Persistent Afib

HI

by Bionic Beat - 2018-07-01 09:46:55

I think you've had 'the cure'.  Well, it cannot be cured but the best they can do is an AV node ablation with a pacemaker.   Sorry, just caught my error, you have not had an AV node ablation but a sinus node ablation.  Its quite possible you will need an AV node ablation as well. 

Then some antiarrythmic drugs to stop the AFib from going far too fast and blood thinners to reduce your chance of stroke. There are quite a few to choose from these days.

You may want to call and let the cardiologist know of the recent findings or have your GP contact them about the antiarrythmic drugs and which blood thinner they suggest.

There are millions of people with chronic AFib and we can do well once we are on blood thinners, just wanted you to know that so that you dont worry too much about it being another 'problem'.  

Best Wishes,

Bionic Beat 

About the same info

by Theknotguy - 2018-07-01 14:11:15

Per Bionic Beat you have two options.  Chemical ablation or mechanical ablation.  A third, lesser known option, is regulation by pacemaker.  Currently Medtronic is the only pacemaker to offer the third option.  

Chemical ablation is by antiarrhythmic drugs such as Cardizem, Flecanide, Metoprolol, Sotalol, and the like.  Most work by slowing the heartbeat which, in turn, lessens the chance of having afib.  There are quite a few of the antiarrhythmic drugs to choose from now.  

Problems with chemical ablation are: 1) the effectiveness of the drug may wear off over time, 2) the drug may cause other problems (such as stopping the heart or exacerbating other problems you already have). 

Mechanical ablation is done by heat or freezing.  A catheter is run up through the arteries, stopped at the area where the afib occurs, then the tissue is either heated or frozen to kill the nerves that cause the afib.  You are usually unconscious when they're doing this type of ablation.  

Problems with mechanical ablation are:  1) The heart may "repair" the ablated area and your afib may return. 2) The ablation effort doesn't work and you continue to have afib.  3) the ablation doesn't work and you have heart damage.

The Medtronic pacemaker is used as a supplement to either chemical or mechanical ablation.  The one I have has two programs running continuously.  These programs shorten the battery life of the pacemaker.  One program is APP (Atrial Preference Pacing).  The other program is Minerva.  When the APP program "sees" a certain type of afib it will increase the heartbeat which can sometimes stop the afib.  The Minerva program will change the heartbeat rhythm and pace you out of afib.  APP works about 10% of the time.  Minerva works about 80% of the time.  The other 10% you're on your own.  Not all people with afib will respond to the programmed ablation Medtronics has.  So you may, or may not be a candidate for the Medtronic pacemaker.  

As Bionic Beat indicated you're put on blood thinners to reduce your chance of stroke, heart attack, etc.  As Bionic Beat indicated there are millions of people with chronic afib and they lead a fairly normal life in spite of the afib.  

I'm on chemical ablation with the pacemaker supplement.  I have afib about 15-16% of the time.  That means out of every 100 hours I'm in afib about 15-16 hours.  Most of the time I don't know it as the afib lasts for just a few minutes at a time.  My EP says I'm not "sick enough" to have a mechanical ablation and that I'm not a good candidate for mechanical ablation - hence the use of the pacemaker.  Most of the time I don't know I have afib.

I lead a fairly normal life in spite of the afib.  Have been all over the United States, Alaska, and over to the UK. (England, Scotland, Ireland, and Wales).  No problems other than the standard afib I have all the time anyway.  

So while afib is a problem you can lead a fairly normal life in spite of it.  

Hope everything else goes well for you.  

Further Comments

by margo12 - 2018-07-01 14:38:12

I guess I have trouble explaining my situation. I will try better.

Thank you. both, for your expertise. I believe you both have commented to explain my options. Here are a few things more to know.

I had a cryo ablation 4 years ago. Long story short, after dealing with dizziness, periods of a racing heart, and passing out, I was diagnosed with sick sinuc syndrom. At that time, I had an AV node ablation and 3 years ago got my Medtronic pacemaker. So I am dependent on the PM. Before the PM, I was on Metropolol  (it was awful) and Xarelto. My PM is set for 70-120 and is a rate response type. So I'm always paced at 70 unless body movement vibration causes the PM to increase my HR. 

This is from my recent test result:

Atrial high rates: 6,334, 100 % of time in AT/AF; longest episode >96 
hours, Avg/Max V rate during AT/AF paced bpm; 
% AT/AF Burden:
Past % AF: 65.5
Current % AF: 100

So from what I gather you both have said, my only option now is to go on a medication to treat the AF. The side effects of those drugs are really bad. However, I know AF also has long-term bad affects. So I guess it's a toss up.

If I've provided you with additional facts which you have recommendations for, I would appreciate your comments. 

Thanks for your expertise!

Hi

by Bionic Beat - 2018-07-01 16:48:25

Yes, the drugs do have side effects.  Not taking them, leaves you open to a stroke.

Up to you to decide if the inconvenience of side effects outweighs a stroke.

Realize that over time, sometimes quite awhile, the body usually adjusts to side effects or you get to the point where it is just 'your new normal'.  If you tire easily, rest.  If you cannot be as active as you were 20 years ago, oh well.

Once the electrical system of your heart changes, your life also changes.  They have wonderful things to make it as 'normal' as possible for us.

I know I am not chancing having a stroke, it could still happen but I am minimizing my chances.

Hope you also make that choice as there is little they can do at that point.

Best Wishes,

Bionic Beat

AV ablation + Pacemaker + Afib

by AgentX86 - 2018-07-01 18:25:35

OK, if I understand it, you have had an AV node ablation, with the (now necessary) pacemaker implanted so you're pacemaker dependent.  Your doctor has just told you that you're in Afib 100% of the time. 

OK. You'll have to be on an anticoagulant but that's not such a big deal (do NOT take warfarin). I had an AV node ablation and PM, after three failed ablations, because of Aflutter (same as Afib, but different). I had the AV ablation because I couldn't handle the Aflutter symptoms (previosly got Aflutter due to the Maze procedure I had because I couldn't tolerate Afib symptoms) and the antiarrhythmic medications damaged my SI node.  The AV ablation stopped 99% of the symptoms of the Aflutter (I can deal with the rest).  You, evidently, aren't symptomatic (with no AV synchrony, you shouldn't be) so what's the big deal, other than having to take anticoagulants for the rest of your life?  Yeah, it sucks but all of us here have been travelling down that road for a while.

Meds

by margo12 - 2018-07-01 19:03:41

You do understand my condition. So now I know my option. I surely have NO PROBLEM whatsoever with being on the blood thinner Xarelto. What I don't want to take is Amiodarone or Metropolol. 

I did feel the affects of AF but they "turned something on" on my PM and now I seldom feel anything. I do feel the affects though...tired a lot as well as ZERO heat tolerance. I guess I've read a lot about how AF can lead to dementia and a weakened heart. That's why I wanted to check out my options now. 

I am making the best of my life at this time. The alternative before the PM was not one I would have chosen.

Thanks again for both of your expertise.

Meds

by AgentX86 - 2018-07-01 21:19:27

I certainly understand your issues with ameoderone and metoprolol.  Ameoderone is probably the most dangerous of the antiarrhythmic drugs.   Though I've been taking metoprolol consistently since January of '07, some can't take the sideeffects.  At my last appointment I asked my cardiologist to take me off it.  His response was "we'll talk next time".

Hotcold tolerance tends to be an anticoagulant thing.  I'm really bad at both extremes now.  It's a good thing I live in Georgia now.  I don't think I could survive Vermont anymore. I have to wear a sweater when we go out to eat.

My understanding of both the dimentia and cardiomyopathy probems is that they're not directly related to Afib, itself.  AF related dimentia is caused by micro-hemmorragic strokes over many years, caused by the anticoagulants.  Eliquis is recommended for patients over 70(?) because of fewer instances of brain-bleeds. Cadriomyopathy is caused by long periods of high heat rates.  Keeping the heart rate under control is an imperritive.  Beta blockers and calcium channel blockers are the tools for this.  Ventricular pacing also keeps the heart rate in check because the ventricles are paced by the pacemaker rather than the atria.

You don't mention what mode your pcemaker is using (which chambers are paced and sensed).  My situation is very close to yours now and mine is a CRT-P (biventricular) pacemaker in VVIR mode.  Since you had your pacemaker before the Afib, you may be in AAI or AAIR mode. Since I'm in constant Aflutter, VVIR mode is used to cut the atria out of the picture completely. They don't do anything for me anymore.  Actually, they're just in the way (one of the relatively small symptoms I can feel occaisionally).  Thinking about it, that may be the programming change they made for you (just a guess).  In AAI(R) mode, the ventricles will follow the atria, just as if you had an intact AV node.  In VVIR mode, the atria are ignored, because the pacemaker in AAI mode would just transmit the arrhythmia to the ventricles.  In VVI mode the arrhythmia is ignored, at the cost of the atrial/ventricular dyssynchrony.

Atrial Fibrillation

by Heart-Rhythm-Center.com - 2018-07-02 08:46:01

Margo12:

Atrial fibrillation is the most common arrhythmia in clinical practice. The most important risk is that of stroke. The most important thing to discuss with your care provider is your risk of stroke and anticoagulation options; aspirin may not be enough and you may need to consider warfarin or one of the target specific oral anticoagulants (Pradaxa, Eliquis, Xarelto). If you are not on anticoagulation or just unsure, you should see your doctor ASAP. Finally, 30-40% of patients are asymptomatic from atrial fibrillation. Good luck!

Heart Rhythm Center Reply

by margo12 - 2018-07-02 12:04:19

Thank you for your reply. I have been on Xarelto (antiocoagulant) since getting my PM so I'm doing all I can there. Thanks again!

AgentX86 Reply

by margo12 - 2018-07-02 12:08:33

 AgentX86

Thanks for your extensive reply. I didn't understand the last paragraph. :) Well, I understand I don't know the answer to what applied to me. I can reply that I had an AF diagnosis BEFORE the PM. So I'm sure that helped determine the type of PM I got.

This is a good article for how heat affects people with AF. 

https://afib.newlifeoutlook.com/managing-atrial-fibrillation-in-summer/

AV Node Ablation and Bi-Ventricular PM

by ADalsmom - 2018-07-03 15:09:15

I had an AV node ablation and a bi-ventricular pacemaker implanted about 10 yrs ago and never regretted it!  My a-fib was so extreme, it would come on all of a sudden and I would get very weak ad almost pass out.  I had all the other procedures.....cardioversions, meds, cox maze (open heart surgery), and ablations with no success.  I was told that the AV node ablation was my last option, which was scary to me since I was 100% PM dependent.  Since that procedure, I never have any problems and my quality of life is back, tho I do feel tired often since I'm still in a-fib a great deal of the time.  I've needed to have 1 PM replacement a few yrs back since my battery was low.  This time I had my electrophysiologist put it deeper in the muscle since my original was just under the skin and uncomfortable.  Now I rarely even remember I have a PM since everything is under control.  Wishing good health and luck to everyone....