follow up?

Hi doctor.  Thank you for providing this service.  First, I had SVT from childhood until June 2000 (I was 34 at the time), when an ablation was performed in a Northern KY hospital.  The doctor stopped my Calan for three weeks prior to ablation, and had me wear a monitor to try to record the SVT.  What was recorded instead was several episodes of AFIB (lasting a few seconds), two epsidodes of VTACH (6 beats each), and PVC's.  My doctor was not concerned with the AFIB or VTACH, and linked it to stopping my calan after 10 years.  All other tests includes stress and echo were normal.  During the monitoring period I was able to find records from previous ER visit that documented the SVT, so the ablation was performed.

The good news is that I have had no sustained SVT for over two years since the ablation.  My questions are as follows:

1) I continue to have PVC's and PAC's, sometimes a 100 or 200 a day.  Does this warrant a follow up visit for further testing?

2) One thing I decribed to my doctor, which was never recorded, was what I sometimes felt before the SVT started.  It was a strange feeling that my heart was not beating correctly.  Sometimes in would last several minutes, sometimes an hour, but it usually lead directly to the SVT.  My doctor thought I was describing AFIB.  Are AFIB and SVT sometimes linked together?  Can one ablation stop both?

Thank you for your time

[CCF-M.D.-KE]

Dear Steveb,

You are describing continued episodes of atrial fibrillation and non-sustained ventricular tachycardia. The holter monitor also seems to have shown PVCs and PACs. The PVCs and PACs can be treated with a beta blocker and don't particularly have any long term implications in the setting of a structurally normal heart.

There are different ablation procedures for different forms of SVT. For example atrial flutter, atrial fibrillation and AVNRT are all forms of SVT which  carry their own individual  ablation techniques. It is unclear what type of ablation you had.

I think you should ask your doctor how frequently you are experiencing atrial fibrillation. A beta blocker would be excellent for controlling  the atrial fibrillation and the NSVT.
Also an apirin 325mg per day may be beneficial. Discuss this at length with your doctor.


Thanks for your question,


CCF-MD-KE

[Kymom]

I am curious to know which N. Ky hospital performed the ablation?  I live in N. Ky.

My 16 year old son has LAF and we will be looking at the possiblity of having a pulmonary vein isolation ablation in the future. I have also been told this is not done in our area and his docs will refer him to another city.

I believe there are different kinds of ablation procedures and perhaps what we are looking at is different than what you had done. When I saw your post, it sparked by curiosity.

The best of luck to you!

[Lynnieben]

I have had 3 radiofrequency ablations for Atrial Fibrillation, with no success. So I wish you luck with your ablation, if that is the route you choose.  I have been trying to post a question to this board for the last week, but I keep getting the response that it is not taking any more questions for the day. Is there a certain time that you need to post a question? I tried as early as 8:00 am this morning, and it said it was full, and could not take anymore questions. If anyone knows what is a good time to post a question, I would appreciate knowing the answer. Thanks, Lynnie :)

[stevebu]

Hi.  The doctor that performed my ablation was Dr. Jefferson Burroughs, and his office is at Christ Hospital in Mt. Auburn.  He did the ablation at St. Elizabeth hospital in Northern Ky.  I know he is in the telephone book.  I found him to be very confident and professional, and I am thankful for the 2 1/2 years of freedom he has given me from meds.  I would not hesitate to call him back if needed.  If he cannot help you, I would suggest going to the Cleveland Clinic if your insurance will cover it.  Let me know if you have any other questions.  Thanks.  Steve

[stevebu]

Try to post between 8:50 a.m. and 9:05 a.m.  You will get through eventually.

[arthur]

I had LAF and it was ablated successfully despite the presence of about a half dozen PV foci (almost all located in the left atrium/PV ostia)..the procedure took about 6 hours and due to the exacting work of Dr. Francis Marchlinski of the Univ of Penn Hospital (Philadelphia) the troublesome focus was identified and ablated with no complications.  - Arthur

[Kymom]

I am quite familiar with St. E's and Christ Hospital both very good heart hospitals. I live in Florence KY, so they are very close to my home. I am also familiar with your EP. My son is being treated by a pediatric cardiologist and a pediatric ep (Cinti Children's). His ep used to be an adult ep and is now pediatric (that sounded funny,huh?). I like this because he is familiar with the adult problem but is also dealing with the child. The Heart Clinic at Cinti Children's is awesome, they have been absolutely wonderful to us. I believe his ep had been in contact with Burroughs and many other ep's across the country.

Thanks to those who shared their experiences with ablation. I am very excited to learn that there is something out there that will cure this crazy thing. Our current plan is to try 1 - 2 additional medcations, getting ready to switch from Sotalol to Flecainade. So far he has been very fortunate with very few side effects from medication. When he has an episode he doesn't feel any different. This is more of a nuiscance than a hindrance for him. The meds seem to work for awhile but then he breakthroughs with AF. Since diagnosis about a year and half ago, he has had around 7 episodes. The last 4 required cardioversion. He has made some adjustments in his life because of this. I can't prove it but there is some correlation with his AF and the level of physical activity preparing and playing football. Nothing ever happens so you can see that when A happens therefore B occurs. Nothing has ever happened during activity or right after activity, it's usually when he isn't doing anything. But, if I look at the period of time and see what was going on during that time, I can see it somewhat. Perhaps I am reaching!

The procedure my son is looking at is Pulmonary vein isolation ablation. While I think this will happen at some point, I do have to admit some fear with it also. I am excited to know that this can be a cure for most people. I am encouraged to hear success stories. I have read alot about it. I keep keying in on the fact they are improving it every day. I also have some concerns about long term effects, the long term effect on a 60 year old is different than a 16 year old. From what I have seen, no one has done this procedure on someone so young, although I am told his age isn't a problem. My thoughts are if meds can buy some time, then I would like to wait while they improve this procedure. If it can be 100% better a year from now, I would like that. Of course, if my son gets to the point where he can't tolerate meds or is in AF frequently, then there is no hesitation in what needs to be done. Our docs support this thinking. Of course, I think they would support whatever we decided. They have talked about sending us to Indianapolis for the procedure. I will cross that bridge when I get there as far as the where and the who.

It seems the docs who do this procedure are all for it and the ones who don't do the procedure are a little more cautious. I think I am on the side of cautious...at least at the moment.

Thanks again for sharing your stories.

[stevebu]

What a small world.  I also live in Florence.  You are right to be proceed with caution.  The first doctor I saw in 1993 was pushing me to get the ablation done, because he was anxious to try out this newer procedure.  He was a little to anxious, so I waited until the ablation was a little more perfected and I found a different doctor.

I wish I would have been a little clearer with my questions to the doctor in this forum.  Since the ablation in June of 2000, I have not had any long runs of anything.  I still notice PVC's, and PAC's, and once in a while a few seconds of what feels like AFIB, but that is all.  I know the PSVT I had before is gone.  Maybe I am just getting all of these terms confused.  

[arthur]

LAF is curable most of the time.  I had the same bit as your son, AFib kicking up about 6 times in one year ( four times due to exertion...playing soccer; two times due to a cold drink after mild exertion).  In all cases, I converted on my own within 10-20 hours.  Please note that LAF has a history of gradually becomming more permanent (as I understand it), perhaps because the atrial tissue begins to remodel itself electrically, making it easier for AF to happen.  I was 52 (3 years ago) when I first got an attack of LAF and since I loved soccer, there was no question as to what I needed to do. ...The normal course of action appears to be to try meds and see what they can do, since an ablation is invasive and carries with it certain risks.  I personally don't like the meds, eg beta blockers or flecainide because the relatively mild side effects bother me too much during competitive sports.  

One more note, ... I went to four cardiologists before finding Marchlinski who knew right away what was causing my problem and how to cure it.  His batting average at the time was 67% cure with one ablation, >85% with two...with 0% complication rate.  I heard that now there are better probes and the risks are much lower.

It's still your call.  Good luck.  - Arthur

[debra21784]

Had an ablatation for a-fib post stroke .Wished I'd had it done before.My rate now stays low(used to get up to 250 with LAFand atrial flutter but still sometimes have irregular beats.Only on coumadin to prevent any more clots.The ablatation is a very safe and easy procedure and you're home after a half day and back to normal activities within a couple of days.Would recommend a academic medical center with good cardiac EP dept.There are radiofrequency ablatations now which seem to deliver a greater sucess rate. For me it was worth it.Would recommend you doing rsearch on LAF because there is literature now recommending coumadin to prevent stroke from a-fib even LAF

[Ianna]

Hello Arthur,

Hope you're well.
-
You know how I feel about these flutters, quivers and bumps.
Nasty, but I somehow have a nice life in spite of...
Now yesterday-evening I was a DUMBO.(a big one, yes)
I ate to much.
Carbohydrates and fastfood.
I felt my stomach swell.
And 'VOILA' there they were!!
All night long: quivers, bumps, small flutters, big flutters and palpitations, it was a nightmare. (And I did so well the past months).
Tried to relax; could'nt make it.
-
Is it the stomach 'touching' the heart and irritating it?
The bowel?  
Or is the Vasovagal Nerve doing 'things'?
Now today I have the occasional bump, but my stomach HURTS!!
Please give me (us) your 'view'. You studied these things, and I know you know a lot about it.
-
Second question:
I read one can have A-Fib but not have any symptoms, just as if you have a normal heartbeat, but still there must be something fluttering hm?
And doesn't it show on a EKG and the other tests?
-
I hope you'll want to answer these questions...
-
Otherwise I'm fine..  (HaHa);-)
Thanks,
-
***Ianna***

[arthur]

Good to hear from you...

I am pretty much convinced of the following 2 phase scenario:
(1) electrical activity from the foci cause premature beats by sending pulses to the pacemaker system (probably the SA node), and (2) the ease with which these focal pulses travel is in part dictated by the state of the nervous system running around and through the normal cardiac tissue.  So, assuming those of us afflicted with premature beats have active foci, those foci are cycling through their ion pulses constantly...a proportion of these ion pulses make their way to the pacemaker system and cause a premature depolarization (PAC). We can change that proportion by odd things like posture, excitement, a big meal, pregnancy, menstrual cycle dependent hormonal swings, what we eat, etc etc etc...the variables that affect the nervous system are immense.

In some circumstances, AFib can seem like a regular beat, perhaps only off to a slight extent...but the basic setup is the same, ie, the fluttering atria, which in some individuals can be readily felt.  Regardless of how they feel, the risks would be the same...potential stroke from clots forming in the inefficient atria.

I am not a medical doctor, so these statements are hypotheses based on research and not on practical knowledge.

Take care,

Arthur

[Ianna]

Thanks again my friend...
-
***Ianna***