A-fib diagnosis

[JP63]

My husband was diagnosed this week with A-fib in a preliminary pre-opt examine for total knee replacement.
We saw a Cardologist the next day who took an EKG and said he had atrial fibrillation, and since the irregular
heartbeat was first notice 8 years ago, he said it was zero percent change of returning the heart to normal
rhythm.  The option given was to start on Coumadin to prevent blood clots as there is a risk of stroke.

We live in a small town with only one Cardiologist.  If there has been no attempt at trying a medication to
regulate the rhythm, how is it known there is not a chance? Also, the Cardiologist said it was ok to preceed with
the total replacement, in spite of the AT finding.  Isn't risk of a blood clot much higher with this untreated condition,
and would it be safe in your opinion?

[BLM_56]

You need to see an ElectroPhysiologist.  EPs are specialists/experts in the electrical activity of the heart.  I don't know where you live but if your husband is as debilitated as I was pre-implant he has to be feeling pretty miserable.  Pre-implant my rhythm was not only irregular it was irregularly irregular.  It would speed up - 140 bpm or so - and slow down - as low as 30 bpm - totally at random with no rhyme or reason.  On a good day I felt half alive.  On a bad day I would get up; prepare a bite of breakfast and go back to bed and sleep till my wife got home from work that evening.  I cold not work and was really not good for much of anything.  More than once I looked at the 40 caliber pistol I carry on the job and wonder if/how badly it would hurt to blow my brains out or put a 155 grain hollow point into my malfunctioning heart.

The problem is one of rhythm control versus rate control.  My understanding is that meds can be pretty good for rate control but not much use for rhythm control.  Also, Ablation is less effective for correcting atrial arrhythmias than for ventricular.  AT BEST the odds on an ablation fixing a-fib are 3 to 2.  If that doesn't work there is only a 50/50 chance a 2nd ablation will correct the problem.  After the 2nd ablation the odds get worse fast.  If the diameter of your husband's left atrium is larger than 5 cm than the odds on ablation START OUT BAD.  Above 5.5 cm the odds are SERIOUSLY against ablation correcting the problem.  Plus if your husband's problem is multi-focal the odds on fixing things are flat out lousy.

I don't know what you bean by "total replacement" but I suspect the Cardiologist was talking about ablating the AV node and pacing the ventricles 24/7.  As I (and several others who visit this forum) can attest you can live nicely with a microcomputer making your heart beat.  It isn't optimum but it a WHOLE FRAKKING LOT better than living with a-fib and the ventricles beating irregularly.

As for coumadin - if he isn't on it he should be REALLY SOON.  A-fib produces turbulence which can cause blood cells to clump and form a clot.  And yes in that instance a stroke is a possiblity - if he's lucky.  If the clot forms in the right ventricle it can travel out the pulmonary artery to one of the lungs.  Google "pulmonary embolism" - but only if you have steady nerves.  

If the clot forms in the left side of the heart then things can get interesting - and lethal - in a hurry.  If the clot happens to enter the coronary artery system (which comes off the heart BEFORE anything else) then you are looking at coronary thrombosis and a heart attack.  If it goes into the aorta and misses the taps for the carotid arteries then it can go to major organs - liver, kidneys, suchlike and wreak havock.  Or maybe it will go out into the body and cause nice things like deep-vein thrombosis or even gangrene.  If the clot exits the left ventricle and goes into the carotid - the first tap off the heart after the coronary arteries - then you are looking at an ischemic stroke.  That sort of thing can KILL you or with luck just disable you.

Coumadin isn't so bad.  You just have to "watch your levels".  They have a test that compares how long your blood takes to clot versus "normal" blood.  The test results in a number.  If you need coumadin - an someone in permanent a-fib NEEDS coumadin or something like it - you want a number equal to or greater than 2.  That means blood tests at least once a month and watching what he eats.  Lots of stuff has vitamin K in it.  If your diet includes a generous number/amount of those foods then you need more coumadin.  Me, I try to just eat low fat (nothing to do with blood clots but over all good for me) and avoid foods rich in vitamin K.  My cardiologist GAVE me a copy of "The Coumadin Cookbook" by MD Rene Desmarais, RCS Greg Golden, and Gail Beynon but you can get it on Amazon.com for around $12.50 in paperback.  Search "books" for the title "Coumadin Cookbook".  B&N has it also for a couple of bucks more.  

Or you can just get rid of your husband by withdrawing his coumadin and feeding him a lot of green leafy vegetables.  Of course he might NOT have a fatal stroke/heart attack and then you'd be stuck with him in a disable state.  If you want to keep him around it's got to be a team affort.  But you really need to head to the nearest large metropolitan area and take him to see an EP.  If you have described things accurately he is likely to wind up with a pulse generator (pacemaker) implanted under the skin of his chest and feeling a LOT better.  I know I do.  I am in better health today that I have been in nearly 10 years.

Good luck. Keep us posted.

Bionic Bill
Cyborg At Large