As you no longer have episodes of tachycardia and are bothered mostly by skipped beats and bradycardia, you and your doctor should pursue alternative medical regimens before considering any ablative procedures. As I have stated, Digoxin may not be the best medication for your condition and other drugs in combination with Beta Blockers may be best. Patients with surgical repair of congenital heart disease may present with particularly difficult arrhythmias to control or cure and careful follow up is required. At some point in the future, ablation and/or pacemaker therapy may be helpful.
Vagal responses are transient and will not cause any permanent changes in rate or rhythm. Unfortunately, even the most skilled physician can miss asymptomatic arrhythmias.
Gastrointestinal events like reflux or overeating may exacerbate episodes of Atrial fibrillation by influencing hormonal or neural innervations of the atria. This is a relatively common scenario. I do not believe it actually causes AF but certainly can increase the frequency of episodes.
The pulmonary function test will not permanently affect her atrial fibrillation though if she is given bronchodilators, the rate may transiently increase. Possibly it can be performed without the use of these medications.
If the fibrillation has been present intermittently for a long period of time it is VERY likely it will return after the Amiodarone is fully washed out. Antiarrhythmic therapy is virtually never curative and will work only if the medication is on board.
Lone Atrial fibrillation is defined as AF in the absence of any structural heart disease including hypertension. It can occur once, be repetitive or persistent.
We usually have a reasonably good assessment of the success of the procedure at 6 months. However, we know that many patients may have late recurrences and monitoring is required for some time. The intensity of that monitoring and the decision as to when to stop the medications is very patient specific. It may depend on the presence of structural heart disease and the risk of stroke.
Occasional skipped beats are common in everyone, even without a history of Atrial fibrillation. By themselves, it is not an indication of recurrence of atrial fibrillation or the need for further ablative therapy. Frequent exacerbations and remissions of symptoms are common and best ignored.
Dr. Andrea Natale
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients. For further details Please visit :Link
Dr. Dhanunjaya Lakkireddy
Dr. Dhanunjaya Lakkireddy, MD, F.A.C.C, FHRS. is a board certified electrophysiology expert and practices at Mid-America Cardiology and The University of Kansas Hospital Clinics in Kansas City, KS, USA. He has several distinctions in clinical and research career to his credit and serves as an associate editor for Journal of Atrial Fibrillation.For further details Please visit :Link
Dr. Dhanunjay Lakkireddy, MD, F.A.C.C, FHRS, The Kansas City Heart Rhythm Institute (KCHRI), KS, USA.
Disclaimer
1. JAFIB and the invited expert reserve the right to decline any question. The question declined will not appear in the list of questions asked.
2. The questions or advice from the expert can not be considered as alternatives to your clinician's advice. This discussion is only for educational/informational use. Your EP doctor is THE person to advice you on treatment and management of your condition.
Feedback : Your suggestion on this new initiative are much appreciated. Please write to the managing editor(editor@jafib.com) about your feedback on "Meet the Expert".
