Ablation and cardiomyopathy

[SteveB47]

History-
3 yrs ago felt very faint
EKG showed Atrial Fib
Followup showed Cardiomyopathy w/15% EF
Otherwise good health.
One unsuccessfull Cardioversion - lasted one day.
Another Cardioversion 3 months later lasted 9 months with Amioderone 200 mg.
Current Meds- Amioderone 200 mg, Correg 12.5 twice a day, Lisinopril 20 mg.
Currently in Afib (for about 3 months).
Tired ALL the time, but can't sleep because of the meds.
Here are my questions:
1.  When I'm in sinus rythm and taking the meds, my heart rate drops to 30.  Dr said it was probably medically induced.  Now that I'm back in Afib, my HR is about 55.  How do you determine heart rate?  Do you count the extra beats as single beats or as part of the existing beat?
2.  I want off the amioderone bad.  If I can talk my doctor into an ablation, how sucessful (ballpark figure - not taking as absolute fact)are ablations with cardiomopathies?
3.  I want another cardioversion, but I really don't want my HR to drop down to 30 again ( yes, I know the consequences).  Any suggestions or recommendations?
4.  If I have an ablation and my HR doesn't increase, would a pacemaker power both the atri and ventracals, or would I be back to having only half my heart working?  

Thanks for a great site.  I refer to this place often.
Yours,
Steve

[Cleveland Clinic]

steve,

thanks for the post.

1) When I'm in sinus rhythm and taking the meds, my heart rate drops to 30. Dr said it was probably medically induced. Now that I'm back in Afib, my HR is about 55. How do you determine heart rate? Do you count the extra beats as single beats or as part of the existing beat?


Heart rate is measured over time, and usually reported as beats per minute. Depending on the method, especially real time measurement of heart rate with most machines, they will count beats and mutiply them by the interval to report the number on a continuous basis. With fibrillation the beat to beat interval varies, so when you have a pvc or extra beat, the multiplier will report a higher heart rate.

2) I want off the amioderone bad. If I can talk my doctor into an ablation, how sucessful (ballpark figure - not taking as absolute fact)are ablations with cardiomopathies?

They are less successful then without. There are alot of factors such as the cause of your cardiomyopathy, regurgitation and the size of your atria that will influence even my best guess.  There are other antiarrythmics available, but all will have some side effects.

3. I want another cardioversion, but I really don't want my HR to drop down to 30 again ( yes, I know the consequences). Any suggestions or recommendations?

This is probably a factor of your coreg and your amiodarone. If you are in sinus and with symptomatic bradycardia while in sinus, a pacemaker may be order.

4) 4. If I have an ablation and my HR doesn't increase, would a pacemaker power both the atri and ventracals, or would I be back to having only half my heart working?

see above. a pacemaker might be an option. in addition to pacemakers that control both the atria and ventricle, there are other options specifically for pacemakers in heart failure depending on how symptomatic you are and the way your heart beats.  

good luck

[DottyCece]

Sounds like you are coping with many of the same issues I have coped with for over a year and a half.  I have had a pacemaker since surgery in May of 2003.  Ater that time, I was cardioverted 7 times for atrial flutter and atrial fibrillation.  My rates had gone up to over 190...so I finally agreed to an AV nodal ablation.  I am pacemaker dependent now (just a ventricular) and doing much better.  However, I am loading and continuing on amiodarone for two months. At that time they will cardiovert one more time to see if I can be converted to sinus rhythm.  If I am, they will revise the atrial lead which was damaged in the surgery I had in April.  If all works well, I will be AV sequentially paced and continue on amiodarone.  I realize amiodarone has numerous side effects but at a dosage of 200 mg a day,  it is much safer.  Also, there is another drug on the horizon (to be released in a year if all goes well) that is similar to amiodarone but has less side effects. So I am hoping to go into that direction.  When one is in Atrial Fib, there is a pulse deficit.  In other words, your radial pulse may be about 35 or so but if you would listen over your heart, the rate may be double that.  That is because when the beats come early, there isn't as much blood in the ventricles to circulate so you are unable to feel those pulses in the radial or other peripheral pulse points.    The important thing is to assess how you feel with these low rates.  All these factors need to evaluated in proposing a treatment plan.

Good luck to you.

[SteveB47]

If you have an AV node ablation and something happens to the pacemaker, the heart will still beat (all though not regular) right? At least long enough to make it back to the hospital?  It may be a last resort type option.  Also, if the AV node is ablated, how can you be cardioverted?  My ignorance is showing.
Thanks.
Steve