First, I hope your second ablation will be successful. Even with lone atrial fibrillation, when present for 10 years, expect only approximately 50% long term success with a 2nd ablation procedure. Usually vagally mediated AF is seen is people with slow baseline heart rates, often athletes, and is not typically related to exercise, so I wonder if your episodes are truly vagally mediated. Antiarrhythmic drugs such as flecainide and disopyramide have \'vagolytic\' properties and may be tried in vagally mediated AF. An atrial pacemaker can also be effective in preventing the slow heart rates and hence the AF episodes. I recommend you discuss this further with the cardiac electrophysiologist who will be performing your ablation procedure. It is still common to have PACs even with a successful ablation for AF.
With a CHADSVASC score of 4, either Warfarin or one of the novel oral anticoagulant (NOAC) drugs (dabigatran [Pradaxa], rivoraxoban [Xarelto] or apixaban [Eliquis]) is strongly recommended for stroke risk reduction. While the theoretical increased risk of stroke when starting warfarin is very low, probably <1/500 or lower for the period of the first month, a simple way to address this concern is to use a subcutaneously injectable low molecular weight heparin (Lovenox) concomitantly for the first 4 days until a therapeutic INR is achieved. The usual starting dose of warfarin is 5mg. You can then have your INR test checked and your physician or Warfarin Clinic nurse can advise on adjusting the dose of warfarin. Another alternative is to use one of NOAC drugs, which are fully effective in 2-4 hours, so this concern does not arise, and no Lovenox injections are needed.
It is much more likely that inadequate sleep would contribute to developing atrial fibrillation. If you are taking the standard (short acting) Rythmol at 300mg tablets, the usual daily dosing is x3/day - so an additional dose of either 150 or 300mg, 1-2 hours before sleep might help. There is also a long acting form of Rythmol (Rythmol SR) which can be taken x2 daily and comes on doses of 225, 325 and 425 mg. The generic name for Rythmol is Propafenone. Please check with your prescribing physician before making any changes to your current Rythmol dosing.
Hello and thank you for the question. With proper monitoring the AFIb and blood thinner can be managed carefully before, during and after surgery. Surgery is often done on such patients quite successfully. Please discuss this with the cardiologist involved in his/her care.
Hello and thank you for your question. Redo ablation after a cryoballoon procedure can vary depending on the nature of the target region. This may require a balloon, cooled tip cryo catheter or a rediofgrequency catheter.
Hello and thank you for your question. Atrio-esophagela fistulas are still ongoing risks of an ablation procedure in the left atrium. They are infrequent with proper care and montioring but still occur.
Hello and thank you for your question. Unfortunately, atrio-esophageal fistula is a rare but potentially life threatening complication of any left atrial ablation procedure for atrial fibrillation.It is seen most often with radiofrequency ablation. Current technology is still fairly early in its development and heating of the foodpipe does occur with current technology. While precautions are taken to minimize this , it remains an ongoing risk of the procedure. As new advances occur, this would be an area for improvement.
Hello and thank you for your question. It would be necessary to know what kind of abnormal heart rhythm was seen. This should be evaluated by your cardiologist and he/she should decide how to proceed.
Hello and thank you for your question. I would still consider not taking this medication as it may be causing a heart rhythm issue. Alternatives are available and should be discussed with your doctor.
Hello and thank you for your question. SShe could be a candidate for a heart failure pacemaker or defibrillator. Please consult a cardiolgist or preferably an electrophysiologist for this option.Please have your physician or a cardiologist evaluate her as soon as feasible.
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.
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