Complicated problems!!!!!!!

[ccu nurse]

I am a 25yo female CCU nurse(had a pacemaker for 1 year) that just had my 4th ablation about a month and a half ago at a wellknown facility.All my other ablations seemed to be successful for a month or so but then I start again with fast rhythms.This time they used both the ESI system and the Carto mapping systems.They did transseptal punctures and burned a left sided tach with inverted P waves and they also ablated 2 other ectopic sites in the right atrium along with burning the slow AV pathway.They were very pleased with the results and me too but 4 days later I suffered from a stroke and have been extremely sick. I am now on Coumadin and regaining my speech and other neuro deficits. The questions I have are #1: while in hospital I had TEE that showed iatrogenic ASD from the ablation with minimal shunting and also they said a PFO because they made 2 holes, how long does this take to close and will it be a future problem? Do I need to have a follow up TEE and if so,when? #2:I am again having tachycardia with rates as high as 220 but it seems to be sinus tach with upright P waves(no junctional rhythms seen so far). Is there anything else I can do or try? Meds don't seem to help much at all.#3: I am also having ventricular pacing in the 130's despite all pacemaker changes and this is causing terrible neck beats and discomfort(it feels the same as when I'm junctional). Is there anything I can do to get this to stop? #4:They mentioned total AV ablation, should I consider this?? Will I still suffer from all the neckbeats and symptoms because of AV dyssyncrony??

[CCF-M.D.-CRC]

Dear ccu nurse,
I'm sorry to hear of the complications with your procedure.  Stroke is a rare but serious potential complication of left-sided ablations.  Hopefully you are regaining the neuro functions you lost. I have tried to answer our specific questions as best as possible below.

#1: while in hospital I had TEE that showed iatrogenic ASD from the ablation with minimal shunting and also they said a PFO because they made 2 holes, how long does this take to close and will it be a future problem? Do I need to have a follow up TEE and if so,when?
A: Patent foramen ovale (PFO) is probably a more accurate description of the situation than atrial septal defect (ASD) although they may use the two terms interchangably.  Usually these will close within the first 6 months following the procedure.  A follow-up surface echo should be enough unless there is additional concern.

#2:I am again having tachycardia with rates as high as 220 but it seems to be sinus tach with upright P waves(no junctional rhythms seen so far). Is there anything else I can do or try? Meds don't seem to help much at all.
A: It would be hard to say without seeing the strips and what the found on the EP study.  Yet another ablation is always an option.  If you wanted to be evaluated here at the Cleveland Clinic I would recommend Dr. Schweikert or Dr. Saliba. you can make an appointment with either of them by calling the number below.


#3: I am also having ventricular pacing in the 130's despite all pacemaker changes and this is causing terrible neck beats and discomfort(it feels the same as when I'm junctional). Is there anything I can do to get this to stop?
A: It would depend on how the pacemaker is programmed and what is your underlying rhythm.  It may be possible to reprogram the device so it is more comfortable for you.  


#4:They mentioned total AV ablation, should I consider this?? Will I still suffer from all the neckbeats and symptoms because of AV dyssyncrony??
A: This would be an option of last resort.  It would control the ventricular rate but would not address the AV synchrony issue and would leave you dependent upon a pacemaker.

[jackdrum]

Sorry to hear of all your problems at your age.   I was a atrial fibrillation patient most of my life, but in 1998 I had the Maze procedure which completely cured me.   I am free of any arrhythmia problems and not on any medication, and no pacer.   It was a complete cure.
I'm not sure if it would be a option for your problem, but it would sure be worth checking on.  I wish you the best on what ever you do.   ***@****