My son has A-Fib and hypertension at age 20???

He had 3 episodes of A-Fib within 1 year. 2 of them he needed to be hospitalized over night. He is an athlete and the fit of health. He was just diagnosed recently with hypertension after an array of tests to rule out many things like pheocryomocytoma and steroid use. He had a kidney doplar, bloods take to check for liver and all other disorders. They said he is too young for any ablation procedures. He has to walk around with a pill of flecinide in his pocket just in case it happens again. Thats what converted him to normal sinus after 24 hrs. in the hospital. Any other suggestions? Please help. He is too young for this and no family history of problems. Thank you.

[Jerry_NJ]

Sorry to read of the problem,  at such a  young age.  I don't understand too young for an ablation...it maybe a way of saying "given his symptoms, he is too young".  Ablations has some risks and is not done unless the benefit/risk ration is strongly weighted to benefit.  I don't know for sure, but I'd think at both ends of the life-expectancy we see age considerations.
1) for the very young, any complication will have to be endured for a long time
2) at an old age (me) there isn't enough time left to justify the risk
In both cased symptoms are key.  From what I read about you son and from my symptoms the decision not to ablate is driven by the fact the patient has mild symptoms.

I take you all external stimulus have been ruled out: you mention steroid.  Can you son identify any other stimulants that may have been tired?  

I'd guess that if a pill can convert him to normal sinus rhythm (NSR) and that will old for many days or weeks, then "carrying a pill around" may not be that big a burden.  I'd think a low dose aspirin would also be recommended to reduce clot risk for the few periods at AFib occur.  

I assume when in NSR you son has full physical and cardiovascular strength.  That has been my personal experience: when in NSR I could engage in full physical activity.

[kay2486]

doctors can be confusing they refuse to operate, which is a simple proceedure yet they say the younger we are the better chance of faster recovery, personally id fight the case, like you say hes young but the doctors may not think hes in danger, all meds that help arrythmias can also cause more arrythmias too, im not trying to scare you, arrythmias can arise in anyone at any time, im sorry your son has developed this and hope you get the help you need

[cindy707]

Many times with atrial fib comes high blood pressure its pretty normal...i know every time my heart went into atrial fib before my ablation was done my blood pressure would soar as well.  As far as being too young for an ablation.....at age 20 your sons heart is done growing...so that is totally ridiculous to me.....ablations were originally intended for people who were going thru atrial fib and there is a HUGE success rate with them especially if there are no underlying factors.  You seriously need to get a second opinion because for that doc to have given your son a pocket pill "just in case" just isn't right.  Do yourself a favor ...hopefully he has seen a heart doctor for this and not a family doc because its not their specialty...if it were my son and it was my family doc i would ask for a referral to a heart doc and if it was a heart doc i would respectfully request a referral to an EP specialist just to be sure...we can't take chances with the heart...good luck and time to get pro active.....your family has to live with this not the doctor...good luck to you and your family and i hope this helped a little.....

[joelcoqui]

He saw 4 doctors 2 of them were EPs 2 were cardio drs and was voted as one of the best from the castle connelly list of mds.. They say his quality of life is not terrible because this happened only 3 times in a year. If it was an every week occurrence that is making his life unhappy, then it would be worth the risk. There is also no guarantee that it will be successful either.  

[Jerry_NJ]

While I am at the other end of the age group, I get the same answer.  I was prepared to take whatever the risk there is from an ablation as I wanted to get back to more vigorous exercise such as running.  But both my Cardiologist and the consulting EP in fact refused to do an ablation saying the benefit/risk ration was too low.  Again, I am a senior age-wise and I have been in permanent AFib for two years, so my probability of success isn't as good as I would guess your son's is.  My probability of complications is undoubtedly much higher too.  

I think it is reasonable to say with occasional, and I assume short lived (minutes or a few hours), episodes of AFib the maximum benefit of ablation is small, and so is the risk.  Another consideration could be insurance coverage.  Of course as (if) the federal takeover of health care continues, ablation would be covered by that "insurance".      

[joelcoqui]

He cant take anything to thin his blood. He is a ball player in college and cant risk a bleeding injury. His A-fib lasted for just under 24 hrs both times during hospitalization. No external stimulants,,,he dont even drink coffee. He does complain that he feels lightheaded and dazed now and then. It does have me concerned because his BP fluctuates way too much and is usually pretty high (approx 150/100 most of the time) so his betablocker metropolol was upped to 100mgs from 25mgs cause its not doing the job.   Thank you all so much for your imput.

[joelcoqui]

It happened again yesterday. He took the pill of flecinide and went into normal sinus rhythm from what he can feel. Now Im going to take him to another EP and Im scared.

[Jerry_NJ]

I take you note to say your son has been in NSR for a long period of time, until yesterday, then back into AFib.  But, the flecinide worked, that's good, right?  

I haven't re-read the whole thread, but it seems to me that the recurrent AFib was expected.  Is there a longer-range plan to do an Ablation sometime in the future?

I'm an old guy, so my situations is different just for that reason, but I mention that I have been in and out of AFib many times over the past 10 years, and always enjoyed the periods of NSR.  Maybe there is a "softer" medication than Flecinide that your son can take to keep him in NSR for a year or more at a time.  Then, perhaps, an Ablation can be successfully performed.

[joelcoqui]

Thanks Jerry. He really wants to do the ablation and one EP DR  is for it too. He could be back on the baseball field at college within 2 weeks he says...and being in college you know they have to have a few drinks here and there so it looks like he may do it within the next month.

[Jerry_NJ]

Good news.  Remember that ablation should have a high probability of success, but it isn't 100% - so be optimistic but prepared.  I understand too that it can take a long period for full healing to take place.  So I am not arguing with your doctor's two week estimate, but I think it may take longer to achieve full recovery results.  The doctor may have given a longer estimate for recovery if the sport was football.

I do believe you are doing the right thing, I'm just more cautious/conservative on outcome estimates.

As for "few drinks" it is best not to be on heart medications, so an ablation that takes him off of all medications will reduce the risks from drinking (alcohol) to just that, the risks of drinking... don't drive.

Best to him and your whole family, I'm sure all will be much better after the ablation.  

[Angel_001]

I was a college athlete too. Although I'm much older now I'm still very active and a triathlete.  Taking pills everyday for anticoagulation and antiarrythmics is not a quality of life I could tolerate.  It sounds like your son has symptomatic AF - he could have had AF for longer than his symptoms have appreared.  Meaning over time the heart is electrically remodling itself and decreasing is over all function.  Afib burden gets worse and it becomes more difficult to treat.  Also, people with AFib are 5-7 time more likely to be a stroke risk.  Treatment options are medication, electrical cardioversion, catheter ablation, and minimally invasibe epicardial surgical ablation. Afib burden is multi-focal and doctors still don't know how to treat it to a full curative state of NSR. I had a friend who suffered from chronic AF for 3 years.  She had multipul catheter ablations at a very well know reputable hospital - but still was in AF and medication.  4 years ago she had surgical ablation and has been in NSR ever since.  What really made her mad was that none of her EP(s) ever gave her the choice of a surgical option.  EP's actually got base their ablations off of an earlier surgical procedure called "the maze procedure".    It doesn't sound like your son has chronic AF and could easily be managed with medication.  However, if medication is not a realistic option for this active young man - a more aggresive (aggressive) therapy may be a good choice.  My friend now competes in atleast 5 triathlon's a year and has been medication free for 3 years due to the success of the surgical option - here is where you can find out some more information: www.ohioafib.com.  Its helpful to have all the options available to you and your son.
Good Luck!

[joelcoqui]

Thank you. Im trying to understand...there are two types of ablation procedures?? surgical maze and catheter?  He has been very angry that his college years feel deprived because of this...worrying that 2 extra beers will put him into a-fib. I believe one of his choices was not to drink alcohol again. That is very difficult for him to do (not that he has a problem). He is on the ball field everyday.

[Angel_001]

Hi Joelcoqui!
Yes, the surgical MAZE is the one I am referring to.  A lot of athletes check out this option b/c due to their active lifestyles they do not want to be on a blood thinner or antiarrythmic.  Early results are favorable to completely be off of meds by 3 months.  Here is another website that can be helpful; stopafib.org  .... there are patient testimony that are helpful.  Also there is a good afib forum on yahoo - where a lot of people who have had the surgical procedure done can comment directly to you.  
I dont blame him on not wanting to miss out on the whole college experience!!  We partied with the baseball players where I went to college....it was fun ;)!!!!!!!  He really should miss out of those experiences.
Keep me posted!
A

[Angel_001]

oops..... I miss typed.  the last sentence should say, "He really should NOT miss out on any of those college experiences".!!!!!!!!!!!!
Cheers
Angel :)

[joelcoqui]

I believe hes doing the catheter. How do they decide which procedure is right for him??. Thats called an EP study. All this top MD has is his history and an EKG... is that enough?

[Angel_001]

Hi Joelqui!
I think he should do just fine with a cath ablation.  It sounds like he has paroxysmal AF which can be resolved with CA.  However, f he has recurrent af persistent for 6 mo after his cath ablation. His AF might be multi-focal.  So a minimally invasive surgical maze could yeild the results you are looking for.  Its just another option that not many cardiologists or EP's recommend - b/c they do not know about it or know how to refer to.

Not all Doctors are gods or have the same exceptional skills/techniques/bed side manner/business or patient care outlook.  So recommendations can be bias depending on referral lines and relationships.  I advocate to my family to be proactive on their own healthcare - do the research and ask LOTS of questions.  All of which, You are doing a GREAT job!  As far as the tests your Dr has to base his decision - "is it enough?"  All I can say is that it sounds like he is making his recommendation to get your son back on the baseball field asap.  Medications cant reliably do that in the context of mangaging a active lifestyle.  An EP study is the standard work up that will help dictate the most approperiate avenue for care.  I wish I could be more helpful for your peice of mind.  BEST of Luck and keep us posted!  PLAY BALL!
Cheers,
Angel

[joelcoqui]

Thats makes me feel more comfortable. Thanks alot. We are making an appointment with the EP head at Columbia Presbyterian in NYC now. My son needs to time the procedure so that hes up and running (in his case catching and hitting) in late Janauary, so mid November sounds good.  I'll let you know how it goes.

[joelcoqui]

My sons cardiologist called and I told him that we were getting 2nd and 4rd opinions from an EP. He was totally against doing the procedure. He feels that if you go to a surgeon, they WILL just do it because its optional, not life and death and they want the job. I have to find someone that wont do the surgery for the wrong reasons. The cardiologist still says NO. I dont know what to do. My son just wants to drink to have a normal party life. Wrong reason heh? .

[Angel_001]

Hi Joelcoqui!
NO - looking to improve your quality of life is NEVER the wrong reason!
Interesting reaction from your cardiologist...sounds like he doesn't want your business.  Unfortunately, medicine is not exempt from the Business World.  There are clear biases.  I've worked in and around cardiac surgery for 14 years.  I'm a "pup" comared to some of the knowlegeable nurses that give great advise in this forum.  But one thing we can all agree on is that no doctor has ALL the right answers.  And there are plenty of doctors I wouldn't let "cut my lawn" let alone treat my health concerns.  You are doing the right thing!!!  Get all the opinions you want untill you find the answer you are looking for.  This country offers the BEST healthcare in the world - I'm sure there is an anwser to the therapy your looking for!

As far as surgeons doing optional surgery....I do not know of any surgeon that could afford to stay in practice if he got less than adequate results.  Surgeons are held to a much more challenging standard - I feel - b/c they are expected to "CURE" the problem.  Where as theraputic doctors try various methods of treatment with some success or failure.  

You are just trying to find answers for the best interest of your son.  Consulting a doctor/surgeon is just another way of getting answers.  No one is signing you/him up for anything.  Most surgeons that I know give fair consultations that will meet your expectations.  Like I said they can't afford to make promises they can't prove.  Having said that,for a corrective SURGICAL option/opinion, is a specialized procedure that not every surgeon is trained to do.  Much like EP's - not all EP's are trained to ablate for A-fib with a catheter.  So research who is the best GP,EP,cardiologist or surgeon that offers the type of therapy you are interested in.
I believe you mentioned that you lived around Boston.  I'm sure there are plenty of EP's that are well respected doing AF ablation.  As far as surgical option for AF - minimally invasive - I'm sure there are some (probably a very few) surgeon that offer this in the North East.  The best advise I can give you is to check out this web site: ohioafib.com.  The sureon Dr John Sirak has his personal cell phone on the website. Call him and ask him your questions/concerns you have. Nobodys charging you - you don't need an appt - you just are looking for therapy options.  I've read from other patients who've had his procedure that he is unbias and very accessable to his patients.

Sorry for the lengthy perspective.  But I feel your frustration and concerns.  You are doing the right thing for your family!  Don't take NO for an answer - you eventually will get the answer you are looking for.
Bona Fortunum!
Cheers
Angel

[cindy707]

Just out of curiosity Angel have you had the procedure done yourself and if so what type of heart issues do you have?  I think that i may have missed this post.  When did you have your box maze done and who was it performed by?  How long ago was it done and where?  I am really interested in this......

[cindy707]

Hellooooo Angel......can you please answer my questions?  I have atrial fib and its important for me to know what your personal experience is with the procedure, your personal recovery time, what to expect....also i saw on your profile that you are a clinical heart team specialist...what is this exactly...what do you do and are you a nurse?  I have never seen a clinical heart team specialist per se so i am assuming that possibly you work at times with Dr. Sirak and thats why you know so much about him or did he do your procedure?  I am super confused Angel...help me out here....

[Jerry_NJ]

I'm a bit lost, maybe I've read too fast.

I understood that you had made a decision based on medical advice to go forward with an Ablation.  Before you "jump rails" to another path based on inputs here I think you will reach the best decision based on the advice you have received from doctors who have physically examined your son and his history.

As I've mentioned elsewhere, I have myself had a surgical maze procedure done while other mandatory heart surgery was being done. There in no doubt in my mind I'd have gone to an Ablation first it that was the recommendation.  As it turns out the maze held me in NSR for about on month.  The good news is your son's condition is much more treatable than my advanced age condition, so I'd be optimistic that an Ablation will work based on the information you have already provided.

As for drinking and college, that is a different set of opportunities and risks.  Nothing is risk free.  

[joelcoqui]

I live in NY...Long Island to be exact. I have also been told that they do not use the maze procedure often anymore. The catheter ablation is what they use now because they have been perfecting it by going a different route around the heart...in front instead of behind so some sort of risk factor is substantially less?  I dont know exactly. As for the drinking in college, my son is a smart student, athlete and very responsible. We are taking a social party here or there and nothing crazy. His plate is too full for anything else.

[Jerry_NJ]

Great, you are planning to go ahead with an Ablations then.  It is also good to understand that there has been improvements in "routing".  that's the key I think.  As I understand it the traditional route is up an artery to the RH side of the heart, then there via a inter-chamber "hole" to the LH side.  That's the main risk factor, as I understand it.  

As an AFib sufferer I'd take the risk but my condition isn't seen as one that has a good chance of success.  I'm sure from what you have said you son's chances of success are much higher.

As for the maze via open hear surgery I think that is a course of last resort, but if one is undergoing open heart surgery anyway, then the additional risk is small. I also understand the maze to be a "shot gun" approach, and the Ablation to be a precision shot approach.  

Sorry if I got off on adding more confusion, said simply I believe the recommended Ablation is the best approach.  Wishing all a great outcome.  

[joelcoqui]

His cardiologist found out (because I needed a referral) that I was getting some other EP opinions for doing my sons ablation. He was totally against it. He said it was a benign A-fib and the risk of a stroke was not worth it. He spoke to me and evidently spoke to my son privately as well after I told him he was away at school. He downright said "NO". Right now its on hold....until the next episode.

[Jerry_NJ]

Yes, I do understand there is some risk associated with Ablation procedures, as with everything else, including not doing it.  The best we can hope for it seems is to have realistic expectations of both success and problems.  

Sorry, I am not going back for a complete review, and my memory isn't the best, but from what you just said it sounds to me like your son may need nothing more than a low dose aspirin to reduce clot risk associated with occasional (assumption) episodes of AFib.

Continuing to wish the best,

[SDalb]

After reading this thread, I just wanted to add something.  I am over 50, had an ablation 25 days ago.  My son has a friend on his highschool football team who had an ablation for afib, two  years ago at age 16.  He had Paroxysmal afib.  He is a multi sport athlete and has not had any issues since.  My self and two guys I worked with have had ablations for afib.  I am still too early to tell if it was successful, but right now it feels that way,  and the other two guys, one was five years ago, are in normal sinus rhythm.  Yes there are risks, but life in general is a risk.  Your son will have to weigh his options.  My biggest concern with afib, was having it become permanent.  Hope this helps.

[joelcoqui]

All the cardiologists we seen are against it. All the electrophysiosists are for it. What do you think that means??

[grendslori]

Hello, it's getting late so I have to stop reading all of the posts ,but I wanted to tell you that my daughter had the surgical ablation done when she was 7 years old at the Texas Heart Institute in Houston. Between then and until she turned 22, she had probably 4-5 cath ablations done. There is a huge difference between those two ways of going. One is a literal open-heart surgery with a 7-10 day hospital stay, not to mention recovery time from a serious surgery. The cath ablation isn't fullproof as far as being a cure, but it means he will be in the hospital as an outpatient and will more than likely go home the same day. No surgical recovery time is needed. It will take time for the heart to settle back down, but that will come in time. A cardiologist is not the one to determine what is done for your son; an EP Specialist is the one you need to listen to. This is HIS specialty. Take care

[joelcoqui]

Yes, but a cardiologist knows your hearts condition, history and needs.  An EP specialist just knows how to fix it....like a surgeon. Would you  go to a surgeon if you had cancer? No, you would go to him if you need it cut out. Am I making myself clear? The EPs are aggressive in going in,,,,its their job.

[joelcoqui]

After seeing the top gun and head of EP dept at NYU, he thinks my sons A-fib happens when blood pressure in high and not in control. Having alcoholic beverages just brings it on strong.. After we get his BP at bay, he has to wear the Cardio net monitor for 2 weeks to see if he has little a-fibs during his sleep or regular daily activities.  If he does have episodes,  then they need to ablate. This Dr. makes plenty sense. Hes not rushing into it..