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Re: Paroxysmal Atrial Fibrillation

Posted By CCF CARDIO MD - CRC on September 30, 1998 at 10:31:49:

In Reply to: Paroxysmal Atrial Fibrillation posted by Jim G. on September 28, 1998 at 18:19:42:

:      I've had Paroxysmal A-Fib since I was a Cardiac Tech/Firefighter at age 35.  I was also a very good "Free Weight" powerlifter until I noticed my strength decreasing, along with a fair amount of fatigue.  These symptoms came on before I even started my exercise routines.  I placed myself on our ambulances' EKG, and found myself to be in A-Fib at 280bpm.  I was placed in the hospital, on Tenormin and anticoagulants.  Stayed in A-Fib for over 3 days.  My doc let me go , since the hospital was driving me "crazy."
     The initial A-Fib ceased, but came back infrequently, sometimes for hours, sometimes days.  I was again placed in the hospital for a week and monitored on Rhythmol.  Sent back to work shortly thereafter, but the same thing kept occurring.
     I was placed in the hospital a third time, this time to be monitored on Amiodarone (And I am fairly aware of the dangers/side effects of this high dose iodine filled med.)  Was sent home, same symptoms, even though I kept a VERY detailed diary as to my b/p, pulse, what I was doing, thinking, time of day, day, etc...
     I was soon medically retired because of the medications I was taking, my infrequent (But very bothersome symptoms and the hazardous conditions that I worked under.
     I've been on Coumadin, Amiodarone (500mg day), Clorazepate, and PRN Ambien.  It has now been three years, and i CANNOT tolerate the sun or heat, I have Cordarone deposits in my corneas, and still have the same probs. since 1995.
     Last week, my Cardiologist told me that he would like to have my AV-Node ablated, and a two lead Pacemaker inserted.
     From a healthy 35 yr. old weightlifter to a 38 yr. old retiree w/ the advice to electronically sever my AV-Node and live on a pacemaker, w/ a permanent A-Fib condition after the procedures are done.  Any suggestions, comments, ideas for alternative treatments or concerns would be greatly appreciated.
                                                                                                 -Jim G.
Dear Jim,
You certainly have my sympathy for the trials you have been through.  Afib can be a very difficult rhythm to control and AV node ablation is a good alternative for someone who has failed medical management.  The purpose of AV node ablation is to control the heart rate at which the ventricles are going.  By breaking the link between atria and ventricles the atria can fibrillate as fast as they want without affecting the ventricles.  It does require a pacemaker to activate the ventricles and you still will need to take coumadin to prevent clots forming in the atria.  Hope this information helps.   I have included further info on afib below.

Atrial fibrillation
A disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles.
Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria.
The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body.
Causes of atrial fibrillation and flutter include dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart.
Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age.
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.
     sensation of feeling heart beat (palpitations)
     pulse may feel rapid, racing, pounding, fluttering,
     pulse may feel regular or irregular
     dizziness, lightheadedness
     shortness of breath
     breathing difficulty, lying down
     sensation of tightness in the chest
Note: Symptoms may begin and/or stop suddenly.
Signs and tests:
Listening with a stethoscope (auscultation) of the heart shows a rapid or irregular rhythm. The pulse may feel rapid or irregular. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter
the heart rate may be 100 to 175. Blood pressure may be normal or low.
An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring--Holter monitor (24 hour test)-- may be necessary because the condition is often sporadic (sudden beginning and ending of episodes of the arrhythmia).
Tests to determine the cause may include:
     an echocardiogram
     a coronary angiography (rarely)
     an exercise treadmill ECG

Treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include digitalis or other medications that slow the heart beat or that slow conduction of the impulse
to the ventricles.
Electrical cardioversion may be required to convert the arrhythmia to normal (sinus) rhythm.
Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition. Atrial flutter is usually a short-term problem.
     incomplete emptying of the atria which can reduce the amount of blood the heart can pump
     emboli to the brain (stroke) or elsewhere--rare

Calling your health care provider:
Call your health care provider if symptoms indicate atrial
fibrillation or flutter may be present.
The links below are good sources of information about atrial fibrillation.

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.
     Sorry for the last "Blank submission to this forum...I'm just learning this process, and I hope I'm doing this correctly now.
     Could you go into a little more detail as to what I can expect during AND AFTER the AV ablation and pacemaker insertion?  Heartbeat sensations? Return of PACs?  Can I return to weightlifting?  Is it true that i won't be able to stand over a running car engine w/ the hood up?  
     The info that you gave initially was "MUCH APPRECIATED", but as a past 9 year Cardiac Tech., and happened to be trained with the generous time donation of my current Cardiologist...I was aware of most of the previous info. that you listed.
     Just would like to know what to expect DURING AND AFTER the procedures...as I was trained in "PreHospital ALS" and not "PostHospital Results."  Again, Thanks!
                                                           -Jim G.
     Thank you so much.  You're very kind to provide this service.

Dear Jim,

Q: Could you go into a little more detail as to what I can expect during AND AFTER the AV ablation and pacemaker insertion? Heartbeat sensations? Return of PACs? Can I return to weightlifting? Is it true that i won't be able to stand over a running car engine w/ the hood up?
A: You shouldn't feel much during the procedure.  You may notice your heart beating fast but that is about all.  Most people tolerate pacemakers very well.  They are fairly "low care" devices.  The only restrictions with the newer pacers is that you cannot be in high energy fields such as around a major power transformer or a MRI machine.  Other than that you should be able to resume your previous lifestyle.  Be sure to discuss your concerns with your doctor before the procedure.

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.

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