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Heart Disease  (Expert Forum)
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Ablation question
Answered by
Cleveland Clinic -
Cleveland - OH
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MedHelp Member's Question

Ablation question

by Sue143, Oct 26, 2003 12:00AM
Hello again. I'm 38, good health. I've had palps. for almost 7 yrs. In July I had a-fib for the first time. It was stopped by a Cardizem drip and I haven't had a-fib since. I had another echo, blood work and Holter monitor. Blood work and echo normal. The Holter shows PAC's and atrial tach. My Dr. thinks the atrial tach. is what triggered the a-fib. I had been taking beta-blockers but they increased my palps and caused my BP to drop too low. so they stopped them.

He sent me to an EP dr. and he said I would be a good candidate for an ablation. He said I could take anti-arrhythmia meds but he didn't recommend them because they may not work and they have a lot of side effects. He said if the PAC's were coming from the same  arrhythmia then they would be gone too if I got the ablation. But he said if my heart was quiet the day of the ablation, then they wouldn't be able to find anything.

He said this won't kill me and I can live with it, but he worries that over time everything will get worse and they'll have a hard time keeping me out of a-fib.

I feel like I have no other options but an ablation. He told me all the risks and I have 2 small children so I don't want to take any risks I don't need to. Are there any other options for me? Is it really possible to get rid of the PAC's? I've read how everyone else still has palps after an ablation.

He told me not rush and think about it and call him if I want to schedule. Is there anything else left for me?



Thanks, Sue
Doctor's Answer

by Cleveland Clinic, Oct 26, 2003 12:00AM
Sue,



I remember your history. Your options are pretty well spelled out for you.



Your options are really meds, no meds or an attampt at an ablation. Each carries risks and benefits. I think the main issue needs to be how well you can live with your symptoms as you are now. An ablation may help with both the SVT and PACs.  

Thus it could impact your palpitations.



It is very difficult to balance the risks and benefits of any procedure, especially when you take into account your family. You should focus on how well you can deal with doing nothing and how that will impact your overall sanity and well being.  If you are miserable all the time from worry about the SVT and palpitations, it might make it easier to reason through to undergo an ablation.



You might talk to others on this forum who have undergone an ablation to get some more insight from those that have gone through it.



good luck
Member Comments (33)

by Sue143, Oct 26, 2003 12:00AM
I forgot to add that the atrail tach episodes only occur from once a week to once a month, and last anywhere from 10 sec. to 10 mins.

by Elrod, Oct 27, 2003 12:00AM
I've got a question for the board. Can a person with chronic A-Fib have success with an ablation. I live near Cleveland and have heard so many good things on this BB about CCF, that I'm ready to talk to my Cardiologist about the ablation. There just seems to be so few that have chronic a-fib. Right now I'm on 180mg of Betapace 2X per day, and Warafin, this is keeping my HR in the 78-98 range. Thank you.

by bubby1, Oct 27, 2003 12:00AM
I am considering ablation at the pittsburgh med center. I am told that I do not need to be in Afib to fine the source any longer. Is this true? I take Amiodorine and coumadin and would like to get off these drugs. My Afib is chronic and I get cardioverted about 2 times a year. Any info would be appreciated

by Sue143, Oct 28, 2003 12:00AM
To: Alice
Hi Alice, I'd love to chat with you. My email is ***@****.

Looking forward to hearing from you.



Thanks, Sue

by Sue143, Oct 28, 2003 12:00AM
To: hankstar
Thank you so much for your insight. You are always so helpful. Right now I am in agreement with you. Unless it gets so unbearable to live with I'm willing to just live with it for now. They said the risks are 1 in 1000 of a possible serious complication. I would like it to be better than that if there's no guarantee that it will work in the first place.



Thanks again, Sue

by arthur, Oct 29, 2003 12:00AM
The risks have gone down from about 2-3% complication rate a few years ago, to 0.1% (according to the post above).  If true, I doubt the risk can get any lower...so the question is whether you can put up with the irritation of occassional afib, or if in fact, the afib poses an additional risk by becomming permanent and leading to a greater likelihood of clot formation and stroke.



I understand that chronic afib is much more difficult to cure via ablation than paroxyzmal afib (PAF), because of gradual physiological changes (remodeling) that occur in the cardiac tissue.  The possibility of a cure remains, however, it's not as high a success rate as for PAF.



Some EPs insist on a preliminary procedure which establishes the protocol necessary to induce the arrhythmia.  In this way, on the day of the actual ablation procedure, the EP has a better chance of inducing the arrhythmia for ablation.  Without this preliminary step, you simply take the chance that it won't show up when you're all wired up, which could be disappointing.



-Arthur

by BJo, Nov 01, 2003 12:00AM
To: Alice
Hi Alice,  My husband had successful RF ablation for A-flutter about 4 years ago at a well-known teaching hospital in the east.  At that time he had both A-flutter & A-fib.  The head EP told him up front, "I can cure your A-flutter but not your A-fib."  According to our local cardio, there is now a possible cure for his paroxysmal A-fib.  Would you mind to contact me & let me know about (what I assume) was your pulmonary vein isolation ablation that you had done at CC.  My email addy is: ***@****.

Thanks Alice,

Betty Jo

by Scared in Ky, Nov 02, 2003 12:00AM
I am scheduled for an ablation the tenth of Novemeber.  I had a holter monitor that revealed bigeminy and pvc and a non sustained run of vtach.  I had a heart cath it came back good.  I however do have mitral valve prolapse its moderate to severe with no to mild reg.  I have been on sotalol which made me bradycardic.  I am now on Tambocor it seems to help some but my heart rate sometimes goes up to 153.  I feel so bad I pretty much stay in bed all the time.  I am scared to do the ablation and I am scared not to.  Is there any other medicine that might help.  Maybe I am just overly anxious....I am on xanax and my sister passed away back in May.  She was only 33 and they say she died from a seizure.

by glassheart46, Nov 02, 2003 12:00AM
To: TO SUE143
I just had an ablation for atrial tachycardia and frequent pac's.  My atrial tachycardia would come on only once in a while like youself but my pac's were very frequent and prior to the ablation they were 24/7.  My ablation was a success.  The ep doc got them all as they were very active as it sounds like yours are.  It was not near as scary as I thought it would be and I was only in for 2 hours.  I decided on the ablation because I did not want mine to turn into a-fib which is a much more dangerous arrhythmia.  I hope this helps you decide.  If you wish to email me my address is:

    ***@****



Take care!

by Momto3, Nov 02, 2003 12:00AM
To: Sue143
Sue, Count me in on successful ablations (Hi Glassheart-It'sME!)

I had an ablation for frequent pvcs in August and it was considered a success. I am scheduled to go back in November so they can try and ablate another foci as I am multi-focal. The doctors are being conservative and that's OK by me!! I have been on beta blockers and more recently Tambacor and Rythmol, but opted for the ablation rather than the medicine. Good luck...

by Momto3, Nov 03, 2003 12:00AM
To: Hankstar
Hi Hankstar, Yes, they were able to ablate a foci in the RVOT. After the procedure the Dr. told us that she felt 70% confident that she successfully ablated a major foci. So that would fall right in line with what you have read. I am not certain what percentage my pvcs have decreased. I do know that I am multifocal and that it is presumed that I have (had) 2-3 major foci. I also know that on a previous holter I registered around 22000 ventricular ectopics, 3000 couplets, some runs, and very frequent bigeminy. Subsequent report showed frequent activity as well. This last report (mid Oct) showed about 6000 isolated pvcs, and only 54 couplets...marked improvement! The doctors are being extremely cautious and conservative because of  cardiomyopathy issues. I've had benign pvcs for many years and have been on beta blockers on/off. Some success initially, but eventually seemed to be more problematic. Since the pvcs were benign, I was able to use BB on an as needed basis, and that worked great.



Last year after an annual checkup, my EF had declined enough to indicate cardiomyopathy. That's a very long story, but the bottom line is that the doctors are confident that the CM was a result of the frequency of pvcs. After 3 months on Tambacor this year, EF improved 10%. Although the antiarrythmics appeared to be effective, I did not like the side effects, and knew I would have to take them forever. I also have MVP/MR and there is a possibility that the valve will need repair in the future. With that in mind, it would be ideal to have no CM and good EF.



I am very fortunate because my doctor is extremely conservative and would not recommend the procedure withou very careful consideration. Although the pvcs are annoying, I have pretty much learned to live with them.  Absent the CM issue, my doctor probably would designate them as benign. However, my records have been reviewed by MANY doctos and this seems to be the consensus.



It does take time for the heart to heal. In August,the pvc activity was markedly reduced. About week 6, the activity picked up. Event montitor and holter showed significant enough frequency to warrant further treatment.  Otherwise, I face the RX again...UGH!!! Thanks for asking.

by Momto3, Nov 03, 2003 12:00AM
To: Hankstar
Hi Hankstar, Yes, they were able to ablate a foci in the RVOT. After the procedure the Dr. told us that she felt 70% confident that she successfully ablated a major foci. So that would fall right in line with what you have read. I am not certain what percentage my pvcs have decreased. I do know that I am multifocal and that it is presumed that I have (had) 2-3 major foci. I also know that on a previous holter I registered around 22000 ventricular ectopics, 3000 couplets, some runs, and very frequent bigeminy. Subsequent report showed frequent activity as well. This last report (mid Oct) showed about 6000 isolated pvcs, and only 54 couplets...marked improvement! The doctors are being extremely cautious and conservative because of  cardiomyopathy issues. I've had benign pvcs for many years and have been on beta blockers on/off. Some success initially, but eventually seemed to be more problematic. Since the pvcs were benign, I was able to use BB on an as needed basis, and that worked great.



Last year after an annual checkup, my EF had declined enough to indicate cardiomyopathy. That's a very long story, but the bottom line is that the doctors are confident that the CM was a result of the frequency of pvcs. After 3 months on Tambacor this year, EF improved 10%. Although the antiarrythmics appeared to be effective, I did not like the side effects, and knew I would have to take them forever. I also have MVP/MR and there is a possibility that the valve will need repair in the future. With that in mind, it would be ideal to have no CM and good EF.



I am very fortunate because my doctor is extremely conservative and would not recommend the procedure withou very careful consideration. Although the pvcs are annoying, I have pretty much learned to live with them.  Absent the CM issue, my doctor probably would designate them as benign. However, my records have been reviewed by MANY doctos and this seems to be the consensus.



It does take time for the heart to heal. In August,the pvc activity was markedly reduced. About week 6, the activity picked up. Event montitor and holter showed significant enough frequency to warrant further treatment.  Otherwise, I face the RX again...UGH!!! Thanks for asking.



Oh, once the first foci was ablated, they did try to identify other foci, but my extra beats settled down. The doctor said the heart settled down immediately after she ablated, what is perceived to be, a major foci....

by Momto3, Nov 03, 2003 12:00AM
To: Hankstar
Yep, I do believe it is because of the cardiomyopathy