A Fib

I have three electrocardioversions over the last five years and am waiting to get my coumadin level to a theraputic place so a fourth cardioversion can be done in the near future.  The cause:  A-fib.  I have had a pulmonary vein ablation in Oct. 2005.  After the procedure I was on Amioterone for 6 months.  I was great from May 2006 until January 2007.  I started feeling the irregular rhythm again.  My electrocardiologist did an EKG and did not find A-fib, but did find a lot of "odd and irregular" beats.  I wore a halter monitor for 24 hours in May and the results also showed very irregular beats all the time.  So, now I am on coumadin and am waiting for an electrocardioversion.  My question is this:  Is there anything neurological that can possibly be causing my heart to be responding with all of these irregular beats?  What part of the brain would control our heart rhythm?  I am discouraged that I may need another pulmonary vein ablation...what are my other alternatives?  Also, what is the effect on my heart in the long run with all these electrical shocks and ablation procedures?  I would appreciate any advice or information that you can give me.

[va_tony]

Sorry to hear that your ablation hasn't solved your afib/pac problem. I understand that second ablations are not uncommon and often results in a "cure". It's possible that the previous PVA did not completely isolate the ulmonary from the atria. One alternative to consider is going on an antiarrhytmic med again.  You mentioned you had good experience with amiodarone.  Other less risky alternatives are tykosin, flecainide, rythmol and sotolol. I've been on rythmol for 5 years with somewhat good results (until recently). I'm not a good candidate for an ablation because my atrium is dilated (5.5 cm dia.).

You ask about neurological causes of afib/pacs. Actually, one suspect is often the autonomic nervous system (ANS), which controls the involuntary functioning of many of the body's organs, including the heart. Often, a form of dysautonomia associated with the vagus nerve will result in arrhythmias like afib.  There is no easy cure for this other than meds and an ablation.

I've had three electrocardioversions in the past. From my reading on the subject (and what my cardiologist has told me) these are harmless. I personally would worry about the long term effects of too many ablations.  Often the scar tissue that's needed for a cure also will later cause new arrhythmias.  But cardiologist's will tell you that the scarring is minor and will not harm you.

Best wishes

Tony

[Jerry_NJ]

Have you had your third electrocardioversion yet?  

I had my fourth electrocardioversion 8 days ago, and as usual all is going well, but no one can predict for how long.  In the past I have used Propafenone after conversion and got about 1.5 years of sinus rhythm.  Last November I had heart surgery, mitral valve repair and the maze procedure.  My repaired valve continues to function well, but he AFib returned about 30 days after surgery.  I hope with the valve fixed I'll get longer relief, sinus rhythm.  There has been some enlargement of my Atrium from the leaky valve, and that may have been what provoked the AFib.  Ablation has not been suggested by my cardiologist, I'll ask next visit/follow-up.