Ablation

[dquenzer]

Heading to Mayo for possible ablation Feb. 20.

I have paroxymal afib.

Doctor said success rate is about 70% cure, 30% aren't cured but do get better--less afib.

Do you find these stats warranted?

How long does the "cure" last?  Any research on this?

What are the most common side effects after an ablation?

Thanks

Doug

[CCF-M.D.-RCJ]

Doug,

Thanks for the post.

Q1:"Do you find these stats warranted?"

By "warranted" do you mean acceptable?  We quote an 80% cure rate -- but the folks at Mayo would say that our cure rate is higher because our patient population is different.   Each center right now is trying to establish themselves as one of the dominant centers, so some friendly competition is often found.  The bottom line is that Mayo has some of the best electrophysiologists in the world, although we certainly believe that we do the afib ablation procedure as well (or better) than anyone.

Q2:"How long does the "cure" last? Any research on this?"

The procedure is only about 4-5 years old.  The research done thus far indicates that late recurrences (after 6 months) are very uncommon.  No one can give you stats past 5 years.  Furthermore, each center has different stats due to the relative "newness" of the procedure and the experience of the physicians performing it.

Q3:"What are the most common side effects after an ablation?"

The most common "side effect" after the afib ablation is an increased frequency in the afib episodes during the first 3 months, presumably from the inflammation caused by the ablation/burning.

The major complications of the procedure primarily involve (1) stroke, (2) major bleeding, and (3) pulmonary vein stenosis.  You'll need to discuss the frequency of these complications with the Mayo physicians, as each center quotes different rates.

If you would like to read more, feel free to check out:
http://atrialfibrillation.org/

Best of luck with your procedure.

[Kristin391]

What approach are they proposing for your atrial fibrillation?  There are many with varying outcomes.  I have worked closely with some of the best electrophysiologists and I have learned that nothing is for sure and if one area is treated, another one can crop up which is what happened to me.  I get cardioverted periodically and am waiting for better data, better catheters and improved techniques and technologies which, I believe, is soon to come.

[NHS]

RE: Q3"What are the most common side effects after an ablation?"

The reply was : "The most common 'side effect' after the afib ablation is an increased frequency in the afib episodes during the first 3 months, presumably from the inflammation caused by the ablation/burning."

If you don't mind doing so, could you please say --

1)Which ablation procedure(s)is/are employed at the Cleveland Clinic

2)Which (if any) of these procedure(s)are more likely to cause increased a-fib episodes, and

(3)What percentage of the Clinic's ablation patients experience them.

Thank you, in anticipation of your prompt and positive response.

NHS

[dquenzer]

I'm not sure what you mean by "approaches".  

The Mayo EP specialist stated the "approach" he is going to use is a catheter ablation of specific hot spots.

These hot spots can come from a number of areas.  He suspects that the hot areas could be pulmonary in origin.  I have been a long distance runner running up to 70 miles a week into my late 30's.  I also ran college track.  He believes that I may have what many athletes have and that is stretched pulmonary veins that become irritated.  So there is a high probability that they will ablate right at the edge of the pulmonary veins and the atrium.  They don't ablate in the pulmonary veins due to the possibility of scarring causing a narrowing.

He also said they will look for "trigger" hot spots.  These are hot spots that get the AFIB going.  They don't try to get all the hot spots, but just the "triggers."

Then he said there could also be veins in the atrium that shouldn't be there.  As I understand these are veins that should have gone away after birth, but didn't.  They found these can become irritated.

It isn't the maze approach.  I have a friend who had a maze done during open heart valve replacement.

I'm sure ablation doesn't work for everyone.  There is that 20 to 30% category.  I have paroxymal AFIB.  I don't have it all the time.  But I want to get this taken care of so I can get off the meds, which eventually don't work and also which can cause numerous other side effects.

[CCF-M.D.-RCJ]

NHS,

Q1:"Which ablation procedure(s)is/are employed at the Cleveland Clinic"

Our approach to afib ablation is called a Pulmonary Vein Isolation, whereby the pulmonary veins are electrically isolated by use of a catheter ablation procedure.

Q2:"Which (if any) of these procedure(s)are more likely to cause increased a-fib episodes"

We just use the one approach.

Q3:"What percentage of the Clinic's ablation patients experience them"

I have to admit I haven't seen any numbers on this.  Perhaps one third or so.

[Lill]

I hope you don't mind me using this thread for related questions.  My 15 year old son is scheduled to go to University of Michigan for consult after 2 EP studies failed to adequately identify the source of his PSVT.  During the last study this past thursday, the cardiologist felt he had a retrograde re-entry pathway adjacent to the AV node.  During mapping of the left side of the heart, he thought his resting heart rate originated in the av node then conducted through the left atrium first.  During both studies, my son had NO episodes of SVT though in everyday life he has many such episodes on a daily basis.  Without antiarrythmics, the event monitor picked up rates of 200 to 240 beats per minute during these episodes.  On flecainide, the rates were 150 to 170 with events lasting seconds to an hour or so.  He is now on rythmol and complains of SOB, dizziness and palpitations (day 3 on rythmol).

Questions:
1. Is U of M a good center to go to?  This will be attempt # 3 at ablation in a 15 year old.  

2. How long should we expect it to take rythmol to become effective?  He started the medication on Friday (150mg Q 8 hours).

3.  Could the increase in events since Sunday,(palpitations,SOB, chest pain and dizziness) be related to the rythmol?  Are there different drugs that may help him?  Flecainide did help at low doses (50mg Q 12) but he developed tremors from it.

4.  Can retrograde re-entry pathways close to the AV node be successfully ablated given the skill of the EP specialist?  We don't want him to end up with a pacemaker at the age of 15, especially since we have not yet exhausted the array of antiarrythmic agents he could try.

Lots of questions, I know.  I would appreciate any help you can give me.

Lill

[Cindy2004]

I had 2 abalations for WPW syndrome in 1998. It had to be repeated in 3 months due to a reoccurence of 250 bpm heart rate.   I have been symptom free since!  I do not need beta blockers any more, and I have not had any problems. I exercise and do all things I used to do (with the exception of drink caffeine - personal thing I guess). Anyway -
I'm really glad this procedure was available and would recommend it to anyone with similar problems.  (I was given a sedative and do not remember a thing about the procedure itself, but I understand they went through my groin and jugular. Recovery was a couple of days of taking it easy.)

[Cathy7]

Has anyone heard of (or, probly not) had a "transthoracic Maze procedure"?

My cardiac surgeon says this is the way to go since it is done on the outside of the heart and there is "practically zero" risk of clots/stroke.  They use small incisions thru the ribs on either side of the chest wall, insert the instruments, including the 'scope, and manipulate the instruments to "burn" around the pulmonary vessels and other hot spots from the outside of the heart.  Each lung is deflated in turn as they work on that side of the heart.  He quoted a "70-90% success rate, but this procedure has only been done in the last year, so there is no long term data yet.

Any comments?  I'm scheduled for one in two weeks.

[arthur]

I had PAF and was cured by an rf ablation procedure at the Univ of PA (Philadelphia) about 3.5 years ago.  It was a PV isolation procedure and it took about 6 hours (I was sedated).  The going success rate then is what it sounds like now, about 60% on the first try and about 80% counting a second ablation as warranted.  I was and continue be an athlete...I work out very strenuously at least three times a week (with an average of about 20 mi run per week).  Although I am now 56, my level of training permits me to play competitive soccer in the over 40 age group (aka over-the-hill group).  I mention this as I figure that there's a lot of folks with PAF symptoms that wonder if they'll ever get their lives back.  The answer is yes.

[dquenzer]

Thanks for the encouragement.

I'm hoping I have as good of results as you had.

I'm just looking forward to being more active again.

Doug

[NHS]

Thank you so much for your prompt reply.


NHS

[jobob52 ford]

Cathy,
I saw that you entered your post a couple of times and you're not getting any response. Are you sure you're not talking about an Epicardio Ablation procedure? They enter under the ribcage and into the pericardium(membrane around the heart),make a study and locate sites for ablation.
This is a relativly new procedure(within the last couple of years)at September of 2003 there were only 35 or so procedures completed.
It is my understanding that these procedures are attempted as a last effort get to an area that can't be ablated from the inside the heart.
It is also my understanding that even though maze and ablation may have similar outcomes, "maze" is accomplished by mapping and making incisions on the wall surface, to create scar tissue to interrupt an electrical pathway. Ablation accomplishes the same thing except by using an electrode and RF signal, kind of a mini welder, to create a burn/scar tissue to interrupt a pathway.
With an epicardio procedure there probably is less chance of a stroke, but it is a much more complex procedure(my opinion) and carries with it plenty of other risks.
Or maybe I'm missing what you're asking altogether, what do you mean, "pulmonary vessels and other hot spots"?
Hope this helps. Good Luck, Bob

[Cathy7]

Bob,

Yes....I guess the procedure you've described is the one I'm having.  I goofed: they call it a "thoracoscopic Maze procedure". They manipulate the instruments and 'scope on the outside of the chest wall.  I know that deflating and re-inflating each lung in turn, cutting thru the intercostal muscles and the pericardium, etc. are risky...but for some reason I'd rather have that more complicated procedure than the one where they are "burning" the heart on the inside with all the blood in the heart.  My cardiac surgeon said "notice what happens when you throw a steak on a hot grill" - all the blood coagulating.  I'm afraid of the clot/stroke risk with the RF ablation procedure.  

I have confidence in this surgeon.  When the Maze procedure is done, the EP doc has been going in afterwards to make sure all of the foci are treated.  He uses the catheter thru the femoral artery into the heart approach, but I am refusing that.  I'd rather just stick with the outside of the heart - that's enough trauma.

I'm s'posed to take amiodarone for a few months afterward.  I understand that med has horrible side effects and few can tolerate it....is that true?  I haven't been able to tolerate any of the other drugs, so I'm not holding out much hope.  Rhythmol (sp?) CAUSED more arrhymias.  Ugh.  I'm ready to be well and go on with my life.

Thanx for your comment....

[Iowa]

I am almost 4 weeks post ablation for paroxysml afib. I have always been aware of when I'm in afib.
So far, so good. No irregular rhythms. While my heart rhythm has been slow and regular, I continue to have chest pain.  The pain post procedure was enough to keep me awake for almost a week.  I've done a lot of searching and have never seen this mentioned in the literature.  It certainly wasn't mentioned to me pre-procedure.  I've also developed a dry persistant cough.  Is the heart pain and cough common?

[arthur]

Folks report pain post ablation at varying degrees, varying locations and for varying periods of time.  The trauma is mostly at the entry points for the catheters, so some pain should be evident at the groin, in particular.  I experienced some pain during the procedure when the catheter punctured the septal wall between atrias and during the actual ablation burn...after which they increased my sedation and cut me out of the rest of the adventure.

Post ablation, the only other source of discomfort I experienced was in some shortness of breath (while sprinting), which I personally believe was due to a minor pulmonary vein swelling (edema).  That lasted just a few weeks.  Your discomfort may be coming from the same source, since the PV swelling could possibly lead to a percieved throat irritation.  This is speculation on my part, and you should probably talk to the EP about these symptoms.  The PV edema (which may be a common side effect of the PV ablation procedure) should not last much longer (literature citations suggest from weeks to months, with almost all cases clearing up eventually).

-Arthur

[Iowa]

Arthur,
Thanks for your input.  I didn't have any discomfort at the insertion points so I guess I should be grateful.  The heart pain has been significant enough to cost me work hours since I can't sleep.  Adding the cough just made it more worrisome.  I see my EP next week.  I'm sure he'll be able to tell me what's up.  I still find it interesting that no one else seems to report any significant pain or lost time following the procedure.

[arthur]

Yup...it always sounds like you're ready to go the next day.
In my case I stayed at home for a few days in order to assure that I didn't unleash any loose clots from either the burns or the healing insertion points.  If you're past the clot worry, and it sounds like you are, then it's likely a PV edema, however small, could be your problem.

There is also an insult to the nervous system (pericardial) that results from the burns.  I have heard of folks complaining of added arrhythmias due to such irritations lasting from days to months.  The tissue injury should be gone in a few weeks, while the nerves tend to take a much longer time to get back to normal.
It's not impossible to consider an irritated nerve connection to your cough issue.

Good luck with your EP.

-Arthur

[Bridgetgc]

New here with some comments and questions on ablation.  Quick history...been suffering with SVT's for 10 years or so and have not been taken seriously until about a year ago when I had Lyme disease a ER doc noticed an abnormality in my EKG.  Finally I got an SVT recorded on an event monitor and the cardiologist put me on flecainide.  I ended up in the ER a couple of weeks ago going 220 beats a minute.  There I found a second opinion with a new cardiologist.  He recomended an ablation which I had about 10 days later.  I'm two days out now and so far I still feel like I was hit by a train.  They did find that I had Wolff-Parkinson-White and zapped out the extra pathway.  They told me that there was a slight chance of recurrence but after 3-6 mos I was home free.  I am very worn out still and my heart beats hard and fast just after walking or excerting even a little.  Is this common? I've had some dizziness also. I'm hoping it's nothing, I'm a 31 year old female with three kids.  Thanks in advance

[arthur]

Your symptoms after ablation are common.  I had one for PAF and the procedure lasted about 6-7 hours.  It is not uncommon for all kinds of arrhythmias to show up after the ablation, though they should be short lasting and rather benign if all went well.  This is due to the irritation the nervous system surrounding the heart has gone through, as well as, injuries to cardiac tissue as a direct result of the ablation.  Actual healing of the injuries should take no longer than a couple of weeks, but the nervous system irritation could last longer.  Once everything calms down (which is what the doctor appears to be saying), your heart should be just fine.  I know it's very trying, and your anxiety re. the whole thing must be up...just hang in there.  

-Arthur

[Bridgetgc]

Thank you for responding. I am feeling better everyday. My cardiologists nurse explained the strange symptoms perfectly.  She described it as "ghost symptoms". It's like I'm going to have a SVT episode or maybe I will pass out but it never comes. Yes, it does make me very anxious especially when I'm not with anyone I know and in a public place. I often wonder if I should have some info in my wallet.

How long before the groin pain stops? It's a pulsing pain. Does that make sense? :)

[Cathy7]

It's me again...

I had the "thoracoscopic Maze Procedure" two weeks ago, and feel like the stock market:   some downturns and slumps, but overall on an upward slope.

I've been to the ER twice with problems secondary to the surgery (weakness due to dehydration with BP of 80/50, which was caused by "too aggressive diuresis" during my hospitalization: and stabbing chest pain due to pleurisy which resolved after 24 hours).  

I still have frequent PVC'S and some atrial fib episodes, but get bouts of weakness which no one can explain.  My surgeon and cardiologist have no idea why I get so weak.  I can barely speak or breathe due to this weakness......even when I'm not in arrhythmia.  I had these bouts before surgery, too, and that's why I went to such an extreme measure with this procedure.

Does anyone else get weak and/or pass out?  I can't work, I can't walk my dog - I've gained 30 pounds in the last three years cuz I can't exercise, and my poor husband is afraid everytime I leave the house by myself.

What could this be?  I've DC'd ALL the affeine, medications (except amiodarone which I'll be on for six months post-op), stress, thyroid medication and dexedrine (which was prescribed for my ADD)that I was on pre-surgery.

Anyone else have this weakness?  What do you do?  I'm sooooo bummed.....I want my life back.

[arthur]

Pulsing pain in the groin...probably due to the healing process post catheter insertion.  Besides the clot, there may be a slight hematoma (clot in the muscle), which could cause additional discomfort.  All this should clear up by the time you are reading this email...if not, follow-up with your cardio.

-Arthur