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Subject: Re: ablation My husband is 55, diagnosed with dilated cardiomyopathy 3 years ago. Put on transplant list but removed after MUGA showed improvement. Atrial fibrillation persists. No further drug options. Defibrillator installed 24 months ago with approx 40 firings caused by the AFIB. All our input suggests ablation and activation of pacemaker within the currently implanted defibrillator. Question: What is the difference between "heart burning", mapping, ablation, etc.? Is there a possibility with dilated cardiomyopathy to correct the AFIB and not need pacing? We also understand that there will be less need for drug control, which we find favorable. If ablation is done the electrophysiologist suggests that improvement of the heart output is a possibility. Comment please. Thank you for your valued input. Linda in Spokane, Washington, USA
Dear Linda, thank you for your question. It sounds like your husband suffers from refractory afib that has complicated things by causing his defibrillator to inappropriately fire in response to rapid afib. If your husband's defibrillator also has pacing functions, then his AV node could be ablated during an electrophysiology (EP) study to eliminate conduction of afib impulse to the ventricles. This is a tricky area with dilated cardiomyopathy because the heart functions best when the atria and the ventricles are in synchrony in sinus rhythm. Afib disrupts this ideal functioning, but there is always the hope that medications will convert afib to sinus rhythm and this harmony will be restored. But, if the heart rate is chronically elevated due to afib, this could also adversely affect the heart function in dilated cardiomyopathy. Once the AV node is ablated, the atria and ventricles can never communicate again and the ventricular heart rate is controlled by a pacemaker. The atria will remain in afib, so blood thinners will need to be continued, but the rapid heart rates associated with afib will cease and be replaced by a constant pacemaker rate. It's hard for me to comment on the heart output and the possibility that the afib can be controlled with medications alone because your husband's case is so complicated. Mapping refers to localization of sources of abnormal rhythm disturbances in the heart during an EP study. Mapping must be done before any abnormal pathway is ablated. Ablation is accomplished through the application of radio wave energy to the inside of the heart with special catheters that eliminate the abnormal pathways and foci of rhythm disturbances. Usually, ablation is a safe procedure but there are rare risks associated with it. Heart burning is synonymous with ablation. I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck! If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart
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