Re: Ablation

Posted By CCF CARDIO MD - MTR on January 19, 1999 at 10:48:35:

In Reply to: Ablation posted by Tracy on January 18, 1999 at 22:37:25:






My mother has had heart problems for the last 20 years.  She is now 57.  She was first treated for mitral valve prolapse.  For the last 10 years, she has been treated for atrial
fib..  Two years ago, she received a pace maker because she had to go on norpace.  She has had numerous break throughs in the last 6 months and they just seem to get progressively worse.  She has been in the hospital several times.  Her doctor told her she has now developed a flutter in addition to her afib..  The norpace is not taking care of this and she has been advised to have and ablation.  The first plan of attack is to look for the path and stop it there.  However, if this is unsuccessful, they will perform the ablation at the av node.  We have tried to research this option but it is hard to find very much information or people who have had this procedure done.  Do you believe this is a wise choice or are there other choices equally as effective.  Mom is scheduled for the procedure on January 26th.  We are short on time and any information you can send our way would be greatly appreciated.  I am not sure my Mom believes this procedure is right for her but we also can't find any alternatives.
  



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Dear Tracy, thank you for your question.  Atrial flutter can often be eliminated through a catheter-based procedure called radiofrequency ablation (RFA).  During this procedure, catheters are used to map the pathway of aflutter in the atria and the pathway is ablated with the application of radiowave energy.  If the aflutter is ablated, then atrial fibrillation is less likely to recur.  However, if the aflutter ablation is unsuccessful, then the AV node can be ablated.  Since your mother already has a pacemaker, if the AV node is ablated, then her pacemaker will control her heart rate and the atrial fibrillation will not be transmitted to the ventricles.  Thus, her heart rate will always be controlled.  Norpace sounds like it hasn't worked to maintain sinus rhythm in your mother, so other medications like sotalol or amiodarone may need to be considered.  Since medications are never 100% successful at maintaining sinus rhythm, an ablation procedure may be the best option for your mother, but you will have to get more details from her own cardiologist.  Finally, your mother should be considered for treatment with coumadin to thin the blood since she is at risk for developing blood clots in the heart from the atrial flutter and atrial fibrillation.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.