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St. Jude Medical

February 01st, 2015
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I've had 4 ablations since 2003. How do I get test results as to what they have done during these ablations and what else they have found about my heart in other tests? I never get anything. I don't even know what shape my heart is in. I never get anything from my EP.

2015-01-30 Answered By : Dr. Prashanthan Sanders,MBBS, PhD

Answer:It is important that you are aware of what was done. I would suggest you make an appointment and ask these questions of your EP.

Should doctors use a TOE with every ablation , what is the safest required temperature during ablation?

2015-01-30 Answered By : Dr. Prashanthan Sanders,MBBS, PhD

Answer:This is debated and there is no consensus. I undertake a TOE before all AF ablation cases. The temperature set during the cases depends on what is being done. With irrigated ablation (mostly AF ablations done this way) the temperature is not so important as it is controlled by irrigation of fluid. The power delivered is what causes the lesion. I would need more specifics to be able to provide more information.

Dr. Boyle replied to my questions on 10-5-14 regarding a second ablation. His comment on the success rate for someone who has had afib for 10 years is only about 50%. I have decided to postpone my 2nd ablation and see a neurologist that specializes in autonomic nerve dysfunction to see if there are other ways to prevent afib and flutter that is triggered by my high vagal tone. Meds haven't done much to stop the episodes, although Norpace is somewhat effective. My af burden is only about 20% so it seems that I should give the neurologist a try before having a second ablation. Comments?

2015-01-30 Answered By : Dr. Prashanthan Sanders,MBBS, PhD

Answer:If your AF burden is 20% (ie you are in sinus rhythm the rest of the time) I would have a second ablation if you were symptomatic. Indeed, I counsel my patients that with current technology a significant proportion will need a second ablation. If they are not prepared for that then they should consider if they should have the first. I am not aware of a neurologist who is working in this area.

Hello Doctor - since you are an EP, I have the following physiological questions about AF. Have been trying to learn as much about the physiological aspects in dealing with mine which has been kept in NSR by Flecainide 2 x 50mg/day. 1) what leads to or is responsible for the genesis of ectopic foci which initiate AF? 2) which keeps the AF going? a) ectopic foci continually depolarizing (firing) or b) multiple re-entrant wavelets of depolarization waves moving in circles re-exciting the same tissue over and over again? If the answer is b), do these self-propagating wavelet circuits need the ectopic foci to continually be firing?

2015-01-30 Answered By : Dr. Prashanthan Sanders,MBBS, PhD

Answer:These are complicated questions and I am going to try and give you an interpreted response to each: 1. All heart tissue is capable of ectopic beats. For example, if you stretch a muscle it initiates ectopic activity. Under the correct exposure this occurs to cause AF - high blood pressure, sleep apnea, diabetes.......etc These are the risk factors known to cause AF. 2. All of the above conditions change the atrial muscle. There are ionic changes, structural changes and autonomic changes. Perhaps importantly there is fibrosis of the atrial muscle. This provides the environment to hinge wavefronts ....rotors, to facilitate ectopic beats....therefore maintaining AF. Answer: C - it is a lot more complex :)

Hi Doctor, I have had 5 ablations for a-fib . I am symptom free. Last ablation was in 2009 . I am on 325 aspirin therapy. Would it be advised to reduce to an 81mg aspirin instead? Aspirin is in the news so much lately with its pros and cons. Thank you

2015-01-30 Answered By : Dr. Prashanthan Sanders,MBBS, PhD

Answer:The risk of stroke as a result of AF is very much dependent on the associated risk factors. These should be re-evaluated on a yearly basis. From a stroke prevention in AF perspective I do not believe there is any data on the two doses that you have suggested. Perhaps more important is whether you need anticoagulation. Your doctor will be able to discuss these with you.

My Lariat LAA ligation a year ago is not complete and the doctor wants me to get a plug-in procedure as a remedy. What is the success rate of this procedure? What can you do if this procedure failed again?

2015-01-30 Answered By : Dr. Prashanthan Sanders,MBBS, PhD

Answer:If the ligation is not complete then it is not likely to protect you from stroke. The alternatives are to either consider oral anticoagulation (pros, cons and risks need to be discussed) or to attempt to achieve closure which is what has been suggested. Technically with some of the LAA gone it would be more difficult and so feasibility and success would depend on the imaging and the physician/centre experience.

Hello Doctor, I have a history of heart palpitation for that am using ditiazem medication from three months and recently stopped because the palpitation does not improved. Recently have been flecainide acetate. What can I do?

2014-11-21 Answered By : Dr. Noel Gerard Boyle,MD, PhD

Answer:You should check with your doctor as to what is the cause of your palpitations (feeling of abnormal heart beats). There are many different causes and the treatment varies with the cause. If atrial fibrillation is the cause, then flecainide may be an appropriate medication for you.

Hi, My father in law is suffering from congestive heart failure, his liver is enlarged and kidneys are to be effected because of his heart is functioning at 30% and he is not responding to any treatment. How long can he survive and can he will be back to a normal shape in couple of days?

2014-11-21 Answered By : Dr. Noel Gerard Boyle,MD, PhD

Answer:Only the doctor who is treating your father can answer these questions. There are many different types of medications to try, and also medical devices such as CRT pacemaker or cardiac assist devices.

When I am lifting weights have a problem with skipping heart beats. Some times it will invasely fast and some times it should be irregular. I have a habituation of drinking coffee and a caffeine per day.

2014-11-21 Answered By : Dr. Noel Gerard Boyle,MD, PhD

Answer:You would need to wear a heart monitor such as a Holter or event monitor to make a recording when you are having the symptoms; then see your doctor to discuss the results.

Hello Doctor, I have a problem with low heart rate is around 53 bpm, then it disposes to be felt like spacey, lightheaded, and dizziness.When am worry it is going to be faint. Some times I have also chest pains. Whether it is anxiety or bradycardia?

2014-11-21 Answered By : Dr. Noel Gerard Boyle,MD, PhD

Answer:53bpm is not a very slow heart rate and may not be the cause of your symptoms; you should see your doctor to arrange a 24 hour Holter monitor or an Event monitor.

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No.of Questions Asked in All Sessions: 949
No.of Questions Answered in All Sessions: 947

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