Ablation Report: PFA for PVI (AFib) and RF (AFlutter)
Reporting back after having my ablation early this week (around 5 days ago). I posted here before a few times and really benefitted from the discussions - sharing my experience in case it helps anyone.
For reference I am based in the US (CA) and in my mid 40s.
Skip to "The Ablation" section if you just want the main event :)
# My AFib History
Since 2018-ish I have had palpitations (mostly PACs) that tended to happen after meals, when I was leaning back seating or lying down, and often at night. During COVID I had a couple of stressful personal + work situations which led a to a full night of a lot of palpitations (Apple Watch ECG said inconclusive - in hindsight it was probably my first AFib episode)
I talked with my doctor and they told me to get a holter monitor (24-hours), which only picked up PACs. I have had high blood pressure for a while so they attributed it to my blood pressure.
Fast forward to 2 years ago, I woke up sweating and saw a couple of low heart rate notifications on my Apple Watch. I managed to catch some recordings via ECG and it looked like a lot of PACs, almost in tri or bigeminy. Same week I got a couple of AFib notifications from the watch.
Went to my doctor (better one than the last) and they immediately got a Zio patch on me (ECG that sticks to the chest for 7 or 14 days). Patch came back with me being in AFib at night or early mornings, up to 10 minutes some times but usually 1 or 2 minutes. Also picked up that I had more PACs (around 5x the last one 2 years ago)
TBH it was pretty crushing at the time knowing I had AFib and this forum as we well as random YouTube videos, the AFib cure book and later on doing deep research into academic articles with GPT helped a lot - I am the type of person that is OK not having control but I need to know what I will be getting myself into longer term.
Over the past couple of years I went from several minutes a day to 1% burden to most recent Zio patch showing 2% burden over 10 days. My Apple Watch have shown as much as 7% burden on some weeks with the per-day max being 11%.
During this time - I tried
- Exercise
- Clean diet, changing when I eat (tried fasting, not fasting, early dinner etc)
- Coffee changes - different amounts, when I have them
- Supplements - Electrolytes, NMN and a bunch of other ones
- Name it, I have probably tried it
I was expecting the above to help with the triggers (I would get into AFib less often) but not reverse the AFib-able substrate in my heart. AFib begets AFib as they say - I mainly expected some slow down to the progression as I wanted to hold out for a while before getting an ablation (more experience with PFA in the US, getting some stability with my life etc)
So far my AFib episodes all stop on their own, helped especially by changes in posture and doing exercise (getting my heart rate up). AFAIK this is pretty common with Vagal AFib after searching a bit online. Longest episode I have had lasted around 4 hours and I had an 1-hour one on a flight (that was fun lol).
# Why Ablation?
In the end, my AFib burden got high enough that I would have to go on blood thinners to be safe given my risk profile. I checked with a few EPs and they mostly said that was the case but whether I should get an ablation given the risks (quotes were 0.5% to 1% severe complication risk usually) was ultimately up to me.
I wasn't expecting going from 1% last year to 2% burden on average to be that different but for me my AFib usually starts with long runs of PACs and this usually happened at night or in the morning just before work. At 2% AFib burden I was basically in AFib multiple times a week and it regularly affected my sleep or my work.
Decided to get it done a couple of months ago as I wanted to stop the progression now and also it is at the point where it's really affecting my life. I find myself worrying about a bunch of things ahead of time - "Will I be lying back if I go watch a movie?", "Will I sleep OK before an important work trip?", "What if I get AFib that doesn't stop on its own during an overseas trip?". Enough is enough I thought.
# The Ablation
I showed up at the hospital in the morning. I went to a high volume center so there were multiple people in the Catheter (Cath) Lab before me. Nurses got me prepped which took about 30 minutes then I waited for an hour or so.
I have deep veins so the IV was probably the worst part of the prep process as the nurse was a bit inexperienced but not the worst amongst many missed jabs I have taken at various annual physical blood draws. Overall the prep was pretty straightforward but my BP was very high so I think I was tense but trying to not show it in front of the nurses and my wife who was there during the initial process and just before I was wheeled into the Cath Lab. For reference other than hooking me up to an IV I also had no food or drink since 12am (I sometimes skip breakfast so not too bad - TBH I was too nervous to be hungry anyway) and they shaved around my right and left groin for the catheter insertion site.
As one of my palpitations and AFib triggers was lying down I did started getting runs of PACs which was the actual worst part of the prep. The nurse all looked at my vitals and seemed unbothered - I assume everyone comes in with high BP and palpitations; I overheard that someone in another room was already in AFib.
# Post Ablation
I don't remember the ablation other than being wheeled in, saying hi to my EP, anesthesiologist and some other staff then waking up in the recovery area. First time I have been under general anesthesia and I spent the first minutes of waking up trying to remember but I couldn't remember anything.
I started feeling some discomfort in my throat - which was the worst part of the initial recovery as I didn't really feel much pain in my catheter insertion site (right groin). I had a breathing tube and TEE (chest echo for blood clots done via the throat) before my ablation started - the nurse explained that some people have a slightly rougher time with this and I was probably one of them.
I was told to be careful with exerting too much force when coughing as the catheter puncture sites are sealed and they are the main things that can go wrong initially to delay being released from the hospital so I was trying to decide whether to cough or not while having the itchiest throat ever.
I stayed overnight at the hospital - I went with this option ahead of time as I knew that my start time was later in the AM and my procedure will be a bit longer if they had to ablate A Flutter as well.
During my stay the most annoying thing was my throat (took a couple of days for the itchiness to go away - cough drops helped a lot) and making sure that I don't accidentally open up the catheter puncture sites (3 small holes on my right groin). I apparently coughed too much again which caused some minor bleeding but it wasn’t painful at all.
After the ablation I also restarted blood thinners (Eliquis). I started on Eliquis a week before the procedure to see if I can tolerate it and I will be on it for 3 months until my EP follow up. This makes the bruising on my arm from the IV and a arterial monitoring line (which was used during the procedure to monitor blood pressure) as well as the bruising on my groin look pretty bad visually - but there wasn't much pain.
Again, for the first day or 2 I mainly felt really annoyed by an itchy throat and a this feeling of chest fullness when I breath deeply - apparently that's from the inflammation from the ablation.
After staying overnight my EP called to let me know that everything went great. They found AFib and Aflutter, ablated both, tried to trigger and didn't see anything. They also noticed a lot of PACs from the PVI area so told me that I might also feel fewer palpitations especially after the recovery (blanking) period.
As I was talking with the EP I kind of nearly teared up as I realized that I have been lying in bed for multiple hours, on my back, and I don't recall having any runs of palpitations or AFib, or even a single palpitation. I felt the sinking feeling that could have been a palpitation but when I checked I just ended up burping or feeling some other thing with my heart beats being regular.
It’s weird to have a quieter heart - might need some time to get used to this.
I got discharged the next day around noon, went home. Going up a flight of stairs was the first time I felt some pain in my right groin). They delayed the discharge a bit as my initial resting heart rate and BP were high - I assume it was the combination of being stressed and also the ablation itself.
It's now 5 days after my ablation and I feel mostly normal. Chest fullness feeling is mostly gone, heart rate isn't too high (resting rate is pretty close to before the ablation, maybe 3 to 5 higher). I can walk around freely now and plan to do more exercise next week once I get an all-clear.
---
I didn't spend much time shortening the above, it's pretty much a brain dump of what happened. Feel free to ask me any questions happy to answer here or via DMs.