a. fib.

[drbiles]

I've had A. fib. for 20 yrs.
normally in excellent health
normal BP 110/70
normal RHR 60
55 yrs old
ex-athlete  
non-drinker
non-smoker
eat healthy
5' 8" 180 lbs
constantly in A. Fib.
Lately i've been in extreme pain especially at the end of the day.
Losing sleep.
with a RHR @ 175 - 225
tried all medication known they worked for a few months but then the a fib would come back with more pain.
2 stress echo's finding heart is healthy as a 25 yr. old heart
2 cardiac ablations
5 cardioversions
3 months of  acupuncture
3 months of Chinese erbologist
currently taking coumadin 7.5 mg daily, cardizm 120 mg 2 X per day, magnesium, potassium.


Can a third ablation get me back to normal sinus rhythm permanently?
what's the success rate of third ablation?
or
should I have the mini-maze procedure? what's the success rate of mini-maze?

Pacemaker is out of the question.
With a pacemaker I would still be in afib, on medication, on coumadin for possible stroke  and limited ability to exercise.

Why can't the cause be treated not the symptoms???
Obviously something is telling my atrium to beat this way and it hurts!!!

[Cleveland Clinic]

Where did you have your ablations done?  Here at the Cleveland clinic we usually quote an 80% success rate of curing atrial fibrillation in patients who have paroxysmal atrial fibrillation (on and of afib, not your case).  Persistent atrial fibrillation (your case) has a much lower success rate of about 65 to 70%.  These number are usually achieved with one ablation in 50%, two in 20% and three in 10% of patients.  So as you can see we do take people for as we call them "three-do's", but it is not very common.  The success rate, therefore, for curing atrial fibrillation in your case, is relatively low with a third ablation.  Of course, I don't know where you had the previous two procedures done.  It is possible, that the ablation was incomplete and if that were the case one could study you again and see whether or not the veins are isolated.  Unfortunately, in the persistent afib patinets, pulmonary veins aren't the only trigger for atrial fibrillation and this is why our success rate with ablating the veins is lower.  We do perform more extensive ablations in such patients, however, our results aren't as good as those for the paroxysmal patients.  The longer one has atrial fibrillation for the harder it is to get them back to normal sinus rhythm with an ablation procedure.  We really don't have any good date on the mini-maze procedure.  I don't think that it is worth having it done as an isolated procedure.  The patients who get is here are those who have valve surgery or bypass.    

[twinbee]

I would try and talk to one of the top EP's in the country to see what they would suggest and if they could help you. I would contact Dr. Natale in Austin, Tx or Dr. Marchlinski at Univ of Penn , Pa. I know that Dr Natale does travel to San Fran on a monthly basis.  Good Luck!  Wishing you well,  and wishing you enough...

[drbiles]

For Marzeis: I tried all medication in various combination numerous different times over the past 20 years. It got to the point that they increased my dosage and caused ventricular tacacardia, and once they lowered my BP to 80/51.
Oh, I noticed on my Bio it has me as Female 5'8" 180lbs.
I'm a male 5'8" 180lbs.

[drbiles]

The ablation was done at John Muir Hospital by Dr. Cho.

I've read where the minimaze has a pretty good success rate.
Valve surgery or bypass would not get the "Minimaze" they would get the Wolf maze.

If you don't think it is worth having it done as an isolated procedure what do you recommend? I cannot live this way.

Oh by the way I noticed the Bio has me as a female, I'm male 5' 8" 180lbs.

[marzeis]

I went into constant A-fib.  Dr wanted to do a TEE and then a cardioconversion, but I refused.  Five days later I was sent home on Coumadin, Cardizem 240,  After two weeks in constant A-Fib tachycardia the dr started me also on Digoxin and that evening I went into sinus rhythm, which was a blessing to me. I do not know if Digoxin did it, but maybe it is worth a try?
mary