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Heart Disease (Expert Forum)
A-FIB turning into V-FIB
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A-FIB turning into V-FIB
by vikkij, May 13, 2007 12:00AM
Thank you doctor for taking my questions.
1. Can A-FIB degenerate into V-FIB or any other dangerous arrythmia?
2. I have had 2 PVI ablations for A-FIB over the last 4 years. These were fairly sucessful but the A-FIB is slowly returning. Is there a point at which the atrium could be damaged from too much ablation scarring?
Thanks for your input.
1. Can A-FIB degenerate into V-FIB or any other dangerous arrythmia?
2. I have had 2 PVI ablations for A-FIB over the last 4 years. These were fairly sucessful but the A-FIB is slowly returning. Is there a point at which the atrium could be damaged from too much ablation scarring?
Thanks for your input.
Doctor's Answer
by Forum-M.D.-MJM, May 13, 2007 12:00AM
Hello,
1. Can A-FIB degenerate into V-FIB or any other dangerous arrythmia?
As far as most people are concerned, no, AF does not lead to VF. In the rare circumstance that someone has a rapidly conductiong accessory pathway (a minority of WPW syndrome or other accessory pathways), yes it can degenerate into a dangerous heart rhythm. The people at risk for the this happening tend to be very young -- teens, twenties, thirties. It is not the typical version of atrial fibrillation.
The next question that most people will ask is how do I know that I don't have that. The EKG of someone with a fast conduction accessory pathway is usually pretty obvious and it causes most doctors alarm when the see it, prompting a visit to an electrophysiologist.
This should not scare anyone. This is a rare case and is usually very evident on a 12 lead EKG.
2. I have had 2 PVI ablations for A-FIB over the last 4 years. These were fairly sucessful but the A-FIB is slowly returning. Is there a point at which the atrium could be damaged from too much ablation scarring?
Another good question. This is the area of atrial fibrillation ablation that we are still working out. The goal is to ablate as little atrium as possible to cure atrial fibrillation -- this helps maintain a strong atrium and helps the heart work as a more efficient machine. On redo ablations, we tend to ablate more. The assumption is that if you are coming back, you must be having symptoms and would benefit from cure, so we ablate more of the trigger areas. We still don't know how much is too much, who can't be cured (and we know there are some that we just can't keep of AF). At this point, the best thing to do is talk to your electrophysiologist about this.
Another small point is that there are many electrophysiologist out there that aren't trained to do this procedure and they are starting to do them. Ask the direct questions -- what is your success rate, how many have you done, where were you trained. It is your right to know this.
I hope this helps. Thanks for posting.
1. Can A-FIB degenerate into V-FIB or any other dangerous arrythmia?
As far as most people are concerned, no, AF does not lead to VF. In the rare circumstance that someone has a rapidly conductiong accessory pathway (a minority of WPW syndrome or other accessory pathways), yes it can degenerate into a dangerous heart rhythm. The people at risk for the this happening tend to be very young -- teens, twenties, thirties. It is not the typical version of atrial fibrillation.
The next question that most people will ask is how do I know that I don't have that. The EKG of someone with a fast conduction accessory pathway is usually pretty obvious and it causes most doctors alarm when the see it, prompting a visit to an electrophysiologist.
This should not scare anyone. This is a rare case and is usually very evident on a 12 lead EKG.
2. I have had 2 PVI ablations for A-FIB over the last 4 years. These were fairly sucessful but the A-FIB is slowly returning. Is there a point at which the atrium could be damaged from too much ablation scarring?
Another good question. This is the area of atrial fibrillation ablation that we are still working out. The goal is to ablate as little atrium as possible to cure atrial fibrillation -- this helps maintain a strong atrium and helps the heart work as a more efficient machine. On redo ablations, we tend to ablate more. The assumption is that if you are coming back, you must be having symptoms and would benefit from cure, so we ablate more of the trigger areas. We still don't know how much is too much, who can't be cured (and we know there are some that we just can't keep of AF). At this point, the best thing to do is talk to your electrophysiologist about this.
Another small point is that there are many electrophysiologist out there that aren't trained to do this procedure and they are starting to do them. Ask the direct questions -- what is your success rate, how many have you done, where were you trained. It is your right to know this.
I hope this helps. Thanks for posting.
Bu the way, does anyone know WHY, after all, an arrhythmia may come back after ablation? Since the path has been "burned", why are there so many cases in which arrhythmia keeps hapenning?
I am quite active physically. The PAF that I had (and is slowly returning) comes from foci located in the atria/PV ostia. These were blocked by ablation. Note, that most ablations do not toast the foci, but are designed to create a non-conductive block between the foci and the rest of the heart. However, with time, and because of extreme exercise, the tissue stretches and new routes are established between the foci and the heart. Bingo, more arrhythmias.
One useful suggestion that the EP gave me is to insure that my blood pressure is under control (it's normally somewhat elevated). The higher the blood pressure, the more the heart tissue will expand under duress. And when the tissue expands, the space between cells gets larger and focal signalling can leach through. Anectodally, since I started taking an ACE inhibitor, the PAFs have been nearly impossible to initiate (usually initiated with sudden stress, ie, increase in adrenaline).
If your blood pressure is even slightly high, you might want to talk to the doc to see if you could take a small dosage of a blood pressure med, and then see if the PAFs are as frequent.
-Arthur