Answer:

What is heart pain? Pain coming from the heart is usually perceived as a severe pressure sensation “like an elephant standing on your chest”, often associated with shortness of breath, sweating, nausea or vomiting. This is what occurs when one has a heart attack due to a blocked artery. It is unlikely you are having this, but cannot be ruled out without further testing. A second type of heart pain can occur due to inflammation around the heart, or pericarditis. This pain is usually sharp or stabbing, is often associated with deep breaths, or is positional. A recent ablation can cause pericarditis pain. This would also be unlikely in your case, if your last ablation was more than a month ago. The pain would not be caused by “an arrhythmia trying to start”. Also, an ablation does not “burn off the veins”, but it actually destroys the muscle tissues, which act like wires, connecting the tissue in the pulmonary veins to the atrium. These symptoms may have simply been due to muscle tension from the stress, or even gastro-esophageal reflux causing what is otherwise known as “heartburn”. In any case, you could certainly call your doctors’ office now or mention this when you see him, as additional tests such as a myocardial perfusion scan to rule out coronary blockages may be appropriate depending on your age and other risk factors.

Answer:

The success rate for one ablation for PAF ranges between 60-85%, depending on the center and operator experience. A second ablation will often identify reconnections of the pulmonary veins, but the success rate should definitely increase to nearly 85% after a second ablation (85% is our success rate at University of California, San Diego, over 5 years followup with an average of 1.4 ablations/patient). If you still have recurrence after a second procedure (especially one that included additional lines and perhaps ablation at sites of CFAE or dominant frequency), then a second opinion may be appropriate. In some cases, depending on the experience of your EP, a third ablation may be appropriate and effective, and may still show reconnections of the PVs in some cases. An alternative would be to start an anti-arrhythmic drug to suppress the AF (some drugs may work better after an ablation than they did before the ablation). It will also be important to monitor these recurrences, since an atypical atrial flutter may occur after linear ablation, rather than atrial fibrillation. Atypical flutter ablation may require a different mapping and ablation approach to cure.

Answer:

The vagal triggers of AF are well known, and include large meals, slow heart rate at night, bending over, etc. as you have noticed. Actually extensive research has been done that shows that vagal nerve stimulation may trigger premature beats from the pulmonary veins, then can then initiate episodes of AF. The problem is eliminating the vagal triggers. Some recent research has shown that low level vagal nerve stimulation may actually reduce AF recurrence, but this treatment is not clinically available in the U.S. yet. We also know that ablation of the pulmonary veins may eliminate the triggers of AF. Thus, if you have not had a good response to antiarrhythmic drugs such as flecainide, then an AF ablation may be appropriate for you, to eliminate your symptoms. However, ablation is not always required if your symptoms from AF are tolerable. Just remember, that in some cases the frequency and duration of AF episodes may increase over time if not treated, eventually leading to persistent AF, which may be harder to treat. Vitamin supplements are not typically too helpful, although magnesium has helped some of my patients. Just as a reminder, previous studies have shown that even 5 hours of AF in a 24 hour perior increases your risk of stroke, and a more recent study suggests that even 5 minutes of AF may increase your risk. Thus, since you have a CHA2DS2VASc score of 2 (age over 65, and female gender), the European guidelines recommend that a patient with a CHA2DS2VASc score of 2 should be on an oral anticoagulant such as warfarin or one of the newer factor Xa or direct thrombin inhibitors to reduce the risk of stroke.

Answer:

With such a strong family history of AF, yours may indeed be familial (genetic). Nonetheless we typically treat it the same as sporadic or lone AF. According to your history you don’t have a very high risk score for stroke (CHADS2 score 0, CHA2DS2Vasc score 1), since you are less than 65 years of age, and do not have congestive heart failure, hypertension, diabetes, vascular disease, or prior stroke. Therefore, you do not need to be on Coumadin. If your AF episodes are very frequent, and that depends on your perspective, but every 10-14 days if fairly frequent, then an antiarrhythmic drug may be advisable. We usually use flecainide 50-150 mg twice a day, with Toprol, to see if it helps suppress the AF. If AF continues to recur even on flecainide, then an ablation may be required.

Answer:

Since your persistent AF is asymptomatic, rate control is an appropriate option for treatment of AF in your case. If you have been in AF for more than a year, it becomes much more difficult to prevent recurrence with either antiarrhythmic medication and cardioversion or ablation. You do not have to undergo treatment with an antiarrhythmic drug or ablation if you are asymptomatic. In fact, if you are under age 75 and have no other risk factors in the CHADS2 score (congestive heart failure, hypertension, age over 76, diabetes and prior stroke), you theoretically don’t need to take Pradaxa either, just aspirin may be appropriate.

Answer:

For Brugada or passing out from heart rhythm disturbances, the best person to see is a heart rhythm specialist. There are some tests which can provoke the Brugada pattern.

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The Framingham risk score indicates the risk of developing significant disease in a decade. It is not for people who have known disease. Your risk score is relatively low, so continue to keep the risk factors down.

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I am unable to answer all these questions as they are too specific without knowing the patient personally. I would suggest follow up with the doctor who prescribed the treatment and either accompany your mother or have a list of questions prepared that you would like answered.

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I am sorry to hear about your boyfriend. The fact that he is responding after rewarming is a good sign. The doctors will likely look for infection as a cause of fever and begin medications for his heart and start rehabilitation when he is able.