Answer:

You are referring to the left atrial appendage. In selected patients, the left atrial appendage can the removed or obliterated to decrease the risk of stroke in patients with atrial fibrillation. The coumadin would then not be required. This is an area of intense interest and research. A thorough discussion with a surgeon and cardiologist experienced in performing either of these approaches would be useful. A key difference at the current time is the surgical approach does not require any coumadin after the procedure.

Answer:

The traditional cut and sew complete maze procedure has a low incidence of atrial scarring and flutters. In an effort to decrease the morbidity of the procedure, less invasive techniques using various energy sources to replicate the traditional maze have been introduced. Each energy source has distinct advantages and disadvantages, including the development of flutter. A thorough understanding of what the surgeon will be treating, the energy source used, and expected results is critical before surgery.

Answer:

Therapy for AF is first for prevention of stroke. Unfortunately as you get older this risk will get higher – so you should keep in touch with your electrophysiologist. Second you should be treating and minimising any risk factors for AF – do this with your electrophysiologist. Anti-arrhythmic drugs and ablation are useful if you have symptoms. As with any intervention, they all have potential side effects. Thankfully most are un common. Patient posting is obviously individual patients experiences and tends to be more likely when searching for effective therapy. Probably the best source of someone to discuss this would be to ask your electrophysiologist if he has some patients that would not mind speaking to you. Most would have some that are willing to be involved. Your local hospital may also have a patient support group if they have an AF program.

Answer:

Thank you for your interest in our work. We are all keen to find out why people get AF – as then it may give us the opportunity to try and prevent the condition. There are a group of patients in whom there seems to be none of the usual risk factors for AF (hypertension, diabetes, obesity, sleep apnea, valvular heart disease.......etc). These patients have generally been said to have no reasons to have AF. When we studied these patients we found that in fact their atrial muscle is normal. We were able to show that the muscle was diseased and resulted in alteration of electrical activity within the heart. In fact, it was quite similar to the changes that we have seen in valvular heart disease, heart failure, congential heart disease...... etc. It suggest that this is the reason people get AF. We now need to work on the causes of these changes. Our hope is that one day we will be able to reverse or prevent these changes. Please email me if you require further information.

Answer:

There is most likely a contributory component of each condition to the other. As you point out it is like the “chicken and the egg” – which comes first.

Answer:

You should have the arrhythmia documented. If it is that reproducible then you should be able to capture it on a holter monitor. Anxious moments can create several reasons for your heart racing – AF is just one.

Answer:

It really depends on how much you are drinking. Alcohol can be directly toxic to the heart. It also has several indirect effects such as weight gain, high blood pressure and potentially aggravating a tendency for sleep apnea. While an ablation may remove your current triggers of AF, if your risk factors continue, it is likely that other parts of the heart will become abnormal and trigger AF.

Answer:

You have 3 risk factors that you have disclosed in terms of getting AF in the future – your getting older, your weight and HTN. Your risk would be above the general population which has a risk of 1-2%. However, I am not aware of a risk calculator as such. You should tightly control your HTN with preferably with an ACEI or ARB. I would also be screened for sleep apnea – which can be a contributor.

Answer:

AF during the surgical period may not occur but AF after is more likely to occur. However, when his next episode will be is un-predictable. He clearly has what is called structural heart disease (by the fact he has had heart surgery) which is a known risk factor for AF.