Minimally invasive treatment options for paroxysmal a-fib

[Dave B.]

I am a 46 year old male with paroxysmal atrial fib. Sotalol and propafenone were somewhat effective, but caused side effects that appeared to be related to anxiety.  I am currently taking atenolol, flecanide, and aspirin which has decreased the frequency and severity of the a fib, but also has caused anxiety related side effects. I take lorazepam as needed (once every 2 - 3 days) when the anxiety peaks or when I think I may be starting an a-fib episode.  While I am currently coping (and will continue to do so if that is the best course), I have read that some new techniques may be in development that could cure the a-fib with minimal risk and post treatment complications. A robotic intercostal approach Maze-like technique is one of these treatments (I am not ready for open heart surgery yet). I also saw a reference to AT500 and EP 1000XP Multi. Cath Ablation System in the forum archives, but I have not been able to find more information on these techniqes. My questions are:

1.)  Is it better to have radiocatheter ablation or one of the newer techniques attempted before the condition progresses to daily a fib or chronic a fib?

2.)  Is a pace maker required after these procedures?

3.)  Would a consult exam at the Cleveland Clinic (I live in Virginia) be adviseable at this time or should I wait until the techniques are studied and tested further?

[Mike Sweeney]

I've had AF for over 20 years.  I'm 50 and 4 years ago the AF came and never went away.  I agressivly sought treatment and found a specialit in the AF field.  I started with cardioversion and Drug therapy. This worked for a while but I always reverted back to the AF.  It was suggested that I have a pacemaker implanted to help keep the beat regular.  Again this worked for a while, but again I went into AF.  A year ago January I had an ablation procedure performed.  I didn't feel it, but my doctor said I had just one incident in the last year that lasted 20 seconds.  I've had no other problems and a pacemaker is NOT required.  Over a year without AF....it's great.

Any Questions

Mike
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[Cleveland Clinic, MD]

Dear Dave,
From what you say it sounds like you would be an ideal candidate for an ablation procedure.  Atrial fibrillation ablation is still somewhat new but we are gaining more experience and have very good success rates.  It is not for everyone yet and there is a very small risk for stroke.  We don't know if waiting will make the problem worse but my bias is that it is better to get it done sooner rather than later.  A pacemaker is not needed after the procedure.  If you would like to be evaluated at the Clinic I would recommend Dr. Schweikert or Dr. Natale.  You can make an appointment with either of them by calling the number below.