Looking for a cure

My rhythm problems have perplexed my EP/ Cardiologist. I had afib w/ rapid vent response that could only be terminated with cardioversion. I subsequently went for EP study in Oct 06' and was found to have AVNRT, he tried to ablate but could not. I then went in again to Tufts NEMC in Nov 06' for another try, this worked for about 6 weeks and was back with a vengence. I then went into the Brigham&Woman's in Jan 07' for another ablation. Dr thought this time was sucessful. I have had multiple event monitors for recurring symptoms. Latest strip showed a WCT at 250 bpm. Initial thought was that it was a V-Tach, but after my Dr had time to really examine the strip it was a very rapid afib with abberency. I have failed drug therapy (Flecainide, Sotolol, Rhythmol) I have 2 different Dr's suggesting 2 different courses of treatment. One suggests trial and error with more meds, one suggests short course amioderone or pacemaker implant. I am so sick of this whole thing and just want my life back. There is not one day that I am not completely worn out. I am only 39 years old and until this, led a very active life. My primary cardiologist is completely perplexed. I can see the frustration on his face when I go in for my appt. and when he says, "I just don't know what more to do" I certainly don't get a warm fuzzy feeling inside.

My questions are:

1. I know that a pacemaker would not cure the afib, but would keep the rate under control. Would this be a decent option for me?
2. My Dr had suggested me getting a 3rd opinion at Mass General with Dr. Mansour. I'm not sure that I want to start over with yet another Dr., how many opinions do I really need?
3. I am not looking for a bandaid to my problem, I am looking for a permanent solution. If I were your patient, what would you suggest I do?

[Michael J. McWilliams, M.D.]

1. I know that a pacemaker would not cure the afib, but would keep the rate under control. Would this be a decent option for me?

If I were 39, I would not want a pacemaker.  You have be Brighams and Womans, go back for a consult from Dr. Stevenson.  Ask him what he thinks.

2. My Dr had suggested me getting a 3rd opinion at Mass General with Dr. Mansour. I'm not sure that I want to start over with yet another Dr., how many opinions do I really need?

I think Stevenson will give you a world class opinion. He will have access to your previous records.  His opinion is respected world wide.  Clearly if there physicians at very reputable institutions have had recurrence, there is something different about this mechanism.  A pacemaker is the easiest fix, but might not be the best long term solution.

3. I am not looking for a bandaid to my problem, I am looking for a permanent solution. If I were your patient, what would you suggest I do?

I would go see Stevenson in Boston, Calkins in at Hopkins, Tchou at the Cleveland Clinic, Morady at U. of Michigan, Packer or Asirvathum at Mayo or a host of other very well respected authorities on EP.

Good luck.

[PikaPika88]

Hi, if you had afib w/ rapid vent response,  "daily runs of afib some short others not short enough" how can you still get not short enough?  Isn't it few beats of A-Fib then it travels to Vent?   From that point will get very very dizzy, the heart could be re started again or it played "loops"?  I might be wrong or misunderstood.  I got a pacemaker and I only got short bouts of A-Fib and A-Tach.  

[Brooke_38]

Thank you for your quick response. Dr Stevenson was consulted and reviewed the rhythm strip with my cardio. His options were short course amioderone, pacemaker or afib ablation. I am now left with 2 Dr's(1 who wants to treat empircally and one who wants to treat aggressively)  .

I guess I will have to seek a 3rd opinion and see what he or she suggest I do.
Thanks again for your insight.