Congestive Heart Failure

[Cibe]

I am a 78 year old male Caucasian with congestive heart failure (dx Oct 2001).  Other health conditions I have include:
• 1 deg AV block identified 1953
• Atrial Flutter dx’d 1986
• Polycythemia Vera, since 1990, dx’d 1994
• Atrial fibrillation, since 1992
• Variant of benign paroxysmal positional vertigo, dx’d 1994
Medications I am taking include:
• Hydrea (for Polycythemia Vera)
• Triamterene (Diuretic)
• Coumadin (for Atrial Fib)
• Lanoxin (for Atrial Fib
• Topral XL 50mg (for CHF)
Supplements taken include:
• CoQ10 – 100mg AM & @ PM
• Bovine Colostrum
• Chlor Trimeton
Height  - 72” ;Weight – 162#; BP 110/61; Pulse – 55 - 70, irregular
Blood Counts:
• Hematocrit – 44%
• Platelets – 260,000
• INR – 2.5 (w/coumadin)
My CHF symptoms include:
• Edema in legs;
• Easily fatigued;
• Shortness of breath with any exertion or climbing stairs.
• Need a daytime nap if don’t get 10 hours sleep at night.
Medications taken to convert to sinus rhythm include:
• Quinaglute
• Norpace
• Codarone
• Rythmol (held sinus rhythm for approx1 year;
Cardioversions attempted  3-4 times, unsuccessful
(Our dog takes us for a 2 mile walk every morning – handle reasonably well as long as on level ground)
Questions:
1. . Do Pulmonary Vein Ablation operations
• improve the quality of life of the CHF patient,
• serve to reverse CHF;
• extend the longevity of the CHF patient?
2.  Might I qualify as a candidate for Pulmonary Vein Ablation to correct Atrial Fib?

[CCF-M.D.-RCJ]

Cibe,

Thanks for the informed question.

Pulmonary vein isolation procedures are particularly useful in patients with "lone afib".  Lone afib describes afib in someone without significant other cardiac medical history.  Your afib could not be called "lone afib" due to your other medical history.  I think that a pulmonary vein isolation procedure would likely not be beneficial for you because the source of your afib is not likely to be found in the pulmonary veins.

Judging from what you have provided, your afib is likely a degenerated rhythm from an aflutter focus.  It is possible that you could be helped by an ablation procedure for the aflutter, if indeed you had this in the past and its sight of origin could be identified during electrophysiology testing.  However, I am also doubtful of this strategy.

In looking at your medicine regimen I am struck that you are not on an ace-inhibitor.  These medicines are standard of care for patients with CHF.  Also, the numnber of cardioversions performed is not high -- many cardiologists would attempt repeat cardioversion if indeed your CHF is made worse by the afib.  Also, why do you have CHF?  Afib is usually not the cause of CHF, although it can be in patients with severe tachycardia from the afib.  Maybe correction or treatment of another condition would improve your symptoms as opposed to treating the afib.

Hope that helps.