A-FIB turning into V-FIB

[vikkij]

Thank you doctor for taking my questions.

1. Can A-FIB degenerate into V-FIB or any other dangerous arrythmia?

2. I have had 2 PVI ablations for A-FIB over the last 4 years.  These were fairly sucessful but the A-FIB is slowly returning. Is there a point at which the atrium could be damaged from too much ablation scarring?  

Thanks for your input.

[arthur]

As someone who had PAF and went through an ablation some years ago, and have some PAF return, I can add a little information.

I am quite active physically.  The PAF that I had (and is slowly returning) comes from foci located in the atria/PV ostia.  These were blocked by ablation.  Note, that most ablations do not toast the foci, but are designed to create a non-conductive block between the foci and the rest of the heart.  However, with time, and because of extreme exercise, the tissue stretches and new routes are established between the foci and the heart.  Bingo, more arrhythmias.

One useful suggestion that the EP gave me is to insure that my blood pressure is under control (it's normally somewhat elevated).  The higher the blood pressure, the more the heart tissue will expand under duress. And when the tissue expands, the space between cells gets larger and focal signalling can leach through.  Anectodally, since I started taking an ACE inhibitor, the PAFs have been nearly impossible to initiate (usually initiated with sudden stress, ie, increase in adrenaline).

If your blood pressure is even slightly high, you might want to talk to the doc to see if you could take a small dosage of a blood pressure med, and then see if the PAFs are as frequent.

-Arthur

[vikkij]

I'm not sure of all the reasons for arrhythmias returning, but the EP in my case told me the lesions burned after the first ablation grew over with new tissue. The second ablation (using a different method)lasted longer but the AF is slowly returning. I guess its as the CCF Doc said, they start with light ablation and work up from there. I worry about a 3rd attempt though.

[tickertock]

As far as I know the most usual cases of a-fib turning into v-fib would be caused by WPW syndrome in which the bypass tract/accessory pathway directly connected from atria to ventricle, in these rare cases when a-fib occurs it can conduct 1:1 to the ventricles and degenerate into v-fib.

[frs87]

I was wondering exactly the same thing.

Bu the way, does anyone know WHY, after all, an arrhythmia may come back after ablation? Since the path has been "burned", why are there so many cases in which arrhythmia keeps hapenning?

[Forum-M.D.-MJM]

Hello,

1. Can A-FIB degenerate into V-FIB or any other dangerous arrythmia?

As far as most people are concerned, no, AF does not lead to VF.  In the rare circumstance that someone has a rapidly conductiong accessory pathway (a minority of WPW syndrome or other accessory pathways), yes it can degenerate into a dangerous heart rhythm.  The people at risk for the this happening tend to be very young -- teens, twenties, thirties.  It is not the typical version of atrial fibrillation.

The next question that most people will ask is how do I know that I don't have that.  The EKG of someone with a fast conduction accessory pathway is usually pretty obvious and it causes most doctors alarm when the see it, prompting a visit to an electrophysiologist.

This should not scare anyone.  This is a rare case and is usually very evident on a 12 lead EKG.


2. I have had 2 PVI ablations for A-FIB over the last 4 years. These were fairly sucessful but the A-FIB is slowly returning. Is there a point at which the atrium could be damaged from too much ablation scarring?

Another good question.  This is the area of atrial fibrillation ablation that we are still working out.  The goal is to ablate as little atrium as possible to cure atrial fibrillation -- this helps maintain a strong atrium and helps the heart work as a more efficient machine.  On redo ablations, we tend to ablate more.  The assumption is that if you are coming back, you must be having symptoms and would benefit from cure, so we ablate more of the trigger areas.  We still don't know how much is too much, who can't be cured (and we know there are some that we just can't keep of AF).  At this point, the best thing to do is talk to your electrophysiologist about this.

Another small point is that there are many electrophysiologist out there that aren't trained to do this procedure and they are starting to do them.  Ask the direct questions -- what is your success rate, how many have you done, where were you trained. It is your right to know this.

I hope this helps.  Thanks for posting.