Re: Atrial Fibrillation

Posted By louis on May 04, 1999 at 20:41:50PI am 52 y/o male in excellent health with solo paroxysmalbrfib for approx 6 yrs. I have had all dx testing including echos (esophageal), stress testing(thallium),r and l heart cath w/swan ganz pressures....all very normal.brI have been on various meds to control rate and rhythm, none of which worked for more that 9 mo, including procanamide, quinidine, flecanide (had adverse reaction w/ventricular tach), and cordorone. I am currently only taking verapamil for rate control and coumadin...no rhythm control med. In the past I have been in atrial fib almost continuously when not controlled w/med. However, in the last 6 mo since I have dc'd the latest drug Cordarone, I have  been in atrial fib approx 8-10% of the time. I have episodes about every 1-2 wks of 8-12hrs up to 36 hrs of atrial fib, then convert on my own. The atrial fib almost always starts when I am asleep and goes away when awake and active.brI have the following questions:br1) Is it possible that the cause of my atrial fib is lessening...or have you known of patients who had atrial fib and experience a complete recovery? Or, should I be more pessimistic and expect it to get worse as I get older?br2) Is there any other medication that I could try to control the atrial fib that has few adverse reactions.?br3) Is there more likelihood that I will continue to have atrial fib at the current frequency, that it will get better or worse (considering that it has lessened from 100% of the time to only 10% in the last 6 yrs).brThank you very much for your support and advice.PPHR WIDTH=75% SIZE=4 COLOR=#000090

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 05, 1999 at 15:19:29PDear Louis,pQ:  Is it possible that the cause of my atrial fib is lessening...or have you known of patients who had atrial fib and experience a complete recovery? Or, should I be more pessimistic and expect it to get worse as I get older?brA: In general afib does not lessen unless treated with medication.  pQ:  Is there an

[louis__0]

Posted By louis on May 09, 1999 at 18:02:44

Thank you  for your feedback...can you give me some idea of what "non medical" options might be on the horizon ?
I have tried several medications all of which either failed or caused side effects. I am currently experiencing an increase frequency and time period of atrial fib even since I wrote my first question. Thank you.

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 10, 1999 at 09:34:57

The non-medical approaches I'm referring to are the Maze procedure and catheter ablations.  The Maze procedure is a surgical option that is currently available and is curative in 80-90% of patients.   It involves open heart surgery and is not usually done unless there is another reason to operate. (i.e. need to repair heart valve).  The catheter approach is still in its infancy but attempts to cure afib through ablation.  In 5 to 10 years there may be a good catheter approach but currently the success rate is rather low.
Hope this helps.  Feel free to write back with additional questions.

[Jef__0__0]

Posted By Jeff on May 25, 1999 at 22:33:27
These ablations .. my daughter has WPW, she is 20 years old, where can I get more information on the cutting edge procedures... it can be a medical site.. I have some medical knowledge in terminology and physiology/anatomy.  I am interested in the studies for treatment by ablation for WPW and who are the best of the best cardiologists/surgeons for this option.  She has not had this WPW all her life, it surfaced in her adolescent years.  I have visited some web sites and they often state that ablation procedures can be done if the node is found?  Do the doctors have trouble locating the area for correction?  Any information from you would be appreciated.  Thank you.

[Cleveland Clinic, MD]

Posted By CCF CARDIO MD - CRC on May 26, 1999 at 14:11:49

Dear Jeff,

Here is some information about WPW and sites with info on ablations.
Wolff-Parkinson-White (named after the three doctors who first described it) is a hereditary condition.  It may not be diagnosed until adolescence but the underlying cause is present at birth.  More information concerning ablation may be found at: http://www.heartcenter.ccf.org:8080/patinfo/patguide/p_ablate.htm
Good luck.
Q: What is the normal condition?
A:In a normal heart the atrio-ventricular or A-V node is the only path for electrical conduction between the atria and the ventricles .
Q: What is the Wolff-Parkinson-White syndrome?
A: If an abnormal conduction pathway runs between the atria and the ventricles, the electrical signal may arrive at the ventricles too soon. This condition is called Wolff-Parkinson-White syndrome (W.P.W.). It is recognized by characteristic changes on the electrocardiogram that indicate that an additional pathway or shortcut from the atria to the ventricles exists. Many patients with the syndrome do not have symptoms or episodes of tachycardia (rapid heart rhythm).
Q:  First of all, what is the cause of WPW? Is it something you 'get' when you over exercise?
Is it genetically rooted?
A: WPW is a congenital condition.  It is not induced by exercise or any other strain on the heart.
Q:  How common, in the general population is WPW?
A: The incidence is about 1 in 1000.
Q: How is the Wolff-Parkinson-White syndrome treated?
A: If a person has episodes of tachycardia , often they can be controlled with simple **************. However, sometimes such treatment doesn't work. Then the person will need to have further tests of the heart's electrical system. The procedure most frequently used to interrupt the abnormal pathway is radio frequency ablation. (http://www.heartcenter.ccf.org:8080/patinfo/patguide/p_ablate.htm)

Most patients with the syndrome can lead normal lives with no restrictions on their activities. This is true even for those who have episodes of tachycardia.
Q: How safe is the ablation? What are potential problems that may arise either during the ablation or afterwards?
A: Ablation is a routine procedure that uses high powered frequency waves to burn electrical short circuits in the heart.  As with any medical procedure there are potential risks and your doctor should discuss these with you prior to the procedure.
Q: Is there any kind of a rating system for the doctors which perform this type of procedure, simply put are some doctors better than others at this procedure and how may I find out who is the best?
A: There are no rating systems per se of individual doctors.  You can ask for success rates of the same procedure in other patients.  There are ratings of hospitals that are published by independent groups such as US News and World Report that give a ranking of programs.
Q:  How common is this procedure and how many are performed daily, weekly or yearly?
A: This is a routine procedure. The number will depend upon the individual group.  The electrophysiology group here does 2 to3 ablations a day.
Q:  Is it common for a cardiologist to recommend the ablation after only reviewing blood tests, and ekg, and an echo test of the heart?
A: Yes.  The diagnosis of WPW is made from the EKG.
Q:  I am currently taking the drug Diltiazem which seems to be controlling my heart problem. Therefore, if I were to postpone the ablation procedure could I possibly be putting myself in danger of further heart problems?
A: This would depend on your specific case and you should discuss this with your doctor.
Q: Are there famous celebrities or scientists, doctors, et
cetera, who have survived this infliction?
A: Not that I know of.  Anyone out there know?
Further information can be found at:
http://www.heartcenter.ccf.org:8080/patinfo/patguide/p_ablate.htm
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.
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.











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