Ablation procedure - arhythmic heat beat
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Ablation procedure - arhythmic heat beat
Hello all,
I am suffering from ventricular ectopic beats - in fact between 5% and 12% daily. I tried everything from cutting out caffeine to reducing stress factors. Nothing seemed to really helped me though. I am totally asymptomatic and have done four 24 hour holters, stress ECG and a 2D of my heart. Cardiologists say I am fine and aren't too concerned. The AMEs I consulted don't see a big problem neither BUT recommended to do an ablation procedure in order to eliminate the abnormal electrical pathway in my heart that fires off these missed beats since too many ectopic beats might cause some more serious problems in the long term. I went to heart specialists in my city and, after a long pre-operation discussion, they agreed to conduct the ablation procedures. Success rates are very high and risks are relatively low they said. I am scheduled for the procedure in two weeks.
I read about people having conducted such a procedure in this forum but only because of some more serious problems such as atrial fluttering etc. Is here anybody who had an ablation therapy done because of an arhythmic heart beat like me? If yes, were you able to retain / obtain your class 1 medical?
Best regards
CrashDash
I am suffering from ventricular ectopic beats - in fact between 5% and 12% daily. I tried everything from cutting out caffeine to reducing stress factors. Nothing seemed to really helped me though. I am totally asymptomatic and have done four 24 hour holters, stress ECG and a 2D of my heart. Cardiologists say I am fine and aren't too concerned. The AMEs I consulted don't see a big problem neither BUT recommended to do an ablation procedure in order to eliminate the abnormal electrical pathway in my heart that fires off these missed beats since too many ectopic beats might cause some more serious problems in the long term. I went to heart specialists in my city and, after a long pre-operation discussion, they agreed to conduct the ablation procedures. Success rates are very high and risks are relatively low they said. I am scheduled for the procedure in two weeks.
I read about people having conducted such a procedure in this forum but only because of some more serious problems such as atrial fluttering etc. Is here anybody who had an ablation therapy done because of an arhythmic heart beat like me? If yes, were you able to retain / obtain your class 1 medical?
Best regards
CrashDash
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CrashDash: I can't speak to your Class I status, though I doubt it will be an issue if the ablation is successful.
However, I can understand your situation, being in exactly the same. Mine were running about 4.5%, and though cardiologists claimed it was insignificant, that's not the case when you lay in bed at night wondering how many beats in a row you'll miss next! It's a very off-putting sensation. Even for me, an MD!
In my case simply taking a beta-blocker drug solved the issue. Cardiology was able to localize exactly where my ectopics were coming from, and he felt it was a tough spot to hit with an ablation procedure. But we had extensive discussion about ablations, and these days the procedure is very successful, and risks extremely low.
So I anticipate you will be just fine afterwards, and expect your AME will just yawn.
However, I can understand your situation, being in exactly the same. Mine were running about 4.5%, and though cardiologists claimed it was insignificant, that's not the case when you lay in bed at night wondering how many beats in a row you'll miss next! It's a very off-putting sensation. Even for me, an MD!
In my case simply taking a beta-blocker drug solved the issue. Cardiology was able to localize exactly where my ectopics were coming from, and he felt it was a tough spot to hit with an ablation procedure. But we had extensive discussion about ablations, and these days the procedure is very successful, and risks extremely low.
So I anticipate you will be just fine afterwards, and expect your AME will just yawn.
obgraham is on the ball.
All I would add is to ask yourself it it is a problem to YOU. If you find the ectopics upsetting and your AME confirms your license is safe then find someone who has done lots, has a good reputation and insist he does it himself!!!
But if it isnt a problem for you leave well alone. Low risk is not the same as no risk, and if the cardiologists are happy to leave it then it is unlikely there will be harm in the future. Hospitals are sadly too often places where 'just in case' procedures led to more complications than the problem in the first place.
All I would add is to ask yourself it it is a problem to YOU. If you find the ectopics upsetting and your AME confirms your license is safe then find someone who has done lots, has a good reputation and insist he does it himself!!!
But if it isnt a problem for you leave well alone. Low risk is not the same as no risk, and if the cardiologists are happy to leave it then it is unlikely there will be harm in the future. Hospitals are sadly too often places where 'just in case' procedures led to more complications than the problem in the first place.
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Thank you for your answers!! 
@obgraham: great to have found somebody with the same problem like me! From your post, I assume that you don't feel them neither, don't you? Just like you, I often ask myself "how many beats does my heart miss at the moment?". I know that this makes it only worse but you can't really stop thinking about them. This is also the reason why I anticipate to eliminate this "problem" permanently. For me, beta-blockers are no option since I don't want to take these pills for ages - not to mention the possible side effects that can occur. Albeit certain beta-blockers such as Bisoprolol or Metoprolol are fine for a class 1 medical (at least under EASA). Which one did you take? Do you know that?
@Radgirl: thank you. For me, it is not a real problem BUT I know that I have them and it drives me mad. I want to get rid of these odd ectopics if anyhow feasible. The doctor(s) who will conduct the ablation therapy are very competent, have a good reputation and doing ablation therapies quite often. They are VERY helpful and I feel like they really want to help ME.
Having asked my AME, he said that an ablation is definitely fine and won't be an issue for a class 1 medical if its successful and no major complications occurred.
@obgraham: great to have found somebody with the same problem like me! From your post, I assume that you don't feel them neither, don't you? Just like you, I often ask myself "how many beats does my heart miss at the moment?". I know that this makes it only worse but you can't really stop thinking about them. This is also the reason why I anticipate to eliminate this "problem" permanently. For me, beta-blockers are no option since I don't want to take these pills for ages - not to mention the possible side effects that can occur. Albeit certain beta-blockers such as Bisoprolol or Metoprolol are fine for a class 1 medical (at least under EASA). Which one did you take? Do you know that?
@Radgirl: thank you. For me, it is not a real problem BUT I know that I have them and it drives me mad. I want to get rid of these odd ectopics if anyhow feasible. The doctor(s) who will conduct the ablation therapy are very competent, have a good reputation and doing ablation therapies quite often. They are VERY helpful and I feel like they really want to help ME.
Having asked my AME, he said that an ablation is definitely fine and won't be an issue for a class 1 medical if its successful and no major complications occurred.
Psychophysiological entity
My wife missed so many beats when she was young that I used to leap up and shake her. She, to this day, is totally pragmatic about medical problems and back then just ignored my cries of horror.
With no training, she won the school mother's race coming waaaay ahead of the local tennis champion and yearly winner. A non event for her, but what we didn't know at that time was the statistical increase in stroke risk in later life. I don't understand the mechanics of that link at all.
With no training, she won the school mother's race coming waaaay ahead of the local tennis champion and yearly winner. A non event for her, but what we didn't know at that time was the statistical increase in stroke risk in later life. I don't understand the mechanics of that link at all.
Atrial fibrillation carries a risk of clot forming in the chamber of the heart because the blood flows 'more slowly' with the irregularity. Bits of the clot can fly off to the lungs so we normally anticoagulate these patients. Ectopics are not thought to have this risk - primarily because for most of the time the heart beat (or heat beat!!!) is 'normal' and the ectopic is just an 'extra' beat.
Recently there has been a suggestion than some people with loads of ectopics may in fact have paroxysmal atrial fibrillation, but for the present the risk is small or zilch - two quite different conditions
Recently there has been a suggestion than some people with loads of ectopics may in fact have paroxysmal atrial fibrillation, but for the present the risk is small or zilch - two quite different conditions
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Crash, what's right for one may not be for another. In my case, 50mg of atenolol stopped my problem in the very first day. It also took 20 points off my marginally elevated blood pressure, and slowed my habitual tachycardia. Double win. I'm no longer requiring an aviation medical, though. (Wish I'd been on it for my IR checkride, though!) By and large I'll choose a pill to an intervention, all else being equal.
Sounds like you have some good cardiology available, and should be able to eliminate this problem without too much of a hassle. Good luck!
Sounds like you have some good cardiology available, and should be able to eliminate this problem without too much of a hassle. Good luck!
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As an irrelevant aside on this topic, I was intrigued how the cardiologist pored over my ECG's, worked out the electrical components, their direction and intensity, and plotted in 3 dimensions where the source would be.
Just like VOR navigation.
Just like VOR navigation.
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Interesting to read, radgirl!
Obragaham, did you hold a medical at the time you took Atenolol?
I guess the ablation therapy is the best option for me. I do really hope that my ectopics come from a place which is easy to ablade! Does anybody here happen to know how such an abnormal electrical pathway firing off arrhythmias can actually occur? Can it happen to anybody or do certain factors play a role here?
Obragaham, did you hold a medical at the time you took Atenolol?
I guess the ablation therapy is the best option for me. I do really hope that my ectopics come from a place which is easy to ablade! Does anybody here happen to know how such an abnormal electrical pathway firing off arrhythmias can actually occur? Can it happen to anybody or do certain factors play a role here?
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Crash, my medical had not been active when my cardiac issues arose. However, I had all the testing FAA requires (including echo and stress ECG) to approve any class of medical while on atenolol, which is an authorized medication.
As I understand it, my AME could have issued my medical, but it would not have surprised me if a special issuance was required, as it was when I needed eye drops.
2 Disclaimers:
I am not, and never have been, an AME! Nothing I say here is official!
I'm pretty familiar with FAA regs, but know little to nothing about the Euro/UK regs.
As I understand it, my AME could have issued my medical, but it would not have surprised me if a special issuance was required, as it was when I needed eye drops.
2 Disclaimers:
I am not, and never have been, an AME! Nothing I say here is official!
I'm pretty familiar with FAA regs, but know little to nothing about the Euro/UK regs.
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JimR: LOL! Actually found that pretty amusing since the doctors said almost the same! 
Thanks obgraham. As far as I know, FAA and EASA (Europe) have more or less the same medical requirements for flight crews. Although EASA might be stricter in some parts, I could imagine. I am not familiar with FAA requirements but here in Europe an OML restriction might be required after an ablation procedure for one year. ... I could live with that.
By the way: are you still taking Atenolol?
Thanks obgraham. As far as I know, FAA and EASA (Europe) have more or less the same medical requirements for flight crews. Although EASA might be stricter in some parts, I could imagine. I am not familiar with FAA requirements but here in Europe an OML restriction might be required after an ablation procedure for one year. ... I could live with that.
By the way: are you still taking Atenolol?
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are you still taking Atenolol?
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CDash, I posted this some time ago but will repeat it since it seems somewhat relevant and have updated it a bit.
I thought I would share my experience with palpitations in the hope that it might help someone out there who is secretly suffering; secretly being the word, because it is amazing the number of people who suffer from palpitations and only open up when prodded a bit.
Apparently they're quite common and doctors will tell this to their patients which is supposed to be a comfort. Unfortunately, the words don't necessarily help overcome the fears that you are about to die, obviously depending on the severity.
I started to have the odd missed heartbeat in my early 50s. Very gradually they got worse although nothing of too much concern until I was in my early 60s, I am now 71. I of course went to the docs to be given a few basic ecgs and to be told nothing wrong. They started to get worse, although in episodes rather than all the time. Sometimes I would get them several times a minute for several hours. Finally the doc gave me a prescription for a beta blocker - Atenolol. It worked to some extent but didn't cure the problem. I tried monitoring what I was eating (and drinking). There was some correlation but nothing that I could say had a definitive pattern. Stress? Quite possibly some correlation but not conclusive. The doc gave me more intensive tests: ecg stress test, nuclear stress test, holter monitor. I also had a heart cathetorization. In part these tests were because I suffer from a mild angina if I exercise too rapidly (there are some pretty steep hills around here), although if I walk gently for awhile before building up the force it doesn't happen. Anyway, no significant obstructions. Eventually given nitroglycerine tablets which, when taken before any exercise, completely eliminates any angina.
So the palpitations continued. Obviously I read a lot, including garbage on the internet. One thing that seemed to be worth trying was a magnesium supplement. I bought some chelated magnesium tablets (ordinary magnesium oxide is not absorbed by the body very well and is just a great laxative; I prefer to live without that!). This was last September 2015. I continued taking the magnesium for about 2 months; nothing, the palpitations continued. I almost gave up, thinking this was another false path. I continued taking them for another month and interestingly the palpitations started to diminish. I took a blood test to see what my magnesium level was; it was at the lowest level on the recommended scale, and this after 3 months of taking a supplement! Goodness knows what it was before. I stopped taking the Atenolol but I upped the magnesium level, although somewhat less than some of the recommendations you see on the internet. Now after another 3 months I very rarely had a palpitation, maybe one every couple of days! I walk about 3 kms every other day (or try to if I'm not feeling too lazy). However, I do take the Atenolol if the palpitations start to come back with any frequency but at a fairly low dosage of 12.5mg (half a 25mg tablet).
I find it strange that no doctor ever mentioned the possibility of low magnesium level to me but hope this will maybe help someone with this problem and to suggest it to their doctor. One caveat, the remedy is obviously not going to work for everyone, because there are other causes of palpitations. I also haven't mentioned any specific dosages because again this is something that should probably be evaluated by a doctor; I am not.
I thought I would share my experience with palpitations in the hope that it might help someone out there who is secretly suffering; secretly being the word, because it is amazing the number of people who suffer from palpitations and only open up when prodded a bit.
Apparently they're quite common and doctors will tell this to their patients which is supposed to be a comfort. Unfortunately, the words don't necessarily help overcome the fears that you are about to die, obviously depending on the severity.
I started to have the odd missed heartbeat in my early 50s. Very gradually they got worse although nothing of too much concern until I was in my early 60s, I am now 71. I of course went to the docs to be given a few basic ecgs and to be told nothing wrong. They started to get worse, although in episodes rather than all the time. Sometimes I would get them several times a minute for several hours. Finally the doc gave me a prescription for a beta blocker - Atenolol. It worked to some extent but didn't cure the problem. I tried monitoring what I was eating (and drinking). There was some correlation but nothing that I could say had a definitive pattern. Stress? Quite possibly some correlation but not conclusive. The doc gave me more intensive tests: ecg stress test, nuclear stress test, holter monitor. I also had a heart cathetorization. In part these tests were because I suffer from a mild angina if I exercise too rapidly (there are some pretty steep hills around here), although if I walk gently for awhile before building up the force it doesn't happen. Anyway, no significant obstructions. Eventually given nitroglycerine tablets which, when taken before any exercise, completely eliminates any angina.
So the palpitations continued. Obviously I read a lot, including garbage on the internet. One thing that seemed to be worth trying was a magnesium supplement. I bought some chelated magnesium tablets (ordinary magnesium oxide is not absorbed by the body very well and is just a great laxative; I prefer to live without that!). This was last September 2015. I continued taking the magnesium for about 2 months; nothing, the palpitations continued. I almost gave up, thinking this was another false path. I continued taking them for another month and interestingly the palpitations started to diminish. I took a blood test to see what my magnesium level was; it was at the lowest level on the recommended scale, and this after 3 months of taking a supplement! Goodness knows what it was before. I stopped taking the Atenolol but I upped the magnesium level, although somewhat less than some of the recommendations you see on the internet. Now after another 3 months I very rarely had a palpitation, maybe one every couple of days! I walk about 3 kms every other day (or try to if I'm not feeling too lazy). However, I do take the Atenolol if the palpitations start to come back with any frequency but at a fairly low dosage of 12.5mg (half a 25mg tablet).
I find it strange that no doctor ever mentioned the possibility of low magnesium level to me but hope this will maybe help someone with this problem and to suggest it to their doctor. One caveat, the remedy is obviously not going to work for everyone, because there are other causes of palpitations. I also haven't mentioned any specific dosages because again this is something that should probably be evaluated by a doctor; I am not.
Last edited by JimR; 9th Oct 2016 at 01:22. Reason: Wrong Atenolol dosage.
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To be honest obgraham I'm not sure anyone makes them. I just checked, they are 25mg !!!!! and cut them in half as I need them. They're in a blister pack and so it's obviously not a good idea to chop up a lot to avoid moisture ingress. I just cut a few and keep them in an airtight bottle. The doc didn't seem to have any problems with my methods.
So maybe it's possible to buy 10mg ones which is closer to the dose I take as needed.
So maybe it's possible to buy 10mg ones which is closer to the dose I take as needed.
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Jim, thank you for that information! I also tried a magnesium supplement (magnesium citrate) but it didn't help much. I think it rather increased the amount of VES. I am surprised that magnesium oxide helped you - cause I was told by everyone that magnesium oxide isn't well absorbed by the body and only about 4% is being absorbed. Interestingly, none of the specialists I have been to mentioned the possibility of taking magnesium neither...
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CrashD, you are absolutely correct that magnesium oxide is not easily absorbed, it's basically just a laxative. That's why I take a chelated form. Unfortunately many magnesium supplements on the market also contain a large proportion of un-chelated magnesium which doesn't help at all, or only marginally (as I discovered on one product I purchased).
I have attached this link which goes some way in explaining things, although one thing they say which is disputed by other sources, is that it can be absorbed through the skin (Epsom Salts). Who knows, I'm not a doctor.
http://afibbers.org/resources/magnesiumabsorption.pdf
Hope this helps and good luck. I did consider asking for an ablation at one time, but don't particularly like the thought of insides of important parts of my body being mucked about with!
I have attached this link which goes some way in explaining things, although one thing they say which is disputed by other sources, is that it can be absorbed through the skin (Epsom Salts). Who knows, I'm not a doctor.
http://afibbers.org/resources/magnesiumabsorption.pdf
Hope this helps and good luck. I did consider asking for an ablation at one time, but don't particularly like the thought of insides of important parts of my body being mucked about with!
Psychophysiological entity
Some of you will remember my self help for heart problems. A real Don't Try This at Home remedy.
If you're board this might bring a smile but I'll tell you now, that pain was very real. When I talk about it hurting as I'm going up a slope, (60' ascent) it hurt so much I could not go any further. Some years on I'm power-walking up that slope every night after dinner. If I've had any heart flutters in the intervening years, it's only been once or twice. They were every day before that.
It was thought the anger restricted the blood flow to my brain. I have no idea why that would happen - it seems utterly counter-productive, and why would that make my heart hurt?
Huh, just read a bit of it and OFSO said this:
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http://www.pprune.org/jet-blast/4178...laying-up.html
If you're board this might bring a smile but I'll tell you now, that pain was very real. When I talk about it hurting as I'm going up a slope, (60' ascent) it hurt so much I could not go any further. Some years on I'm power-walking up that slope every night after dinner. If I've had any heart flutters in the intervening years, it's only been once or twice. They were every day before that.
It was thought the anger restricted the blood flow to my brain. I have no idea why that would happen - it seems utterly counter-productive, and why would that make my heart hurt?
Huh, just read a bit of it and OFSO said this:
My dear old lady doctor in Germany years 'n years ago told me arrythmia while the heart was at rest is no problem, it's when it happens under load you should get it checked out.
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http://www.pprune.org/jet-blast/4178...laying-up.html
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Jim, I had to look up what exactly "chelated" magnesium is. I will have a look at the article you posted. 
... I can truly understand that you didn't want to have an ablation therapy. I don't really like the though of it either but it's probably the best option in my case since I don't want to take Beta-Blockers (which might interfere with my class 1 medical as well).
I don't know how much time has gone by since you thought about an ablation but in the past couple of years the ablation technology has done a huge step forward and the risks are really low, although there are some (like with any other invasive intervention I assume).
Like Loose rivets said, I would always be very cautious when it comes to home remedies. Though, you can't really go wrong with magnesium my GP said. If you take too much, the human body will simply drain it. So the worst thing that can happen is ... diarrhoea.
By the way - my ablation therapy will be next monday. If everything goes well, I'll be back home on tuesday. Pretty nervous... I will let you know what the result will be.
... I can truly understand that you didn't want to have an ablation therapy. I don't really like the though of it either but it's probably the best option in my case since I don't want to take Beta-Blockers (which might interfere with my class 1 medical as well).I don't know how much time has gone by since you thought about an ablation but in the past couple of years the ablation technology has done a huge step forward and the risks are really low, although there are some (like with any other invasive intervention I assume).
Like Loose rivets said, I would always be very cautious when it comes to home remedies. Though, you can't really go wrong with magnesium my GP said. If you take too much, the human body will simply drain it. So the worst thing that can happen is ... diarrhoea.
By the way - my ablation therapy will be next monday. If everything goes well, I'll be back home on tuesday. Pretty nervous... I will let you know what the result will be.
