Usually AV junctional ablation is one of the last treatments attempted to control the heart rate during atrial fibrillation. There are a few important things to keep in mind about this procedure. First, it will result in a permanent electrical separation between the top chambers (atria) and bottom chambers (ventricles) of your heart. This means that you will be dependent on your pacemaker, and it is very likely that you will be paced 100% of the time. There are some patients who are at risk of developing a weaker heart muscle if paced all of the time, and your cardiologist can tell you whether you might be one of them. Second, you should understand that AV junctional ablation will not prevent episodes of atrial fibrillation. You will continue to have atrial fibrillation just as often as you do now, but the heart rate will not increase because the rapid firing of the atria will not be transmitted to the ventricles. Warfarin will still be necessary for stroke prevention. Although most patients have fewer symptoms from atrial fibrillation after AV junctional ablation, it is not guaranteed to eliminate all symptoms. Usually this procedure is reserved for patients whose heart rate during episodes of atrial fibrillation cannot be controlled with any combination of medications.
The esophagus is always monitored during atrial fibrillation ablation to prevent delivery of too much energy near it, which could lead to atrial-esophageal fistula. Different centers use different techniques to monitor the esophagus. Here at UCLA, we use a combination of barium contrast in the esophagus, allowing us to see it on X-ray, as well as a temperature probe in the esophagus, that tells us if any heating has taken place during ablation. These techniques are not meant to prevent PV stenosis, a different complication of atrial fibrillation ablation. Since the procedure can be done with patients under light sedation or fully asleep under general anesthesia, the method of filling the esophagus with barium will be different. Awake patients can swallow the paste, while those under general anesthesia have the barium injected into a tube in the esophagus. Exercise is an important part of staying healthy, and if you are able to control your atrial fibrillation with exercise you should continue to do so. This is unusual.
PV isolation is the cornerstone of atrial fibrillation ablation, but some electrophysiologists ablate in other areas as well (depending on the patient). Some of these include lines to the mitral valve, across the roof, or between circumferential ablation lesions. Although the pulmonary veins are the most common origin of ectopic beats that cause atrial fibrillation, other structures can also trigger the arrhythmia, including the Ligament of Marshall and the superior vena cava. Sometimes ablation will be necessary at these other sites in addition to the pulmonary vein area.
The esophagus is always monitored during atrial fibrillation ablation. Different centers use different techniques to monitor the esophagus. Here at UCLA, we use a combination of barium contrast in the esophagus, allowing us to see it on X-ray, as well as a temperature probe in the esophagus, that tells us if any heating has taken place during ablation. Since the procedure can be done with patients under light sedation or fully asleep under general anesthesia, the method of filling the esophagus with barium will be different. Awake patients can swallow the paste, while those under general anesthesia have the barium injected into a tube in the esophagus. Intracardiac echo is used in most patients in this country during atrial fibrillation ablation, can be done whether they are awake or under general anesthesia, and is not related to whether barium is used.
PV isolation is almost always performed in atrial fibrillation ablation, but some electrophysiologists ablate in other areas as well (depending on the patient). Some of these include lines to the mitral valve, across the roof, or between circumferential ablation lesions. Although the pulmonary veins are the most common origin of ectopic beats that cause atrial fibrillation, other structures can also trigger the arrhythmia, including the Ligament of Marshall and the superior vena cava. Sometimes ablation will be necessary at these other sites in addition to the pulmonary vein area.
There have been no high-quality studies of dietary supplements showing a reduction in atrial fibrillation. Ongoing studies, including one with fish oil supplements, should be published in the next few years.
There are many benefits of weight loss, including lower rates of diabetes, vascular disease, and sleep apnea. While not all studies have found the same results, it appears that atrial fibrillation is more common in those with sleep apnea. However, there is no guarantee that your atrial fibrillation will go away even after the dramatic weight loss you asked about.
The connection between the brain and cardiac rhythm is not well understood. The heart has a rich supply of autonomic nerves which receive input from the brain, but it is not known exactly how brain injury causes arrhythmias. I believe that the treatment of your father’s atrial fibrillation should be similar to that of other patients with atrial fibrillation: keep the heart rate under control, consider medications or ablation to prevent episodes of atrial fibrillation. One challenge may be that blood thinners such as warfarin, which prevent stroke in atrial fibrillation, may be impossible to give him because he had intracranial bleeding. If this is the case, catheter ablation would not be an option, since it requires high-dose blood thinners during and after the procedure.
There has never been a large head-to-head comparison of catheter ablation versus cardiac surgery for atrial fibrillation. Although you have been quoted similar success rates for the two procedures, it is generally felt that in the hands of experienced operators, surgery for atrial fibrillation has a slightly higher success rate, especially if it is the standard (“cut-and-sew”) Maze procedure. However, it is far more invasive than catheter ablation, since it requires open-heart surgery, instead of needlesticks for the ablation procedure. The risks of the surgical approach are probably higher, and the recovery is more difficult. Although it is an individual decision, most patients opt for the catheter ablation first, and only if unsuccessful consider surgery for atrial fibrillation.
Most young patients like yourself with intermittent atrial fibrillation have palpitations, shortness of breath, dizziness, or other symptoms with episodes of atrial fibrillation. However, it is possible to be in atrial fibrillation without being aware of the arrhythmia. Heart rate alone will not tell you whether you are in atrial fibrillation. Your doctor can tell by feeling your pulse or listening to your heart, and noticing that it is irregular during atrial fibrillation. The best way of diagnosing an episode of atrial fibrillation is with an EKG. Usually atrial fibrillation is a long-term problem, unless it is clearly related to some reversible underlying cause. You should ask your doctor how long you need to take amiodarone, since this medication could have side effects if used for a long period of time, especially in a young patient. Catheter ablation is often effective in controlling the symptoms of atrial fibrillation when medications are not successful.
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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