Aa
Beyond meds for AFIB
Could you please discuss "cures" for AFIB if meds are no longer effective. Could you please, at least, include PVA and MAZE and any more that you consider effective. Also, can you relate the "success rate" experienced by the Cleveland Clinic for each procedure, and in my analysis, success is long term, not just immediate post procedure. My EP has told me that I need to start thinking about treatment beyond meds. Thanks.
Can anyone PLEASE help me, I am so confused right now about my husband. I took him to the doctors Friday and they told me that he has severe cardiomypathy with an ejection fraction of less then 25% , and possible has a viral cardiomypathy, I don't understand what all this means? he is also in CHF and in Atrial Fib. They also said he was at high risk for with this severe low enjection to have sudden death in malignant arrthymias. He is on meds but I do not understand what all this means is he going to die? PLEASE HELP ME?? My email is ***@**** Thank you
Thank you so much for following up on my question. The reason I ask is that I have a family member whose pulse sometimes seems irregularly irregular, but two holter moniters have been normal, just PACs. We will probably do a event monitor if I notice the irregular pulse again - but since I have a stethescope I though I could check that way also. Thanks again!
That's a good question, and i suspect you are right. I have never really used a stethescope for that purpose...i just usually detect a-fib by radial pulse. I will pick the brain of my favorite cardiologist (i see him every day at the hospital) and get back to you.
steph
steph
Thanks for your responce to my question. Do you know if (with a stethescope)you would still hear a "lub-dub" sound with each beat when in afib? Or would it sound different because only the ventricles are contracting in a normal way?
A-fib is classically described as "irregularly irregular", meaning there is no pattern to the irregularity (there are some arrhythmias out there that are irregular, but they come in groups of two, or three). The pulse can be very rapid (if there is a rapid ventricular response to the fibrillating, or quivering of the atria), and i find it to be more faint than a regular pulse. It is just all over the place, with no rhyme or reason. i have recently become more in-tune to pulses, because of my own tachycardia, and i will say it is not always an easy one to pick out in my patients (i am a physical therapist, NOT a doctor)
steph
steph
Does anyone know what afib sounds like when using a stethescope?
I had very symtomtic AFib and various meds tried without success.
Eventually had a PVI ablation but AFib came back. Had a second PVI ablation about 12 months later which has been almost totally sucessful. 18 months down the track, I just get the occasional burst of AFib and it usually only lasts a couple of minutes. I've got my life back.
The PVI's are fairly non-invasive and are done under heavy sedation so you don't know much about the operation.
Just make sure the procedure is done in a major center that specializes in PVI's.
To me, the MAZE procedure seems very drastic (opening up the chest and cutting up the heart) in comparison. My EP mentioned this procedure but was totally against it just for AFib.
Good luck.
Eventually had a PVI ablation but AFib came back. Had a second PVI ablation about 12 months later which has been almost totally sucessful. 18 months down the track, I just get the occasional burst of AFib and it usually only lasts a couple of minutes. I've got my life back.
The PVI's are fairly non-invasive and are done under heavy sedation so you don't know much about the operation.
Just make sure the procedure is done in a major center that specializes in PVI's.
To me, the MAZE procedure seems very drastic (opening up the chest and cutting up the heart) in comparison. My EP mentioned this procedure but was totally against it just for AFib.
Good luck.
Anybody that has a PVA, PVAI, or MAZE care to comment.
Good question. A-fib is certainly very frustrating, and if you have exhausted all pharmacologic options, then it's time to look at the next step.
I did NOT have A-fib, but a vagally mediated atrial tachycardia that mimicked A-fib. Focal ablations were not successful for me, but i had a PVI (pulmonary vein isolation) at Oklahoma University Medical Center, and so far (knock wood...it's been two months) absolutely NO recurrence of a strange arrhythmia that showed up EVERY time i swallowed. My doctor also performed 2 ganglionated nerve plexi ablations...this is a very new approach, but one he feels very strongly about with regards to A-fib. I traveled all the way from Pennsylvania to see this guy, and it was well worth it.
Part of the success of the procedures you mentioned (as with any medical procedure) is the skill of the EP, and the number of cases that the team has done. My local EP, at the time of my referral to OUMC had only done a handful of PVIs. He was very upfront with me about this, and encouraged me to look at a larger institution with good success rates. I don't know what part of the country (0r world, for that matter) you are writing from, but i would encourage you to do the same.
Good luck with your decision, and here's wishing you NSR!!
steph
I did NOT have A-fib, but a vagally mediated atrial tachycardia that mimicked A-fib. Focal ablations were not successful for me, but i had a PVI (pulmonary vein isolation) at Oklahoma University Medical Center, and so far (knock wood...it's been two months) absolutely NO recurrence of a strange arrhythmia that showed up EVERY time i swallowed. My doctor also performed 2 ganglionated nerve plexi ablations...this is a very new approach, but one he feels very strongly about with regards to A-fib. I traveled all the way from Pennsylvania to see this guy, and it was well worth it.
Part of the success of the procedures you mentioned (as with any medical procedure) is the skill of the EP, and the number of cases that the team has done. My local EP, at the time of my referral to OUMC had only done a handful of PVIs. He was very upfront with me about this, and encouraged me to look at a larger institution with good success rates. I don't know what part of the country (0r world, for that matter) you are writing from, but i would encourage you to do the same.
Good luck with your decision, and here's wishing you NSR!!
steph
PVAI (pulmonary vein antral isolation)
The tissue around the pulmonary veins can generate premature beats and is a substrate that can perpetuate atrial fibrillation. In a PVAI procedure we ablation the area outside to the veins to isolate them from the rest of the atrium.
There are many types of maze procedures. The role for the MAZE is a matter of debate. Some hospitals do a primary maze (meaning surgery for no other reason besides AF) and other hospitals only when they have another reason for open heart surgery. In my opinion (and many will disagree), I reserve MAZE procedures for people who have another reason for open heart surgery.
All of these procedures vary by institution and by operators within the institution, but they are trying to achieve the same common end.
In general:
70-90% success for catheter based PVAI for a normal heart and atrial fibrillation
Generally about 60-70% for people with cardiomyopathies.
For people with valvular problems and cardiomyopathies, the success rate varies by the operator and the type of cardiomyopathy. You will have to consult an experienced EP to discuss success rates that may apply to you.
I do not know the success rate for MAZE procedures and the quoted success rates for any procedure depend on the definition of success (no AF, decreased AF, no AF with medications, etc) and how often they check for asymptomatic AF. This can be a moving target in the literature.
This is a very tricky subject and I recommend what ever you decide to do that you see a high volume experienced operator in a good medical center. Don't be someone
The tissue around the pulmonary veins can generate premature beats and is a substrate that can perpetuate atrial fibrillation. In a PVAI procedure we ablation the area outside to the veins to isolate them from the rest of the atrium.
There are many types of maze procedures. The role for the MAZE is a matter of debate. Some hospitals do a primary maze (meaning surgery for no other reason besides AF) and other hospitals only when they have another reason for open heart surgery. In my opinion (and many will disagree), I reserve MAZE procedures for people who have another reason for open heart surgery.
All of these procedures vary by institution and by operators within the institution, but they are trying to achieve the same common end.
In general:
70-90% success for catheter based PVAI for a normal heart and atrial fibrillation
Generally about 60-70% for people with cardiomyopathies.
For people with valvular problems and cardiomyopathies, the success rate varies by the operator and the type of cardiomyopathy. You will have to consult an experienced EP to discuss success rates that may apply to you.
I do not know the success rate for MAZE procedures and the quoted success rates for any procedure depend on the definition of success (no AF, decreased AF, no AF with medications, etc) and how often they check for asymptomatic AF. This can be a moving target in the literature.
This is a very tricky subject and I recommend what ever you decide to do that you see a high volume experienced operator in a good medical center. Don't be someone
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