Catheter Abalation

[Jillyd]

my husband recently had catheter abalation in December 2006
which was unsuccessful.
The surgeon tried for 5 hours to fix it.
He has told my husband he may be able to try the procedure again this year.
Can anyone tell me if there is a greater success rate the second time.
has anyone had the procedure through the chest instead of the groin.

[JVR]

Correction:  My first ablation attempt was in August 2004,(not two).  Sorry for the typo.

[JVR]

I have a long history of ablation attempts.  First two in August of 2004, and then next in Feb. of 2006. for V-tach. They were considered unsuccessful due to the fact that they weren't able to induce me into V-tach when I was on the table (go figure), but did ablate some areas.  It didn't take care of the problem.  Third attempt was successful due to the fact that they were able to induce the v-tach, ablate, but after 7 hours, still had stray PVC's coming from all different areas.  This led them to do an MRI, Signal average EKG, echo, and right-ventriculargram to test for something called ARVD.While I was in the cath lab for the ventriculargram, they decided to try to ablate those stray PVC's another time.  Again they weren't able to induce the V-tach, so no ablation was done.  Tests results are not back yet for the ARVD.  Was put on Amiodarone to control the V-tach which was still happening, as well as Toprol XL, and a Magnesium supplement. AFter 1 month on Amiodarone, V-tach is controlled, but still suffer from constant PVC's brought on with VERY little activity.  Doctor is considering a 5th attempt at ablation to try and go after those PVC's.  Anyone ever gone through this?  We're very frustrated as to what to do.  I've been with very good doctors at UCSF. Please comment

[besblair]

i have been in a-fib for 18 months. have had 3 cardoverisions - been on meds. but still going into a-fib every month or so.  the coumadin makes me ill all the time. i am scheduled for a PVI on 1/12/07. any advice would be helpful.  also am having a tee test done on 1/10/07. the dr. said the tee test along with a CT scan will give him like a road map so he has a better chance of correction.  any comments or thoughts.

[StephPT]

The doctor was Dr. Warren Jackman at Oklahoma University Medical Center in Oklahoma City.  He is very good, but only accepts referrals from doctors (meaning the doctor that did your husband's procedure would have to contact him, and he and the team sit down every wednesday to decide which cases they would like to accept.  They specialize in doing the cases that other people have failed at).  The other poster was right.  Cleveland Clinic is very good, as is Mayo Clinic.  You need some place that has done hundreds in a year, not just a few.

I don't know much about the ganglionated nerve plexus ablations, but what i do know is that my arrhythmia was directly related to the vagus nerve (part of the parasympathetic nervous system), and that by ablating the nerves, there was a greater chance of success with the procedure.  If you google "ganglionated nerve plexus ablations" you will likely find some research that Dr. Jackman has done.  There isn't much out there, as only Dr. Jackman and one other team in california are working on this concept (this was very frustrating for my boyfriend at the time, who was a doctor, because he wanted to read up on my procedure and there wasn't much out there!)

My last ablation was also a pulmonary vein isolation...that is the treatment of choice for A-fib.  There are 4 pulmonary veins that enter into the left atrium of the heart, and the heart tissue and vein tissue intertwine...this is thought to be the focus of A-fib.  So, if you burn a circle around each one (which is what the ablation is), you cut off a lot of potential pathways.

Swallowing-induced SVT just means that every time i swallowed food, drink, or burped (causing a change in the esophageal pressure in the other direction) my heart rate would temporarily go up to 200 bpm.  i was never in a constant A-fib (mine was mostly a flutter), but i got dizzy when i was eating, and it was rather uncomfortable.  That's why i chose to have it done.

I forgot to address the issue of the hematoma in the last post.  If they didn't apply adequate pressure on the right groin, it could definitely be the cause of the hematoma.  Even when they DO apply pressure, those can happen.  Frustrating, i'm sure.

My first two procedures were a waste of time, as i was asleep, and not swallowing (I ended up staying awake for the second two, and drinking soda on the table to induce my own arrhythmia), so nothing could be done.  They were done 2 months apart.  My second two were done 6 months apart.  The doctor recommended at least 2 months of healing, but i needed 6 months as there was traveling involved, and i also needed to work up the courage to go through another 9 hour day, lying on that table, drinking soda.  it was a long day!!

I hope this helps.  you are a good person for trying to find what's best for your spouse!!

steph

[dquenzer]

I was ablated for paroxymal afib and it succeeded the first time.  But mine was a pulmonary vein isolation which is a very specific type of ablation.

I have a friend who had constant afib and he had a maze procedure done while having a heart valve fixed.  It took care of the constant afib.  But the maze is an open heart surgery and is only done with in conjuction with a necessary surgery.

The EP I went to was at Mayo in Rochester, Minnesota, USA.  They are the real pros as well as Cleveland Heart Clinic.  If you have socialized medicine like Canada I wouldn't trust the doctors simply because they really don't do enough ablations (too expensive).  

If you want to get rid of constant AFIB you need to go to a very very good EP specialist.

[Jillyd]

Hi Steph
Thanks for your reply
Can you please give me the name and location of the EP who fixed your AF.
Do you have any more info on how the nerve plexi may contribute to this condition.
Please explain what you  mean by a (swallowing - induced SVT that was treated like an A-Fib)
I have heard that it does not help if you are in AF all the time.
Was your AF present all the time or was it paroxysmal.
How long did you wait between each procedure.

[StephPT]

Here's what i can tell you, and my knowledge only comes from my own experiences and my work in a hospital, so take it as you wish.

When you say "permanent A-fib", i assume you mean all the time, as opposed to "paroxysmal A-fib" which is intermittent and unpredictable.  The research has shown that the longer A-fib is present, the harder it is to get rid of, by any means (medication, cardioversion, or ablation).

15 procedures in one year is not a lot, by any means.  And, just because he had done 15 ablations doesn't mean they were all A-fib ablations, so please correct me if i'm wrong.  The EP i originally saw does 1-2 ablations every week, but had only done a handful of A-fib ablations in his lifetime.  they are MUCH more challenging.  The guy who eventually fixed my arrhythmia (which was a swallowing-induced SVT that was treated very much like an A-fib), does approx. 8 ablations every week (he oversees two EP labs simultaneously, directing a team of doctors in each one...he is one of the best in the world) and is doing cutting edge research regarding A-fib and the role that nerve plexi in the heart play in it's cause.

As for being short of breath, this is not uncommon with A-fib, which is a very inefficient heart rhythm to be in...you just don't circulate blood very well that way.  He is also common post-procedure, as the heart recovers.

With regards to being cold, this may be the coumadin (warfarin).  It is a blood-thinner (and, it's also rat poison), and can make one chilly.

I understand your frustration with a failed ablation, as it took 4 attempts (2 with this world-class guy, and i had to travel quite a distance to see him) before it was resolved.  I think i second opinion is a wonderful idea...it's just a shame that it's so long until that happens.

Good luck!
steph

[Jillyd]

My husband has permanent Atrial Fibrillation.
The procedure was performed at The Prince Of Wales Hospitial Sydney Australia.
We were advised by the cardiologist the surgeon was the best one for doing this operation.
His name is Professor Mark Mcquire.
he advised us he has performed approx 15 abalations last year.
Everyone was successful.
he has not had to perform a second one yet.

After the procedure in post op the staff only applied pressure to his left groin and not his right groin.
Since the surgery he has had a bleed in his right leg causing a hematoma, brusing and swelling.
Would this have been caused because no pressure was applied to the groin straight after the surgery.
he is taking Sotatol 80 mg twice a day to slow his heart rate.
He also is taking Warfarin daily.
One of his symptons is feeling cold all the time even though it is 38 deg here at the moment.
What would be causing this sympton.
Another sympton is he gets breathless very easily, just by walking around.
Is this symptom caused from the surgery and will it get better.
We have arranged to see another cardiologist on the 8/1/07 for a second opion.

[Momto3]

Sorry to hear the ablation attempt was unsuccessful.  

I had two ablations in 2003 for pvcs.  The doctor told me ahead of time that it might take more than one procedure because I was multifocal and they planned to ablate conservatively. Each procedure took about 7 hours, and both were done via the groin. I was really happy with the results after the first procedure (a holter showed a drop from over 20,000 pvcs/day to 6,000/day), but the doctor felt it would be best to ablate again.  

What type of arrythmia does your husband have?

[CollegeGirl143]

First we'de need to know

what type of arrhythmia does your husband have? Where was the procedure done? Who specifically did it and do you know how many ablations they have done in the past?