Journal of Atrial Fibrillation

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St. Jude Medical

September 03rd, 2010
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I am considering undergoing my first ablation procedure, but my wife and I were told that if I do so I cannot go back onto the antiarrythmics (Multac and Metoprolol) that I am currently taking and expect them to be as effective. These meds have worked well since June 2010, but I have had brief AF episodes 3 times. Will I not have a "back up" if I choose to go ahead with the ablation?
2010-09-01 Answered By : Dr. Suneet Mittal

After you undergo the ablation, there would be no problem in going back to these medications if they were deemed necessary by your doctor(s).

For patient with A-Fib and high stroke risk, is AGGRENOX a better or worse replacement for Warfarin at monitored INR of 2.5% ? Why? Thank you.
2010-09-01 Answered By : Dr. Suneet Mittal

The current scientific data show that warfarin is the most effective drug in this setting. There are no data to support the use of Aggrenox in this setting.

My Cardiologist told me that Afib ablation was not perfected because of too many points to ablate and was not for me. Is this true?
2010-09-01 Answered By : Dr. Suneet Mittal

It is difficult to answer your question without having significantly more information about the nature of your atrial fibrillation.

My Cardiologist states that Afib Ablation is still not good and because there are so many places on the atrium that needs to be ablated it does'nt work well. And, if I had an atrial flutter he would approve of an Ablation because only one point on the atrium needs to be ablated. Is this true?
2010-09-01 Answered By : Dr. Suneet Mittal

Atrial flutter ablation has a very high efficacy because every patient undergoes the same ablation. Although there is not just “one point”, there is just “one area” that need to be targeted. This is located in the floor of the right atrium, the upper right chamber of the heart. Atrial fibrillation ablation generally involves ablation within the left atrium (upper left chamber of the heart). During the ablation, typically all patients undergo ablation around the pulmonary veins. However, unlike atrial flutter, patients then often need additional ablations within the left atrium (and sometimes even in the right atrium) based on the particular circumstances of their AF.

I have sent this question before but did not get an answer. Let me repeat. I am 74 and am in good health excepting my AF condition. It started 5 years ago and is getting worse. Typically, each episode lasts between 24-40 hours and the interval between episodes ranges between 5 -8 days. I can tolerate the AF condition. My concern is the risk of stroke due to formation of clot in LAA. Right now, I am taking Dabigatran when I am in AF. I like to know if this is sufficient for stroke prevention and whether there may be other options I should consider. Thanks.
2010-09-01 Answered By : Dr. Suneet Mittal

You describe a condition known as paroxysmal atrial fibrillation (AF). You may be a good candidate for antiarrhythmic drug therapy and/or catheter ablation for long-term management of your AF given the frequency of your episodes. Dabigatran is currently not available in the United States. It should be noted, however, that currently available scientific data do not support the use of anticoagulant medications like dabigatran in an "on/off" mode that you are using. Rather, the data are limited to using the medications on a daily ongoing basis.

Three questions related to aspects of MiniMaze or TTM vs catheter ablations: 1) are transmural lesions more or less effective compared to catheter ablation lesions and why?; 2) are MM/TTM lesions more or less likely to promote (or allow) regrowth or reconnection of afib circuits; 3) are there any hypotheses being tested that transmural lesions created by MM/TTM are more harmful to the heart's wall structure compared to "lighter", non-transmural lesions created by standard catheter ablations? It has been impossible to find any references or articles which speak to any of these questions, so I hope you will respond to all three with some detail. Many thanks, Ken (afib patient, paroxysmal, schedule for TTM but trying to cover all bases ahead of time)
2010-09-01 Answered By : Dr. Suneet Mittal

Both catheter and surgical based approaches to atrial fibrillation (AF) ablation aim to create transmural lesions. Recurrences of AF occur because neither system can accomplish this goal with 100% efficacy. There are many reasons for this, including the need to limit energy delivery to prevent collateral damage and the difficulty in maintaining good contact with the tissue being targeted for ablation at all times. Nonetheless, both types of ablations can be associated with similar types of complications.

This is a follow up to my question regarding prednisone-I just learned that the first course of 5 pills I had was 50 miilgrams and the FDA warns about cardiac problems from it-do you have any information on the correlation between atrial fibulation and the high dosage of prednisone I had?You have not answered my last question and I truly look forward to hearing from you-On the internet there is much mention of this Thanks
2010-09-01 Answered By : Dr. Suneet Mittal

From your question, it sounds like you were treated with a short course of oral steroids. Assuming that this is correct, I do not believe that this treatment should materially affect the likelihood of you developing atrial fibrillation.

how to treat a blood clot from AFIb which is not essentially a stroke?
2010-08-13 Answered By : Dr. David J. Wilber

From your question, it is not clear whether you mean a blood clot in the heart (such as left atrial appendage) or a part of a clot that has broken off and lodged elsewhere in the body (embolus). Blood clots in the heart are initially treated by anticoagulation with coumadin, and if present despite good therapeutic levels (INR around 3) the addition of aspirin. Rarely, clots present despite medical therapy, and depending on their particular characteristics, may need to be removed surgically. The treatment of an embolus to another part of the body than the brain also requires anticoagulation (and potentially other measures), but how this is done depends on how recently the embolus occurred, and what damage it has caused.

recently my pulse rate has been ranging from 45 - 58. What does this show. is this very serious?
2010-08-13 Answered By : Dr. David J. Wilber

Many healthy people have slow heart rates. The number alone is not as important as how an individual feels. Slow heart rates may cause fatigue, poor exercise tolerance, dizziness or even fainting. However if none of these symptoms is present, and exercise capacity (the ability to do daily activities etc) is normal, there is little reason for concern, and the exact pulse rate not important. If you have symptoms related to a slow pulse you need to discuss with your doctor the best way to deal with this (may involve stopping heart rate slowing drugs, or possibly a pacemaker)

i have afib , how often should i test for electrolyte test?
2010-08-13 Answered By : Dr. David J. Wilber

While levels of electrolytes such as magnesium and potassium have received a lot of press as a potential factor that influences the likelihood of having AF, most otherwise healthy people have very good internal processes for maintaining body electrolytes at optimal levels. Certain types of medical illness (diarrhea, some types of kidney disease) or drugs (water pills most commonly) can disrupt the normal body processes for maintaining electrolytes, Supplementation and monitoring may be needed. In my own experience, electrolyte levels have a minor impact on AF for most patients.

No.of Questions Asked in All Sessions: 338
No.of Questions Answered in All Sessions: 338

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