Afib and ablation

[67 m20F chump]

Any of you know anything about treatment for afib?  Specially they shocked me back into normal but it didn’t last.  No kidding I had my special issuance medical in my hand.  The next day back in afib.  

 

I’m looking at ablation.  Any of you have experience with it?  RF or cryogenic?  Any problems from it?

 

pm if you would like.

[Hank]

My dad has afib. After a couple of cardioversion attempts, he had a partial ablation. Then several years later, he had a complete ablation and received a pacemaker. Coumadin all along.

Last year he received a Watchman implant, with the goal of reducing stroke risk and eventually reducing / eliminating the Coumadin.

He began having symptoms in Spring of 2001 or 2002; didn't get the pacemaker for 6-8 years. Still going strong now.

Hope your treatment goes well.

[DXB]

37 minutes ago, 67 m20F chump said:

Any of you know anything about treatment for afib?  Specially they shocked me back into normal but it didn’t last.  No kidding I had my special issuance medical in my hand.  The next day back in afib.  

 

I’m looking at ablation.  Any of you have experience with it?  RF or cryogenic?  Any problems from it?

 

pm if you would like.

I think we have a cardiologist Mooney pilot here somewhere. @Deb maybe?  No MD will ever want to give patient-specific medical advice on the internet, but maybe some general perspective could be had.

[RogueOne]

My mother in law is 81 and struggling with afib. I wish you well. Sure hope you get it back in rhythm. Good luck 

[67 m20F chump]

I’m interested in if anyone has gotten a medical back and how they got back into rhythm.  

[amillet]

I had an RF ablation in August 2009 for “atrial flutter”.  Had to repeat again in September 2009.  Special issuance for about three years, then cleared for normal third class. I take metoprolol daily now. 

[Little Runaway]

1 hour ago, 67 m20F chump said:

I’m interested in if anyone has gotten a medical back and how they got back into rhythm.  

I had an RF ablation procedure in 2011 to correct A-Fib. I was 37 at the time. It took about 6 months to get the procedure scheduled with a cardiologist. I had to be on Warfarin (Coumadin) for a few months prior to the procedure, if I remember correctly. It was a PITA having to have bloodwork done a couple times a week for three months but the procedure went well with a pretty short recovery time.

The FAA required a 6-month waiting period before they would consider a special issuance. They required a report from my cardiologist after wearing a Holter monitor for a week or two and having some bloodwork done. My cardiologist gave me a letter and I took it to my AME, who, submitted the cardiologist letter with my application for a 2nd Class medical. It didn't take long (a few weeks, maybe) before I received a mail response from OKC with a Special Issuance 3rd Class medical enclosed (I can't recall what else they wanted before they would issue a 2nd class--it may have been more information from my cardiologist but I was able to get a 2nd Class shortly thereafter). The conditions of the Special Issuance were that I was required to wear a Holter monitor for 24 hours and see an AME every year for five years (the Special Issuance was only valid for one year). I was also required, of course, to report any further symptoms. After the fifth year I received a letter from Oklahoma City informing me that a Special Issuance was no longer required.  

I did a lot of research prior to choosing RF ablation, and more importantly, my cardiologist. I fly professionally (not airlines) so I wanted to minimize the time I would be without a medical. My supervisor, at the time, had a great idea. He had a contact at the FAA in OKC and was able to find out which cardiologists in my area were able to get the paperwork to the FAA, with the right information, in a timely manner. Apparently some are terrible and don't want to deal with it.

 I chose the cardiology clinic based on this information. I didn't have much control over who in the clinic performed the procedure but he was top-notch. He sat down with me for about 45 minutes and made sure all of my questions were answered prior to scheduling the procedure. I asked him about success statistics and how he mitigated risk. He was able to answer all of my questions and it was clear he was methodical and knew his trade. He also agreed to help me with whatever the FAA required following my recovery. My procedure lasted about 8 hours--they had trouble getting me into fibrillation and I actually had a couple of different fibrillation modes. 

As far as getting back to sinus rythm, that's probably bordering on medical advice so I'm not comfortable posting what worked for me on this forum. I'm happy to discuss it with you if you want to PM me.

Good luck. It's a stressful experience but it definitely worked out for me and I've been in sinus rhythm for years. I've heard that the new cryo stuff is less likely to damage surrounding tissue, or result in the need for a pacemaker, but I'm not sure as I haven't needed to look into it!

Aaron

[tigers2007]

Has anyone here ever been cardioverted in a non-emergency setting? I never knew they did this.
I’ve played with cardioversion with a few people when I worked EMS nearly two decades ago. The most fun was asking the patient if they “wanted to get hit in the chest with many small baseball bats or one giant baseball bat” (shocking them 100 joules multiple times or 200 once). The screams were somewhat terrifying. The scariest I saw was pushing adenosine on a 22yo pregnant female with wicked SVT. Heart stopped for waaaay too long but went back online sinus tach. Holy crap we had to clean our pants after than one. Murphy’s law here too as she was a big girl, was in the upper bedroom of a bungalow with the narrowest stairs in the world, 3AM, and there was like no lighting in the house. I have no clue what we would have done if she gorked out up there. Called the medical examiner?
Anything cardiac scares the daylights out of me. I guess I shouldn’t have ordered chili fries for lunch today.



Sent from my iPhone using Tapatalk

[Hank]

1 hour ago, tigers2007 said:

Has anyone here ever been cardioverted in a non-emergency setting? I never knew they did this.

Dad's two or three cardioversions were scheduled in advance, in the OR, under anesthesia. Good results, at least fifteen years ago for the first one. He's 81 now.

[oregon87]

This may be a really silly suggestion, however, it worked for me.  I was diagnosed with afib in my late 30s.  Spoke with a cardiologist who suggested ablation having reviewed my heart monitor results.  After I was told there was a risk of pacemaker post procedure, I elected to say HECK NO to that!  As such, I was put on a beta blocker for a few years, requiring a special issuance.  Here's the good part.  Concurrent to taking the beta blocker, I was also taking Zyrtec for allergies.  Unfortunately, no doctor put together the irregular heartbeat with antihistamine use.  As I grew tired of taking pills, I quit Zyrtec cold turkey.  The antihistamine hangover was a bit rough and it took a few weeks to feel right, but I haven't had an irregular heartbeat since and am off the beta blocker, as well.  Sure, I sneeze a bit more in the summer, thank you Central Oregon juniper, but I feel 100% better. 

[Wistarmo]

I am a practicing Cardiovascular Surgeon with about twenty-five years’ experience treating atrial fibrillation.  

It is important to know which category of afib is present: paroxysmal, persistent, or permanent.  Your Cardiologist can tell you.  In general, paroxysmal afib occurs sporadically and is self-limited.  Persistent afib has episodes that last longer or require cardioversion.  Treatments are available for these forms of afib.  Permanent afib can only be managed with medicines.

The original treatment for afib was created by a surgeon and requires open heart surgery.  It is named the Maze Procedure, so-called because a “maze” is created by dividing atrial tissue to break up the chaotic electrical rhythm that causes afib, leaving a defined pathway for the electrical signal.  The atrial tissue was originally divided with a scalpel or scissors and then sewn back together; it is now accomplished with other technologies. The surgeon can directly see exactly where to make the divisions.  In skilled hands, it is highly successful, with sinus rhythm restored in 90% of cases. The left atrial appendage, a source of blood clots and stroke, is closed off. The disadvantage is that it requires open heart surgery, and is generally only done if heart surgery is required for another heart problem. 

Cardiologists developed an alternative, called an “afib ablation”.  It is not nearly as successful as the Maze procedure.  Five year success rates at maintaining sinus rhythm are poor for persistent afib, and multiple procedures are often required. The cardiologist cannot directly see inside the heart, and must use some form of imaging to place the divisions.  The left atrial appendage is not closed off. A separate Watchman procedure would be necessary for that, provided the patient qualifies  The advantage is that it only requires a catheter inserted into the femoral vein and can be done as an outpatient.

Over the last few years, the Hybrid Maze procedure has been developed.  Rather than Cardiac Surgeons and Cardiologists competing with different procedures, they collaborate together to solve the problem. The surgeon goes first, with a procedure involving small incisions and a scope, to treat the outside of the heart under direct vision.  The left atrial appendage is closed off directly. The patient can usually go home in two days. A month or two later, the cardiologist performs a catheter based study of the surgeon’s work, and can usually correct any breaks in the maze line easily. That is done as an outpatient. Success rates are approaching that of the original open Maze Procedure. 

Generally, I would consider a cardiology ablation acceptable for paroxysmal afib as it is in the early stages and success rates are reasonable. For persistent afib I would recommend a Hybrid Maze procedure, with far superior results.

One final point is that there is another cardiology procedure called an “A-V Node Ablation”. This is confusing because it is also called an ablation. This involves destroying the electrical pathway between the atria and the rest of the heart.  This results in a very slow heart rate, so a pacemaker must be placed. This does nothing to correct the atrial fibrillation.  It should only be done in patients who continue to have very rapid heart rates who have no other treatment options. 

Edited September 25, 2019 by Wistarmo

[67 m20F chump]

Thanks Doc!  I see the E P doctor Monday.  I had the cardioversion and it lasted 3 months.  I asked about this on another forum and guys are saying the got about 4 years of normal with ablation.  I will ask about the hybrid maze procedure.  I was hoping for a more permanent fix.  I have 16 years to go before retirement.