ablation vrs pacemaker

[sailingspaz]

My 79 yr old father had a stent placed in 2003 for a 90% LAD occlusion, he developed AFib 2 years later and has been poorly rate controlled since that time.  He has been cardioverted once and had his med dosages toyed with.  He is very practical and strong willed, was told he had high cholesterol 20 years ago and cut out cheese and butter just like that and has maintained healthy eating habits, no smoking, and is very active..works out at the Y 3x a week and has a 6 pack, ie he is fit!!  Meds are coumadin, metoprolol, atorvastin and ASA.  Today he had a significant TIA, symptoms took 6+ hours to resolve (right facial droop, slurred speech, word salad and right hand"clumsiness") was treated in ED with LMWH and increase in coumadin dose (INR 1.6).  His cardiologist had previously stated he was a poor risk for ablation and would insert a pacemaker instead, although he also has let him remain in AFib for 2 + years! I'm an ER nurse and don't understand the rationale behind that and would like to know which procedure would be more appropriate or if there are any other options. Thank you Ann C.

[cindy707]

I kind of have the same question as Jerry does of why implant a pacemaker?  As he said and i am sure you are aware PM's main duty is for people with bradycardia.....and in having a TIA as severe as he had and being on all of the blood thinners something is just a little off here to me .....so did he throw a clot or is there an issue with plaque in his arteries?  I don't know if i agree as to leaving your dad in permanent a fib was such a great idea at his advanced age.....but the doc seems to have put him on all of the meds that would have prevented a TIA so i am wondering where the source of this came from...as far as tossing in my opinion of which way i would go personally i would say the ablation if the source is the atrial fib and where i would lead him if he were my dad.  Ablations are no brainers however the doc probably has a reason for shying away from it but to me my question was could the TIA have been avoided thru the procedure?  Good luck

[Jerry_NJ]

I do not know of any reason to apply a pacemaker for the treatment of AFib unless it is accompanied by bradycardia (Not sure that is possible).  A pacemaker is used to stimulate more heartbeats, not cancel some out... that's my understanding, if wrong I hope someone will correct me.

I too am in "rate control" (I take both a beta blocker and a calcium channel blocker) and "blood clot mitigation" (take warfarin with a target INR of 2 to 3).  I have been in permanent AFib since late 2007 and my symptoms are mild.  Both my cardiologist and the consulting EP say an Ablation has a low probability of success, and it does entail risks, so they will not do that procedure on me.  I'm sure I can find a doctor that will, but I have decided to live with the AFib.  I'm just a bit younger than your father, I am 71 and the only 6-pack I have is one I buy at the beer story.  I don't drink it all at once :)  

The above said, I admit I don't know what a "significant TIA" is, maybe others would also benefit from an explanation.   As for the symptom list you provided I do not relate them to AFib either.  

Hope you get some more helpful inputs.