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Anita! What you have is progressive AF related to rheumtic mitral valve disease. The fact that you go in and out spontaneously after MAZE tells me that your atrial substrate is modified enough to preserve rhythm control. However, it has not done the job completely. The lightheaded spells after the AF episodes needs to be addressed. This could be post AF conversion pause. Or you may have episodes of severe bradycardia that needs to be evaulated and treated. You may need event monitoring to understand your rhythm during these episodes. You can try a class III agent - Sotalol or Dofetalide instead of the current classs IC agent. Obvioiusly, a catheter based ablation endocardially may help you to get the job done and accomplish rhythm control. Please discuss these options with your EP.

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Obviously, success rates for persistent and permanent AF is less than paroxysmal. My success rates for persistent AFs range about 70-80% at this point, Normal sized left atrium is a very good prognostic factor. A redo ablation at an experienced center may help complete the job.

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Treatment of AF is mostly driven by symptoms. If you are symptomatic despite good rate control, then rhythm control should defintitely be considered. Your case is an example of the natural progression of paroxysmal to a more persistent form of AF. Cardioversion will help you get converted to sinus rhythm but will not help to mainitain your rhythm in the long term. So you may need an additional antiarrhythmic drug to help you maintain sinus. If you dont' have signfiicant Coronary disease or structural heart disease you may start with drugs like flecainide or propafenone. Please consult your cardiologist or EP for further care. Radiofrequency ablation is a treatment option if you meet criteria.

Answer:

Coughing spells after the ablation is worth further exploration. Make sure you were not started on any angiotensin converting enzyme inhibitors or Angiotensin receptor blockers after the ablation. These two groups of drugs can cause dry nagging cough in a small percentage of patients. Hemoptysis (bloody sputum during coughing spells) could be indicative of atrio bronchial fistula, again its onset is relatively acute. Severe ipsilateral PV stensosis can cause coughing spells. CT scan of the heart can address the two issues that I mentioned above. Cardiac MRI can give similar information also. I am sorry that your ablation did not work. But recurrences after ablation are not uncommon - incomplete isolation, new AF triggers, iatrogenic atrial reentry tachycardias can cause these. I don't think the system being down for a few minutes would have had any bearing on your outcomes. The catheter cools within a few seconds immediately after the applications is turned off. Since I don't know the complete details of what your situation is I may not be able to make any further comments. Please talk to the EP who had treated you and ask him or her for more details and I bet they will be more than happy to discuss

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It is quite possible that the wide complex tachycardia could atrial flutter with one to one conduction. Cardiac hemodynamics can be significantly altered if your ventricular rates are fast enough. Thorough review of the ekgs and rhythm strips will help to make this distinction and rule out Ventricular tachycardia. Please make sure you are on adequate AV nodal blocking durgs (sufficient cardizem dose). Atrial flutter ablation is very successfull in the order of > 95%. There are several institutions that can offer RF ablation therapy on the east coast. I consider atrial flutter ablation as one of the bread and butter cases that any well trained EP should be able to offer. IF you need specific references please write to us where you live and we should be able give you a few names. (andrea.natale@jafib.com)

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Skip your 1 pm dose and take your evening one. Watch for a signs of dizziness or slowing heart rate. You should be ok.

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I do not think that Verapamil is causing your episodes to last longer. AF is just unpredictable. Discuss with your cardiologist the other drugs and how suitable they are for you. There are antiaarhythmics which are more effective than rate control meds as the ones you are taking now.

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I am so sorry for what you have been going through. But first let me tell you that you always have all the right to ask about, and discuss the results of your tests with your doctor. You may also request copies of these test results to be sent to you for your records. The size of the left atrium is one of the important factors to consider when assessing the efficacy and the success rate of the ablation. The normal left atrial size is roughly 3.5-4.5 cm. Of course, the bigger the atrium is, the more difficult it is to achieve complete cure from atrial fib with one procedure. Hopefully the monitor will be able to show whether or not you have rhythm problems other than atrial fibrillation, like atrial flutter or conduction issues resulting in pauses and causing you to feel dizzy.

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This depends on your symptoms and how often you get them. WPW causes the heart to go into high rate tachycardia which may be associated with low blood pressure and dizziness. In rare cases, if WPW is associated with atrial fibrillation, tachycardia can occur at an even higher rate leading to serious consequences.