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Heart Disease (Expert Forum)
Ablation
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Ablation
by dquenzer, Feb 01, 2004 12:00AM
Heading to Mayo for possible ablation Feb. 20.
I have paroxymal afib.
Doctor said success rate is about 70% cure, 30% aren't cured but do get better--less afib.
Do you find these stats warranted?
How long does the "cure" last? Any research on this?
What are the most common side effects after an ablation?
Thanks
Doug
I have paroxymal afib.
Doctor said success rate is about 70% cure, 30% aren't cured but do get better--less afib.
Do you find these stats warranted?
How long does the "cure" last? Any research on this?
What are the most common side effects after an ablation?
Thanks
Doug
Doctor's Answer
by CCF-M.D.-RCJ, Feb 01, 2004 12:00AM
Doug,
Thanks for the post.
Q1:"Do you find these stats warranted?"
By "warranted" do you mean acceptable? We quote an 80% cure rate -- but the folks at Mayo would say that our cure rate is higher because our patient population is different. Each center right now is trying to establish themselves as one of the dominant centers, so some friendly competition is often found. The bottom line is that Mayo has some of the best electrophysiologists in the world, although we certainly believe that we do the afib ablation procedure as well (or better) than anyone.
Q2:"How long does the "cure" last? Any research on this?"
The procedure is only about 4-5 years old. The research done thus far indicates that late recurrences (after 6 months) are very uncommon. No one can give you stats past 5 years. Furthermore, each center has different stats due to the relative "newness" of the procedure and the experience of the physicians performing it.
Q3:"What are the most common side effects after an ablation?"
The most common "side effect" after the afib ablation is an increased frequency in the afib episodes during the first 3 months, presumably from the inflammation caused by the ablation/burning.
The major complications of the procedure primarily involve (1) stroke, (2) major bleeding, and (3) pulmonary vein stenosis. You'll need to discuss the frequency of these complications with the Mayo physicians, as each center quotes different rates.
If you would like to read more, feel free to check out:
http://atrialfibrillation.org/
Best of luck with your procedure.
Thanks for the post.
Q1:"Do you find these stats warranted?"
By "warranted" do you mean acceptable? We quote an 80% cure rate -- but the folks at Mayo would say that our cure rate is higher because our patient population is different. Each center right now is trying to establish themselves as one of the dominant centers, so some friendly competition is often found. The bottom line is that Mayo has some of the best electrophysiologists in the world, although we certainly believe that we do the afib ablation procedure as well (or better) than anyone.
Q2:"How long does the "cure" last? Any research on this?"
The procedure is only about 4-5 years old. The research done thus far indicates that late recurrences (after 6 months) are very uncommon. No one can give you stats past 5 years. Furthermore, each center has different stats due to the relative "newness" of the procedure and the experience of the physicians performing it.
Q3:"What are the most common side effects after an ablation?"
The most common "side effect" after the afib ablation is an increased frequency in the afib episodes during the first 3 months, presumably from the inflammation caused by the ablation/burning.
The major complications of the procedure primarily involve (1) stroke, (2) major bleeding, and (3) pulmonary vein stenosis. You'll need to discuss the frequency of these complications with the Mayo physicians, as each center quotes different rates.
If you would like to read more, feel free to check out:
http://atrialfibrillation.org/
Best of luck with your procedure.
The reply was : "The most common 'side effect' after the afib ablation is an increased frequency in the afib episodes during the first 3 months, presumably from the inflammation caused by the ablation/burning."
If you don't mind doing so, could you please say --
1)Which ablation procedure(s)is/are employed at the Cleveland Clinic
2)Which (if any) of these procedure(s)are more likely to cause increased a-fib episodes, and
(3)What percentage of the Clinic's ablation patients experience them.
Thank you, in anticipation of your prompt and positive response.
NHS
The Mayo EP specialist stated the "approach" he is going to use is a catheter ablation of specific hot spots.
These hot spots can come from a number of areas. He suspects that the hot areas could be pulmonary in origin. I have been a long distance runner running up to 70 miles a week into my late 30's. I also ran college track. He believes that I may have what many athletes have and that is stretched pulmonary veins that become irritated. So there is a high probability that they will ablate right at the edge of the pulmonary veins and the atrium. They don't ablate in the pulmonary veins due to the possibility of scarring causing a narrowing.
He also said they will look for "trigger" hot spots. These are hot spots that get the AFIB going. They don't try to get all the hot spots, but just the "triggers."
Then he said there could also be veins in the atrium that shouldn't be there. As I understand these are veins that should have gone away after birth, but didn't. They found these can become irritated.
It isn't the maze approach. I have a friend who had a maze done during open heart valve replacement.
I'm sure ablation doesn't work for everyone. There is that 20 to 30% category. I have paroxymal AFIB. I don't have it all the time. But I want to get this taken care of so I can get off the meds, which eventually don't work and also which can cause numerous other side effects.
Q1:"Which ablation procedure(s)is/are employed at the Cleveland Clinic"
Our approach to afib ablation is called a Pulmonary Vein Isolation, whereby the pulmonary veins are electrically isolated by use of a catheter ablation procedure.
Q2:"Which (if any) of these procedure(s)are more likely to cause increased a-fib episodes"
We just use the one approach.
Q3:"What percentage of the Clinic's ablation patients experience them"
I have to admit I haven't seen any numbers on this. Perhaps one third or so.
Questions:
1. Is U of M a good center to go to? This will be attempt # 3 at ablation in a 15 year old.
2. How long should we expect it to take rythmol to become effective? He started the medication on Friday (150mg Q 8 hours).
3. Could the increase in events since Sunday,(palpitations,SOB, chest pain and dizziness) be related to the rythmol? Are there different drugs that may help him? Flecainide did help at low doses (50mg Q 12) but he developed tremors from it.
4. Can retrograde re-entry pathways close to the AV node be successfully ablated given the skill of the EP specialist? We don't want him to end up with a pacemaker at the age of 15, especially since we have not yet exhausted the array of antiarrythmic agents he could try.
Lots of questions, I know. I would appreciate any help you can give me.
Lill
I'm really glad this procedure was available and would recommend it to anyone with similar problems. (I was given a sedative and do not remember a thing about the procedure itself, but I understand they went through my groin and jugular. Recovery was a couple of days of taking it easy.)
My cardiac surgeon says this is the way to go since it is done on the outside of the heart and there is "practically zero" risk of clots/stroke. They use small incisions thru the ribs on either side of the chest wall, insert the instruments, including the 'scope, and manipulate the instruments to "burn" around the pulmonary vessels and other hot spots from the outside of the heart. Each lung is deflated in turn as they work on that side of the heart. He quoted a "70-90% success rate, but this procedure has only been done in the last year, so there is no long term data yet.
Any comments? I'm scheduled for one in two weeks.
I'm hoping I have as good of results as you had.
I'm just looking forward to being more active again.
Doug
NHS