Need to decide on Catheter Ablation + Pacemaker or Maze procedure

[Carolyn__0__0]

  I am a 55 year old female with A-Fib. A-Fib was diagnosed in Oct. 1998 when I was admitted to the hospital with fluid in my lungs and a clot in my left atrial. Since then I have been though all the tests and everything else seems to be fine(my blood pressure etc.) A catheterization shows everything clear and free of any problem.
  I have had 5 Cardioversions, only 2 worked for a few days at a time. We have tried all the medications and none of them work. The most they have been able to do is slow the heart down and not very good at that. My doctor feels it is still going to fast.
  Right now I am taking 3mg Coumadin, 0.125mg digoxin, 240mg Cardizem and 400mg Pacerone daily. My doctor feels we need to look at other alternatives. I should also mention that the tests revealed a Rhumatic Mitral Valve and I am told it will need replacing in 5 to 10 years.
  Recently I saw an Electrophysiologis who has recommended a Catheter Ablation and a Pacemaker or my only other choice is a maze procedure which your clinic offers. One procedure being low risk and the other high risk. I am confused about which is the best way to go. I am an active person and I understand that a Pacemaker has it's limitations.
  I would like more information on the Maze procedure and it's benefits. My doctor's concern is that it would mean 2 open heart operations (because the Mitral valve will need replacing) and a second operation would be harder because of the scar tissue from the first one. It it possible to do both at the same time?
  I need to make this decision soon as my doctor is concerned about the effects that
   the pacerone can have on other organs when it is not doing the job it should.
  Thanks for your time.
  Carolyn

[CCF CARDIO MD APS]

_
Dear Carolyn,
Yours is a fairly unique case in that your a.fib is literally impossible to control medically, and my best advice to you is to come to the Cleveland Clinic (if not at least to a place like this that has vast experience in treating rheumatic/valvular heart disease, difficult to treat a.fib, and one that has experience with Maze) for an evalution.  One thought I have in reading your history is how much is the a.fib related to your valvular heart disease and as you ask, would the a.fib abate with fixing the valve (a.fib is often a sign that a valve needs to be fixed sooner rather than later.)
It is possible to have both procedures done at the same time, however it needs to be appropriate for your specific case.  Also, the Maze procedure is being done now without open heart surgery, i.e. done with catheters much like a cardiac catheterization (through veins and arteries in the groin.)  This technique (i.e. Maze with catheters, not open heart)is still in 'experimental' but very close to being available to all patients.  
Just so you know, Maze is a technique whereby the likelihood of an abnormal rhythm (a.fib)is reduced by making cuts/lines of scar throughout the atrial walls to block the propagation of the abnormal rhythm.  The statistics, i.e. success rate and risks of the procedure, are highly dependent on the institution and the operator who performs the procedure; thus I suggest you seek an opinion here.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
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