Atrial Fibrillation

[DangerMouse]

I'm wondering if anyone has any experience with this condition?

DH has been suffering from this for just over 4 years. The first couple of years he was on Sotacor which did not reliably hold his heart in rhythm. The past couple of years he has been on Rhythmol which has worked much better but still does not keep him in rhythm all the time.

We feel it is time for him to have the catheter ablation procedure his cardiologist had mentioned sometime ago. His doctor has felt he could wait while they continue to improve the procedure but I hate seeing the effect this has had on DH's energy levels and tiredness. He is only 44 and I want him to feel 44 not 84.

So has anyone had the catheter ablation done or know anyone who has had it done? How would we locate the best place he should have it done, as obviously his cardiologist will recommend those in his own group.

[Moemg]

I know two people who had it done with great results .They both went to a specialized heart center in sarasota,fl..

[Dudester]

I'm mainly a lurker on this board, but I am an "afibber," so I'll try to answer your question the best I can. I've had afib for about 3 years, and I have had a catheter ablation. But I do have to give you some background. There are two major forms of heart arrhythmia: atrial fibrillation and atrial flutter. I won't go into the difference here. I was suffering from flutter when I had my ablation, which was done in Seattle, where I live. I far as I know, the ablation completely cured my flutter, but after the ablation, I went into fibrillation, which according to my cardiologist happens about 20% of the time. I'm now on Sotalol, which seems to do a pretty good job of controlling my afib. However, I do suffer from low energy levels like your husband.

The moral of the story is that ablations for fibrillation have a fairly high level of failure - I don't know what the statistics are off the top of my head, but there is probably at least a 20% failure rate. You don't get killed or anything - you just still have afib. The procedure takes one or two days at a hospital.

There are other procedures that you might want to consider. See the URLs below.

There are several support groups for fibrillation on the web - I'll give some URLs later. Based on what I've read, the following comments may be of interest:

1) If possible, see an electrophysiologist rather than a cardiologist (EP is a subspecialty of cardiology).

2) The word on the street is that the best EP in the US is a Dr. Natale at the Cleveland Clinic (which has a highly ranked Cardiology department). His ablations are supposed to have a fairly high success rate.

3) There is also a very highly respected EP in Bordeaux, France, who has a name whose spelling is so odd that I don't remember it. I get the impression that before the dollar started dropping in value, you could get an ablation for about $15K, which includes flight over, stay at hotel, the procedure, etc. By American standards, this is dirt cheap.

The are several afib support groups on groups.yahoo.com where you might get some additional information. Just do a search.

There is a group at The AFIB Report - www.afibbers.org - Resource centre for atrial fibrillation and lone atrial fibrillation. I believe that the guy who runs the group had an ablation in Bordeaux.

I personally am waiting for medical advances before I do more than take meds.

I'll try to answer any more questions you may have.

Good luck.

[Rich_by_the_Bay]

Quote:

Originally Posted by DangerMouse So has anyone had the catheter ablation done or know anyone who has had it done? How would we locate the best place he should have it done, as obviously his cardiologist will recommend those in his own group.

DangerMouse, it's a complex situation. In older patients we generally opt for controlling the rate rather than trying to retun them to normal rhythm like we used to do. Even then your cardiac pumping capacity takes a 20% hit in AF versus normal "sinus" rhythm.

A thorough evaluation would also include thyroid blood tests and an echocardiogram to assess the heart for any signs of valve problems.

There are new techniques (ask about pulmonary vein isolation) and I am referring more and more young patients to electrophysiologists for potentiall curative ablation. Don't like the idea of having them on strong medications for 30-40 years. But every case is different, and we don't know the long term outcomes from ablation.

Don't forget the importance of anticoagulation for stroke prevention from AF. Not every patient needs it (and aspirin is a good choice for many patients) but at least make sure it is addressed along the way. In young otherwise healthy folks, it is not always necessary.

An experienced electrophysiologist is important but you shouldn't have to cross the country to find someone very good. Most university medical centers and large private groups have established experts in the area.

Good luck with all of it.

[Dudester]

It's me again. DangerMouse's original question got me curious. I checked and found out that there is a entry "Catheter ablation" in the Wikipedia. This article cites a paper which states that ablations have a high success rate for certain conditions, such as atrial flutter. However, for atrial fibrillation, the paper says that the success rate is about 28%. The success rate is apparently higher for "younger" sufferers, where "younger" seems to be defined as less than 50 years old. I always like to double check the stuff in the Wikipedia if possible. However, the cited paper appeared in a medical journal which is not online and which I don't have access to. I have to assume therefore that the Wikipedia article accurately quoted the paper.

It is part of the lore of afib sufferers (not of cardiologists) that the success rate varies *significantly* from cardiologist to cardiologist. However, I am not aware an any statistics that support this belief.

[ScottFromUtah]

I had an EP/CA (electrophysiology/catheter ablation) operation two weeks ago tomorrow. The cardiologist who did the operation does nothing else; he works 100% on AF (atrial fibrillation cases).

I had atrial fibrillation and atrial flutter. An recent MRI showed severely enlarged left atrium and aorta, indicating that I have suffered this problem for at least 5 years (I'm now 62), although it was diagnosed only two years ago. Medication didn't work. During the five+ years, I run 6 marathons and 8 half-marathons; I completed about six triathlons; and I went on about 10 century rides (cycling) and one double-century (200 miles in one day). IOW, even with AF, I was extremely active. The doctor said that my high level of activity slowed the ill effects of AF. But last October, after I finished a (slow) marathon, the AF was so bad that I could no longer exercise (doctor's orders). So I have been inactive for about 8 months.

My cardiologist gave me the green light to start exercising last week, only 4 days after the EP/CA operation. On Saturday (10 days post-operation), I ran 5 miles with no heart symptoms or arrhythmias. I think it will still take me several weeks to see if I'm "cured", but so far, I'm extremely encouraged ... and thrilled.

At the time of my operation, the cardiologist said that I had a 75% chance of success--meaning that I would experience essentially no more AF. That's a lot higher than the 28% quoted above.

My recommendation: find a top-notch specialist and have the operation.

--WithAllMyHeart (now you know where I got my screen name)

[Dudester]

Quote:

Originally Posted by WithAllMyHeart At the time of my operation, the cardiologist said that I had a 75% chance of success--meaning that I would experience essentially no more AF. That's a lot higher than the 28% quoted above. My recommendation: find a top-notch specialist and have the operation. --WithAllMyHeart (now you know where I got my screen name)

The Wikipedia article that I quoted in an earlier post contains the following quote:

Quote:

For atrial fibrillation, several experienced teams of electrophysiologists in US heart centers claim they can achieve up to a 75% success rate. However one recent study claims that the success rates are in fact much lower. Single procedure success rates have been published in this study at 28%.

If this quotation is accurate, then your cardiologist cited a widely believed but wrong percentage for the success rate.

It is interesting to note that two outcomes have been been reported in this thread: mine and yours. My ablation clearly did not cure afib since I still have it; yours was apparently successful. Based on this sample (admittedly ridiculously small), the success rate of posters to this thread is 50%, which is clearly less than 75%.

I concur wholeheartedly with your recommendation to find a top-notch specialist, but the question of the poster who started this thread was, paraphrasing, "How do you do that?" Do you have any ideas?

Nevertheless, it is always gratifying to hear about someone whose afib was cured. Congratulations, may you be an inspiration to others.

[DangerMouse]

As an update, my husband has an appt. with his cardiologist this month. At that time we will talk to him about the issues and get his recommendation which EP he should see to assess his chances.

My husband is in the Scripps network. When I went through their website they show a 70 to 90% success rate, dependent on age. I found the website for Dr Natale and that quoted 80% for first time and 95% for second time.

I'll update as we find out further info.

Thanks everyone for their input.

[ScottFromUtah]

Quote:

Originally Posted by DangerMouse As an update, my husband has an appt. with his cardiologist this month. At that time we will talk to him about the issues and get his recommendation which EP he should see to assess his chances. My husband is in the Scripps network. When I went through their website they show a 70 to 90% success rate, dependent on age. I found the website for Dr Natale and that quoted 80% for first time and 95% for second time. I'll update as we find out further info. Thanks everyone for their input.

Glad to hear that your DH has cardiology appointment. I believe that the success rate is more in the 70-90% range that your website quoted.

As mentioned in a PM, I had EP/CA (electrophysiology/catheter ablation) operation two weeks ago. I went from not being able to work out (except for walking), which lasted a period of about 8 months, to now when I can run five miles with no erratic heart beat, flutter, or fibrillation. I think my EP/CA worked, but I'm waiting a few weeks to see if my heart stays regular.

Again, good luck to your DH.

[Scooby7]

Hi all-

Atrial fibrillation is a disease many have, and very few understand. I have seen percentage statistics given on posts, and these can be very misleading to the non-practitioner.

I read at least 20 papers a month on current treatment strategies for atrial fibrillation. I would just caution everyone reading this to get lots of information before deciding treatment. There are very few electrophysiologists (EP) that perform the MAZE procedure in their labs. The MAZE procedure is the only curative therapy for chronic atrial fibrillation at this time.

You should be seen by an electrophysiologist, and a cardiac surgeon prior to deciding your treatment. Recent advances in the cardiac surgeons MAZE procedure have yielded very high success rates in the operating room. Surgeons also remove the atrial appendage during their procedure which decreases a patients risk of stroke.

Good luck in your decision-

[DangerMouse]

DH sure his cardiologist and is now scheduled to see the EP next month. Cardiologist feels DH is a good candidate as he last time he had echo/xray there was no sign of an enlarged top chamber which can hurt the chance of success.

Cardiologist explained how some success rates quoted are misleading. They expect a 60% success rate first time around and for those that have to come back for seconds, after they are done it comes up to 80%.

Will let you know how it goes.

[ScottFromUtah]

Quote:

Originally Posted by Scooby7 Hi all- Atrial fibrillation is a disease many have, and very few understand. I have seen percentage statistics given on posts, and these can be very misleading to the non-practitioner. I read at least 20 papers a month on current treatment strategies for atrial fibrillation. I would just caution everyone reading this to get lots of information before deciding treatment. There are very few electrophysiologists (EP) that perform the MAZE procedure in their labs. The MAZE procedure is the only curative therapy for chronic atrial fibrillation at this time. You should be seen by an electrophysiologist, and a cardiac surgeon prior to deciding your treatment. Recent advances in the cardiac surgeons MAZE procedure have yielded very high success rates in the operating room. Surgeons also remove the atrial appendage during their procedure which decreases a patients risk of stroke. Good luck in your decision-

Hi Scooby7,

Thanks for the information. I had not heard of the MAZE treatment, and don't even know if my cardiologist (who specializes in AF) does that treatment. Because of the invasive nature of the procedure (open-heart surgery), I would think that it is a treatment of last resort. Before a MAZE operation, patients should first try drug treatment (didn't work for me), and then have the relatively minor catheter ablation (which did seem to work for me). If my AF returns, I might need to seriously consider MAZE.

Is this the approach you recommend?

--Scott

[Scooby7]

My only recommendation is to get as much information as possible before doing any therapies. There is quite a bit of misunderstanding and unfortunately, many patients are told to take the medicine and deal with it. Recent advances should allow most patients to be free of AF and coumadin or other blood thinners.

I am glad you had a succesful catheter ablation and hope you are done with AF!