This is an interesting observation. However, I don’t think it is that simple. I have had many patients with magnesium supplementation with limited efficacy…
You could consider reablation as this could suppress both the PACs and the pauses. Some physicians could recommend to implant a PM if the pauses are significant but it would make more sense to me to repeat the ablation procedure.
The values of your ECG parameters have to be validated by a doctor as the automatic measurements by the machine are sometimes wrong. If confirmed, I would suggest to stop Multaq. The change in your arrhythmia is likely to be due to an incomplete effect of the drug that has organized your AF (into atrial flutter) and shortened atrial fibrillation to some episodes that are now not exciding the simplest form: PACs. But this is not improving your quality of life, as frequently observed, AA drugs are not perfect. AMiodarone would be more effective but at 66 years old, you may be too young and the chances for developing significant side effects are high!
Your description is the one of a Tamponnade where the hemodynamics was further impaired by the arrhythmia. What surprise me is that you don’t mention drainage?
A valvular AF usually requires a significant Valvular disease as the concept is that the changes in hemodynamics are responsible for changes in the atria and therefore AF. As a consequence, a grade 2 valvular disease is the minimum and a higher grade is more likely to be responsible for the AF. Mitral valve is much more frequently concerned than Aortic.
Yes, an Ap can be diagnose on a surface ECG without an EP study. An Ap that is seen on the surface ECG defines the WPW syndrome. These pathways are a risk factors for AF. Your thrombo embolic risk varies with factors like blod hypertension, diabetes, previous strokes …At 51 yo, the risk is likely to be low, this is probably why your cardiologist put you on Aspirin.
Not to the best of my knowledge but I doubt this would work as once AF as started, it remodels the atria and favours recurrences. Prevention would be safer.
Surprisingly, a therapy guided by the type of AF is in fact not superior to a more standard approach. Flecainide is in my experience one of the most successful drugs. Dysopiramide could be tried.
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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