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April 25th, 2015
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Dr Lakkireddy, I understand that many patient have the LAA as the origin of their arrhythmia. There are surgeries and devices to effectively remove the LAA. But it serves various functions. Why not ablate around its entrance as you do around the pulmonary veins, preserving its capacity to maintain compliance and produce peptide? This would serve the aging active athlete better than elimination, yes?

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:In paroxysmal AF patients LAA seems to play a much bigger role in arrhythmogenesis. Ablating around the LAA from inside seems to be appealing - there are technical and anatomic difficulties in getting the job done. Complete electrical isolation of the LAA is very difficult and oftentimes they reconnect much faster. When it is isolated it looses its contractile function - despite rhythm control there will be significant stasis of blood resulting in the clots and higher risk of stroke. often times the area around the LAA osmium is paper thin and has pits that can lead to perforation and major complications. So removing it either by ligating or clipping it eliminates the arrhythmia source also reduces the effective LA volume and we believe also results in the alteration of the sympathetic systems to result in better AFib control. In most of the people the other parts of the heart and body compensate for the acute loss of atrial natriuretic peptide. So that is not something we should worry about.

At 25 years old I had a stim pace Icar catheter pulm ablation 11 months ago. It was done by the best Dr. in NYC. I dont know exactly what kind it was but my AFib was vagal induced from choking, vomiting, or drinking alcohol. I have been AFib free for 11 months until this weekend with some social drinking. My heart rate was approx 130 (pre surg it would be as high as 180). I was in it for no more then 1/2 hr. I took a few baby aspirins as a precaution and I went for a brief jog down the street. I have got buzzed on alcohol several times before with absolutley no issues. Why now? Can it be a freak thing or too much alcohol at once??? What do you think? I am a very responsible person and my concerns will be that I will be leaving the country and I dont need it to happen again. I have no insurance. Thanks for your input.

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:Alcohol is frequent trigger for AFib. It alters the physiology of the heart muscle and is notoriously associated with occurrence of AFib. My advice to you is to stop drinking Alcohol and get yourselves periodically checked. Read this article for more information on the link between alcohol use and AFib http://www.ncbi.nlm.nih.gov/pubmed/25707748

I have had paroxysmal afib for 33 years and am currently 63. My weight is normal, BP normal, normal LA size, normal thyroid, excellent blood lipids, no smoking, moderate achohol, no structural heart disease, and am very active. I am a vegetarian with fish a couple times a week and have good vitamin D and B12 levels. My afib has always been random but more often in winter. I am doing everything right but still have afib that lasts about 12-14 hrs. I do have stress problems. Does a full yoga and meditation program have any hope or is it time for an ablation?

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:Looks like stress seems to be a trigger in your case. I was not aware of any data on the winter preponderance of your AFib burden. May be your professional life gets more stressful during the winter months. Yoga seems to definitely improve the overall AF burden in patients with paroxysmal AF like yourself. In our YOGA MY HEART study we studied practice of yoga in paroxysmal AF patients with good results. You should definitely try. Please see the below link for more details of the study http://www.ncbi.nlm.nih.gov/pubmed/23375926

Hi Doctor,My ECG report: Vent Rate BPM:56 PR Int:137, P/QRS/T:115-97-179, QT/QTc:375-363, P/QRS/T Axis:61-50-48, RVI/SV5 Amp:0.51-0.00, RVS/SV1 Amp:1.67-1.52 ECG Analysis Result: 801 Sinus Bradycardia 803 Sinus Arrhythmia 851 Premature Atrial Complexes 612 T Abnormality (Negative T) **Undefined Abnormal ECG** please let me know the status,thanks

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:Again I cannot give you a consultation on EKG findings. Your clinical picture is equally important. Contact your doctor or cardiologist to discuss your EKG findings and their relevance to your situation.

Hi My boyfriend has been getting chest pains the last two days. On the right side of his chest. We get an ECG yesterday and these were his results: P/PR 142/192 ms QRS: 99 ms QT/QTc: 436/431 ms P/QRS/T Axis: 23/32/31 deg Heart Rate: 57 BPM Sinus rythem (slow) Premature ventricular complexes Inter-atrial conduction delay RSR in V2 Borderline ECG Is there something else we should worried about?Please suggest me,thanks.

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:It is hard to judge his EKG alone and give you a diagnosis. Based on the finding you describe on the EKG there seems to be no immediate concern. He has premature ventricular complexes if they are more frequent and symptomatic you should seek a consultation with a cardiologist.

Doctor, i had a cardiac ablation for paroxymal afib.My cardiologist said the results of my two-day heart monitor showed no signs of afib.He said my ablation was a success as there was no signs of afib and took me off coumidin. Is my afib likely to recurr at some point in the future?what I have to do to decrease recurrence? Thank you.

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:Ablation for paroxysmal AFib is more successful than the non paroxysmal Afib. However, the 5 year recurrence rates are higher. So you should undergo periodic monitoring either using external or implantable monitor. Decisions regarding your oral anticoagulation should be made on your baseline stroke risk. If your stroke risk is high you should stay on the anticoagulation. Maintaining appropriate weight, regular exercise, minimizing alcohol, better control of your blood pressures and diabetes and sleep apnea can all be helpful to preventing recurrences.

Hi, My husband had tachycardia.He had a catheter ablation last week and we were told that it was successful. Yesterday he had a tachycardia episode that he could not stop, but could only get the heart rate to go down to 90-100.what is his position and what will happens if heart rate goes down.

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:It is not uncommon to have recurrences after tachycardia ablation. the rates of recurrences are different for different types of tachycardias. Especially after AF ablation it is relatively common to have a few episodes of AF or other atrial arrhythmias as the tissue heals. Most of the times these settle down over the next 8-12 weeks. In some it is a sign that there are areas that might reconnected and reinitiating the arrhythmias. Contact the physician who performed the ablation and ask about next plan - medications or repeat ablation? Sometimes it takes more than one ablation to get the problem fixed. Based on what you describe slow heart beat is not issue. Heart rates can be as low as 40-50 bpm with out being symptomatic. Good luck.

Hello doc, Recently my uncle had a cardiac arrest at home and put on Ventilator. Now his ventilator was removed,Oxygen was being given through mouth by using ventilated pipe.He had a weak heart since 7 months LCD 15 percent.In hospital he was opening half eyes since one weak with pain stimuli,today again they put him on ventilator,what is happening we are confused? Today they going to perform trachosomy,Please advise us about this,Thank You.

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:Sorry to hear about your uncle. People with weak heart otherwise known as cardiomyopathy have poor pumping function. By LCD you meant Left Ventricular Ejection Fraction, I assume. Low ejection fraction is one of the big predictors of sudden cardiac death. He could have been considered for implantable defibrillator therapy to prevent the complications he is currently facing. Cardiac arrest is a resultant of a sudden electrical storm inside the heart called ventricular tachycardia or fibrillation, where the heart ceases to pump sufficient amounts of blood to the rest of the organs. Of all the organs brain is the most sensitive to lack of blood supply. My suspicion is he suffered significant brain injury that is also affecting his respiratory center and higher brain functions. Tracheostomy is one way of managing his airway and ventilation for long term. Overall prognosis is guarded. You should talk to the attending physician regarding the prognosis and appropriate decisions regarding termination or continuation of care can be made based on your uncle\'s will.

Hello, I am Annet, a woman of 44. Since October last year I suffer from A-fib. Most of the time it's just an irregular hartbeat. Sometimes my heart races. When my heart is irregular I am just a little bit short of breath. Is this also A-fib?

2015-04-18 Answered By : Dr. Dhanunjaya Lakkireddy,MD, FACC, FHRS

Answer:Dear Annet In majority of people the AF is mostly disorganized and irregular with symptoms of irregular heart beat, fluttering etc. Sometimes AF can be more organized into a flutter where instead of irregular heart beat you may have a rapid regular racing heart beat or pulse. People who have AF may also have Atrial flutter, atrial tachycardia and sometimes simple atrial and ventricular premature beats that can also give you irregularity. The alteration in cardiac physiology when you are in arrhythmias is what gives you shortness of breath. You should seek your doctors opinion and make sure you are on appropriate treatment in terms of stroke prevention, rate and rhythm control Good Luck DL

Hi, I had a stent placed in my heart after 2 days am feeling some tingling in my hands and some pain in my heart.I had a blockage in my artery between 70-80 percent.I didn't get any attack.Am taking the medicines like plavix, aspirin 81 mg, fifth oil 1200 mg, and simvastatin 20 mg. Taking this type of medicines is enough to control my pain in heart and hands.Please tell me, Thank you.

2015-03-16 Answered By : Dr. Eduardo B. Saad,MD, PhD, FHRS

Answer:It seems prudent to contact your cardiologist and tell him about these symptoms. They might be normal but also may represent some sort of residual ischemia.

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