even if we fix the Atrial Flutter it is possible that my natural pacemaker isn't working correctly, only by taking the wait an see appproach after the procedure, would he be able to tell for sure. He has done hundreds of these and he has not had any problems doing them.

I talked with my family doctor and my cardiologist and they both seem to think I should follow the advise of the EP. In fact they think I should get this done ASAP. The EP had said when I saw him though, that there was no hurry, no one has ever died directly from having Atrial Flutter, unless they had other issues going on. The EP said your heart, even if it goes into a pause will always revert back into ryhthym/ My concerns are many. One thing I have not asked the EP because I didn't think of it at the time is: Has he ever done an ablation on a patient with mechanical valves, especially two mechanical valves? Of course all of the other concerns have to do with the risks. I guess I shouldn't dwell too much on the risk, or no one would ever have any procedure done. :)

The question I would like to ask everyone is:

Does anyone know if there is any dangers of having an Ablation with having mechanical valves? I found one site on the internet, that said an ablation success rate was good for tissue valves, but should not be done for mechanical valves. The cathereter could damage the mechanical valve. The article I read was over two years old. Does anyone on this site know of anyone who has a mechanical valve and has had an ablation? or seen any updated articles in regards to this? I would appreciate all answers. Right now I am apprehensive about having this done. One side of the coin it could cure my problem, on the other hand, I could end up in worse shape, especially if they damaged one of my artificial valves during the procedure, never mind the obvious risked factors involved. Again any help would be deeply appreciated. Thanks.
 
Lorraine,

I'm glad you have a good EP now, call him and ask about your mechanical valves.

I read online somewhere that they are very careful to avoid prosthetic valves, there are procedures where they freeze the part where the continuous loop is rather than radiofrequency. This Wikepedia article has good info.

I didn't see your earlier post until today, yes, the Bisoprolol is a beta blocker.
 
Hi Lorraine,
I'm watching your posts with interest, because I am scheduled to see an EP for atrial flutter. My flutter has no symptoms, and in fact I feel great. My heart is controlled by a pacemaker, which was needed post surgery. All my pacer checks and ECGs show that I am constantly in flutter, and my surgeon wants me to see an EP. Each time I am tested I believe that the flutter will have disappeared but it is stubbornly hanging on.

I'm being referred to the same doctor that put in my pacemaker, and that reassures me. He was very efficient and was chosen specifically by my surgeon. I suspect that I will have a long time to wait for my appointment, because the referral was made three weeks ago, but I still have not got a date for the initial consultation. I'm also a bit nervous because I have a mechanical heart valve plus the pacer, and I do not want the treatment to damage these.
 
Hi LucyLou,

Yes, I plan to call the EP tomorrow, about mechanical valves. Thanks for referring me to Wikipedia. I know my cardio mentioned they could freeze rather than the radiofrequency. I will have to listen to my recording again, but I thought the EP did mention the latter as the procedure he used. I'll have to check. The more I read the more comfortable I'm feeling about all of it. Again the biggest concern I havve, is has the risk factor diminshed more on doing it with patients with mechanical valves in the last few years.
 
It does seem that the issue with mechanical valves and the Ablation Procedure is that the probe they are inserting into your artery then travels up and into your heart where it will pass through the heart valve. There are instances where the probe will get stuck in the mechanical valve, or in some other mannor cause damage to it. So, if the freezing tecnique also involve them passing a probe up through your heart valve I would think the same possibilites for damage exist.

This does prompt one to research more into what the procedure for the freezing technique is.

rob
 
Madsometimes,

In between my episodes of A Flutter I feel fine also, well maybe a little tired, but otherwise fine. But now you are in constant A FLutter and can't even feel it. That is probably more disconcerning. I am just learning now all I can about Atrial Flutter and the heart rate. What I am understanding about Atrial Flutter, it is a continuous loop of the electrical signal in the right Atria. Am I correct? Your heart rate is under control, correct, due to the pacemaker? So they want to do the ablation in hopes they will abate the flutter. When you do see the EP you need to ask him how safe doing this procedure with your mechanical valve and pacemaker. Of course any info that is posted here from my questions will help you too. I too an anxious about how safe this procedure is with the artificial valves. As I told LucyLou, I do plan to call my EP tomorrow and ask him the stats on doing the procedure on a patient with mechanical valves and also how many has he done on patients with mechanical valves. I am with you my friend, I do not want any damage done to my valves.
 
I think my pacemaker prevents me from feeling the flutter, and prevents my heart rate from going too high (100% paced). I don't really understand how, because my settings are to sense in the upper chamber and pace in the lower, with a maximum heart rate of 130 and a minimum of 60. My actual heart rate is 70-80, so the pacer must be filtering out the flutter. Another question to ask the EP!

Anyway I am happy that I am feeling well. In the last week my ability to climb steep hills has really improved. I would like to think I am out of flutter, but I know better than to make assumptions. I was really shocked when the pacing technician said I was in flutter. They cannot properly check my pacer leads with the flutter, so they are keen for it to be fixed.
 
Lorraine,

I can't address any of the issues surrounding ablation in a patient having mechanical valves, but I can say that I agree that you should press onward to learn all you can in order to make an informed decision for your future. I never had a-flutter, but immediately post-op I did have a few bouts of afib. For me, it was just as if I was the energizer bunny and some prankster stole my battery. When I went into afib, all I could do was look for a place to nap. The incidents never lasted long, but they were unsettling. As far as I know, I've not had a bout of afib in a year or so. I'll find out next time they check my pacer.

BTW, if you have an electrophysiologist you like, stay with him (or her). These folks can work wonders of all kinds. I don't know where I'd be without mine.

Please keep us posted, little sister!
 
Lo-Rain...;-)

Lo-Rain...;-)

Hey there Lorraine - has your EP mentioned magnesium which will help regulate a heartbeat. I don't know the difference between afib and aflutter, but I'm a huge proponent of 400mg magnesium daily! It was actually prescribed to me by an EP about 12 years ago when my heart was flopping all over the place. Worked....and no drugs or procedures needed..!!
 
Back
Top