HCM afib

I have HCM. The last 3 years I have had afib. I have had 4 ablations, with some progress for short periods of time. The doctor who I am seeing (probably the best and most aggressive Dr for atrial rhythms in the world) says one more ablation should get what is left. The problems are, however, that first I do not want to go 10 ablations deep, and second I think all the ablatioins are causing structural problems in my LA. My LA 54mm.

I have always been told that a/v node ablation might not help, because I would need the atrial kick of sinus. However, if my heart rate stays low, and I am able to get off all these meds that affect my blood pressure/heart efficiency, then maybe an a/v node ablation would help.

There is also the surgical maze and LA reduction surgery. I do not know much about it. Either way, I guess I am asking any HCM afib patients out there, what they have done. Did they go 5 or 6 radio frequency ablations before finding success? Did they have the a/v node ablation? Did it help? Keep in mind my LA is 54mm. Those with larger would have less success, those with smaller would have more success. Thank you for any insight.

-R

[Jerry_NJ]

Just some input.  I had a mini-maze when I underwent mitral valve repair in November 2007.  That did not stop my AFib. The surgeon gave the procedure a 60% chance of success... I am in the 40% group.  Your odds may be much better given you have normal size LA (mine was much larger) and you are much younger, I'm twice your age.  I have not had any ablation work and my cardiologist and a consulting EP said no, due to my low symptom problems with AFib and the medications, and a low probability of success... again you heart condition is much better than mine, but still ablation hasn't worked you tell us.   I am sorry it hasn't worked for you, but it sounds like it is worth another try given what your doctor says.

[grendslori]

My daughter has had several ablations done to try and control all of the electrical problems with her heart (WPW,SSS,RBBB,LBBB, A-Fib and NSVT with a Mahiem Fiber) She also had a severe form of HCM that affected all of the walls of the heart, not just the septal wall which is the most common form of HCM. More than likely your ablations are not what is affecting your LA; it's the HCM that is probably doing that. Arrhythmias are a very common result of HCM and can be difficult to treat because if one does something to treat the arrhythmia, the HCM may not tolerate the treatment too well. Another thing is that doctors don't tend to tell their patients that if the electrical tract to be ablated is not electrically active on the day of the ablation, the doctor will have a very difficult time trying to ablate that tract and therefore the arryhythmia is going to be still a problem.

[ksig]

I have AFib and have had 4 ablations, the last for ablating the AV Node/junction.  I am happy that I did the last one.  I already had a pacer, so the procedure was only 30 min in length but still had to lay flat for 4 hours (only used one catheter!).  I still have AFib but I am not on any meds except for coumadin.  Previously I was on a boat load of meds including Tikosyn. The pacer reegulates your heart and you are not reaching those high rates any more.  That is such a great feeling to be in NSR for sustained periods of time.  I am due to have my pacer switched in 6 weeks as as the generator is low on power.  I am looking forward to the new pacer model as they continuously make improvements  (maybe the new one will come with a GPS..HAHA)  To reiterate, I have never regretted the AVJ ablation.

Good luck to you as you make your decision.
ksig

[PikaPika88]

Pacemaker with GPS is not very useful.  I wish it can through external charger so we don't need to cut and sew when the battery run out.