Need a cure

I had a MI in Dec. 2000 and had 2 Multi-link tetra stintsplaced, in Jan. 2001 I had 1 Multi-link stint, in Aug. 2001  I had 2 Cortis BX Expandable stints, I started haveing A-fib in Feb. 2005, I would have episode aprox. every 60 days. The time in A-fib would vary from as little as 2 hours to as much as 26 hours,I was never converted, I feel when I go out and when I come back in, I was put on amiodarone, but had a problem, so was put of Sotalol 160 twice a day and Digoxin, I am insulin diabetic, I take 50 units of Lantus daily, 5 units of Novolog with meals as needed, 850mg Glucophage twice a day, 7 1/2 mg glyburide twice a day. Diovan 80mg ,Plavix 75mg, Asprin 325mg, Crestor 20mg, Levothryroxine 0.25 all 1 per day, isordil 20mg 3 per day, lopid 600mg 2 per day and Codeine 30/Acetaminophen 300mg 2 per day. In May 2007 I had a 95% block and a 90%, I had Cypher Sirolimus-eluting Stints at LAD(MID)AND RCA.I took Amiodarone again from May until July 18, 2007 was put back on sotalol 80mg 2xday, My episodes of A-fib after the last stints was lasting 60 to 102 hours, coming every 13-15 days, I had Electrophysiologic study with Ablation at Central Baptist Hosp, Lexington, KY on 9/25/2007. For 6 days I had no A-fib, since the 7th day post surgery I have had A-fib lasting from 30 mins. to 42 hours. This Tuesday I will be 1 month out of surgery, When will this stop, I was told I could have a few problems for 3 months but this is worse than before the surgery, I have only been in regular beat 30 hours in the past 10 days. I still take the medications above except my sotalol is now 120mg twice daily. I am so sick of being sick!! When I am in A-fib all my energy is gone and I must go to bed, I am only living my life the few hours I am in regular beat this ablation seems to have made it worse. Any help with what to do is greatly appreciated.

[Michael J. McWilliams, M.D.]

I can understand.  Atrial fibrillation is very symptomatic for some.

The success rate for first time ablations in structurally normal hearts in the 60-70% range.  The failures will often need a redo procedure.  This can increase the success rate to the mid 70 to 90% range depending on which literature you read.  

We typically wait about 3 months for the ablation lines to heal before considering a second procedure.

My approach to this problem would be:
1. make sure the rate is controlled.
2. if the rate is controlled and you still have symptoms, repeat the procedure
3. in the mean time if sotalol is not working and you do not tolerate amio, tikosyn is your only other anti arrhythmic option.
4.  pacemakers are sometimes needed to assist with rate control medications or occasionally to modify the AV node to prevent rapid conduction (AV node ablation).

The problem with AV node ablations is they make you pacemaker dependent.  Not everyone feels better when they are pacemaker dependent and there is no way back once the AV node is ablated.

Do you know what your ejection fraction is?  If it is less than 35% after year heart attack, an ICD might be indicated and the pacemaker would leave more room for rate control with medications.

I hope this answers your questions.  Good luck and thanks for posting.

[dentedkev]

GOOD LUCK AND GOD BLESS

[skip717]

Thank you for the info. I have been told that scare tissue is forming and this may help? My ejection faction is 55%. I am 62 years old, male 6'1" 240lb.

[Michael J. McWilliams, M.D.]

that is good.  give it some time and see what happens.  I know waiting the hardest part.

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