Ablation?

[Lyn2]

I am trying to make a decision regarding an AV node ablation.  I am 34, female. I take amidodarone 400mg, cartia xt 360, midodrine, coumadin, lasix, advair, and I have a pacemaker for SSS.  I have bouts of a-fib several times a day, often with rapid ventricular response. My EP doc, recently increase the doses of my meds. We are at the end of the rd. with medications.  But now I have edema. Normally, I am 100lbs., now I am 120lbs. I cannot lay flat, I have been very sick to my stomach, breathless, and very itchy (in the past has always correlated to liver enzymes). I am debating calling my EP to tell him about what is going on.  But I think I must decide at this point whether to pursue the ablation, which he says is inevitable. Weighing the drug side-effects vs. ablation, do you have a recommendation?  Do you think I should just do it soon, rather than wait?  Can the meds. actually cause heart failure.  I don't understand that?  Is that what is happening, and does it reverse once they are stopped?  Thank you so much.  I welcome you to this forum, and all the repetitive and complex problems that we all throw at you.  Good Luck!

[rosmarin]

A related discussion, atrial fibrillation worsening breathlessness was started.

[Burly]

Hi, I have trouble with A-fib due to my heart disease of Hypertropic Cardiomyopathy...I have a pacemaker...worked great controlling episodes for about a year and a half.  But the last 5 months I find myself in the ER or staying a night or two in hospital every month trying to get back into sinus rhythm.  Cardioversions haven't even helped.  I am on Amiodarone now...and still in A-fib for a month now.  The medicine keeps it in a low enough pace that I can function a little....but am filling up with fluid so on lasix...hasn't helped this past week...so am on 120mg a day starting tomorrow...Anyway, my doctor told me of some other options...and one is the AV Node Ablation.  On July 9 I had the atrial ablation done....but within 5 days I was back into A-fib.  I need to talk with someone who has had the AV Node ablation and their reaction.  It just seems to be so final for me.  One good thing is that I already have the pacemaker.  And anything to get off these medicines...for 21 yrs...different medicines...each time a new one came out...I think I got on it.  The side effects are awful...so anything that I can get off meds would be great.  Please let me know your comments on the AV Node Ablation.   Thank you.  I am 53...doctor said he has more patients in their 70's and 80's that have had this procedure done....Any comments would be appreciated.

[soojay]

Hello,

I am a 44 yr old woman who four and a half years ago had my first episode of A-fib in which I had to be cardio-converted. My cardiologist put me on 180mg of cardizem.

This past April 2002 I had my second episode on which I went to the e.r. and they were getting ready to convert me when my heart converted itself after nine hours. My Dr. increased my Cardizem to 240mg per day.

In May 2002 I had my third episode and again went to the e.r. and again my heart converted itself after approx. 9 hours. My Dr. put me on Rythmol 450mg per day. I had a bad reaction so he reduced the Rythmol to 300 mg per day then reduced further to 150 mg per day also reducing my Cardizem to 180mg per day.

Yesterday I went into A-fib again. I got my cardiologist on the phone and he told me to take 150 mg of Rythmol immediatly and to go to the e.r. if it did not convert in an hour to hour and a half. It did convert and I was so relieved not to go to the e.r.
My Dr. increased my rythmol back to 300mg per day.

I wrote this brief history because I am wondering if anyone has had a similar experience with their atrial fibrilation and if so what type of treatments or guidance you can give me as this is causing me concern and frustration over what appears to be an acceleration in my A-fib condition. Thank you in advance.

[Lyn2]

Irene and doctor,
I know the doctor probably won't read this, but I am very thankful for the thoughtful response.  I am seeing my EP doctor this afternoon, and have some questions ready.  Irene, it was great to hear of your success with an AV node ablation. My doctor has made me feel a little reluctant about it.  He said in my case it could make things worse, which I can't imagine, and why, I don't know. It would be great to get off meds.  I don't mind taking the coumadin.  There aren't daily side effects with that.  I guess the one thing that concerns me is...if I am in heart failure from having a-fib, the AV node ablation is not going to cure the a-fib, so would the heart failure continue.  Well, all questions to ask.  Thanks again.

[Irene]

I had an AV node ablation a year ago and it has transformed my life.  I am not on any drugs now apart from aspirin, and pacemaker dependence seems well worthwhile.

[CCF-M.D.-KE]

As you know atrial fibrillation is a condition where the upper chambers(atria) of the heart beat erratically sending multiple electrical stimuli to the bottom chambers(ventricles) of the heart. This causes an irregular heart beat which is often very fast. Atrial fibrillation carries with it a risk of stroke. If the rapid heart rate is not controlled the heart muscle may weaken and cause symptoms of heart failure. However these symptoms are  reversible upon the restoration of a normal heart rate. Atrial fibrillation itself may also cause fatigue, breathlessness, palpitations, chest pain and decreased exercise tolerance.

Your case is complex. Your symptoms of weight gain, breathlessness and the inability to lie flat may be related to heart failure. However, you should discuss them with your doctor so that he/she may perform tests to find out the cause. Maybe an echocardiogram and/or stress test. If not already done, an evaluation of the activity of your thyroid gland(TSH) would be useful.  

Cartia(diltiazem) and amiodarone don't exactly cause heart failure, but in some cases may aggravate pre-existing heart failure. The drug amiodarone causes a number of side effects which may affect  the liver, lungs, eyes, thyroid gland and skin. There are other medications used to treat atrial fibrillation such as sotalol, flecanide,and propafenone which have fewer side effects. You may be a candidate for one these medications. However, I would recommend discussing with your doctor some of these other medical options, which may prove helpful.

An A-V nodaly ablation is a procedure where the electrical communication between the upper chambers(atria) of the heart and the bottom chambers(ventricles) is interrupted. After this procedure one is completely dependent on a pacemaker(which you have) and  may still require coumadin. There is also an atrial fibrillation ablation which involves using radiowaves to ablate portions of veins which deliver blood to the heart (pulmonary veins). If successful some patients may stop taking coumadin.

At this point I would recommend further discussion with your doctor about other medications and an atrial fibrillation ablation.

Thanks for your question.