Canada
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Canada, May 18,  2020  12:34pm EST

First EP consult. Advice please?

Hello,

I am scheduled for a phone consult next Tuesday, my first with an EP.  Could you help me with which questions to ask?  My chief complaint is the shortness of breath that has grown to incapacitating over the 1.5 years since diagnosis:  paramoxyl AF, EF within normal range, on Eliquis bid, female, age 76, use pip.

The sob now strikes within 10-15 minutes of AF onset and from then on I am restricted to lying down until NSR.  If I'm on my feet I have had to rush to a chair or couch to prevent fainting.  If I were out driving or on a walk when an AF episode starts it would be a significant problem.

Do you think an ablation is a consideration?  or a change in medication?  I am not looking for advice, just something to help prepare me for the discussion

My cardiologist has advised me to let the EP know of my autoimmune condition (Sjogren's symptoms).  I'm not sure what this has to do with AF but maybe someone here does.

Here are my questions so far:

Is an ablatiion recommended for me?  Why or why not? 

What kind of ablations does he do?  Cryoablation? (supposed to be pref)

Does he use general anesthetic? (preferable, less pt movement & discomf) 

How are the recoveries from his procedures? 

What would he predict for my recovery?

If not an ablation, what?

Supplements?  Magnesium and/or potassium if my levels are normal?  I am taking Omega 3s with the permission of my cardiologist.

Thanks for any advice you are able to give,

Canada

10 Replies
  • depotdoug
    depotdoug, May 18,  2020  1:03pm EST

    Canada, You sure have got all or most of all the right questions. Are you on any other meds, like rhythm control or rate control Rx's?

    I would go with all those questions myself, in fact I think i've got all of those ?'s answered.

    Have you researched, looked at your EP's CV or past EP/Cardiology practices?

    That's enough for now.

    Let us know how it goes..

    Doug

  • Edhammer
    Edhammer, May 18,  2020  1:40pm EST

    Nice job on the questions. Asking about medications is really good. Asking about positive outcomes as well as negative ones. How many. Getting a feel for how well he listens to your concerns. It took me a couple of times to find the right fit. Somebody to work with, not just somebody to work on you. Someone who doesn't oversell a solution. Afib is different for all of us. My EP told me not to get too cocky when I was recovering.  He said it could come back.

  • Canada
    Canada, May 18,  2020  1:46pm EST

    Thanks, Doug.  That's helpful.

    Eliquis is my only med for AF but I am on Coversy Plus - 8 mg - for hypertension.  I do get some intermittent racing but my cardio says it's not unusual for someone like me with racing problems to begin with.  I could add that I was in the ER initially for "fast AF" with a HR to 160 or more.  And it usually goes to 150-160 with an episode. I am hoping I don't need to move to a different AF med or add to it since I don't have adverse effects from this one.

    I have looked at the EPs profile but I can't find any details on the type(s) of ablation he does.  He appears to be the only EP in Vancouver and his CV is impressive.  He works out of THE heart hospital in Vancouver.  His ratings are flawless - 5 stars, no exceptions.  I think I would be in good hands.  This is a phone consult so I have asked if I can send in a medical history/summary for myself ahead of time; that is ok'd by the office.  I'm pleased about that.

    Canada

  • Canada
    Canada, May 18,  2020  3:29pm EST

    Thanks, Ed.  Good things to keep in mind.

  • bfboca
    bfboca, May 19,  2020  5:17am EST

    Hi Canada.  Re: the first visit with an EP.  Your intro infers you are only on a pip for your paroxysmal afib.  It seems to me that you should inquire about taking AAR's on a daily basis rather than depend on "as needed."  And see how well that works for you.  At least give it a chance before pursuing an ablation.  Taking daily meds for your condition could prevent afib events in the first place or at least minimize them and possibly their duration.  Also, figure out if there are any triggers that are causing these events for you.  Lose weight if necessary, exercise, etc.  Sorry your afib events are so debilitating for you.  And best of success in finding your "cure" with your new EP.  Bob

  • Larkspur
    Larkspur, May 19,  2020  11:59am EST

    Hi Canada,

    I have a similar history with Afib--episodes were intense with a high ventricular rate (as you have) and shortness of breath and feeling faint for the duration. When I finally got to an EP rather than a general cardiologist, her immediate comment was that she did not want me to have any Afib at all! This is not only for comfort but because Afib begets Afib--in other words, it leads to progression of underlying problems in the heart like changes to the tissue. You didn't mention how often you get episodes and how long they last, and those questions could help determine the best treatment for you. My episodes have been stopped (at least for a few years) with a low dose of Flecainide--I also take a low dose of a beta blocker (which is a safely precaution when taking Flecainide) and Eliquis.

    So if you are getting fairly regular episodes, your choices might be ablation or a daily antiarrythmic. If you and your EP decide on ablation, ask him how many he has done as that is the biggest predictor of success--several hundred is a must; several thousand is better. As to cryo or RF, one is not necessarily better than the other and some ablations involve both as cryo can only be done on the pulmonary veins and mapping might reveal other sources of your Afib. I just had a FaceTime consult with my EP and it worked really well--I just had to take all my vitals myself. Best wishes!

  • Canada
    Canada, May 20,  2020  1:57pm EST

    Good points, both of you.  My cardio has mentioned a regular anti-arrythmic but I haven't been quick to add another med (I'm not a med taker if I can help it), also the propafenone leaves me with a very unpleasant taste over an extended time.  It may come up with the EP.  My weight has always been fine but stress is over the top with a death in the family and layers of complications with virus fallout added on.  I am a walker and do that as much as my energy allows.  I have lifelong insomnia issues, hormonal upsets, an autoimmune condition.  

    My episodes average 1/mo except that I've had a break since March (increased stress so that doesn't make sense).  They generally last 2-2.5 hours or until the propafenone takes effect.  (Two pills to start with and a 3rd after an hour.)  I had a phone consult with my cardio yesterday who said the EP does not do cryo; felt that would not be appropriate since it is not an "electrical" procedure.  He did say the EP has a new machine however.  He wants me to report my autoimmune issues since there is a clear correlation with AF.  This is the only EP in Vancouver so we don't have much choice.

    Thanks, much appreciated!

  • DkinAA
    DkinAA, May 20,  2020  5:45pm EST

    Hi, Canada. We all respond to drugs differently. Here's my experience: I started with PIP propafenone last fall, and soon went to daily -- I was PIP-ing every other day or so. But like you, the propafenone really turned off the episode pretty fast. Daily dose cut the episodes way back. I experienced that metallic taste from the propafenone at first, then it seemed to fade after I went on the daily dose - rarely get it now. My EP's clinic also gave me a beta-blocker propranolol to take during an episode but only if my HR was over 100 -- it worked really well at bringing HR down. The daily dose works pretty well, but I'll probably need to increase the dose somewhat because I still get an occadional stress-related "breakthrough" episodes (like reading too much COVID news). EP said to just double the next daily dose and also to take the propranolol if HR over 100. So now I am on a daily-dose with PIP combo.  So far, so good.

    My attitude is that drugs are less invasive than surgical procedures, so I'll try that first ... but as soon as the drugs don't help, I'm up for an ablation!

  • Canada
    Canada, May 21,  2020  12:12pm EST

    The recurring theme here regarding an ablation - or not - seems to be to go the meds route first.  I'll keep it in mind for my appointment.  Thanks, all.

  • bfboca
    bfboca, May 22,  2020  5:09am EST

    Hi Canada.  Re: try meds first?  Excellent decision.  Why not?  It works for probably more than two million afibbers.  And I hope it works for you.  Bob

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