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Massive stroke/death following ablation
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Massive stroke/death following ablation

Hopefully someone get give me and my family some direction and feedback on this subject. We just lost our mother last week to a massive stroke that led to her death. We now believe this is a result of some complication from a cardio ablation she had on May 7 and a cardio version on May 14 as well as neglect to some lingering symptoms following these procedures.

Here is her story:
In Oct of 08 she was first diagnosed with AFIB and under went the first of 3 cardio version that took place between Oct and Feb, Each time she went into rythum with no problem but within 2-3 weeks she was back out again.  She was able to function with the help of medications the last being flecanide however on May 1 her cardiologist told her that the medication was no longer able to manager the problem and she needed to have cardio abaltion.  After much hesitation and research she agreed.  The procedure was done on May 7 late in the evening. That very night she developed a intense cough and had severe pain in her chest that required pain medication.  Everyone wrote it off as expected from the procedure.  She was sent home the next day in worst shape than she arrived in.  The cough got worst and the pain lingered.  She was returned to the Dr. mid week because she was unable to breath and sleep because of the cough. Never once was blood work done or a chest xray. The cardiologist said her heart was out of rythum again and he wanted to do another cardio versions which he thought would help with her discomfort.  She agreed and it went well but she continued to get worst with the cough and discomfort. during the next 2 weeks she made several visits to the cardiologst and internal Dr seeking help for her cough and pain. Nothing was done.  On Friday May 19 she made one more visit to the hospital for a chest xray which showed she had fluid in her lungs (most likely pnuemonia (pneumonia)) but was still not seen by her Dr.  The next morning she woke up and had a massive stroke. It was rapid and completely debilitating. The MRI showed she had what they called "shower strokes" which means there are so many blood clots in her brain that came from the heart the brain damage was massive and she was going to die.  She lived on her own until Thursday, May 28th.

Sorry for all of the details but our curosity in this is if anyone has ever heard of anything like this happening before and if so any ideas on what would have caused it. When she arrive at the hospital her heart was in rythum and coumadin levels at theraputic level so none of that indicated this should have happen.

Just would like to here from anyone that has heard of anything like this before.

Thank you
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Avatar_f_tn
I'm so very sorry about your mother. That is a terrible thing to have happen and I can't even begin to imagine what you are going through. You have raised some tough questions here because it is next to impossible for most of us non-professionals to even begin to speculate on what might have happened with your mother. While there are many extremely knowledgeable people on this site, the best information you could get would come from her doctors -- if they are willing and able to communicate freely with you and you have some modicum of trust in them. I would also encourage you to speak with the patient advocate or patient representative at the hospital where the procedure was done. When something like this happens you may find once you get beyond the immediate grief that you have to be assertive with the medical professionals to get the answers and information you are looking for, and even then it may be difficult or impossible to say exactly what caused your mother's stroke and subsequent death -- either because they don't know or won't say.

With that caveat in mind, I'll try to share with you the little bit that I know about AFib ablations and stroke, but I am NOT a medical profession. Your mother's condition of having AFib is a major risk factor for stroke by itself and ablation procedures for AFib tend to carry a significantly higher risk (and are generally less successful) than ablations for other conditions, (like SVT) so having a very well trained and experienced EP specialist perform the procedure on appropriately pre-selected patients at a facility with recognized excellence in outcomes is important and sometimes, despite doing research, patients end up in less than good hands because fellows (trainees) do the work, or hospitals may be experienced at ablation for SVTs, but do fewer for AFib and don't distinguish between the two types when offering their services, etc.. But even in the best of hands things sometimes go wrong. There is some discord in the medical community about whether or not ablation for AFib is done far too frequently and by physicians and facilities that don't have the necessary expertise or experience since the outcomes are often unsuccessful and the complication rates can be high.

When ever catheters are introduced into the veins and heart, clots can form and travel through the body. Additionally, burning the lesions also causes both clots and "charred tissues", both of which can cause stroke - generally, the more burns, the more risk of stroke. In addition, many doctors recognize the need to continue with blood thinning medication in AFib patients AFTER the ablation for a period of many months as in some patients the clots have already formed in the heart during all those bouts of AFib so that even if the heart is reverted to normal rhythm, the clots may still be waiting around from BEFORE the ablation was done and when the heart starts pumping normally and more forcefully, the clots dislodge and move to critical areas in the body (brain and lungs). Clots can get into the lungs as well as into the brain. Coughing and shortness of breath can be indications of this and I am surprised they did not do x-rays or more sensitive tests to rule this out.

There are other things that can go wrong with ablations that cause coughing, chest pain and shortness of breath, like phrenic nerve damage, infection, heart attack and atrio-esophageal fistula, but I think it is unlikely that these would cause a massive stroke - although a fistula could cause air embolism, which can result in stroke. While ablations are touted as "fast recovery", there are studies that clearly suggest it easily takes 3, and possibly up to 6 months before healing and recovery are complete and late procedural complications are not unheard of, but often these late problematical outcomes are not recorded in some of the studies because they are not considered "directly linkable" to the ablation procedures since AFib carries it's own risk of clots. However, since you report your mother was obviously in distress from the very day of her procedure, I can understand that you would be suspicious that the procedure was in some way to blame for her stroke.

Because ablation is so common these days, there are those within both the patient and the medical community who maintain that it is not taken seriously enough because while the complication rate may be fairly low, the complications from this procedure can be catastrophic. I am surprised to read that you report despite a number of doctor visits, they did nothing more than reassure her and send her home - this would give me some real cause for alarm as it seems there were clear warning signs that something was wrong but no one caught them or realized they might be more serious than the usual post-procedural discomfort.

There are reports of "shower-strokes" in the literature on ablation related complications. I'm not sure how common they are, but I have noted them in a few studies. For an in depth look at some of the current issues and complications of ablation for AFib, try googling Heart Rhythm Society Meeting in Venice for 2007. There is an excellent series of video slides from a variety of presenters around the world, some of whom directly address stroke and complication rates. It's a bit technical, but I found it very helpful when doing my own research into this subject. Also try googling the terms stroke, AFib ablation and shower stroke and see what you find. Hopefully others on this site, who have more first hand experience and information, will respond to you.

Again, I'm truly sorry about your mother and hope that you find the answers and closure you need. Just remember you have a right to honest and accurate information about your mothers condition and treatment, as well as the right to be treated with respect by the medical community.
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Avatar_n_tn
Heartfelt condolences for your loss.

Every patient reacts more or less differently to the specific arrhythmias, surgery, and drugs your mom had. Truthfully, doctors have no idea how a patient will react. All they know is most will tolerate it well. Perhaps they overlooked contraindications to the procedure, but probably not.

As ptadvoc8 said, coughing and chest pain after that type of surgery are a strong sign of clots/embolism. However, it's very hard to say that coughing and chest pain aren't "normal" after such a procedure, or even in "healthy" people of your mother's age.
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Avatar_f_tn
I too, send my sympathies to your family! I have only told one family on this site to do this and I am telling you the same thing: get a lawyer involved. I would not consider the idea of going and talking to the hospital; they will become defensive of their actions and will alter any records they have to save themselves. A lawyer can access those records BEFORE they have a chance to alter them. There are always risks involved with any proceedure especially those dealing with the heart. Did your mother have a chest x-ray BEFORE her proceedure? That would have shown any problems with the lungs prior to her ablation. I doubt she contracted pnuemonia (pneumonia) just like that, that quickly after an ablation unless something went wrong somewhere. People on these forums can't answer your questions and you are going to need those answers to find peace. Someone wasn't doing their job properly.
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Avatar_m_tn
Sorry to hear about your mother's passing.

Was she not on a blood thinner following the procedure? I seriously doubt that this was a direct result of either the cardioversion or ablation. The cardioversion would not have had any clotting risk and the ablation was done too far back to be to blame. It seems highly likely that the afib is the ultimate cause.
That said, perhaps her doctors were negligent in some way. It's hard to know given the limited history provided and the fact that emotions usually bias one's recollection (at least mine do). As I read it here, it looks like the doctors went directly to the most-probible diagnosis without peeling away the layers. What did the x-rays reveal? Who was the attending physician and did (s)he talk to your mother's other doctors?
I hope that the doctors were not negligent. And hopefully, this will be a learning experience for them. Medicine is a very tough profession and lessons are extremely expensive. Often times a doctor is not negligent by the letter of the law or even by his/her current scope of knowledge but is underprepared given his/her prior experiences.
Our thoughts will be with you and your family.
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612551_tn?1247839157
To my limited understanding as a fellow AFib suffer, the fine post by "ptadvoc8" is excellent.

My EP consultant and my cardiologist have recommended I not have an ablation for my AFib due to the risks and the facts:  1) my life expectancy is not increased by regaining Sinus Rhythm - given I take meds for rate control and an anticoagulant to reduce clots, and 2) my symptoms are well tolerated as are the medications. 3) AFib ablation of the left atrium is, I believe, the highest risk ablation of all the types done due the complication of getting into the left atrium.

There is a lot more to my "story" but I provide this as additional AFib experience relative to deciding not to go for an ablation.  
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