Permanent afib and ablation

[Tuttle4]

Hello my husband has been in permanent afib for 5 years. He has had 2 cardioversions and one ablation. Never put him in normal sinus for even a minute. He recently had prostate surgery and because of hospitalizations he was without his digoxin for 2 doses. He has an ICD that is intended to shock him if his HR goes over 180. Well it did and it shocked him 5 times and he was in normal sinus for 6 hours then flipped back. His EP said he wants to talk to him about another possible ablation this week because his HR has been creeping up to 150 at times. His ICD reports his HR via a monitor. His fit bit watch says his resting rate has been 70-90. We are scared for another procedure. Has anyone had a successful ablation in permanent afib?

[Desanthony]

I can’t really advise you but I would warn against paying too much attention to the fit bit. They are not that accurate really although they can be close I only use mine as a way to see if and when my heart rate goes up - or down but take little notice of the actual numbers it gives me. I have a chest strap heart monitor with a wrist worn read out that gives me a better and instant reading which I use for the gym which constantly gives me an immediate and, I believe more accurate reading. Having said that the fit bit is a guide and is useful for watching trends. I would be inclined to go with the EP and go forward with plans for the ablation as he did resume NSR for a while which means that an ablation could work. He doesn’t, when it comes to the crunch have to go through with it. I do t know how long he might have to wait in your area but most places have waiting lists of at least 6 month and more commonly 12 to 18 months. However, it does depend on how much the AF affects his life- if he has few symptoms which he can live with and can take the medication to alleviate the symptoms and other effects AF can give then maybe not.

[KMRobbo in reply to Desanthony]

Desanthony correct . I had similar experience wife's fit bit had me at 75- 80bpm but my Garmin sports watch with chest belt had me at 165bpm.

[Tuttle4 in reply to Desanthony]

good to know about the fit bit. He has an ICD device in his chest. There is a monitor that reports his readings to the EP I am assuming those are pretty accurate. We will see what they say tomorrow. Thanks for responding. Glad you are doing well.

[Desanthony in reply to Tuttle4]

Yes those will be accurate.

[Sean_C]

Hi Tuttle, I went into AFIB (persistent - when I'm in, I'm in, until a DCCV) after (or perhaps during, the last 2 miles were dreadful) the Birmingham Half Marathon in 2016 ( I ran to raise money for CRUK). I had 4 cardioversions up until November last year (2021) when I finally decided to go for the ablation (my EP had been telling me to have it for 2+ years). My last cardioversion only lasted 24 hrs and I was back in persistent AF for about 6 months before my ablation came up.I had an RF ablation, under GA, on the 25th November. It is now 4 and a bit months and I am still in normal rhythm, feeling stronger all the time.. weird thumps and short bursts of rapid HR are getting less and less. I am a cyclist, and so some weight training 2x per week, and have been riding my bike for two months, steadily building up (with the EP's blessing) distance and intensity and I'm now doing 60-80 miles per week.

I had a 10 day HR monitor last month, showed no AF whatsoever, just the occasional ectopic, or pause.. my EP said they were completely innocent.

I was taken off the anti-coagulant two weeks ago. Still on low dose Bisoprolol and Ramipril daily (1.25) but that is just for BP purposes.. I am mildly hypertensive and had picked up 6 or 7 pounds in weight. I am working on shedding those and hope the BP will drop by itself so I can stop those two drugs too.

Hope that helps.

Regards

[Tuttle4 in reply to Sean_C]

that's awesome thanks

[JOY2THEWORLD49]

HiHas he been tried on CCB a calcium channel blocker?

On Metrolpolol my HR was avge daily 186

On Bisoprolol 156 avge daily

On CCB Diltiazem 120mg a.m Bisoprolol 2.5mg p.m

HR 93 avge daily

Night rate avge is 48!

CCB has controlled my rapid persistent AF HR.

AF on exertion.

cheri JOY

[Tuttle4 in reply to JOY2THEWORLD49]

I am glad this has worked for you. From what I have read CCPs should not be taken for people with heart failure. My husband's Ejection fraction is 30%

[CDreamer in reply to Tuttle4]

Hi - I’m a bit late to this thread but had some thoughts:

Is the low EF caused by the AF or the AF result of the HF?

Questions I would be asking is if the atria is dilated:-

what are the chances of the success of the proposed ablation?

Is the AF or the high HR in AF of the most concern?

My understanding is that the chances of maintaining NSR after ablation for someone in permanent AF over time would be quite low but is that the aim?

At this stage I think it very difficult to know which is the best option.

What are your husband’s thoughts, hopes and fears? I think one has to not only consider the clinical aspect but also the psychological and how resilient your husband is because that will affect recovery. How did he recover from the first ablation? How long did that last for?

Age and general health/wellbeing are big considerations. Is quality of life or longevity more important?

My husband (then 95) was in persistent AF 3 years ago with an EF of 36% but with a relatively low HR of around 120 max. He wasn’t a candidate for ablation so decided, as last resort, to try Amiodarone. We had a lot of fears about the side effects but he has tolerated it very well and converted back to NSR after about 3 months. He continues to take a maintenance dose of Amiodarone, has maintained NSR and now EF is back up to 56% and Echocardiogram results good and the AS now much improved.

His QOL is very much improved. Just wondered if Amiodarone had been muted as a possibility?

The difference is that my husband did not have a high HR, in fact his AF was caused by SSS and Brady/Tachycardia.

Hope some of those thoughts might assist you both in making this very difficult decision. Best wishes

[Tuttle4 in reply to CDreamer]

HelloWe are really not sure what came first the af or the heart failure. We went to see the Electro cardio this week. He said his first ablation was the old way of doing it cyro? He thinks it very probable they did not get everything. They did an echo today so we will see if his heart function has improved. His quality of life has been decent since recently. He has worked full time in maintanance in a factory. Heart rate creaps up to 150 at times. His EP does not like that. They would like his HR to be lower. At rest it is between 70-80. The meds he is on also really lowers his blood pressure to like 90/60. Really hard to feel well with BP being so low. His is scheduled for his ablation on 4/19. We are cautiously optomistic.