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Heart Disease (Expert Forum)
Radiofrequency Albation Procedure: Failure or Normal?
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Radiofrequency Albation Procedure: Failure or Normal?
by Bill Gong, Jun 11, 2007 12:00AM
Dear dcotors,
This message was posted on the patient-to-patient forum seveal days ago. I hope you can help me in a more professional way.
My father-in-law is 72 years old, living in China, close to Shanghai. He has had paroxysmal atrial fibrillation for many years. Following recommendations from local doctors, my father-in-law had the Radiofrequency Catheter Ablation procedure done on May 11, 2007. However, since the fifth day after the procedure, he started having persistent atrial fibrillation. His heart beats 110 to 120 times per minute. Before the procedure, it was only 50-60 beats per minute. The problem is that it is very difficult for my father-in-law to communicate with the doctors. Therefore, my parents feel really sad.
My questions: 1) Do you think the change from paroxysmal to persistent is a result of failure of the procedure or an improper procedure? 2) Do you think having another radiofrequency ablation procedure is helpful? What is the best time for the second procedure after the first one? 3) What is the best approach in the world to lowering heart beat rates and defibrillating? What is your recommendation if you have a patient like my father-in-law?
Many thanks,
Bill
This message was posted on the patient-to-patient forum seveal days ago. I hope you can help me in a more professional way.
My father-in-law is 72 years old, living in China, close to Shanghai. He has had paroxysmal atrial fibrillation for many years. Following recommendations from local doctors, my father-in-law had the Radiofrequency Catheter Ablation procedure done on May 11, 2007. However, since the fifth day after the procedure, he started having persistent atrial fibrillation. His heart beats 110 to 120 times per minute. Before the procedure, it was only 50-60 beats per minute. The problem is that it is very difficult for my father-in-law to communicate with the doctors. Therefore, my parents feel really sad.
My questions: 1) Do you think the change from paroxysmal to persistent is a result of failure of the procedure or an improper procedure? 2) Do you think having another radiofrequency ablation procedure is helpful? What is the best time for the second procedure after the first one? 3) What is the best approach in the world to lowering heart beat rates and defibrillating? What is your recommendation if you have a patient like my father-in-law?
Many thanks,
Bill
Doctor's Answer
by Forum-M.D.-MJM, Jun 11, 2007 12:00AM
Hello,
1) Do you think the change from paroxysmal to persistent is a result of failure of the procedure or an improper procedure?
We are still learning a lot about AF ablations. It is known that the best case success rates are about 80-90%. There are many ways to achieve the same ends. Even if procedures are done correctly, there is still a chance there is atrial fibrillation after the procedure.
We know that some people will develop a left sided atrial flutter after a fib ablation. It is possible that he is now in flutter and needs a redo procedure to treat the atrial flutter.
2) Do you think having another radiofrequency ablation procedure is helpful?
It improves the chances of success and can treat atrial flutters left after the AF ablation.
What is the best time for the second procedure after the first one?
There is no standardized answer to this. Some people like to control the heart rate and give several months to see if the healing scar takes care of the arrhythmia. I have seen other people return to the lab within a few days to a week.
3) What is the best approach in the world to lowering heart beat rates and defibrillating?
It depends on the individual. Some people are appropriate for simply heart rate control and others medical therapy. If these approaches fail, an AF ablation is appropriate. Some people (dlerly, high risk, etc), ablating the connection between upper and lower heart chambers and placing a pacemaker is appropriate.
Cardioverting is done the same through out the world, although some centers may be more aggressive than others.
What is your recommendation if you have a patient like my father-in-law?
If it is atrial flutter and I cannot control with medications, I would take him back to the lab for a repeat ablation. If it is atrial fibrillation, I would do my best to avoid taking him back before a few months to allow the atrium to heal. It is also reasonable to try medications like flecainide, sotalol, tikosyn, etc. Honestly it is a judegement call and seeing the patient, hearing the history, trial and error with medications are important components of the decision tree.
I hope this helps. Thanks for posting.
1) Do you think the change from paroxysmal to persistent is a result of failure of the procedure or an improper procedure?
We are still learning a lot about AF ablations. It is known that the best case success rates are about 80-90%. There are many ways to achieve the same ends. Even if procedures are done correctly, there is still a chance there is atrial fibrillation after the procedure.
We know that some people will develop a left sided atrial flutter after a fib ablation. It is possible that he is now in flutter and needs a redo procedure to treat the atrial flutter.
2) Do you think having another radiofrequency ablation procedure is helpful?
It improves the chances of success and can treat atrial flutters left after the AF ablation.
What is the best time for the second procedure after the first one?
There is no standardized answer to this. Some people like to control the heart rate and give several months to see if the healing scar takes care of the arrhythmia. I have seen other people return to the lab within a few days to a week.
3) What is the best approach in the world to lowering heart beat rates and defibrillating?
It depends on the individual. Some people are appropriate for simply heart rate control and others medical therapy. If these approaches fail, an AF ablation is appropriate. Some people (dlerly, high risk, etc), ablating the connection between upper and lower heart chambers and placing a pacemaker is appropriate.
Cardioverting is done the same through out the world, although some centers may be more aggressive than others.
What is your recommendation if you have a patient like my father-in-law?
If it is atrial flutter and I cannot control with medications, I would take him back to the lab for a repeat ablation. If it is atrial fibrillation, I would do my best to avoid taking him back before a few months to allow the atrium to heal. It is also reasonable to try medications like flecainide, sotalol, tikosyn, etc. Honestly it is a judegement call and seeing the patient, hearing the history, trial and error with medications are important components of the decision tree.
I hope this helps. Thanks for posting.
