Six Month Check/Questions ~ ~

I go for my first 6 month check up with my EP/cardio Dr. at his Heart Hospital office this Thursday, April 15 a.m. I learned from my 3 month check of my PM earlier I still have A-fib, but the tech said everything else was ok.

Are there any questions I should ask during this 6 month check? I know it will definitely be an in/out visit because his scheduler called me this a.m. to re-schedule my appointment earlier on Thursday so he can catch a flight to speak at a meeting. If I am having any troubles, I do not know. I am tired all the time, but like the 3 month tech said, "do not blame every little thing on your PM".

I keep hearing of ablations on this PM site. Is this where they go in and cautherize a vein? Would this be anything the Dr. might talk about re: A-fib if he wants/needs to treat it? IF A-fib is not giving me any "fits" ~ I can not feel it if it does, will he need to treat it AND if so, what will he suggest in your opinion?

I know my question is very trivial compared to some of our good PM friends who are having complications at this time.

Thanks for your good advice for me as in the past comments,
Carolyn G. in TEXAS ~
Love, love, love those TEXAS mosquitoes ~ Big & Ugly!

10 Comments

Addition to my Question ~ ~

by Carolyn65 - 2010-04-13 01:04:25

In re: to the comment from justme, when they burn or freeze a portion of the heart muscle, this sounds really permanent. Eventually, or even after one ablation, does this hurt/ruin/damage your heart muscle or leave any muscle to continue? Wonder if burn/freeze heart muscle shortens your heart's life, as in MY life? Would it get to the point you would not have any muscle left to ablate or even have to pump a muscle?

How many ablations can one person have until there is not any muscle left to work? Does this burn/freeze cut down on the strength of the muscle eventually. I do not know if the Dr. will say this; just want to be prepared.

I am just boiling over with questions because I felt as good, if not better, before my ablation/PM on 10/09. Once in a great while I feel SOB, tired a lot, was slightly lite headed for the first few weeks, etc. Most of the time I feel great, if I don't have to walk on hard surfaces (cement/tile) for more than 10-15 minutes. Legs just give out. The other day I was stressed to the max over a bad contractor I hired ~ my legs became so weak and rubbery, I had to sit down or fall down!

Thanks for all your help PM Club friends,
Carolyn G.

AFIB + ABLATION

by pete - 2010-04-13 04:04:10

If your heart cannot cope with AFIb the the best treatment by far is a Biventricular Cardiac Resynchronisation Pacemaker with only 2 leads fitted, permanently pacing the Right and left Ventricles, followed six weeks later by a Heart AV node Ablation. This leaves you with permanent AFIB but the ventricles beat in synchrony and at a steady beat controlled entirely by the pacemaker. You are 100% dependant on the pacemaker. Sounds scary but it is not.
They usually use a RF ablation probe inserted into an artery in the leg and fed up to the heart to carry out the ablation. There is some risk. But it is one of the easier and shorter ablations to perform. There is no pain. It takes less than 30 minutes. The results are usually very good and sometimes outstanding as in my case.

ablations

by golden_snitch - 2010-04-13 04:04:52

Hi Carolyn,

there are several of us who have had five or even more ablations. If it all, ablations do very little damage to the heart muscle and by no chance one could/would burn or freeze the whole heart muscle. The spots that are ablated are usually very small, and the ablation is rather superficial because if they would burn too deep you end up with a tiny hole in your heart. I have had six ablations and my heart muscle is just fine, EF is around 60% which is pretty normal.
In your case there doesn't seem to be a need to ablate again because your av-node is already ablated and pulmonary vein isolations (ablation to treat AF) don't work well in patients who have permanent AF which is why you had your av-node ablated instead.

I'm sorry to hear that you've got the impression that you felt better before the ablation and pacer. But I remember your posts before the whole procedure very well, and since you were not symptomatic before, I never understood why you had this procedure or why your cardio talked you into having it done. Please tell you him that there now is no difference or that you felt better before because maybe in the next patient he won't be so fast in making the decision to ablate. An av-node ablation is usually considered last resort in highly symptomatic patients with permanent atrial fibrillation, but if you are not symptomatic it won't change anything.

Best wishes
Inga

?

by golden_snitch - 2010-04-13 05:04:09

Hi,

but Pete, CRT devices was developed for and only help patients whose ventricles are not beating insync, and who suffer from heart failure because of this. In AF patients it's not that the ventricles don't beat insync, they beat insync but irregularly because they get those very irregular electrical signals from the atriums which are in fibrillation. Carolyn says she wasn't symptomatic before her AV-node ablation, and afterwards doesn't feel any different (she has already had that done, is 100% pacer dependent). There is, from what she tells us, absolutely no sign of heart failure. So why would a CRT device be needed?
I have never ever heard, not even at international EP congresses, cardios suggesting to implant CRT devices in patients who suffer solely from AF and not some kind of heart failure. Even in heart failure, a CRT doesn't always help because not every type of heart failure goes along with the ventricles not beating insync. If you have any scientific references for what you just posted, I'd be interested to read them.

Best wishes
Inga

Heart Rate for AFib

by cfritza - 2010-04-13 09:04:05

Heart Rate (bpm) Atrial fibrillation Atrial: 350-600 Ventricle no set rate.

Atrial Flutter Atrial:250-350 Ventricle no set rate. Sounds like a fast beat to me. Got these out of my Cardiovascular Nursing Secrets book.

Afib ablation

by golden_snitch - 2010-04-13 10:04:18

Hey,

pacer can't keep you out of AFib, it can only help when you have pauses, bradycardia or chronotopic incompetence. Afib is just too fast for the pacer, in order to try to stop it the pacer would need to overdrive the atrial rate which in Afib is more than 400bpm. Generally speaking, as soon as a rhythm is faster than the pacer, the pacer is inhibited. For example in my case that happens when my AV-node suddenly decides to make a rate of 80bpm at rest; the pacer is set at 70bpm, and when the AV-node kicks in with 80 the pacer stops doing its job as long as this av-rhythm is there.

The reason why one sometimes ablates the AV-node in patients with permanent Afib (very important that it's permanent or persistent, if it's paroxysmal one rather goes for a pulmonary vein isolation) is simply that those irregular, and sometimes too fast or even too slow, impulses from the fibrillating atriums can after this ablation no longer reach the ventricles and make those beat irregularly. The connection between the atriums and ventricles is cut, and the pacer takes over in activating the ventricles. The pacer doesn't care about Afib in the atriums, it just paces the ventricles at a steady and appropriate rate. But it could not do that as long as the AV-node is functioning because this node will always allows impulses from the atriums to travel into the ventricles.
Once the AV-node has been ablated, the Afib doesn't really need to be treated any longer, the only treatment the patient then needs is anticoagulation with Coumadin, Warfarin etc. to prevent blood clots.

Inga



pain question

by justme - 2010-04-13 10:04:51

Hi Carolyn,
you asked about the pain during an ablation and i have heard many people say that it didn't hurt or they couldn't feel it. I was not one of those people. It HURT. The nursing staff acted like I was crazy and couldn't possibly feel it. I think it depends on how they are doing it and what type of sedation they are using at the time. I've had 2 attempts, and even though I swear that I would never do it again after each of them, I would do it again in a heartbeat.
I don't think that it is very likely that they could do something super drastic that would kill the heart muscle totally, and you already have a pacemaker so that's not even a potential risk.
I wouldn't jump to this conclusion unless the Dr was recommending it for a symptomatic reason.
good luck.

Thanks For All Your Good Comments ~ ~

by Carolyn65 - 2010-04-13 11:04:17

Everyone's comments are most helpful. INGA, you are right. I remember your original comments. I did not/do not know why I had the ablation/PM done after all. It was not an emergency, no passing out, no SOB, no dizziness, no anything. Just A-fib at the time.

The heart Dr. had tried meds, heart stop/start a couple of times or more to shock it back into normal ~ na-da. The heart Dr. said eventually I would want to get a PM if he could not treat with meds/shocks/etc. I went ahead and had the ablation/PM implant. I guess further "down the line" in my life, I would need a PM ~ just wished I had listened to you who said get a second opinion. I do not think an ablation/PM was "mandatory" at that time.

I am on rat poison the rest of my life due to DVT. I did have a blood clot in my lower right leg 3/09, before being put on rat poison. I take Warfarin, 5g, six days a week, with 2.5g on Wednesday. This seems to keep me in the range the tech wants ~ 2.0-3.0. Two weeks ago I was down to 1.9 and do not know why. I have an INR when I go to the Dr. 4/15. I watch my vitamin K.

Please, if the rest of you have any advice, questions for my Dr., etc., please keep sending me your posts.

You all mean so much to me,
Carolyn G. in TEXAS ~ Lemons? Make Lemonade ~

ablation

by justme - 2010-04-13 12:04:18

no question is too small!
An ablation is where they burn or freeze a portion of the heart muscle to try and fix or prevent an arrythmeia.
Not sure the answers to your other questions though :-)

heart rate Afib

by golden_snitch - 2010-04-14 03:04:02

Just wanted to add since there was some confusion: the heart rate in the ATRIUMS is usually higher than 400bpm when you are in Afib, and that is what the pacer can't keep up with.
Best
Inga

You know you're wired when...

Your favorite poem is “Ode to a Cardiac Node”.

Member Quotes

I finished 29th in London in 2 hours 20 minutes 30 seconds which is my fastest with or without a device so clearly it didn’t slow me down ! I had no problems apart from some slight chaffing on my scar - more Vaseline next time.