I will stay tuned. I’m the recipient of an AF ablation 2 years ago with zero episodes since the procedure. I wear a wristwatch that can detect AFIB on a daily basis. I voluntarily wear a week long holter monitor every 6 months. Both provide some independent verification for my results. The 8 months prior to my ablation, with the use of medication daily, I experienced AFIB every few days. These lasted 4 to 24 hours. My condition was likely headed to permanent AFIB. The medication had side effects that were difficult to tolerate. In fact the medications weren’t being particularly effective. It bears mentioning that I didn’t have contributing medical conditions or heart disease. My thought is that AFIB is sometimes a stand alone condition and at other times secondary condition triggered by other chronic diseases. The stand alone maybe is more successfully treated by ablation than AFIB that accompanies other chronic conditions. I know this is anecdotal information but I also know what I know. My ablation gave me back my quality of life.
Mine is standalone. No contributing factors have been found so far. It's really frustrating, and while medication is helping now, it seems to be less effective as I go forward through this situation. I would love to have a "why" for this!
Your insights about atrial fibrillation are right on the money. Back when I was training in medicine and cardiology (1970s), we referred to your condition as "lone" atrial fibrillation because it occurred in a fairly broad age group and had no underlying heart disease or other medical conditions. It does make sense that the ablation might be more successful in those without other underlying causes but I don't know whether that has ever been specifically studied. I wonder if Dr. Mandrola has any information on this aspect.
A friend and I had MIs within days of each other and had stents placed in the LAD (widow maker) location. We were both low risk on all of the Framingham parameters and quite physically active.
He reported an immediate improvement to his former rapid onset of breathlessness upon exertion. I did not experience that relief. The pulse oximeter showed high (97%) oxygen saturation while climbing stairs, suggesting that circulation and air exchange were not the issues. I suspect that I have a mitochondrial dysfunction stemming from the typical high carb and seed oils diet that the food 'pyramid' promotes and am working on a reduced carb and reduced seed oil diet to see if that will facilitate the turnover of the mitochondrial complement to a less glucose centric composition.
In the Orbital trial what would be the reason to expect an immediate (?) improvement in exercise time after the procedure?
Was there no reduction in angina?
Perhaps it might take a patient some time back at exercise to fully take advantage of the newly opened coronary? Presumably metabolic scans confirm improve blood flow in the affected myocardial muscle.
Thanks for these articles. I had some kind of atrial ablation 5 years ago after one significant episode of atrial flutter landed me in the ER and then a failure of meds followed. If I feel any "skipped beats" or a cluster of rapid ones I hold my nose and cough hard and that seems to make it stop. Have been prone to this when severely fatigued all my life. Though I still admire and even venerate the EP who treated me I'm hoping I never see him again.
That pattern suggests that you were experiencing paroxysmal supraventricular tachycardia (PSVT) which is a benign arrhythmia---paroxysmal atrial tachycardia, flutter, or fibrillation. It is usually easily terminated by the valsalva maneuver which is simply trying to force an exhalation against a closed airway. PSVT poses no real risk and doesn't require any treatment unless it is very frequent and bothersome.
The episode I had started when I bent over to pick up a pen off the floor on a Sunday afternoon. I had been grading papers. I stood up and my heart was doing 130 bpm. I let it go 3 hours then went to urgent care. The guy there said my heart was starting to "show signs of stress"so he sent me to ER across the street. It took the ER doc an hour to get it into normal rhythm, and I guess it was the IV with some beta blocker that did it. He said he initially thought it was SVT but then thought it was "just flutter". The urgent care guy had tried having me do the vagus nerve stuff, bearing down, etc but nothing worked.
After that, it was a few weeks of trying the most horrible meds ever invented (beta and calcium channel blockers) to prevent any such thing occurring again. They were far "worse than the disease" so no go. Then a few months after that I realized the blood thinner was crushing me so that went off the loading dock. So I had the ablation.
I still don't know what that event was. I don't know if what I still experience is the same kind of thing and I hope it's what you suggest. That was one of the most depressing experiences I've ever had.
Hard to be sure without seeing the EKG but I would bet that you experienced an episode of paroxysmal atrial flutter. Isolated attacks of rapid heart beat are either atrial tachycardia, atrial flutter, or atrial fibrillation. The first two produce a regular heart rate and fibrillation an irregular heart rate. Any doctor would be able to differentiate fibrillation from the other two and certainly would have told you so. Paroxysmal just means that the episodes come on for no identifiable reason and end the same way. They may last only a few minutes or, in the case of atrial flutter, persist for a longer period. Vagal stimulation through Valsalva maneuver or carotid artery massage may terminate an attack of atrial tachycardia but usually won't work for flutter or fibrillation. People with paroxysmal atrial tachycardia often have a long history of periodic episodes often going back to childhood. No treatment with drugs or anything else is necessary unless the attacks are so frequent that they disrupt your life in some way. Paroxysmal atrial fibrillation may presage a future persistent atrial fibrillation but that is the only significant negative feature and that can be managed very easily with an old medication (digitalis) that has very few side effects. Paroxysmal SVT NEVER warrants anticoagulation. Even persistent atrial fibrillation has only a very slight risk of subsequent stroke and the need for anticoagulants to prevent this is quite debatable. Dr. Mandrola has presented a number of studies on this website that bear that out.
When they finally got my heart slowed down the beats were irregular for a minute or so. Then it settled into a regular rhythm and I guess that fits the paroxysmal atrial flutter. Thanks for your comment. The whole thing was confusing.
Premature beats are very common and will often be mistaken for an irregular rhythm. It used to be common practice to give medication to suppress premature beats. But once 24-hour portable heart monitors came into common use, it became apparent that these were detected frequently in most people and that practice was , thankfully, abandoned. When your heart rhythm reverts to normal after a sustained tachycardia, there will often be some irregularity in the initial moments. Your episode had to be paroxysmal atrial tachycardia or flutter---they are much the same; some focus in the atrial conduction system started firing off at about 260 per minute and half were able to be conducted down to the ventricular conduction system. The junction between the atrial and ventricular conduction systems is the AV node and it can't repolarize quickly enough to transmit at rates much over 200 per minute. This can be alarming but isn't dangerous. I spent a lot of time in my practice explaining to people that abnormalities in the heart's electrical system were not necessarily a sign of heart disease.
This is a great study, but is it going to answer the question we all want answered (only a secondary endpoint)? Don’t we already know the answer to the primary endpoint, that Afib burden will be less as already addressed in previous studies?
But alas, I am ashamed that we rely on other countries to answer these important questions. Lack of motivation/integrity in the US healthcare system is the only reasonable conclusion as to why we don’t.
I will stay tuned. I’m the recipient of an AF ablation 2 years ago with zero episodes since the procedure. I wear a wristwatch that can detect AFIB on a daily basis. I voluntarily wear a week long holter monitor every 6 months. Both provide some independent verification for my results. The 8 months prior to my ablation, with the use of medication daily, I experienced AFIB every few days. These lasted 4 to 24 hours. My condition was likely headed to permanent AFIB. The medication had side effects that were difficult to tolerate. In fact the medications weren’t being particularly effective. It bears mentioning that I didn’t have contributing medical conditions or heart disease. My thought is that AFIB is sometimes a stand alone condition and at other times secondary condition triggered by other chronic diseases. The stand alone maybe is more successfully treated by ablation than AFIB that accompanies other chronic conditions. I know this is anecdotal information but I also know what I know. My ablation gave me back my quality of life.
Mine is standalone. No contributing factors have been found so far. It's really frustrating, and while medication is helping now, it seems to be less effective as I go forward through this situation. I would love to have a "why" for this!
Your insights about atrial fibrillation are right on the money. Back when I was training in medicine and cardiology (1970s), we referred to your condition as "lone" atrial fibrillation because it occurred in a fairly broad age group and had no underlying heart disease or other medical conditions. It does make sense that the ablation might be more successful in those without other underlying causes but I don't know whether that has ever been specifically studied. I wonder if Dr. Mandrola has any information on this aspect.
I look forward to hearing the results but am somewhat skeptical of any study that uses a subjective primary endpoint like quality of life.
A friend and I had MIs within days of each other and had stents placed in the LAD (widow maker) location. We were both low risk on all of the Framingham parameters and quite physically active.
He reported an immediate improvement to his former rapid onset of breathlessness upon exertion. I did not experience that relief. The pulse oximeter showed high (97%) oxygen saturation while climbing stairs, suggesting that circulation and air exchange were not the issues. I suspect that I have a mitochondrial dysfunction stemming from the typical high carb and seed oils diet that the food 'pyramid' promotes and am working on a reduced carb and reduced seed oil diet to see if that will facilitate the turnover of the mitochondrial complement to a less glucose centric composition.
I have long appreciated the thoughtfulness and balance of John Mandrola's views
Thank you so much for sharing your thoughts once again
Thank you for bringing this to attention! Now I’m looking forward to hearing the trial results in the ESC congress!
In the Orbital trial what would be the reason to expect an immediate (?) improvement in exercise time after the procedure?
Was there no reduction in angina?
Perhaps it might take a patient some time back at exercise to fully take advantage of the newly opened coronary? Presumably metabolic scans confirm improve blood flow in the affected myocardial muscle.
Your posts are SUPER helpful. Thank you for all you do
Thanks for these articles. I had some kind of atrial ablation 5 years ago after one significant episode of atrial flutter landed me in the ER and then a failure of meds followed. If I feel any "skipped beats" or a cluster of rapid ones I hold my nose and cough hard and that seems to make it stop. Have been prone to this when severely fatigued all my life. Though I still admire and even venerate the EP who treated me I'm hoping I never see him again.
That pattern suggests that you were experiencing paroxysmal supraventricular tachycardia (PSVT) which is a benign arrhythmia---paroxysmal atrial tachycardia, flutter, or fibrillation. It is usually easily terminated by the valsalva maneuver which is simply trying to force an exhalation against a closed airway. PSVT poses no real risk and doesn't require any treatment unless it is very frequent and bothersome.
The episode I had started when I bent over to pick up a pen off the floor on a Sunday afternoon. I had been grading papers. I stood up and my heart was doing 130 bpm. I let it go 3 hours then went to urgent care. The guy there said my heart was starting to "show signs of stress"so he sent me to ER across the street. It took the ER doc an hour to get it into normal rhythm, and I guess it was the IV with some beta blocker that did it. He said he initially thought it was SVT but then thought it was "just flutter". The urgent care guy had tried having me do the vagus nerve stuff, bearing down, etc but nothing worked.
After that, it was a few weeks of trying the most horrible meds ever invented (beta and calcium channel blockers) to prevent any such thing occurring again. They were far "worse than the disease" so no go. Then a few months after that I realized the blood thinner was crushing me so that went off the loading dock. So I had the ablation.
I still don't know what that event was. I don't know if what I still experience is the same kind of thing and I hope it's what you suggest. That was one of the most depressing experiences I've ever had.
Hard to be sure without seeing the EKG but I would bet that you experienced an episode of paroxysmal atrial flutter. Isolated attacks of rapid heart beat are either atrial tachycardia, atrial flutter, or atrial fibrillation. The first two produce a regular heart rate and fibrillation an irregular heart rate. Any doctor would be able to differentiate fibrillation from the other two and certainly would have told you so. Paroxysmal just means that the episodes come on for no identifiable reason and end the same way. They may last only a few minutes or, in the case of atrial flutter, persist for a longer period. Vagal stimulation through Valsalva maneuver or carotid artery massage may terminate an attack of atrial tachycardia but usually won't work for flutter or fibrillation. People with paroxysmal atrial tachycardia often have a long history of periodic episodes often going back to childhood. No treatment with drugs or anything else is necessary unless the attacks are so frequent that they disrupt your life in some way. Paroxysmal atrial fibrillation may presage a future persistent atrial fibrillation but that is the only significant negative feature and that can be managed very easily with an old medication (digitalis) that has very few side effects. Paroxysmal SVT NEVER warrants anticoagulation. Even persistent atrial fibrillation has only a very slight risk of subsequent stroke and the need for anticoagulants to prevent this is quite debatable. Dr. Mandrola has presented a number of studies on this website that bear that out.
When they finally got my heart slowed down the beats were irregular for a minute or so. Then it settled into a regular rhythm and I guess that fits the paroxysmal atrial flutter. Thanks for your comment. The whole thing was confusing.
Premature beats are very common and will often be mistaken for an irregular rhythm. It used to be common practice to give medication to suppress premature beats. But once 24-hour portable heart monitors came into common use, it became apparent that these were detected frequently in most people and that practice was , thankfully, abandoned. When your heart rhythm reverts to normal after a sustained tachycardia, there will often be some irregularity in the initial moments. Your episode had to be paroxysmal atrial tachycardia or flutter---they are much the same; some focus in the atrial conduction system started firing off at about 260 per minute and half were able to be conducted down to the ventricular conduction system. The junction between the atrial and ventricular conduction systems is the AV node and it can't repolarize quickly enough to transmit at rates much over 200 per minute. This can be alarming but isn't dangerous. I spent a lot of time in my practice explaining to people that abnormalities in the heart's electrical system were not necessarily a sign of heart disease.
You just educated me better than any cardiologist I've ever talked with about what happened. THANK you!
This is a great study, but is it going to answer the question we all want answered (only a secondary endpoint)? Don’t we already know the answer to the primary endpoint, that Afib burden will be less as already addressed in previous studies?
But alas, I am ashamed that we rely on other countries to answer these important questions. Lack of motivation/integrity in the US healthcare system is the only reasonable conclusion as to why we don’t.
Your answer to this question may be more appropriate for another post, but what are your thoughts on "hybrid" ablations?