Firstly you need further investigation with ultra sound Doppler of the leg to diagnose further DVT. Yes it is possible to have DVT whilst you are on Coumadin (although less likely). If a proximal large DVT is diagnosed on ultrasound scan a few days of rest is advised whist considering additional treatments such as placing an IVC filter.
The longer the duration of Afib lower is the success rate following cardioversion. The success rates also depend on other factors such as left atrial size and concomitant heart valve disease etc. These are the factors that determine the success rate following ablation as well.
Yes it is possible to have one further attempt at ablation (as we sometimes do). However before further attempts at ablation there are a few issues to be addressed- how long you have been in AF/ left atrial size/ LV function and so on. This would aid the physician in decision making regarding further attempts at ablation (assess possible success rate).
You have paroxysmal AF. There are better medications than Diltiazem to prevent AF recurrence (Flecainide/sotalol/doefitilide etc). You need to discuss with your cardiologist if you could switch over from diltiazem to one of these medications.
There are better antiarrythmic drugs than Metoprolol to prevent recurrent episodes of atrial fibrillation. Assuming that you do not have coronary artery disease or structural heart disease, you could try one of the following drugs Flecainide/propafenone/sotalol/dofetilide. If you continue to have recurrence of atrial fibrillation whilst on one of the above mentioned medication, you could consider ablation procedure.
There are two aspects that need addressing in his case. Firstly is he adequately rate controlled, this can be assessed by performing 24 hour heart rate monitoring. Secondly, if he has been getting anginal symptoms he needs coronary angiography to assess the state of his coronary arteries.
Xarelto is an anticoagulant medication. If you are having bleeding gums whilst on Xarelto you need to ensure you do not have conditions that predispose to excessive bleeding tendencies. You may need blood tests to check platelet counts, liver function and kidney function. You would need to discontinue aspirin if you are using it concomitantly with Xarelto.
Yes poor blood pressure control can trigger episodes of atrial fibrillation. In a significant proportion of patients with high blood pressure, no underlying cause can be identified. This is termed as essential hypertension. In your case since secondary cause has been ruled out it becomes essential that optimum blood pressure control is achieved by usage of suitable antihypertensive therapy. I also doubt the diagnosis of Vagally induced AF as you have responded positively to beta blocker therapy (vagally induced AF is usually made worse by beta blocker therapy).
Yes CT scan of chest is the correct test to pick up mediastinal abnormalities. Although esophageal injury leading to pneumomediastinum is a well recognized complication of AF ablation procedure, this usually occurs within a few days and highly unlikely to occur 5 months post procedure
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".
