ABOUT 'BEAT YOUR A-FIB'...


"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


CryoBalloon ablation

CryoBalloon Ablation: All EPS Are Not Equal (Part II)

Second in a two-part series by Steve S. Ryan, PhD

In Part I of this article, I shared my dismay at reading two O.R. reports of Cyroballoon Ablations that left me alarmed and disturbed. The first case was performed at one of the most prestigious A-Fib centers in New York City.
In each case, what’s alarming is what the EP didn’t do! The CryoBalloon ablation was less than the standard. The very minimum steps were taken.

Is Performing CryoBalloon Ablations Too Easy?

That relative ease has lead some EPs to cut corners. They just isolate the PVs without doing anything else.
CryoBalloon ablation is relatively easy to perform compared to RF (point-by-point) ablation.

That relative ease has lead some EPs to cut corners. They just isolate the PVs without doing anything else—they don’t bother to identify where A-Fib signals (potentials) are coming from and they don’t try to induce A-Fib after the ablation.

Some EPs performing CryoBalloon ablations may not have a full skill set. Others may lack the motivation to hunt for non-PV triggers.

My fear: If this becomes a trend, I fear CryoBalloon may become a step backwards as a treatment for A-Fib patients. Could CryoBalloon Ablation turn into a second-tier or inherently inferior procedure?

Choosing an EP for a Cryoballoon Ablations

Are you considering a catheter ablation (RF or Cyro)? Before selecting your electrophysiologist (EP), you must do your research and check their credentials and experience. For guidelines, see our Find the Right Doctor for You and Your A-Fib.

When choosing an EP for a Cyroballoon Ablation, you should research:

1. Are they certified in Clinical Cardiac Electrophysiology (CCE)?
2. Did they have a good track record doing RF ablation before they switched to CryoBalloon ablation?
3. Do they perform at least 25 ablations a year to maintain their proficiency?
4. Will this EP commit to pursue and ablate non-PV triggers?

Take Away: All EPS Are Not Equal

You want an EP with a proven track record in RF ablation who can call on those skills if needed to identify and ablate non-PV triggers.

You don’t want an EP new to the field who is only doing CryoBalloon ablations because they are so much easier to do. EPs don’t all have the same training, skill level, and motivation. Indeed, many non-CCE certified EPs perform catheter ablations for A-Fib.

You want an EP with a proven track record in RF ablation who can call on those skills if needed to identify and ablate non-PV triggers. The EP should have established protocols for doing this and should be able to explain them to you. For example, something like this:

“If you are still in A-Fib after Cryoablation of the pulmonary veins, I will withdraw the CryoBalloon catheter and replace it with an RF catheter. I’ll identify the non-PV trigger spots, then isolate each with the RF catheter.”

All EPs are not equal. To become A-Fib-free, do your homework! Find the right EP for your Cyroballoon ablation.

Additional reading: To learn more about O. R. reports see our Special Report: How & Why to Read Your Operating Room Report

CryoBalloon Ablation: Alarming O.R. Reports (Part I)

A two-part series by Steve S. Ryan, PhD

Often when A-Fib patients contact me, I’ll advise getting a copy of their O.R. (Operating Room) report so I can read exactly what was done during their ablation. The details in an O. R. report can be quite revealing and usually reassure me that their EP did a good job.

An O.R. report of a catheter ablation is a blow-by-blow account of your EP’s actions.

But sometimes the report is disappointing. I just read two O.R. reports of CryoBalloon ablations that left me alarmed and disturbed.

O.R. Report #1: Ablation Without Identifying the Source of A-Fib Signals

The first CryoBalloon ablation was performed at one of the most prestigious A-Fib centers in New York City.

At the beginning of the ablation, it appears the Electrophysiologist (EP) made no attempt to first map the source of the patient’s A-Fib signals (mapping at the beginning or before hand is standard procedure at most A-Fib centers).

During the ablation the EP did not check for non-PV triggers or even attempt to identify the source of her A-Fib signals or potentials. The EP merely ablated the pulmonary veins (PVs), but did check for entrance and exit block.

At the beginning of the CryoBalloon ablation, the EP made no attempt to first map the source of the patient’s A-Fib signals.

At the end of the CryoBalloon ablation, he did not verify all A-Fib signals had been terminated by trying to trigger A-Fib with pacing or drugs like isoproterenol. (Triggering A-Fib means a new round of A-Fib isolation.) Once again, this verifying step is standard protocol for most ablations at most centers.

Result: the CryoBalloon ablation appeared to successfully isolate the patient’s PVs, and luckily she seems to be doing well.

My Observations

What’s alarming is what the EP didn’t do! This CryoBalloon ablation was less than the standard.

The very minimum steps were taken: isolate the Pulmonary Veins and little more. There was no effort to check for non-PV sources of A-Fib signals. No verification that all A-Fib sources were terminated. In fact, this patient may still have spots producing A-Fib signals.

Why go through an ablation if the EP didn’t do a thorough job? If the patient’s A-Fib returns, a second ablation may be required.

Now you know why I was disturbed by this O. R. report. Now, let’s look at the second report.

O.R Report #2: Non-PV Triggers Still Causing A-Fib

I read another O.R. report of a CryoBalloon Ablation on a patient who was in persistent A-Fib for two months before the ablation.

After isolating the PVs, the patient remained in A-Fib.

After isolating the PVs, the patient remained in A-Fib…the EP simply electrocardioverted the patient back into normal sinus rhythm.

Instead of looking for and ablating the source of these non-PV triggers, the EP simply electrocardioverted the patient back into normal sinus rhythm. (That’s certainly faster and easier than looking for non-PV triggers.)

Result: The patient was back in A-Fib within a month.

MY OBSERVATIONS

According to the patient, when the patient and his family first met with the CryoBalloon ablationist, they asked the right questions:

“What will you do if I still have A-Fib after the ablation?”

The EP said he would not stop until all the A-Fib spots were found and ablated.

In reality, instead of doing that, he just electrocardioverted the patient back into normal sinus rhythm without looking for and ablating the patient’s still-firing non-PV triggers.

It’s no wonder the patient was back in A-Fib shortly after this ablation.

Again, I was alarmed and troubled by what I read.

Take Away: O. R. Reports

An O.R. report is a blow-by-blow account of your EP’s actions. Indeed, the details in an O. R. report can be quite revealing. In these two cases, alarmingly so.

Read our free report.

Read our free report.

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Read more about O. R. reports in our Special Report How & Why to Read Your Operating Room Report

NEXT TIME, IN PART II: Is Performing CryoBalloon Ablations too Easy?

Is Cryoballoon as Effective and Safe as RF Ablation? A Clinical Study

There have been few randomization trials directly comparing CryoBalloon ablation to RF ablation.

That’s why Dr. Armin Luik and his colleagues developed the FreezeAF clinical trial―to directly compare CryoBalloon ablation to RF ablation for treating patients with paroxysmal atrial fibrillation. Dr. Luik (U. of Freiburg, Karlsruhe, Germany) presented the study results at the May 2015 meeting of the Heart Rhythm Society.

CryoBalloon catheter

CryoBalloon catheter

FREEZEAF Trial: Patients and Method

In the FREEZEAF study, 315 paroxysmal A-Fib patients with a mean age of 60 years were randomized to either a CryoBalloon ablation (n=156) or a RF ablation (n=159) of the pulmonary veins. Clinical follow up was at three, six, nine and 12 months.

The FREEZEAF Study Results

The FreezeAF trial researchers noted that a number of CryoBalloon ablation studies have demonstrated its efficacy and safety for treatment of A-Fib, but few studies have compared the two techniques head-to-head.

How did Cryoballoon compare to RF Ablation? … Continue reading this report…->

After Ten Years, Repeat Ablation by Dr. Kerwin at Cedars-Sinai (CryoBalloon)

Pete & Beth Nyquist his A-Fib story on A-Fib.com

Pete & Beth Nyquist

A longtime A-Fib.com reader, Pete Nyquist, recently wrote us with an update about his A-Fib:

“My first ablation 2006: Thanks to your A-Fib.com website, I found Dr. Walter Kerwin and Cedars-Sinai Medical Center in Los Angeles. He did my Cryo Focal ablation in 2006, and it lasted almost 10 years without a problem.

My second ablation 2015: Recently, (September) I came out from Nashville, TN, to have Dr. Kerwin perform another procedure on me. This time it was the Cryo-Balloon. It took six hours, but Dr. Kerwin feels it was a great success. I was released on September 11, 2015 and since then feel great.

I highly recommend anyone considering having a Cryo-Balloon ablation done, to fly to Los Angeles and have Dr. Kerwin do it at Cedars-Sinai. Don’t just settle for anyone who can do an ablation. (see: All EPs Doing Abaltions Are Not Equal). Dr. Kerwin pioneered the Cryo Balloon and has devoted his entire life to curing A-Fib.

Thanks again for your A-Fib.com website and for leading me to Dr. Kerwin. I welcome emails from A-Fib.com readers.

Regards. Pete Nyquist, Nashville, TN, Ptnyquist(at)sbcglobal.net”

For more patient A-Fib stories, visit our page: Personal A-Fib Stories of Hope for over 80 first-person reports by patients, many of whom are now free from the burden of atrial fibrillation.

Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

Ross-J Hunter

Ross J Hunter

Pulmonary Vein ablation (PVA), using RF point-by-point isolation, or using CryoBalloon technology? It is really a choice of one or the other?

What happens when you combine the two techniques? Do ablation success rates increase?

To answer these questions, UK researcher, Dr. Ross J. Hunter devised a single-center study to compare three different ablation strategies. He divided 237 Paroxysmal A-Fib patients undergoing their first ablation into three treatment groups.

Group 1 Strategy: standard RF point-by-point ablation of the Pulmonary Vein openings (PVs) using an irrigated tip catheter guided by a 3D mapping system.

Group 2 Strategy: CryoBalloon ablation using the Arctic Front CryoBalloon catheter, and if PV isolation wasn’t achieved using the CryoBalloon alone, RF focal lesions were added.

Group 3 Strategy: RF point-by-point ablation followed by two applications of the CryoBalloon.

Success Rates After One Year

Group 1:  At one year 47% were A-Fib free and off of all antiarrhythmic drugs; (This is a relatively low success rate compared to some centers using RF ablation.) Average procedure time was 211 minutes;

Group 2:  The one year success rate was 67% (significantly better than the RF group); Important Note: In addition to the CryoBalloon, 31% needed RF focal lesions to achieve PV isolation. Average procedure time was 167 minutes;

Group 3: After one year the success rate was 76% which was better than the CryoBalloon alone, but the difference wasn’t ‘statistically significant’ (meaning it could have occurred by chance). Average procedure time was 278 minutes.

The Study Results: How the Three Strategies Compare

Best result: Group 2 Strategy:CryoBalloon plus RF lesions as needed strategy’. It was faster, easier to use and was more effective after one year than the Group 1 strategy ‘RF point-by-point ablation’.

Disappointing result: Using the novel Group 3 strategy of combining ‘RF ablation followed by CryoBalloon ablation’ did not significantly improve results and took longer to do.

Most surprising result: When the authors designed this study, they thought the combined approach of ‘RF ablation followed by CryoBalloon’ (Group 3) would turn out to be superior to the other two strategies. Their prediction was wrong. It turned out it was only superior to ‘RF alone’  strategy (Group 1).

The Bottom Line

The take-away: About 30% of CryoBalloon ablations required RF focal lesions to achieve isolation of all A-Fib signals and to restore the patient to normal sinus rhythm.

What This Means for A-Fib Patients

For the best results with a CyroBalloon ablaltion, you want an electrophysiologist (EP) who is not only experienced with CryoBalloon, but who can also use RF technology when needed to map and isolate A-Fib signals originating beyond the pulmonary veins.

Finding the right EP: Be cautious. With the advent of CryoBalloon ablation, some EPs with little or no expertise with RF ablations are now doing CryoBalloon ablations. Why? Because they’re easier to perform. As a patient, you want to stay away from EPs who only do CryoBalloon ablation.

Here’s an example why:

Recently a patient, still in A-Fib, sent me the O.R. (Operating Room) report of their CryoBalloon ablation. From reviewing the report, it appears the EP didn’t make any attempt to map and isolate non-Pulmonary Vein (PV) triggers, and simply shocked the patient to return him to normal sinus rhythm. This may work in some cases. But for this patient the ablation was a failure.

Most experienced EPs who have switched from performing RF ablations to CryoBalloon ablations have the ability, skill and experience when needed to use RF technology to isolate non-PV triggers when needed.

Questions to Ask Prospective EPs: to find the right EP for your CryoBalloon ablation ask:

What do you do if I’m still in A-Fib after you do the CryoBalloon ablation?
Will you use RF techniques to get me back into normal sinus rhythm?

(You want an EP who answers ‘yes’ to the second question.)

References for this article

CryoBalloon Ablation Study: 30% of Patients Required RF to Achieve Isolation

Graphic: CryoBalloon positioned at opening to pulmonary vein

CryoBalloon positioned at opening to pulmonary vein

CryoBalloon ablation is very effective. But for the best results, you want an EP who is not only experienced with CryoBalloon, but also, when needed, can use RF to map and isolate non-PV triggers.

A recent, but limited study of about 75 paroxysmal A-Fib patients undergoing their first CryoBalloon ablation, found about 30% required the additional use of RF focal lesions to achieve isolation (to restore normal sinus rhythm).

When selecting an EP, be cautious. With the advent of CryoBalloon ablation, some EPs with little or no expertise with RF ablations are now doing CryoBalloon ablations because they’re easier. Stay away from EPs who only do CryoBalloon ablation.

Most experienced EPs who have switched from RF to CryoBalloon ablation have the ability, skill and experience to use focal point RF as needed to make you A-Fib free during your CryoBalloon ablation.

Seek out these experienced EPs by asking:

 “What do you do if I’m still in A-Fib after you do the CryoBalloon ablation? Will you use RF focal lesions to achieve isolation?”

To learn more about these research findings see By Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase? Or browse our Index of Articles: Research and Innovations.

References for this article

Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

Research Findings

Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

by Steve S. Ryan, PhD

Ross-J Hunter

Ross-J Hunter

Pulmonary Vein ablation (PVA), using RF point-by-point isolation, or using CryoBalloon technology? It is really a choice of one or the other?

What happens when you combine the two techniques? Do ablation success rates increase?

To answer these questions, UK researcher, Dr. Ross J. Hunter devised a single-center study to compare three different ablation strategies. He divided 237 Paroxysmal A-Fib patients undergoing their first ablation into three treatment groups.

Group 1 Strategy: standard RF point-by-point ablation of the Pulmonary Vein openings (PVs) using an irrigated tip catheter guided by a 3D mapping system.

Group 2 Strategy: CryoBalloon ablation using the Arctic Front CryoBalloon catheter, and if PV isolation wasn’t achieved using the CryoBalloon alone, RF focal lesions were added.

Group 3 Strategy: RF point-by-point ablation followed by two applications of the CryoBalloon.

Success Rates After One Year

Group 1:  At one year 47% were A-Fib free and off of all antiarrhythmic drugs; (This is a relatively low success rate compared to some centers using RF ablation.) Average procedure time was 211 minutes;

Group 2:  The one year success rate was 67% (significantly better than the RF group); Important Note: In addition to the CryoBalloon, 31% needed RF focal lesions to achieve PV isolation. Average procedure time was 167 minutes;

Group 3: After one year the success rate was 76% which was better than the CryoBalloon alone, but the difference wasn’t ‘statistically significant’ (meaning it could have occurred by chance). Average procedure time was 278 minutes.

The Study Results: How the Three Strategies Compare

Best result: Group 2 Strategy:CryoBalloon plus RF lesions as needed strategy’. It was faster, easier to use and was more effective after one year than the Group 1 strategy ‘RF point-by-point ablation’.

Disappointing result: Using the novel Group 3 strategy of combining ‘RF ablation followed by CryoBalloon ablation’ did not significantly improve results and took longer to do.

Most surprising result: When the authors designed this study, they thought the combined approach of ‘RF ablation followed by CryoBalloon’ (Group 3) would turn out to be superior to the other two strategies. Their prediction was wrong. It turned out it was only superior to ‘RF alone’  strategy (Group 1).

The Bottom Line

The take-away: About 30% of CryoBalloon ablations required RF focal lesions to achieve isolation of all A-Fib signals and to restore the patient to normal sinus rhythm.

What This Means for A-Fib Patients

For the best results with a CyroBalloon ablaltion, you want an electrophysiologist (EP) who is not only experiened with CryoBalloon, but who can also use RF technology when needed to map and isolate A-Fib signals originating beyond the pulmonary veins.

Finding the right EP: Be cautious. With the advent of CryoBalloon ablation, some EPs with little or no expertise with RF ablations are now doing CryoBalloon ablations. Why? Because they’re easier to perform. As a patient, you want to stay away from EPs who only do CryoBalloon ablation.

Here’s an example why:

Recently a patient, still in A-Fib, sent me the O.R. (Operating Room) report of their CryoBalloon ablation. From reviewing the report, after ablating the Pulmonary Veins (PV), it appears the EP didn’t make any attempt to map and isolate non-PV triggers. When the patient didn’t return to normal sinus rhythm on his own, the EP simply cardioverted the patient back into normal sinus rhythm. This may work in some cases. But for this patient the ablation was a failure.

Most experienced EPs who have switched from performing RF ablations to CryoBalloon ablations have the ability, skill and experience when needed to use RF technology to isolate non-PV triggers when needed.

Questions to Ask Prospective EPs: to find the right EP for your CryoBalloon ablation ask:

What do you do if I’m still in A-Fib after you do the CryoBalloon ablation?
Will you use RF techniques to get me back into normal sinus rhythm?

(You want an EP who answers ‘yes’ to the second question.)

References for this article

A Must Read, if You Are Considering a CryoBalloon Ablation…

CryoBalloon catheter

CryoBalloon catheter

Question: What happens when you combine CryoBalloon and RF ablation techniques? Do success rates increase?

To find out, UK researcher, Dr. Ross J. Hunter devised a single-center study to compare three different ablation strategies. He divided 237 Paroxysmal A-Fib patients undergoing their first ablation into three treatment groups.

Group 1 Strategy: standard RF point-by-point wide of the Pulmonary Vein openings (PVs) using an irrigated tip catheter guided by a 3D mapping system.

Group 2 Strategy: CryoBalloon ablation using the Arctic Front CryoBalloon catheter, and if PV isolation wasn’t achieved using the CryoBalloon alone, RF focal lesions were added.

Group 3 Strategy: RF point-by-point ablation followed by two applications of the CryoBalloon.

Read my new research report and learn what the findings mean if you are considering a CryoBalloon ablation. See Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

By Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

Research: Combining RF and CryoBalloon Ablation Techniques

Combining RF and CryoBalloon Ablation Techniques

Research Findings

By Combining RF and CryoBalloon Ablation Techniques, Do Success Rates Increase?

RF point-by-point ablation for Pulmonary Vein (PV) isolation is technically challenging, time consuming, and the first-time success rate is variable. CryoBalloon ablation is easier and faster.

Question: What happens when you combine the two techniques? Do success rates increase?

To find out, UK researcher, Dr. Ross J. Hunter devised a single-center study to compare three different ablation strategies. He divided 237 Paroxysmal A-Fib patients undergoing their first ablation into three treatment groups.

Group 1 Strategy: standard RF point-by-point wide of the Pulmonary Vein openings (PVs) using an irrigated tip catheter guided by a 3D mapping system.

Group 2 Strategy: CryoBalloon ablation using the Arctic Front CryoBalloon catheter, and if PV isolation wasn’t achieved using the CryoBalloon alone, RF focal lesions were added.

Group 3 Strategy: RF point-by-point ablation followed by two applications of the CryoBalloon.

Success Rates After One Year

Group 1:  At one year 47% were A-Fib free and off of all antiarrhythmic drugs; (This is a relatively low success rate compared to some centers using RF ablation.) Average procedure time was 211 minutes;

Group 2:  The one year success rate was 67% (significantly better than the RF group); Important Note: In addition to the CryoBalloon, 31% needed RF focal lesions to achieve PV isolation; Average procedure time was 167 minutes;

Group 3: After one year the success rate was 76% which was better than the CryoBalloon alone, but the difference wasn’t ‘statistically significant’ (meaning it could have occurred by chance); Average procedure time was 278 minutes.

How the Strategies Compare

In this single center study, the CryoBalloon plus RF lesions as needed strategy (Group 2) was faster, easier to use and was more effective after one year than RF point-by-point ablation approach (Group 1). Using the novel strategy of combining RF followed by CryoBalloon ablation (Group 3) did not significantly improve results and took longer to do.

Editor’s Comments:
When the authors designed this study, they thought the combined approach of RF followed by CryoBalloon (Group 3) would turn out to be superior to either RF alone or CryoBalloon with RF as needed. But the combined RF followed by CryoBalloon strategy was only superior to RF alone (Group 1).
Key Result for Patients: The most important finding of this study is that about 30% of CryoBalloon ablations required RF focal lesions to achieve isolation (and restore normal sinus rhythm).
CryoBalloon ablation is very effective. But for the best results, you want an EP who is not only experienced with CryoBalloon, but also, when needed, can use RF to map and isolate non-PV triggers.
Be cautious. With the advent of CryoBalloon ablation, some EPs with little or no expertise with RF ablations are now doing CryoBalloon ablations because they’re easier. Stay away from EPs who only do CryoBalloon ablation.
For example, recently a patient, still in A-Fib, sent me the O.R. (Operating Room) report of their CryoBalloon ablation. From reviewing the report, it appears the EP didn’t to make any attempt to map and isolate non-PV triggers, and simply shocked the patient to return him to normal sinus rhythm. This may work in some cases. But for this patient the ablation was a failure.
Most experienced EPs who have switched from RF to CryoBalloon ablation have the ability, skill and experience to use focal point RF as needed to make you A-Fib free.
Seek out these experienced EPs by asking “What do you do if I’m still in A-Fib after you do the CryoBalloon ablation? Will you use RF focal lesions to achieve isolation?”
References for this article

We Answer Loads of Your Questions about Catheter Ablations

Catheter inserted into the heart and through septum wall into Left Atria

Catheter inserted into the heart and through septum wall into Left Atria

At A-Fib.com, we have answered thousands of patient questions—perhaps the same questions you have right now.

In FAQs about Living with A-Fib, we discuss Catheter Ablation, Pulmonary Vein Isolation/Ablation and CryoBalloon Ablation. We provide answers to the most frequently asked questions by patients and their families.

Some of the questions we answer: Are there different types of Pulmonary Vein Ablation?, I’m 82 years old, am I too old to have a successful Pulmonary Vein Ablation?, Will an ablation take care of both A-Fib and Flutter? and During an ablation, how much danger is there of developing a clot?

We also answer questions about Chronic A-Fib, exercising after a PVA, length of catheter procedure and RF energy vs. Cryo freezing.

We invite you to browse through the lists of questions. Then, just ‘click’ to read the answer. Go to -> FAQs about Catheter Ablation, Pulmonary Vein Isolation/Ablation, CyroBalloon Ablation

 

Joe Mirretti A-Fib Story

A-Fib Patient Story #81

Joe Mirretti, Gurnee, IL

Joe Mirretti, Gurnee, IL

Two Months After A-Fib Diagnosis, 62-Year Old Cyclist Has CyroBalloon Ablation; Difficult Three-Month Blanking Period

By Joe Mirretti, Gurnee, IL, May 2015

I just turned 62 and have been an active cyclist all my life. I also run and lift weights. My resting heart rate is 47.

December 2014: First A-Fib Attack

On December 11, I got on the stationary bike, and my pulse was 100 without doing anything. When I started pedaling, it went up to 140. I thought something was wrong with my heart rate monitor. When I drove home, my heart rate was all over the place.

My wife, Wendi, took me to the Emergency Room (ER). One nurse came in and thought I had gone back into sinus rhythm since my pulse was in the 70s, but that was double my normal heart rate. When I stood up, the ER staff became more alarmed—my pulse jumped up to 170-180. They confirmed that I had Atrial Fibrillation (A-Fib).

Electrocardioversions Don’t Last, Drugs Have Bad Side Effects

The A-Fib felt terrible. I was out of breath, had palpitations, I couldn’t exercise, my heart was thumping in my chest.

The A-Fib felt terrible. I was out of breath, had palpitations, I couldn’t exercise, my heart was thumping in my chest….Even with drugs, the A-Fib would wake me up in the middle of the night.

They Electrocardioverted me December 12, 2014. That worked for about a week. But December 17 while lying in bed I sneezed and went right back into A-Fib. I had another Electrocardioversion December 19 which this time only lasted 4-5 days.

For a while I was on Diltiazem 160 mg/d and later flecainide 150 mg/2Xday. They also put me on the blood thinner Eliquis. But I had terrible side effects from these drugs, such as vertigo. When I’d take flecainide, hours after dinner my pulse would even out before going to sleep. But 3-4 hours later the A-Fib would wake me up in the middle of the night.

In early January I had a chiropractic adjustment to my back which seemed to put me back into sinus rhythm for 12 days.

With Active Life Style, Learns About Catheter Ablation

Because of my active life style, my cardiologist at Northwestern in Lake Forest (North of Chicago), Dr. Ian D. Cohen, thought I would probably need a catheter ablation.

He helped me schedule an appointment on January 9 with Dr. Albert C. Lin of the Northwestern Un. Feinberg School of Medicine/Bluhm Cardiovascular Institute which has a branch in Lake Forest. I was very impressed by Dr. Lin. He was very interested in hearing everything we had to say and was confident. I asked him if the chiropractic adjustment was responsible for getting me back into Sinus. He couldn’t say for sure, but he predicted I’d go back into A-Fib. Needless to say, he was right.

Extremely Symptomatic, Decides “I Can’t Live in A-Fib”

My wife, Wendi, and I both agreed that I should have a CryoBalloon ablation as soon as possible. I was so symptomatic I couldn’t live in A-Fib, the drugs caused me terrible side effects, and the cardioversions didn’t work.

I had read that the faster you correct or get A-Fib cured, the better.

I had read that the faster you correct or get A-Fib cured, the better you are. And we liked Dr. Lin. He was very encouraging, but wasn’t telling us we need to do this. He said, “Don’t make a decision now. Go home and discuss it.”

We decided to go with the ablation. Dr. Lin was able to schedule us for a CryoBalloon ablation February 12, 2015.

A-Fib Research Online: Encouraged By Stories on A-Fib.com

I Googled everything on A-Fib as much as I could. The stories and information you gave on A-Fib.com really helped me move forward.

I just think it’s so wonderful they are developing these ablations so quickly and improving them. I read your story how back in 1998 you were in the hospital for nearly two weeks when you had your ablation. (See Steve Ryan’s A-Fib story.) I was only in the hospital overnight.

I’ve always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.

I don’t understand how some people don’t feel anything when in A-Fib. I always wore a heart rate monitor when I worked out. I’ve been keeping records of my workouts daily going back 25 years. I noticed a couple of years ago I may have had some brief episodes of A-Fib, but they corrected themselves. However, I didn’t know anything about A-Fib at that time.

I’ve always had skipped heart beats. The doctors have seen it on my EKGs and stress tests but were never concerned about it.

February 2015: My CryoBalloon Ablation Day Arrives

I remember counting the days until the scheduled ablation. That’s how bad the A-Fib symptoms were, and they were getting worse. I had an MRI on February 10, 2015 at Northwestern in Chicago.

The morning of February 12, ablation day, we got up at 4:00 am since I was the first patient of the day. My wife, Wendi, did a great job getting me there, as she does not like to drive in the city, and rush hour in Chicago is crazy. (I had not driven in three weeks because of the vertigo.)

The ablation took about four hours. I woke up in perfect sinus rhythm! Dr. Lin said he CryoAblated all four pulmonary veins, and that everything went as well as possible. He sent me home the next morning on no meds except Eliquis.

Difficult Recovery—Dealing With Weird Sensations and Worry

The recovery was difficult. The next day, out of the hospital I felt pretty rough, like I had been hit by a truck. I had no A-Fib the first 8 days, just occasional rapid heartbeats.

I was encouraged to exercise. The eighth day I got on the stationary bike for an hour. Later I had a short A-Fib attack. Dr. Lin put me back on a ½ dose of flecainide for a while.

Like everyone has said in their stories, A-Fib does such a job on your head. Every time you feel something, it scares you like you’re going back into A-Fib.

That’s been a mental battle. That’s why reading those stories helps, what other people went through those first three months. You’re going to get a number of strange things happening to you during the 3-month blanking period after an ablation. Mine have been very short.

Dr. Lin and his office were terrific during this time. I could call any time, and his assistant or Dr. Lin would call me right back.

I’m not having any A-Fib, my skipped beats and palpitations are getting shorter and shorter.

He said that my heart was otherwise very healthy. Dr. Lin said that clinically everything that has happened to me is very good, I’m not having any A-Fib, my skipped beats and palpitations are getting shorter and shorter. He thought I had around an 80% chance of success, and 90% if I had to go back for a second ablation. He said that my heart was otherwise very healthy.

But it’s a mental battle. What I’ve read is your heart is trying to go back into A-Fib and the beat is now blocked. Your heart is adjusting and getting used to beating normally again.

On and Off Meds During 3–Month Blanking Period

The day I left the hospital Dr. Lin took me off of all meds except Eliquis. But after I got the short bout of A-Fib, he put me back on ½ dose of flecainide, 75 mg 2X/d for one month. Then he put me on a little bit of metoprolol 25 mg because Diltiazem caused me such bad side effects. He said he did that because there is a possibility that the flecainide in rare cases could cause rapid heartbeat.

About a month after my ablation, he took me off of flecainide. Since then I’ve only been on 25 mg of metoprolol and Eliquis. I have given up my morning expresso and only have one glass of wine with dinner.

Lessons Learned: Three Months Post-Ablation 

I am very pleased I went ahead with the ablation. I’ve passed my 3 month blanking period (I was 30 days on a Holter monitor) with no A-Fib. I’m biking for an hour 3 days a week. I hope to encourage others with A-Fib to seek help. There are solutions out there.

If you have A-Fib, I would definitely explore ablation options as soon as possible for many reasons (i.e., avoid side-effects or reactions to meds, increase your chance of success with just one procedure, reduced anxiety and stress, etc.).

It’s helpful to read stories of other A-Fib patients. (Go to A-Fib.com/Personal A-Fib Stories of Hope.) It helps to hear what other people are going through.

After ablation, don’t push too soon. I advice you to get back to exercise slowly to give your heart a chance to heal.

In writing my story, I hope to encourage others with A-Fib to seek help. There are solutions out there. I was very healthy to begin with which probably helped the odds of the ablation being successful.

Point of Interest: Just 8 days after my ablation, my 34-year-old son, Dominic, went into A-Fib! He called me at 10:00 at night. I couldn’t believe it. Happily he’s been in sinus rhythm since they cardioverted him. [Joe and Wendi have five children and six grandchildren.]

Joe Mirretti
Email: mirritaly(at)aol.com

Editor’s Comments:
Ablation as First Choice Treatment: From the date Joe had his first A-Fib attack to his CryoBalloon ablation was barely two months!
I want to commend Dr. Ian D. Cohen, Joe’s cardiologist at Northwestern in Lake Forest. He understood that A-Fib patients don’t have to suffer through months or years while trying different drugs. Current guidelines allow you to get an ablation right away. Based on Joe’s active lifestyle he referred Joe for an ablation. 
More doctors today understand how A-Fib drugs are often ineffective and have intolerable side effects, and how terrible it can be to live in symptomatic A-Fib.
You can have a catheter ablation right away if you want. A catheter ablation is a low risk procedure (it isn’t surgery—there’s no cutting involved). It’s one of the safest cardiac procedures you can have.
Coping with the Blanking Period: We’re grateful to Joe for calling our attention particularly to the mental aspects of dealing with the blanking period after an ablation. We certainly need to develop more help and instruction so that patients can cope better during this time.
The Genetics of A-Fib: Joe’s son developed A-Fib, too. Although the exact incidence of the familial form of atrial fibrillation is unknown, recent studies suggest that up to 30 percent of people with atrial fibrillation may have a relative with the condition.
If you have a family member who has A-Fib, your chances of developing A-Fib are much greater than the average person’s. You need to be more attentive and you ought to see an Electrophysiologist (EP) to get tested for silent A-Fib. (Some people say that all A-Fib is genetic. But we don’t have the research and studies to confirm this hypothesis.)
Patrick T. Ellinor, MD, Mass. General

Genetics research with Patrick T. Ellinor, MD

Join the Genetics Research Studies Underway: Several A-Fib research centers around the US are doing ground-breaking research on genetic A-Fib. If you have 3 or 4 family members with A-Fib, you can join these studies at no cost (except travel). You and your family would be involved in cutting-edge research that is changing the way we identify and treat A-Fib. For further info, contact Dr. Patrick Ellinor at Mass General:
Dr. Patrick T. Ellinor, MD, PhD Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit St., GRB 109, Boston, MA 02114. 617-726-5067 Fax: 617-726-2155 E-mail: pellinor(at)partners.org

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