I apologize for being so quiet lately. I haven’t published anything personally since March when I celebrated four years of afib-freedom! The truth is, my heart (and overall health) couldn’t be any better so I haven’t had anything to report.
Although I will tell you I’ve been extremely busy responding to emails. I get about an email a day from people battling afib that want my advice or simply just want someone to talk to. Because I respond to every single email I receive, it takes up the bulk of my spare time these days so I haven’t had time to post much on this blog.
I had my annual checkup with my local EP on Wednesday, March 23rd so I thought I would take a break from my emails and post an update. Even though I haven’t had a minute of afib since my ablation back in March 2015, I still do an annual check up for a couple reasons.
One, I want the reassurance and peace of mind that my heart is indeed as healthy as I feel. Second, I want to stay “in the system,” which I’ll explain what I mean by that in a minute.
Getting Reassurance & Peace of Mind
I get the reassurance and peace of mind I need by “demanding” an echo every year during my annual checkups with my local EP. My echo results this year were perfectly normal. There weren’t any changes in my heart and I still have a very healthy 60% ejection fraction.
For those of you that might not be familiar with what ejection fraction is, it compares the amount of blood in the heart to the amount of blood pumped out during each contraction. The “fraction,” or percentage, helps describe how well the heart is pumping blood to the body.
Normal ejection fraction is anywhere from 50-70% so at 60% ejection fraction I’m right in the middle of normal.
While it was great to hear my heart was structurally sound, it was equally exciting that they didn’t record a single PVC or PAC when they did the ECG. Normally when I have these annual checkups, they see one or two benign PVCs or PACs. When I had my 2016 checkup they recorded reams of PVCs and PACs during my ECG. This time around it was nothing but solid normal sinus rhythm! This was the first annual checkup since my ablation where they didn’t detect a single PVC or PAC!
Here were my other pertinent vitals at this visit:
Blood Pressure: 108/76 (I have always had low blood pressure numbers so this is normal for me)
Weight:177 lbs. (I’m not happy about this because I’ve gained seven pounds since the beginning of the year)
Heart Rate: 49 bpm
Oxygen Saturation: 99%
As my EP told me, I’m as healthy as can be. It was a great appointment.
“Staying in the System”
You may be wondering why I continue to have annual checkups with my local EP when I haven’t had any afib or heart issues since 2015. As I mentioned previously, I do it for peace of mind, but I also do it to stay “in the system.”
I pray that I won’t have any heart issues for years to come but I always like to prepare for the worst. To that end, I think it’s important to stay in front of my doctor and touch bases with him once year. That way if something does come up, I can call him and hopefully he’ll remember who I am and can get me in quickly.
I believe, or I hope anyway, that I’ll get better care if my doctor knows who I am as opposed to being a patient he hasn’t seen or talked to in years. I essentially want to keep a direct pipeline to my doctor open for the foreseeable future “just in case.”
To that end, it kind of makes me nervous that I haven’t seen or talked to the doctor that did my ablation since 2015. I live in Minnesota and he practices down in Austin, TX so it’s not practical for me to have an annual visit with him especially since I’m doing so well. It would be a waste of time and money for both of us to meet. Still, though, I worry about not being able to get an ablation scheduled quickly in the event afib returns and I need a second one. I guess I’ll cross that bridge when I get there – IF I get there (I’m praying I never do).
Other Tid Bits of Information
I have a very comfortable and open relationship with my EP. I can talk to him about anything and he’ll sincerely listen and give me as much time as I need. Usually what I do during these checkups is ask him a variety of general questions as it pertains to atrial fibrillation and ablations.
One of the requests I ask for every year during these checkups is a prescription to flecainide and metoprolol. Again, I’m always preparing for the worst. I pray that I’ll never need these drugs, but I ask for them as insurance in case afib returns.
I couldn’t remember, however, what the protocol was for taking these drugs if afib returns so I asked him. He said I should take 300mg of flecainide at the onset of an episode and wait 30 minutes or so. If my heart rate is so high that it’s unbearable, then I could take 25mg of metoprolol to help slow down the rate. He said I should wait another 30 minutes or so and see how I feel. If I’m still miserable, then I can take another 25mg of metoprolol.
He said I could safely take up to 100mg of metoprolol if necessary, but he cautioned that if I convert to normal sinus rhythm fairly quickly, say in 6-10 hours, I would likely be very tired and lethargic because of all the metoprolol in my system.
The half-life of metoprolol is around 3-4 hours so if I took 100mg of metoprolol within a couple hours of an episode, I would still have at least 50mg of it in my system if I converted to normal sinus rhythm within 6-8 hours. I suspect I would indeed be very tired, if not knocked on my butt, with that much metoprolol in my system if my heart rate was back to my usual 50 beats per minute!
My game plan is to avoid the metoprolol all together but if the episode is too unbearable, then I’ll probably just stick to 25mg of metoprolol and see how it goes. Again, I hope I don’t have to put any of this to the test anytime soon!
WARNING: The protocol my doctor outlined for me is MY protocol. Don’t copy it without talking to your doctor about your own health situation. I can’t stress this enough as we are all in different situations. I only share the specific details of my protocol to give you some things to talk to your doctor about if you’re interested. This specific protocol is called the “pill in the pocket” protocol.
The other topic my doctor brought up was atrial flutter. This came up as we were discussing my game plan if afib returns. He told me if afib returns there is a chance it won’t be afib at all. He said I may actually experience atrial flutter.
Atrial flutter is very similar to atrial fibrillation with the main difference being the regularity of the irregular heartbeat. With atrial fibrillation, your heartbeat is often all over the place. It can fluctuate between an abnormally low heart rate to an abnormally high heart rate repeatedly. Think of a roller coaster of ups (very high heart rate) and downs (normal heart rate or abnormally low heart rate). That’s afib. Your heart rate is all over the place. Your heart rate can be at 60 bpm one minute and then 170 bpm the next minute.
Atrial flutter, on the other hand, doesn’t have those ups and downs. Instead, it’s a car with the cruise control set to 150+ mph. When you’re in atrial flutter your heart just takes off and doesn’t go up or down. The heart rate just stays elevated – usually around 150 – 170 bpm.
For more information on atrial flutter vs. atrial fibrillation, please read this article on MedicineNet.com.
Let me try to explain why people who have had successful ablations often experience atrial flutter rather than afib when they have an episode. This explanation is based solely on my memory of the conversation and I admittedly didn’t understand it completely so any doctors reading this will have to forgive me for any inaccuracies.
When you have an ablation, scars are left around the pulmonary veins and other trigger sources in the heart. These scars block the errant electrical signals from wreaking havoc on the heart. Over time, these scars change and even heal. This part I know is true and I fully understand.
He had a great analogy. He said if you have a scar from anything – be it a surgery, injury, burn, etc. – it changes over time. Sometimes, the scar will almost completely disappear. Scars on the heart from an ablation are no different. They change over time and sometimes heal.
As the scars change or heal, an errant signal may break through and wreak havoc, but because the break through is isolated to one spot, it results in atrial flutter and not afib. He described the errant signal as circling around the atria in a regular but faster than normal rate, thus atrial flutter. This part of his explanation and illustration (he was actually drawing this on a sheet of paper) was a bit fuzzy, but I think you get the general point.
The main takeaway was that if I experience an episode in the future, I may just as likely experience atrial flutter as I may experience atrial fibrillation. I can’t just assume it’s afib. It could be atrial flutter.
Again, I hope I never have to find out one way or another but it’s good to know. I never even considered experiencing atrial flutter until this conversation so it was enlightening.
That was the gist of my conversation with my EP. Like I said, there just wasn’t much to talk about this time around.
After Visit Summary
My appointment with my doctor this year was very brief given that I didn’t have any issues and I didn’t have a lot of questions. My appointment only lasted about 30 minutes.
My doctor congratulated me on my great heart health and told me to keep doing what I’m doing and that “we’ll do this again next year.” That’s my game plan – to keep doing what I’m doing, which is nothing special by the way, and I’ll see him again next year!
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Thanks so much for this info. I’ve had Paroxysmal AFIB for most of my life now and I’ve been successfully cardioverted twice, medication doesn’t lower my heart rate at all so they go straight to the cardioversion option.
Praying for no more cardioversions as my last was in 2017. I am getting bariatric surgery this year to help with my weight issue.
Was your AFIB constant? If not, how’d you deal with your flares?
Should I get an echo each year as well? In my last echo, it showed one half of my atrium was enlarged which scares me.
My afib was not constant. I had paroxysmal afib. Fortunately, my episodes rarely lasted more than 6-8 hours. I dealt with my episodes with the pill-in-the-pocket approach. When I’d have an episode, I would take my flecainide. It would convert me to NSR fairly quickly. Like you, I used to handle my episodes with cardioversions but the flecainide was a game changer as I didn’t have to go to the hospital anymore! You might want to talk to your doctor about it. They’ll know what pill-in-the-pocket is.
Good luck with your surgery and I hope you don’t have any afib episodes moving forward!!
Travis, I was diagnosed with Afib a few years ago. I was then a 68 yr old healthy male, worked out regularly and was fit. After medication did not work I agreed to an ablation. I got the Afib ablation 4 yrs ago and was fine for 3 yrs when I got symptom of Aflutter. At first medication (flecainide and metoprolol) worked and I was fine but after 6 mos the medication stopped working. We tried a cardioversion which worked but only for 30 days. Next week I have the Aflutter ablation. I am told it is an easier procedure than the Afib and has a higher rate of success. Living with Aflutter is more difficult than Afib, in my opinion, because you have to be careful with active exercise. But I am hopeful the procedure is successful and I can have a period of normalcy for a while. But this is definitely a journey and not a single event!
My heart is in flutter for the last four days at 125 to 130 bpm I have tried the tips on your web page to convert I am out of options I can not afford a er trip I was there less then 2weeks ago when do you know when to go to the er I live in Round Rock tx I don’t care for my doctors they are no help just want to push pills or scary expensive medical procedures I need help
I live in the Austin area and having trouble with what I think is AFib. When my heart goes into it, I can’t get a blood pressure, just errors. I have a new machine that shows when you have an arrhythmia. I went to the Er once but by the time I got there, it had converted . They keep me several hours hooked up before letting me go. Would you please tell me which Rhythm doctor you see here in Austin. I am 81, not over weight, do lots of yard work and had a stress test after that ER visit and they said was normal but still having problems. I had Graves Disease when I was 30 and my heart hate is always fast. Normally I have low BP and take a 1/2 of Atenolol 25 mg in the morning. I would take more but I also have Glaucoma and they don’t want my BP to get really low at night. I usually have the AFib spells in late day or about 10pm at night. I know I need a good rhythm doctor, the Cardiologist I go too, not too happy with. I am going to change doctors and hoping I could go to the one you liked. Thanks for any advise.
I apologize for chiming in, Travis, I know this question is for you, but I can’t help but recommend Dr. Jason Zagrodzky out of Austin, with Texas Cardiac Arrhythmia. He has several satellite locations as well, I see him in Waco, which we live near.
That is good to know as I live in Leander and most doctors I see are in Round Rock or Cedar Park at their satellite offices. Very hard for me to get down town Austin to their main offices. I will look him up. Thank you. I knew there was a arrhythmia clinic with several doctors but love to have recommendations. Thanks again
You are very welcome! I’ve been a patient of Dr. Zagrodzky’s for over 15 years now, and I’d give him a 10 star rating if I could!
Post Oak Center South (Drs. Bailey, Canby & Zagrodzky)
4316 James Casey, Bldg. C, Suite 201
Austin, TX 78745
Phone (512) 381 0170 (office)
Phone (512) 512-807-3150 (appointments)
Fax (512) 381-0171
Although this says South, the map shows it to be around 30 minutes from Leander, and you can take 183 and 360/290 to it without having to travel I35.
Best of luck to you, Bettye, and my apologies to Travis, once again, I hope it was OK to post this info.
Congrats, we communicated via email before and after my ablation in Jan. 2019, I experienced palpitations for 66 days after ablation, now I have been afib-free for 8 months, I am feel great. I had bother atrial flutter and afib, the doctor just did me for both.
Wish you good luck and you have good good chance afib never comes back.
Congrats on your excellent results in your follow-up visit. My experience with pip with fleck and beta blocker is that when I feel the afib will start I take immediately 2,5 mg of bisoprolol some times 5 mg then after 10 minutes if the afib continues I take only 100mg of fleckanide.
After 3 to 5 hours my afib converts to normal rhythm.
In the last months my afib episodes began to be more frequent hence I am thinking of pv ablation. I am not in USA so I am thinking to do it in Bordeaux France. Do you have any information about their requirements and if there is better options in Europe?
Best wishes for all.
Bordeaux is one of the best afib centers in the world. They pioneered the ablation. If I was in Europe, they would be the only center I would go to – period.
I wish you the best!
Hi Travis! My name is Flavio and just emailed you! Thanks a lot!
Hello Travis, I am glad you are doing well. You always help me to keep my mind clear when I am stress and thanks to you I am more positive than the last year after my ablation.
I am not worry about you for the next years, I wish you all the best!
Thanks! I’m glad I was able to help you. You know where to find me if you ever need me. God Bless!
Thanks for the update. I am experiencing Afib episodes about one every six weeks now. I am seriously considering ablation this coming year, so it’s good to get your feedback on your results.
Sorry to hear you’re still battling afib. When you’re ready for an ablation be sure to contact me. I’ll do what I can to help you through the process.
Travis, I am so happy you are doing well. Yours was the first website I found after my afib diagnosis and has been very helpful. May you continue to have good health.
Thanks Cantrell. I’m glad you found this website helpful!
Thanks for sharing
Happy you are doing well…..what’s missing from most comments, is the AGE of the person. I am 78, female, overweight, and have persistent AFIB for last 2 years, with minimum episodes (that I am not aware if I am having any, except for breathlessness), but being 50 lbs. overweight, anyone my age and weight would be breathless carrying groceries into the house….Anyway, my thing is to MANAGE my AFIB, dieting (really trying), chiropractor and acupuncture, and doing TM every day (Transcendental Meditation), all with good studies. I can actually go into a “zone/trance” with meditating (lucky me), plus I’m on blood thinner (Eliquis), and a few other things, beta blocker. I watch Dr. Sanja Gupta (UK) on YOUTUBE a lot and his reasons to have or have NOT ablation (which is why I don’t want one unless an emergency. I would not like to be the patient who has to have multiple ablations at my age.
You are to be commended for all the hard work you’re putting in trying to manage your afib. I wish you the best in your weight loss efforts as well.
I read this blog before my ablation and it gave me comfort. I had it done at the beginning of March and had three days in May where it started up again. The surgeon told me not to worry as it was too early and since that day I have never had another incident. I am going on Thursday for my final sign off. They like to get rid of you in the UK I think.
None of the previous triggers, alcohol, stress or caffeine have any effect on my seemingly but I am keeping my fingers crossed it will remain like that.
Congrats on your ablation! I wish you many years of NSR!
That is wonderful news, thank you so much for the update! May that continue for all your years! I, too, currently see an EP from Austin, TX, have since 2004, and I don’t know what I’d do if I had to switch! He comes to one of his satellite offices in Waco, TX, so we kind of meet 1/2 way. I am now only seeing him once per year so I’ve had to “wean” myself from the every 6 months visit. My last appointment went very well, for that I am thankful!
Glad to hear you have a doctor you like and trust – and glad to hear your last appointment went well!
Hey there Travis!
I am so happy to hear that you are still Afib free. On November 21, 2019, it will be 2 years since my ablation and I have been AFib free as well. I see my EP for my annual in January. I agree with you about keeping that annual visit so that they remember who you are! I am still on Metoprolol only 25 mg 1 x day and Eliquis 2x day. Hopefully, I can get off the Metoprolol in January. I had a stroke in December 2016, so I am sure I will remain on Eliquis. I actually feel more secure on iit and have no side effects. I wish you continued good health!
Mary Ann just curious, did you have the stroke while on Eliquis?
Hey there, No they started me on the Eliquis after the stroke. Prior to the stroke, I was taking an aspirin each day.
Congrats on your ablation! I hope you’re able to get off the metoprolol. I wish you the best!
I was 3 yrs afib free after a 6 hour ablation. I had tried sotalol loading with 3 day hospital stay at 2 different doses but it didn’t work for me. I had the 6 hour ablation. I had flutter on the right and afib on left.
I had just had a great EKG on a Wed and went to dermatologist on Thursday and had several pre cancers frozen with liquid nitrogen .. 3 on my head and 1 on face and 1 on arm. It got in my mouth.
I woke up Fri am at 530a and heart racing. I went to hospital and pulse 150. I was admitted and given IV of cardiozem and they determined flutter.
I started 500 mcg of Tikyson which I had never heard of and then QT lengths between beats a little too slow and reduced to 250mcg twice a day.
My EP doctor said may have to have a tune up down the road. I had a loop recorder under skin so I would not have to take Xarelto which I don’t like. The 3 year battery life up and will possibly be getting a replacement.
Ablations do work. I am thankful for mine. Your article made sense as my event was flutter after 3 years ablation.
I hope everyone stays well !!
I hope you don’t need a tune up ablation but if you do it wouldn’t be the end of the world. The success rates after two ablations are very high. Furthermore, the touch up/tune up ablation is almost always much quicker and simpler than the first one. I wish you the best!
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