Aa
persistent a-fib + ablation
Seven years ago I had CHF. My heart is now good, with a good ef, excellent nuke stress test results, etc, but I am left with persistent a-fib. I have had 7 cardioversions in the past 7 years, since it is the only way to get back into rhythym once I go into a-fib. I take 900mg propafenone, 5 mg warfarin and 120mg diltiazem daily. When I go into a-fib, it is always 5-7am and takes my body at least 8-12 hours to adjust in order to function reasonably. I have been in rhythym for 10 months
this time.
My questions are: Is ablation the proper solution for persistent a-fib at this point in time? Will ablation techniques evolve enough in treating persisent a-fib over the next few years to give it a try?
Are Michigan and UPenn the top 2 U. S. facilities for persistent a-fib treatment? What are the success rates for ablation with persistent a-fib?
this time.
My questions are: Is ablation the proper solution for persistent a-fib at this point in time? Will ablation techniques evolve enough in treating persisent a-fib over the next few years to give it a try?
Are Michigan and UPenn the top 2 U. S. facilities for persistent a-fib treatment? What are the success rates for ablation with persistent a-fib?
Sorry I just do not have an answer to your question.
Sorry Ian
Sorry Ian
I'd RBBB when I was 15 (first ECG). Now I got LBBB too! I don't know what hope should I expect?
Hi,
I have A-Fib events about once a week.They can last from one to six hours,and go back to NSR on their own accord.I was born with LBBB,and have this problem all my life,although I did not know what it was untill about 8 years ago,when my HR started acting up after exercise.I now take Amiodarone 200mg and Warafarin 1.25mg daily,and also have a pacemaker to avoid any Brad problems.I checked out ablation and decided against it,as the A-Fib does not really bother me,max BPM is 120,and the success rate is not that high.
Regards Ian
I have A-Fib events about once a week.They can last from one to six hours,and go back to NSR on their own accord.I was born with LBBB,and have this problem all my life,although I did not know what it was untill about 8 years ago,when my HR started acting up after exercise.I now take Amiodarone 200mg and Warafarin 1.25mg daily,and also have a pacemaker to avoid any Brad problems.I checked out ablation and decided against it,as the A-Fib does not really bother me,max BPM is 120,and the success rate is not that high.
Regards Ian
MEDICAL PROFESSIONAL
Hello,
Is ablation the proper solution for persistent a-fib at this point in time?
You could have so many different answers to this quesition depending on who you ask. What you need to decide is when does this bother you enough that you are willing to accept a 1% risk of stroke. It is important to take that one percent risk seriously because they do happen and while they are usually not devastating strokes, they can be severe. If you feel terrible in AF and you think once per year is too much, then you are ready. I think medical therapy is a reasonable way to treat AF and think that a cardioversion once per year is not that often. I would advise my own family to wait until you are requiring several cardioversions per year. This is really an individualized decision.
Will ablation techniques evolve enough in treating persisent a-fib over the next few years to give it a try?
Techniques are always changing and hopefully improving. The latest and greatest technique is also the newest and does not have the best long term follow up. It takes time to determine what works best now and what will work in the long term. We have reasonable success (60%) range for persistant AF (defined as lasting more than 7 days or requiring cardioversion).
Are Michigan and UPenn the top 2 U. S. facilities for persistent a-fib treatment?
I am biased because I trained at the Cleveland Clinic. I am honestly not sure how you compare the long term follow up of different instituitions. The records get very tricky. I will give you an example: one recent study reported a high success rate for atrial fibrillation ablation but did not include left atrial flutter as a failure -- it is known that about 1/4 will have a left atrial flutter after AF ablation and require a repeat procedure to get the success numbers you are use to reading. A center can make their numbers look as good as they want to by playing with numbers and definitions. There are a lot great AF centers across the country. I would not limit them to MI or Penn. I good list of academic centers includes Cleveland, MI, Penn, Mayo, OK, etc. There are also a lot of well trained private practice AF programs out their as well. Find someone you trust and some one with good training at a top center. Ask them how many they have done and if they had formal training. Don't let them off the hook with that -- ask them how many were observed and how many have they actually performed. There are people trying to do AF ablations after spending a day watching anothe doctor do them. Do your homework.
What are the success rates for ablation with persistent a-fib?
About 60%, some places will quote higher. Not everyone follows up or calls in events, so it is hard to the true number.
I hope this helps. Good luck and thanks for posting. If you think about it, let us know what you decide to do.
Is ablation the proper solution for persistent a-fib at this point in time?
You could have so many different answers to this quesition depending on who you ask. What you need to decide is when does this bother you enough that you are willing to accept a 1% risk of stroke. It is important to take that one percent risk seriously because they do happen and while they are usually not devastating strokes, they can be severe. If you feel terrible in AF and you think once per year is too much, then you are ready. I think medical therapy is a reasonable way to treat AF and think that a cardioversion once per year is not that often. I would advise my own family to wait until you are requiring several cardioversions per year. This is really an individualized decision.
Will ablation techniques evolve enough in treating persisent a-fib over the next few years to give it a try?
Techniques are always changing and hopefully improving. The latest and greatest technique is also the newest and does not have the best long term follow up. It takes time to determine what works best now and what will work in the long term. We have reasonable success (60%) range for persistant AF (defined as lasting more than 7 days or requiring cardioversion).
Are Michigan and UPenn the top 2 U. S. facilities for persistent a-fib treatment?
I am biased because I trained at the Cleveland Clinic. I am honestly not sure how you compare the long term follow up of different instituitions. The records get very tricky. I will give you an example: one recent study reported a high success rate for atrial fibrillation ablation but did not include left atrial flutter as a failure -- it is known that about 1/4 will have a left atrial flutter after AF ablation and require a repeat procedure to get the success numbers you are use to reading. A center can make their numbers look as good as they want to by playing with numbers and definitions. There are a lot great AF centers across the country. I would not limit them to MI or Penn. I good list of academic centers includes Cleveland, MI, Penn, Mayo, OK, etc. There are also a lot of well trained private practice AF programs out their as well. Find someone you trust and some one with good training at a top center. Ask them how many they have done and if they had formal training. Don't let them off the hook with that -- ask them how many were observed and how many have they actually performed. There are people trying to do AF ablations after spending a day watching anothe doctor do them. Do your homework.
What are the success rates for ablation with persistent a-fib?
About 60%, some places will quote higher. Not everyone follows up or calls in events, so it is hard to the true number.
I hope this helps. Good luck and thanks for posting. If you think about it, let us know what you decide to do.
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