Pappone Procedure

Thanks to everyone for their great posts and information!

I am 37 years old, fit, othewise healthy with permanent LAF. Started out with occasional episodes, goofball cardiologist told me at 29 I was just a Type A personality, stressed out a bit and I drank too much coffee and wine. Well, low and behold, with no treatment, I went permanent. Tried all the drugs -- only thing that worked a bit was Amiodarone but my Doc wanted me off it so now just on Toporal and Coumadin. This keeps the rate down, but a fib is a constant.

Earlier this year I just got fed up and despite the PACE study, really think that long-term afib can not be good for the health of my heart. PACE was generally a much older age group.

Decided to really research Abaltion. Both my local Caridiologist and my local EP suggested that the new(ish) Pappone procedure was a good option for me. After looking into it, it seems to be working for a lot of people. Have talked to Pappone actually and he recomend that Dr. Fred Morady at Univ. of Michigan to do the procedure in the States. I have met with Morady and was VERY impressed. Nice guy too. Anyone out there with Pappone procedure experience or had a abalation at Michigan?

Thanks.

Todd
Washington DC

No such experience but an extensive search of the literature shows that Natale's technique (Cleveland Clinic) quite similar to Pappone's with possibly even better results.
As per literature, all other practitioners appear to be lagging well behind.

Todd,

I'm afraid your first "goofball" cardiologist was correct. I'm afraid that stress, coffee, and wine all deplete your nutrient stores that your heart needs, in order to beat in rhythm. Being that you're still so young and doing some research, you might want to start reading at www.mgwater.com, under arrhythmias. You then might want to speak with your doctor about supplementing with Mg. glycinate. Your heart is crying out for it.

Richard

Thanks for your post. Only reason the guy is a "goofball" is he sent me home with nothing more than a comment -- no diagnosis! I had to wait 5 years till I was in permanent afib and another cardiologist said: "You have AFib." I totally buy the idea that all these are factors are involved in my afib. I just wish we could have nailed it down when it was only occasional.

Oh well. Enjoying studying up on all of the items you point out. Definately getting on Magnesium angle. Just bought a bunch of books on the topic.

As for Natale and Pappone comparision in earlier post, I need to investigate this a bit. This site is certainly very big on Natale and CCF!

TM

Todd,

You're correct, if your cardiologist didn't point that out. You would at least known more about what to investigate. It may not be too late for you, as Fran was chronic for, I think, 10 yrs., and she turned it around. I wish you the very best, and certainly hope you try nutritive therapy first, before ablation, being that you're so young, and the long term effects of ablation are not known. When we get older, such as myself at 57, we begin to want quality over quantity, but I'm giving nutrition another year, after my meeting with Dr. Gersten. If that doesn't work, I'll almost be 59, as I'm turning 58 in a couple of weeks, then I'll seriously consider ablation.

Richard

Todd
You have researched well and Dr Morady is your man .Three weeks ago
I was fortunate to sit in on an hour lecture given by Dr Morady here in the Tampa Area .I came away saying how lucky the Michigan people are to have such a Doctor .
He was introduced as someone that has written over 500 papers on this subject and was involved with the development of the Swan Ganz catheter .
His brief lecture included his thoughts on the French and Italian approach to catheter abalation of atrial fib. and why he favors the Pappone procedure .
He also discussed anticoagulation and the need to keep the plasma levels between the therapeutic INR (2-3) when taking coumadin and why these levels are difficult to maintain .
Fixed -dose Ximelagatran 36 mg twice daily is, or will soon be available but may be an expensive substitute .
He discussed the mechanism by which obstructive sleep apnea may predispose to AFib .Hypoxemia- hypercapnia-sympathetic surges-acute increases in BP->activation of strech receptors and electrophysiological effects; and the benefit of using CPAP following cardioversion in sleep apneic patients .

I had been seriously thinking about the use of ACE ihibitors even though my blood pressure is not an issue .Migraine headaches had been a major concern of mine before they were replaced by episodes of afib .I knew if I could dilate blood vessels that were responsible for my headache I would get relief .Now I'm thinking this is what I have to do to get back in sinus .
My life long problem is how to control the constriction and dilatation of my blood vessels .Hot and cold receptors in my brain not in sink .
I also observed the three -five pound weight swing during and after Afib episodes and wondered what part my kidneys were playing .I assume Atrial Fib. results in the accumulation of fluid and conversion back to sinus heralds an out- pouring of fluid .
As if on cue Dr Morady discussed the use of Irbesartan to maintain sinus rhythm after cardioversion .Irbesartan/Avapro lowers blood pressure by stopping angiotensin working which results in dilated blood vessels .
His lecture hand-out also included the renin-angiotensin system in Atrial Fibrillation .From what I can see during the prolonged rapid atrial pacing while in atrial fib .Angiotesin II->activation of extracellular signal-related protein->firoblast proliferation->atrial fibrosis .The use of Angiotensin II antagonists and ACE inhibitors blunt acute electrical remodeling .
Amiodarone he discussed and added that along with the many known side effects .Amiodarone did effect gonadal function and was 60% more responsible for atrophy of the testes than other drugs .A sure reason to look to other treatments for AFib .
Also the surgical Maze procedure could be attempted in patients undergoing open heart surgery but the other forms of LA Ablation were more favored .
Pacemakers were not seen as necesssary as with the improving success of the LA Ablation .
On demand approach to taking medication .'It benefits the patients to take meds. this way .I would suggest they take Propafenone 300mg every 6 hours until they convert as well as Irbesartan .'Irbesartan 150/300mg daily .

You have to be brave to start taking your meds. on demand .I can remember asking my cardiologist if I could take my meds. this way and he dismissed it as being totally irrational .He always favored the pacemaker approach .Well I have started, and in the past four weeks I have had my usual two episodes of AFib weekly but have converted after 300mg of Propafenone each time except once when I converted after the second dose .Perhaps in the future I will add Avapro 75mg daily as well, to see if this benefits me .Then sometime in the future if I still have PAF I will decide on a third LA Ablation . I supplement with Magnesium and take Coumadin as well .

Above is an account of what I interpreted from the lecture others may have seen it differently .I hope that Atrial Fibbers will have an opportunity to discuss their concerns with Dr Morady in the future .
The 12 pages of his lecture has file no.232 on it so I guess can be obtained from Michigan State University Hospital .

HenryT.,
I was told that you pee more when you are in atrial fib/flutter.

Nancy

Nancy.,
Vagal stimulation during my Afib episodes can at times get me teary eyed and my nose can run when I start to discuss emotional subjects but when the atria flutter and fibrilate there is no 'atrial kick' so 20-30% less volume is made available to the ventricles for circulation .I believe prolonged AFib can result in heart failure and that is why Digoxin is still favored for chronic AFibbers .When we return to sinus we can return to our pre Afib weight .
To me nothing is clear-cut .Was it the constriction or dilation of blood vessels that gave me relief from my migraines?

just remembering that beta blockers are quite often prescribed for migraine. I had migraines up until onset of AF, then they stopped. Then I got them back when I stopped medication, but I stopped AF through eating no proccessed foods and then stopped migraine through eating a paleo diet. They are tied up.

Fran