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St. Jude Medical

July 03rd, 2015
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Is there any correlation between gastroesophageal reflux and Afib or Aflutter? If there might be, does this have any relevance to individuals who experience Afib or Aflutter after eating a large meal? If relevant, should these patients undergo testing for reflux before an abaltion?

2015-07-02 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Potential relation exists in the presence of a hiatal hernia. This is well reported and I have several cases where we ended up fixing the hernia first, and the AF improved, then performed PVI and it went away altogether. Large meals can often trigger AF by a vagal nerve stimulation reflex.

What tests should routinely be performed before a person undergoes an ablation for a-fib or a-flutter? If an echocardiogram is among those tests, is there a particular type of noninvasive echo that can help determine if a person being abalated for a-flutter will subsequently develop a-fib?

2015-07-01 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Basic labs to exclude renal disease (BMP), coagulation blood tests and blood count, also, ECG and we recommend some type of imaging, either cardiac CT angio (gated) for LA and PV anatomy, or cardiac MRI. This allows precise anatomic location during mapping and ablation and can serve as an excellent guide and predictor of who is a good candidate for AF ablation. An Echo is not as helpful for AFib ablation, but if undergoing Aflutter ablation, it can predict who is at higher risk to develop AFib in the future. Mainly that would be LA volume or diameter, mitral valve function and ejection fraction.

Good afternoon Dr. Ellis. I have read several articles on ECGI and FIRM mapping. ECGI identifies FOCI and Rotors NON PVs and decreases the RF burns during ablation. Based on the current mapping techniques and the use of FIRM and ECGI what is your recommendation for patients based on the methodologies described above for a successful outcome? Thank you very much. Take care.

2015-07-01 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Early in development still, but a very interesting approach. I think as the resolution of mapping improves, it will become an important adjunct to pulmonary vein isolation by wide area ablation. Right now, it is not clear who to use this in. I have seen several live cases in the EP lab at sites where they specialize in this approach, and it definitely can limit the amount of additional ablation performed. The question that remains is….does it really work longer term, or do you just make more rotors in new locations over time.

I understand clinical trials are underway for the use of Eplerenone in prevention of AF recurrences after Cardioversion. Also, I saw a clinical train for certoparin. Do you have the current status of the efficacy regarding these medicines. Please advise. Thanks.

2015-06-29 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:There is a previously published randomized trial or Eplerenone after persistent AF catheter ablation and lower recurrence rates were reported with use of the medication. This may help with beneficial remodeling post ablation in sinus, and could reduce non-PV triggered AFib substrate. Interesting data, and I often place my persistent AF ablation patients on aldactone 25mg daily for 3-6 months post ablation.

Is there any way to differentiate typical atrial flutter from atrial fibrillation based solely upon symptomology? What clinical signs and/or tests can determine if a person definitively diagnosed with typical atrial flutter also has (or is likely to have) atrial fibrillation?

2015-06-29 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Yes. Flutter is often regular and at intervals of 300bpm. 2:1 atrial flutter would be HR 150bpm, 4:1 at 75bpm. Etc. 50% of patients with Aflutter will develop atrial fibrillation as well, so they are commonly co-existing. I typically monitor patients intermittently for up to 3 years after atrial flutter ablation, and will not stop blood thinners if CHADS 2 Vasc score 3 or higher out of concern for late Afib related stroke.

I am 72 male in good shape, exercise moderately (swim, bike). BP normal, no pills. Get AF and tachycardia - mostly at night 20% of time - skipping a beat. Get faster beat and arrhythmia when exercising too hard like running up several flights of stairs. Do I need an ablation or can one live with that, taking aspirin and watching for the symptoms to not go worse?

2015-06-18 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Great questions. At age 72, ASA alone may be ok, if you have no other known stroke risk factors. However, the NUMBER ONE risk for AF related stroke is age, and this is due to the decline in velocity of emptying of the left atrial appendage (LAA). I would not say that aspirin alone is the only therapy you need for long term stroke protection. As far as symptoms from AFib go, if tolerable, you can always continue as you are doing, and only intervene if worse. One consideration is that ablation is likely to prevent the progression from intermittent AF to persistent AF, and this may provide improved quality of life and in recent studies, reduced cardiovascular mortality.

Assuming the patient is 58 yrs. old and otherwise in good health with no heart or cardiovascular problems, does having an abaltion for typical a-flutter INCREASE the chances of subsequently developing a-fib? If so, is there any way to determine the likelihood of that patient subsequently developing a-fib, i.e., by an echo of the left atrium, etc.?

2015-06-18 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Its been shown that 50% of patients with typical atrial flutter ablation, develop atrial fibrillation within 3 years. This is NOT an effect of the flutter ablation, but rather, that it turns out, most patients who have been diagnosed with atrial flutter, also HAVE atrial fibrillation…but it may just not have been picked up yet on monitoring. Many experts think that perhaps we should target both Afib and atrial flutter at the same time when performing an ablation procedure for either AF or flutter.

had afib for 5 yrs,highly symptomatic, take pill in pocket when needed, initially had 2 episodes per year, then 7 episodes every 2 weeks, and no episode for 6 months, then 2 episodes in last 10 days. Did my afib progress, or is it possible to have clusters of closely occurring clusters without real progression?

2015-06-11 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:Atrial fibrillation is essentially always progressive. The patterns of recurrence can change with changes in associated triggers like worsening obesity, sleep apnea, high stress, uncontrolled hypertension, and increased alcohol intake. Additionally, though a history of AF has been present for many years, diseases like hyper or hypothyroidism should be considered.

I am 66 years old male and i have grade 1 diastolic heart failure from 3 heart attacks. I have a oxi and heart rate meter for my finger,my cardiologist keept my heart rate as low.I have noticed that I can cough and my heart rate will go really high upto 183-209.Is this normal or else any thing serious that i have to be worried.

2015-06-11 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:First I would want to know that there was a true correlation between the finger monitor and a Holter or ECG of the HR jump to 180-200. That sounds like an artifact and inaccurate measurement of the rate. If real, there are some patients with arrhythmia triggered by cough, it is usually a variant of SVT.

Hello Doc, I am 56 years old,i am Having an ef of 16 to 22 % and angiplasty 2 years ago. Doctor said that it is stable and gave medications.How good is the prognosis for this.What does having a heart failure means and what can we do to prolong the life span? Please suggest me

2015-06-11 Answered By : Dr. Christopher R. Ellis,MD, FACC, FHRS

Answer:The following medications are essential in heart failure- beta blocker (metoprolol, carvedilol), ACE inhibitor (lisinopril), possibly spironolactone, and some diuretic therapy (lasix). After this, if the heart function remains depressed, then a defibrillator should be considered which can prolong your life. Additionally if you have a left bundle branch block, a BiV-ICD (with resynchronization pacing) would be of great benefit.

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No.of Questions Asked in All Sessions: 1005
No.of Questions Answered in All Sessions: 1004

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