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At age 54 diagnosed with a-fib. Planning ablation. Is this a premature decision/risk?

By Anonymous April 15, 2010 - 7:34am
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My brother was 39 living with a fib when he collapsed with ventricular fibrillation. Kept on support for 4 days, declared dead on my birthday. He was taking coumadin and tambacor. I am not comfortable taking meds for the rest of my life with their risks. I am also concerned about the particular risk of treatment as a female.

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Dear Anonymous

Thank you for your question and welcome!

I am so sorry that your brother died at such a young age, and on such a day for you. I can imagine your birthdays will never be the same again and we are very sorry for your loss.

You are correct to have concerns about surgery based on the fact that you are a woman. There can indeed be differences in outcomes although you are lucky to have age on your side; you are young enough to be a better candidate than someone of a more advanced age.

There is an article I'd like you to read, regarding your situation: http://www.empowher.com/media/article/study-shows-women-atrial-fibrillation-af-have-catheter-ablations-later-men-and-have-wo

Besides medication, your options are:

Cardioversion is a procedure that uses an electrical current or drugs to help normalize the heart rhythm. If atrial fibrillation has lasted 48 hours or more, you may be given blood thinners before this procedure.

Ablation Therapy
In some cases, an area of the atria that is deemed to be responsible for the atrial fibrillation may be surgically removed or altered (ablated) with various techniques, including cryoablation or radiofrequency ablation , to prevent it from persistently generating the rhythm disturbance.

Lifestyle Changes
Avoid caffeine and other stimulants because they may trigger another episode. Alcohol may also act as a trigger in some people.

Read more on our detailed Atrial Fibrillation page here: http://www.empowher.com/media/reference/atrial-fibrillation#definition

Anon, I know you know this, but there are risks in every surgery.

Here is an idea of what the surgery will entail, as the risks involved:

Risk Factors for Complications During the Procedure
Allergies to medications, shellfish, or x-ray dye
Pre-existing heart or lung conditions
Serious recent or chronic illness
Bleeding disorder
Kidney disease

What to Expect
Prior to Procedure your doctor will likely do the following:

Perform electrophysiology studies to pinpoint the location of the abnormal rhythms
Instruct you to stop taking medications previously used to control your arrhythmia

The day before and the day of your procedure:

You will be instructed not to eat or drink anything for up to eight hours before the procedure.
You will be admitted to the hospital.
A nurse or physician will explain the procedure to you.

Before the procedure, local anesthesia will be applied to the insertion site.

During Procedure
During the procedure, you will be given IV fluids and medications, fluoroscopy, anesthesia, and a sedative to help you feel more relaxed.

Description of the Procedure
When the procedure begins, the groin or upper thigh area, where catheters are to be inserted, is cleaned, shaved, and numbed with a local anesthetic.

A special ablation catheter is inserted and fed through a blood vessel up into the heart. Your doctor will watch its progress on a fluoroscope, an x-ray machine that provides continuous, real-time images of the inside of the body.

Once the catheter reaches your heart, your doctor will use another catheter tipped with an electrode in order to reproduce your arrhythmia. When the approximate location of this arrhythmia has been identified, your doctor will first test the area by cooling the ablation catheter tip to 30°C. This temperature will temporarily stop the arrhythmia if it has been correctly targeted, while being warm enough to avoid doing permanent damage to any nearby normal tissue, which will thaw and recover.

Once the exact location of your arrhythmia has been confirmed, your doctor will then cool the tip of the ablation catheter by another 100°C—down to -70°C. This extreme cold will freeze and scar the heart tissue, thus eliminating the arrhythmia. Your doctor will then try to reproduce the arrhythmia again and continue treatment until the arrhythmia can no longer be reproduced.

After the Procedure
You will be moved to a recovery room and observed for a few hours for symptoms, rhythm problems, and bleeding from the catheterization sites.
You may feel groggy from the sedative.
The catheter insertion site may be bruised and sore.
If the groin area was used as the insertion site, you will be instructed to lie in bed with your legs out straight.
If the wrist or arm was used as the insertion site, you will not need to stay in bed.
The sheath that was placed at the insertion point will be removed.
The insertion site will be monitored for signs of bleeding, swelling, or inflammation.
Your vital signs will continue to be monitored.

How Long Will It Take?
The procedure will take 2 to 4 hours.

Will It Hurt?
You may feel some minor discomfort as the catheter is inserted.
You may feel light-headed, experience a rapid heartbeat, or experience chest pain during the freezing process.

Possible Complications
Although complications are rare, they may include:

Damage to or perforation of the heart or blood vessels
Inadvertent interruption of normal conduction (requiring a pacemaker)
Heart attack

Average Hospital Stay
Most patients stay overnight for further observation and are discharged the next day.

Postoperative Care
When you return home after the procedure, do the following to help ensure a smooth recovery:

Take aspirin as prescribed, usually for 2 to 4 weeks, to minimize the risk of clot formation at the ablation sites.
Return to any usual light activities, such as walking or taking the stairs, but refrain from heavy lifting or any strenuous activity for 24 hours; in most cases, you will be able to return to your normal activity level within a few days.
Schedule a follow up visit with your doctor to check the catheterization sites and review the procedure.

This procedure has an extremely high success rate and a low recurrence and complication rate. However:

Patients with atrial fibrillation or ventricular tachycardia may need to continue antiarrhythmic therapy.
Patients undergoing cryoablation of the AV node typically require a pacemaker.
Read more: http://www.empowher.com/media/reference/cardiac-catheter-cryoablation

Anon - it's pretty big surgery so I don't blame you for wanting to really evaluate your options. But as you can also read, the outcome is generally very positive.

Has your health care provider approached you about surgery? Does he/she think you are a good candidate?

April 15, 2010 - 12:51pm
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