Atrial fibrillation and ablation

Hi
I like to seek some comments and views of ablation.

I have brady/tachy syndrome and atrial fibrillation with underlying hypertrophy cardiomyopathy. I have a PM implanted 2+ years back, and is on Sotalol and aspirin. I have no major problems all year long. Recent check-up however show-up new statistics
1. Increase incidence of atrial fibrillation since last check-up 1 year ago.
2. Intensity of afib increased from prior year readings.
3. Total 6 afib events greater than 1 hour of which 2 events were greater than 3 hours in duration. Total 6 hours of afib > 100 bpm, some were at 273 bpm and greater.
4. Afib events paced 1.6% compared to previous 1.2%.
5. Atrial pacing 96% from previously 93%
6. Ventricle pacing less than 1%, no change
7. B/P is fine at 110/78 bpm

In those recorded events, my own records confirmed I felt those fibrillations and main symptoms was shortness of breath and fatigue over the duration. The med tech thinks I am in great shape, nothing to worry about.

However the cardiologists thought otherwise. The doc thinks I am now symptomatic and recommends a 2 step approach
1. Go for atrial ablation (with only 60% chance of success)
2. If it does not work, proceed to a/v node ablation
The doc thinks I do this within next 6 months.

I sought a second opinion and this other cardio ask me to re-consider. The stats and especially ask me to consider how I felt about the symptoms. If it is tolerable then the problem is not medically significant enough to warrant an ablation. He prefers not to venture to these procedures since I have hcm and more complications could arise than what it is intended to fix. He recommended that I stay with medication and never forget the importance of aspirin (for protection from stroke due to afib).

I am leaning to no ablation and do any check-up in 6 months.
I like your views particularly if there are any criteria for electing an ablation.

Thanks in advance.





2 Comments

Decision

by ElectricFrank - 2008-12-06 11:12:54

I agree with you and the second doctor. Unless you are having serious enough symptoms to interfere with life, the potential adverse outcomes aren't worth the risk. You always have the option of doing it later if things get worse. Also, it is possible the problem will clear up on its own. There are so many things that can cause irritability of cardiac tissue such as a virus, allergies, emotional stress, and the stars lined up wrong! I periodically go through times of frequent PVC's and then they clear up for months. I have rejected both meds and procedures.

frank

Decision

by Bionic Beat - 2008-12-07 01:12:44

I agree with you and the second doc too.

Unless you're plagued by AFib, the risks of ANY ablation or other invasive procedure just aren't worth your quality of life.

With some AFib, you need to be on a blood thinner but it sounds as if aspirin is adequate for your short periods of AFib.

My understanding (after 30 years of intermittent AFib) is that they don't worry about it unless it goes on for over 24/48 hours.

I was always told to get to the hospital at about the 35 hour mark, to be cardioverted if needed.

An hour or so 'shouldn't' cause a clot......but ask your docs about this.....a clot is the risk you take with AFib.

I was only offered an AV node ablation after months of uncontrolled AFib. My resting HR was 165 and I needed help to get upright.

Wait til you need an ablation.....then go forth and don't be frightened.....I'm 2,000% better nearly a year later.

Best Wishes,


Bionic Beat


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