I'd love to mine you guys brains for information on an ablation topic that we don't hear much about. Here goes:
I have autonomic dysfunction or dysautonomia as well as Afib. This was evaluated through extensive autonomic testing that included a Tilt Table Test. The involvement of the autonomic nervous system in Afib is pretty clear. We read of vagal Afib and adrenergic Afib referring to Afib triggered by either the parasympathetic or the sympathetic branch of the ANS. Mine seems to be mostly vagal--always starting about 3 a.m. or while otherwise resting. The heart has autonomic ganglia and it is somewhat common, I believe, to ablate these ganglia as some studies show them to be involved in the initiation and continuation of Afib.
I also belong to a Dysautonomia Forum and recently two members posted that they had gone into a cardiac ablation
without dysautonomia and came out of it
with dysautonomia. This makes me wonder about what effect ablating the autonomic ganglia in the heart might have on someone with latent dysautonomia or on someone who already has dysautonomia. These autonomic ganglia have both sympathetic and parasympathetic aspects. This concerns me as, for me, dysautonomia is far more debilitating than Afib as mine is presently controlled with flecainide. But, drug therapy will most likely fail at some point and then the usual practice would be to move on to an ablation. But, I'd really hate to have my existing dysautonomia exacerbated from an ablation. Here are a couple of articles on the whole subject--they are a bit difficult for me, so I'm wondering if anyone can boil down key points as to the risks of the exacerbation of dysautonomia that might be encountered through an ablation.
Quote
Conclusions
The intrinsic CANS [cardiac autonomic nervous system] plays an important role in the initiation and maintenance of AF and may provide both the substrate and trigger for AF. Acute autonomic remodeling may play a crucial role in AF maintenance in the very early stages. The benefit of adding GP ablation to the standard PV isolation procedure for patients with paroxysmal AF is supported by both experimental and clinical data. In addition, given the close association between GP activity and CFAE, GP ablation may replace CFAE ablation as part of the ablation procedure for persistent AF.
[
www.ncbi.nlm.nih.gov]
And:
Quote
Summary
It is clear now that autonomic dysfunctions and the complex interactions among the different components of the cardiac autonomic innervations play an important role in the pathogenesis of AF. However, further investigation is required to determine whether intervention aiming at the specific components of the cardiac autonomic innervation could lead to improve clinical outcome of AF management, especially that of the ablation procedure.
[
www.ncbi.nlm.nih.gov]
I am also wondering if ablating these ganglia might be a possible cause for the elevated heart rate usually occurs after an ablation.
Thanks for any ideas on this!
