The risk of stroke as a result of AF is very much dependent on the associated risk factors. These should be re-evaluated on a yearly basis. From a stroke prevention in AF perspective I do not believe there is any data on the two doses that you have suggested. Perhaps more important is whether you need anticoagulation. Your doctor will be able to discuss these with you.
These are complicated questions and I am going to try and give you an interpreted response to each:
1. All heart tissue is capable of ectopic beats. For example, if you stretch a muscle it initiates ectopic activity. Under the correct exposure this occurs to cause AF - high blood pressure, sleep apnea, diabetes.......etc These are the risk factors known to cause AF.
2. All of the above conditions change the atrial muscle. There are ionic changes, structural changes and autonomic changes. Perhaps importantly there is fibrosis of the atrial muscle. This provides the environment to hinge wavefronts ....rotors, to facilitate ectopic beats....therefore maintaining AF. Answer: C - it is a lot more complex :)
If your AF burden is 20% (ie you are in sinus rhythm the rest of the time) I would have a second ablation if you were symptomatic. Indeed, I counsel my patients that with current technology a significant proportion will need a second ablation. If they are not prepared for that then they should consider if they should have the first. I am not aware of a neurologist who is working in this area.
This is debated and there is no consensus. I undertake a TOE before all AF ablation cases. The temperature set during the cases depends on what is being done. With irrigated ablation (mostly AF ablations done this way) the temperature is not so important as it is controlled by irrigation of fluid. The power delivered is what causes the lesion. I would need more specifics to be able to provide more information.
The only way to make a doagnosis is to see your doctor and arrange for a Holter monitor or Event monitor, in order to record your heartbeat when you are having the palpitations.
53bpm is not a very slow heart rate and may not be the cause of your symptoms; you should see your doctor to arrange a 24 hour Holter monitor or an Event monitor.
You would need to wear a heart monitor such as a Holter or event monitor to make a recording when you are having the symptoms; then see your doctor to discuss the results.
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".
