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I have had 5 atrial fib episodes since March and several irregular heart arrhythmias since mid July. I was started on flecainide at 50 mg BID in late April to prevent AFib and was tried on atenolol after the first breakthrough. I discontinued atenolol due to unmanagable side effects. I just discontinued the flecainide due to allergic reaction to the drug. I live in Corvallis, Oregon and am now considering my options including PIP, mini maze and catherter ablation. Nuclear med stress test, echo and CT scan all indicate that my heart is sound. My blood pressure is typically 110/60. I am 53 and female. My quality of life is severely impacted. What is your opinion of the options I have laid out? Are there others I should consider? Thank you in advance for your insight.
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

Please refer to my opinion above regarding surgical ablation procedures. But no matter what your choice will be, because of your symptoms and their impact on the quality of your life, you are an ideal candidate for ablation. You are still young and healthy not to pursue one of the options available for you. I urge you to meet with a surgeon and once with EP so you can make an informed decision. Make sure to choose an operator with a long track record of good outcomes and long follow up greater than 6 months.

i have had two significant episodes of atrial fibrilation, both of which eventually corrected themselves and a few smaller ones which quickly settled down. i believe each episode was caused by drinking very cold water very fast. i have been put on 12.5 mg. of metropolol but it makes me very drowzy. my doctor suggested i cut 25 mg. pill into thirds to reduce the amount i take. is there any problem with doing this?
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

The only problem I see is how you can accurately divide the pill into 3 doses!! It will be difficult. You may ask your cardiologist to switch you to a CA channel blocker instead of Beta Blocker (the Atenolol).

Dr. Natale, I had a consult with Cleveland Clinic last June. I wanted to see you but you had already left. I saw Dr. Saliba. I am a young 65 yr old woman who has had lone a-fib for 10 yrs. In 2001 I have a single Pulmonary ablation by Dr. David Haines. It lasted 9 months. I have been on 50 mg flebanide and 25 mg of toprol for the last 3 yrs. Last Jan had to double the dose because I was having way too many breakthroughs. My concerns are: 1) Last echo shows normal left ventricular size and function with and LVEF of 50-55% but I have moderate to severe mitral regurgitation with the atrial size of 4.4. This distrubs me because 3 yrs ago my atrial size was 3.8 and moderate mitral regurgitation - big jump. I know large atrium size reduces the chances of a successful ablation. 2) I'm concerned that flecanide will stop working and I do not want to go on the stronger antiarrhythmic durgs - that destory you organs. 3) I'm concerned that I may go from lone afib to chronic afib and then the success rates for ablation drops quite a bit. Questions: 1) Could you address my concerns? 2) How long did Dr. Saliba train under you at Cleveland? 3) He quoted a success rate of 75 to 80% - is this his success rate or is the success rate of all PVI's done by all drs/hospits. WHAT IS YOUR SUCCESS RATE - because I consider you the gold standard. 4) Would you schedule me for an ablation just from reviewing my records and consult from Cleveland or would you need to see me twice - once before ablation and then the ablation...and of course a follow up trip. Do you have a number at St. Davids in Texas and HOW LONG IS YOUR WAITING LIST? Do you just do new procedures from Texas and California? - I live in Virginia. It's an honor to get to ask you these questions.
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

Success rates vary from one operator to the other. In general left atrial size is a factor to be considered. The success rate could very high (in the 90%) while your LA is still within normal limits. I perform procedures both in California and in Austin, wherever more convenient for you. Please feel free to email Mrs Beheiry and she will be able to arrange your visits. Her email is Salwa.BeheiryRN@gmail.com

I have MTV surgery at Mt. Sinai NY, in April. I was released from hospital 8 days later with diagnosed AFIB. Was immediately put on coumadin/linisoplril/81mg aspirin. Local cardiologist still looking to see if AFIB will disappear. Have had Holter/and event monitor. Looking a another Holter in a week. No history of AFIB prior to surgery where they repaired Mitral and Tricuspid with ring and band. 64 yrs , 160 lbs....after many years of no exercise, started 5 years ago 2/3 time week 1hr 25 min exercise with zest prior to now. I except for short burst of exercise where I get palpitations and quick hr up not really too much of a symptom. Am now walking about a fast 45 minutes each day; Bottom line: is there an obvious fix for AFIB out of surgery ? can you recommend AFIB specialist that may be 2nd option to assist my local doctor who I suspect is fine but really not an AFIB guru ?
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

Afib is not uncommon following certain heart surgeries. It seems to me that you are healthy and relatively young and hopefully you have many years in front of you to live a healthy life. You have AF you have to worry about two main risks, Stroke and heart failure. You also have to assess the impact of AF on the quality of your life, meaning that whether or not you have symptoms which alter your life style.The advice of a good electrophysiologist can help you assess those risks and advise you on your best option. Dr Larry Chinitz at NYU is an excellent physician to consult with. Best of luck.

I am very distressed by ectopics, and wonder if there is any medication or ablation hope for these, other than beta blockers? My cardiologist says no, that Flecainide might help, but it is too dangerous "just" for ectopics even for someone like myself with an otherwise normal heart. I find ectopics very depressing and they make me quite anxious. (I have long term anxiety which is not correctable by any med or therapy that has been tried, but I am not anxious when nothing is wrong, so fixing the ectopics would be wonderful, I would have my life back.) I am 64, no other significant health problems except weight which ballooned after going on Toprol XL eight years ago, which I am working on by walking 30 minutes a day. I am 5'8" 200 lbs. The Toprol also causes lethargy and some shortness of breath. I was diagnosed with parox. afib and rare svt 8 years ago. Actual afib only happens a couple of times a year now that the Toprol XL was increased to 50 mg twice a day (now at 75 mg twice a day) and magnesium was added. After an afib episode a month ago, I have been in freq. ectopics every since. A two day monitor showed 1400 PVCs and 280 PACs. It seems that the past few years, the recovery period in ectopics after afib has increased significantly, as well as the frequency of the ectopics. I fear that this time I will not revert to a low rate of ectopics, as it has never taken this long before. Besides any medication or ablation possibility, could you tell me what you think of physical exertion while in freq. ectopics? It used to make things worse, but my current cardiologist says it may reduce afib and ectopics in the long run, while my previous cardiologist in another state said it would have no effect. Does Dr. Natale do ablations for ectopics (both PVCs and PACs)? Do you know a doctor in RI or Boston who specializes in ectopics problems? Thank you very much.
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

Ectopics are premature beats either from the atria (PAC) or from the ventricles (PVC). They are rarely harmful. However they may trigger some sustained arrhythmia as AF in your case. I agree with your doctor that Flecainide is perhaps a strong medication for a problem that is not serious. In many instances PVC can be ablated with great success. However an EKG showing the morphology of the PVCs can be very helpful to give a more accurate opinion.

i would like to know when you will be at either akron general or metro hospitals again. my grandmother is being referred to you by her cardiologist out of youngstown,ohio "Dr. David Hoffman". my grandmother is a resident of youngstown, ohio and if she can see you here in ohio she would love that............. Dr. Hoffman spoke extremely high of you. please let me know a.s.a.p. thanks so much.
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

I am not in Akron very frequently. However I can recommend Dr Bob Schweikert in Akron General who is a very skilled electrophysologist and I trust very much.

I had a third ablation for AFib in May and then started dofetilide a week later (500mcg twice a day). I am also on coumadin, diltiazem and atenolol. I have been in NSR since May 19 but had a few breakthroughs this week! The breakthroughs last for less than 30 minutes but drum up feelings that AFIB is BAAACK! What are the chances that AFIB is returning?
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

It is not uncommon to have recurrence of AF within the first 3-4 months after the ablation procedure. I would wait another 2-3 weeks and see if you will have other recurrences before we determine the success or the failure of the procedure.

Dear Dr. Natale, There is a lot of confusion in the A-FIB and PAC community concerning supplementing one's diet. What are your views on daily vitamins, calcium for women, potassium, taurine and magnesium. Also would you address the long term effects of coumadin and sotalol. This would greatly help so many people searching the internet for professional answers rather than depending on lay people for their answers. Thank you so much.
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

Daily multivitamins within the RDA are always recommended. Calcium is also very important for women who are approaching menopause. There are no long term effects of Coumadin or Sotalol that I am aware of. Side effects of these two medications are usually known while being taken.

I am a 56 yr old male diagnosed with lone AFib in July 2003. I have NO other health issues. EF is normal and NO coronary artery disease. I have been converted 3 times in Sept 03, Oct 04, and Feb 08. I have been on three Rhythm drugs . Rhytmol SR has been the best. I started on this at a dosage of 225 mg 2x per day in Nov 04 but have been on 325 mg 2x per day since my last conversion this past Feb. This higher dosage drove me to a pulse rate of about 45 but also brought me back to sinus rhythm in April. I was out of rhythm for about 48 hours.To counter the bradycardia I was given a pacemaker on May 29th 2008. I feel much better! I chose not to have an AFib ablation beacause of the higher probabilities of complications from the procedure and due to the fact that the side effects from Afib other than the 04 episode have not been severly disabling although my wife might feel differently(bad moods from feeling tired).I also take 25 mg toprol XL, 10 mg Lipitor, and Coumadin. Would you still anticipate that the AFib episodes will increase with age and what are the possible directions my treatment might take if the Afib does get worse?
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

AF is known to get worse with age. Your options could be other medications or ablation.

Dear Dr. Natale: My a-fib is being controlled right now by 80 mg. Sotolol 2x a day. I also take 7 mg. Warfarin a day, and I do not like taking it as it seems to sap my stamina to say nothing of the huge bruises I now accumulate at the slightest bump. When the a-fib seemed beyond my previous medications, I was ready to do ablation. My question is twofold: Should I continue w/plans for ablation or be satisfied with the improvements I now have? Also, I understand there are many physicians who allow their patients to go off Warfarin when they have achieved 6 mos. without an episode (which I have)--what could make this an option for me? Thank you--Eileen Graham
Answered By : Dr. Andrea Natale, MD, FACC, FHRS, FESC

Answer:

Eileen, since I have no knowledge of your age or any other health issues you might have, I am not able to advise on the Coumadin issue. I recommend ablation for those patients who believe that either AF or the meds are causing them to have symptoms or when AF is a factor in the quality of their lives.

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