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Answer:
Hi. It sounds like you are having paroxysmal atrial fibrillation. You should definitely see your cardiologist. You should be on blood thinners to prevent stroke, and there are medications to help slow or control the heart rhythm. Afib is very common as you get older, but should be able to be managed and there is no reason you can not live a normal life. If bothersome, catheter ablation can also be used to potentially fix the afib. This should be a common problem for your cardiologist to handle. If nothing is being done, consider getting a second opinion.
Answer:
It sounds like you have paroxysmal atrial fibrillation. You can try to avoid alcohol, which is a common AF trigger, but otherwise there is not much you can do from a lifestyle perspective. You should definitely see your cardiologist or a heart rhythm specialist (electrophysiologist). There are many options to treat AF and help you feel better, including antiarrhythmic medications and/or catheter ablation. Remaining on the Pradaxa is important to prevent stroke. If you reply with your location (country+province/city), I can recommend a heart rhythm specialist nearby. Best, EPG
Answer:
Hi. You need to discuss this with your cardiologist. High blood pressure is bad for both your heart and kidneys. You likely need more medication to help lower your BP, not less. I would not stop anything and discuss with your cardiologist. This forum is mainly for heart rhythm issues. Best. EPG
Answer:
The left sided superior vena cava (SVC) is a normal variant anatomy. There is a fetal connection between the coronary sinus and subclavian vein via the left SVC. This vein typically becomes atretic in adults and becomes a residual ligament - the ligament of Marshall, which is richly innervated by nerves and a potent trigger for AF. In many patients, the left SVC can also be a trigger for AFib, similar to the pulmonary veins. Treatment for AF in patients with persistent SVC is similar - medications to prevent stroke and control heart rate, anti arrhythmic medications if needed. It is useful to know about the left SVC if ablation is performed - isolation of the left SVC is often required and can be accomplished with catheters or cryoballoon.
Answer:
The hope was/is that more circumferential ablation would lead to less PV reconnection and better success rates for first time AF ablation. The results from the STOP-AF trial comparing cryoballoon to antiarrhythmic drugs basically showed equivalent outcome of cryoballoon and RF ablation (~70%). However the second generation cryoballoon may have better first procedure results, and is certainly faster than RF ablation in most hands. Irrigated RF and cryoballoon are currently being compared in the \"Fire and ICE\" trial being performed by Karl Heinz Kuck in Germany, and should have results available next year. I worked quite a bit helping to develop the Cardiofocus laser balloon. Again, the hope was that direct visualization and laser ablation would lead to less PV reconnection. In the pivotal randomized trial comparing first procedure success with irrigated RF vs. laser balloon, the freedom from AF at 1 year were almost exactly the same: 61.1% cryoballoon vs. 61.7% RF. It may be that these results will improve further as operators get more experience with the laser balloon.Other trials are looking at efficacy of a circular multi electrode catheter (nMARQ). Persistent AF does have a higher likelihood of needing more procedures; it depends how long you have been in persistent AF. But some people are free of AF after 1 procedure, and many are free of AF after 1 procedure with an anti arrhythmic drug. You can email me directly at UCSF for specific recommendations in your area.
Answer:
Tough question. There is more and more data that treatment of obesity and sleep apnea is critical for reducing AF burden. I think in the future we will have to pay more attention to comorbid diseases (hypertension, obesity, sleep apnea) and treating them rather than just treating the AF. This is the best way to reduce AF on a population level. Studies using long term implanted monitors will also show that the prevalence of AF is likely much higher in an older population than we thought, and several studies will randomize patients with detected AF to anticoagulation. I doubt there will be significant advances in anti arrhythmic medication - the cost of development and risk makes it difficult for companies to develop. In terms of ablation, I think we will see more progress toward simultaneous circumferential ablation using tools like cryoballoon and circular ablating catheters rather than point-by-point ablation. This may make the procedure quicker and safer. For persistent AF, I think we will see systems developed that allow high density mapping using multiple small electrodes inside the atrium to more convincingly identify AF sources and drivers outside of the pulmonary veins. Several investigators are working on non-invasive ablation using carbon or proton beams from outside the body. This may be > 10 years off, but could transform ablation by making it non-invasive. The genetics of AF is likely complex due to multiple genes, and I don\'t think genetic manipulation to treat of prevent AF will be available until the distant future.
Answer:
Most centers perform catheter ablation with manual catheter manipulation. Remote (robotic) navigation comes in 2 types - manipulation of catheters remotely using steerable sheaths (i.e. Hansen or Amigo) and manipulation of catheters using magnetic navigation (Stereotxaxis). Note - I have used Stereotaxis for AF ablation but not Hansen. In my opinion, the major advantage of Stereotaxis is less orthopedic stress from wearing lead aprons and less radiation exposure for the operator. The major limitation is that contact force applied to the heart is limited by the strength of the magnetic field to ~ 18 grams. Proponents of this technique argue that more consistent force and use of higher power creates equivalent lesions to the higher contact force used with manual navigation. In my experience, Stereotaxis works fine but typically takes longer for setup and does not offer much advantage, other than a near zero rate of cardiac perforation. There are no contact force sensing catheters developed yet that work with Stereotaxis, though indirect measurements of catheter stability are used. Remote sheath technology can use any catheter and apply high force. Initial iterations of this system had an unacceptable high rate of complications (mainly perforations) due to limited tactile feedback. Modifications of this system to give the operate feedback and limit forward force have been developed. Bottom line is very few operators nationally are currently using these systems for AF ablation. There are no prospective multi center randomized data I know of comparing these systems to manual catheter manipulation, though smaller single center studies have been done. I perform manual catheter based ablation and would recommend that, though I have no problem with remote navigation systems if your physician is very experienced with them and has a good track record. Outcomes in good hands may be equivalent, but not better than, standard catheter ablation.
Answer:
The factors to consider are mainly operator volume, operator experience, ablation approach, and an operator who will be available to care for you after the ablation. I don\'t really feel comfortable giving out individual names in this forum - there are many excellent operators nationally and internationally. if you send a note to my personal email with your location, I would be happy to suggest an expert near your location. AF ablation is nearly always covered by insurance in the US.
Answer:
I don\'t think you should limit your exercise significantly. The main issue is that in most young healthy individuals, atrial flutter starts as atrial fib and than sustains as atrial flutter. So you should have some monitoring performed and be aware that even though the flutter is ablated, you may still have atrial fibrillation. >50% of individuals will have AF after atrial flutter ablation. If running consistently triggers atrial fib, you could consider decreasing exercise, adding anti-arrhythmic drugs (often not tolerated in athletes) or atrial fib ablation.
Answer:
The decision of whether to try another drug vs. ablation is up to you and based on personal preference. For persistent AF I often consider dofetilide if your kidney function is normal, as it works quite well and has few side effects. The only downside is the need for a 3 day hospital stay to monitor your heart rhythm during drug initiation. Cryoablation is only approved for ablation of paroxysmal AF, though some also use it for persistent AF. For persistent AF, if you choose ablation I would recommend a wide antral pulmonary vein isolation using an irrigated contact force catheter. Targeting non-pulmonary vein AF triggers may also be helpful. If your persistent AF has been present for < 1 year, the outcome of ablation will be better. If you remain unsure what strategy is best, there is little downside to trying a drug first, and then if you have recurrence or drug intolerance, proceeding with ablation.
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