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Heart Disease (Expert Forum)
ablation of vagal reflexes
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ablation of vagal reflexes
by tallron, Jan 31, 2005 12:00AM
I am a 60yr male without any known structural heart problems. I have had worsening atrial fibrillation for 15yrs in spite of giving up caffeine and alcohol and taking 6 medications at one time or another. My condition is partly inherited and partly due to my life long dedication to exercise (5 marathons). I have always noted a vagal component to my AF, but this became much stronger about 2 yr ago, when simply eating or sleeping could trigger an episode. I have had 2 PV isolation-type ablations now – one ostial, one atrial, but still have AF lasting 1-3 hr about once per week, even though I take Amiodarone and Toprol, daily. Also, at my request, I have taken Enalapril and Diovan for 3 yr. I am considering a third procedure and am interested in the vagal reflex ablation of Dr. Pappone. The research behind it seems compelling and the clinical claims are remarkable, but I understand that there is some question about its validity. What is the current opinion of this procedure at your clinic? Thanks.
Doctor's Answer
by CCF-M.D.-MJM, Jan 31, 2005 12:00AM
Boy that is a tough question. I asked a few electrophysiologists what they thought. It may be too early to tell. The procedure is still experimental and the data is still very early. I agree it is encouraging, but I think it is way too early to tell. We do a lot threepeat ablations here and have fairly good success. You are always welcome to see one of our electrophsiologistst to see what they think and have to offer.
I can't offer much more than this for now. Hopefully your next procedure, if you decide to do another, will be successful. Good luck.
I can't offer much more than this for now. Hopefully your next procedure, if you decide to do another, will be successful. Good luck.
Erik
I had a PV ablation one year ago and is working fine. The type I had was a large circle that encompassed both pulmonary veins, and not just the type that went specifically around each of the pulmonary veins.
I'm not sure if one procedure has more success than another, but it might be worth asking.
it sounds like you had an atrial ablation, which i had about a yr ago. earlier i had an ostial ablation, which only involves the opening of the pv. the first kind is supposed to be about 20% more effective. though in my case, the ostial, done first, helped me alot and a follow up atrial ablation has not helped at all. having had 2 pv isolations and still af about once a week, i think my case is more involved, hence, my interest in the vagal ablation.
Thanks.
Uptowngirl
The paper which Prof Camm of St George's Hospital Medical School in London wrote in Falk and Podrid supports the idea that whilst vagal AF can be a useful classification, it is by no means a simple affair.
Finally, I have had an ablation at one of the world's leading AF/ablation clinics. I brought the subject of my own generally vagal response up with the EP, and he responded that "80% of the patients they see have vagal responses". The worst of my own vagal responses disappeared overnight with the ablation, though I still have a residual tendency towards vagal symptoms when the odd breakthrough arrhythmia threatens. I also have ventricular premature contractions (PVCs) which occur along with vagal symptoms - they are worst when my heart rate is low, and after certain foods. It appears that this is not unusual for these benign ectopics.
On balance, I would say that it is the AF that should be treated along tried and tested lines (PV ablation, flutter line in the R atrium, and mitral isthmus line in the L atrium) along with any obvious extra-PV foci, before entering upon territory that may be less proven.
Vicky
http://www.vagalafibinfo.fsnet.co.uk/
I read these as:
- if the EP tests for withdrawal of vagal response after left atrial work (PVs), this helps to define an end-point. It's therefore not the main aim of the procedure, but helps them to know when the procedure is complete
- ablating the right atrium for vagal denervation makes it worse (this was the method tried in the dog heart, ISTR)
ERIK
Do a google search on Dumping Syndrome, you might find it very interesting to read.Don't read just one article , read several on it.