This is a very difficult question, because it involves information that we have not really collected as yet. I think the real impetus for AF ablation should be symptoms. We are on solid ground in knowing that ablation is the best way to relieve symptoms referable to AF. We are on shaky ground saying that ablation can prevent AF related morbidity and mortality, although trials are ongoing to help understand this question better. I don’t think the criteria are based on economics at all, but our best estimate at risk / benefit analysis.
Although “arrhythmias” are listed as side effects for desipramine, I think this is merely a caution and should not prohibit use with careful monitoring of your EKG and your symptoms.
It sounds like the situation that you are describing is very complicated, and I would ideally like to know more details. However, it is difficult for me to understand how this procedure could have caused optic nerve damage.
Flecainide and all antiarrhythmic drugs have the potential for side effects, including many that are not typical or well recognized. That being said, I am not aware of flecainide having an affect on weight loss, and it is not something that I have heard patients complain of.
I am not sure that I completely understand the mechanism of AF terminating following intercourse, but I think it is most likely to be due to the same mechanism as after exercise – that is, sympathetic nervous system activation (as opposed to oxytocin release). Even if it was oxytocin, I would be concerned that there are so many other potential effects of this powerful chemical, it would not be a very specific drug to treat AF. In addition, and potentially with an unfortunate effect for you, this effect (i.e. AF termination) usually does not last for very long in the course of one’s battle with AF.
In general, any other antiarrhythmic drug should not be used with Tikosyn. Tikosyn works by increasing the QT interval (on the EKG), and other medications (some antibiotics, as well as a list of much less common drugs) that also increase the QT interval all need to be avoided. A list of drugs that increase the QT interval is kept up to date on longQTdrugs.com
This is a difficult question to answer without meeting in person. The therapies are all quite different from each other, both in terms of affects and risks, and their relative merits depend on your symptoms as well as your age and other medical problems. That being said, the only choice of the three that can be reconsidered (if things do not work out) is amiodarone. If you do not feel well on amiodarone, or if it is ineffective, it may be easier to consider more permanent interventions.
There is always a tension between convenience and experience, but I think that 1000 procedures is probably more than adequate experience. Dr. Natale is a gifted physician, but in addition to the travel, there is also the consideration of how long it would take to get a place on this ablation schedule. If you have a good feeling about your doctor closer to home, I would probably follow through there.
Although there have been studies demonstrating the increased efficacy of use of 3D mapping systems in ablation, I do not find them so convincing, mostly because most programs use them anyway. I think the biggest impact of these systems is the increased comfort and confidence of the operator. More important is the question “what is the success rate of ablation for permanent AF?” Although there are many claims in the literature, the average efficacy for a single procedure without antiarrhythmic medications is approximately 50%; this success rate goes up with multiple procedures or the use of drugs.
This is a difficult question, mostly because the assay that would be required to measure the effect of Pradaxa is not clinically available. The interaction that you describe is certainly true, but is variable between individual patients. At present, patients on both agents are just monitored closely for side effects; standard dose reduction of Pradaxa is not performed.
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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