I do not think that weight loss and exercise had a negative affect, AF just gets worse over time. The best strategy for recurrent AF depends on the acuity of your symptoms; however, if you are considering repeat ablation, it would probably be best to do so quickly as things certainly seem to be accelerating. Ablation procedures are more successful (and usually a lot easier for patients to tolerate) than they were 6 years ago. Many programs “discriminate” and do not offer ablation to patients older than some arbitrary number; many publications argue against this practice, as complication and efficacy rates in (well selected) patients > 80 years of age are the same as in younger patients. The decision really comes down to how severe your symptoms are. By the way, they probably are attributable to the AF (and not to developing heart failure)
PVCs (early extra beats from the ventricles) do not have anything to do with atrial fibrillation. PACs (early beats from the atria) can be related, but can also be normal.
There are no great answers to your question, although if anything were to have an affect, it would be treatment with medications like Metoprolol. Surgery causes stress, and AF episodes are very common in the early post operative period. I don’t think it has anything to do with anesthesia, but the stress related with the procedure and soon thereafter.
I am not sure exactly what condition you are describing, but I take your question to mean that you are having early atrial beats that are happening frequently enough to cause symptoms. The physician that I am most familiar with in the DFW is Robert Kowal at Baylor
First of all, I don't think I would want to take daily medication for something that happens every four years. Infrequent AF episodes are perfect for "pill in the pocket" therapy - no medicine during most days, then a dose of antiarrhythmic drugs to terminate the episode of AF when needed. I think I would not do medicine or ablation at your current stage of symptoms. The question about which is better still needs to be formally answered. My opinion is that for people that have enough AF to warrant treatment, and have access to a physician / program that is accomplished at ablation, I would pick ablation over medications.
This question, like many surrounding long term anticoagulation, remains controversial. I believe that this situation does not warrant treatment with coumadin, and the AF guidelines support this opinion. Many experts are saying that the availability of new agents may change this, but I disagree
Ablation is always an option, but it seems that if you have been able to cope with AF for 24 years, why would you want to pursue that now? The decision about ablation is difficult for many patients, and a conversation by email cannot substitute for a visit to a thoughtful electrophysiologist. If you are interested in ablation at all, I would highly recommend such a visit
I agree that metoprolol is unlikely to be helpful in this situation. The options are trying different antiarrhythmic drugs in substitution for Multaq or AF ablation. His bundle ablation is also an option for some patients, but mostly when the problem is a rapid rate during AF, which is not the case for your husband.
In order to appropriately answer your question, more information is required with regards to: 1. Which size is your left atrium (maximum transverse diameter in four chamber view apical); 2. Which size is your left ventricle (maximum transverse diameter); 3. Which is the left ventricular injection fraction of your left ventricle? All these aspects are relevant to select the most appropriate interventional strategy in your case, although the previous experience with electrical cardioversion (both external and internal) makes the probability of successful catheter ablation quite unlikely. After investigation of your heart size and dynamicity, your cardiologist should be in the best position to take the most appropriate therapeutic option in your case.
You do not appear to be a good potential candidate for catheter ablation of your atrial fibrillation. Did you try every antiarrhythmic drug combination to further limit or even eliminate your atrial fibrillation relapses? If not, full exploitation of those options should be undertaken. In addition, all information is required with regards to the size of your heart, of your heart chambers and of the movement of the myocardium walls. With all this information in mind, your doctor should be in the best position to take the most appropriate decision with regard to which therapy is most appropriate in your case, including the possibility of catheter ablation.
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".
