Dr. Natale

I have an interview with Dr. Natale in July. If he decides to do the procedure, it will be in October in SF. I am very excited about getting the procedure done by Dr. Natale. What would be a deciding issue that he would not do the procedure. That causes me a lot of concern.

If your afib isn't frequent enough or debilitating enough is one possibility. It used to be that if you had not failed a few AAR drugs first they wouldn't consider ablation, but with more recent research indicating ablation is more effective than AAR drugs up front, that may no longer be a limitation in approval?

Other health issues could be a consideration of course too, but if you are otherwise reasonably healthy and have a well documented case of AFIB that isnt well controlled and causes you frequent problems and reduced Quality of life then I doubt there will be any restrictions.

Confirming your insurance will pay for it is a good idea as well.

Shannon

Thanks Shannon,

I went to the doctor at Pali Momi today and he said I was in permantent Afib, he did not think a electrocardioconversion would work. The good news is I don't feel the effects as I did before. I am on pradaxa, Diltiazem 180MG SA, and flecaninide 200 twice daily that keeps me comfortable. I really thought I was not in afib when I went into the doctors office, I guess the EKG doesn't lie. I see that hope is on the way.

Tom,

Why the flecainide if you are in permanent afib? This is usually prescribed to keep people out of afib.

Marian

Marian,

Flecainide is my own decison. It has converted me before. The cardio doctors have lost hope that I will convert. I have the medication for flec from my primary heath care provider.

Tom,

Again, why take an AAD when it it clearly not working? The fewer drugs you take, the better. Especially if they appear to be useless.

lisa

Lisa,

You're right. I was just clinging to hope. I'll have to face reality. The heart rate is under control. I will have to live with that for now.

Tom,

When (if) you do go off Flec, be careful of how you do it. It may not be working to keep you in NSR ( or convert), but removing it abruptly may cause some problems.

Given what you have stated, there is no reason to go "cold turkey". Your body is used to it. It didn't get used to it in your system overnight, and unless there is a reason to stop it instantaneously, wean yourself off it slowly.

Better safe than sorry.

lisa

I would wonder if Dr Natale would consider using the convergent approach in your case:

<[www.a-fib.com];

(Also see the fuller discussion of the hybrid procedure about half way down the page.)

Presumably he would also be interested in assessing the following factors that affect the likelihood of CA success:

<[books.google.com];

and would advise you of the effect they might have on probability of success.

I do not know at what point he would refuse to do a CA based on these factors.

If he did reject you, you could try the others on this list:

<[www.a-fib.com];

or perhaps a surgeon.

-- Dick

Dick,

I'm still not sure that this young Doctor knows what he is doing alot of the information he gave he last time was not correct. Several years ago when I had the nuclear stress test the heart was in fine shape except a slightly enlarged left atrial. I'm getting a second opinion later this month from a better known cardiologist.

There was a lot of hope that convergent or hybrid procedure would be the answer for the tough cases. The results recently presented at the HRS annual symposium was disappointing. When I get home, I will try to find and post the abstract.

Tom,

I have an appointment with Dr. Natale in SF in late June. My ablation would be in September from what I understand.

I'll also be asking him these questions, and whether timing is an issue (I am on Warfarin and would just as soon not wait if at all possible and if an ablation is the way to go). I will post after my appointment and see if that helps you in any way.

Our situations may be different. I have intermittent afib, however a return to full time work in a very stressful position led to an uncontrolled series of episodes recently. My last echo showed a weakening of the heart (dilated cardiomyopathy). I was diagnosed 10 years ago (I am 50 now) and for many years 25 mg. of Atenolol a day and an aspirin were all that was required. Things have changed.

In my case it seems as though stress is a major factor, even when I'm not completely aware of it.

Thanks MBuscher,

Any help with information would be greatly appreciated. Feel free to use my email address.

Tom

MBuscher
Be sure to look into the success for treating cardiomyopathy with high doses of coenzyme Q10 --- the ubiquinol form is found to be effective.
Check out the post in The General Health Forum - Coenzyme Q10 - the Spark of Life.
<[www.afibbers.org]>

The studies by cardiologist Peter J. Langsjoen, MD, indicate success in reversing cardiomyopathy with doses “averaging 580 mg/day of ubiquinol (450-900 mg/day).”(2)

There is considerable online information about Dr. Langsjoen's work with cardiomyopathy patients. If you can't find it, email me and I'll help.

Stay away from statin drugs.

Jackie

Tom, I would stay on Flecainide for the following reasons hopefully not much fibrosis has accumulated in your atrium:

The progression of AF through more frequent and
longer episodes to persistent and, in some cases,
permanent AF is caused by electrical and structural
remodeling of the atrium. Flecainide helps prevent
electrical remodeling by slowing conduction across
the myocardium and increasing the refractory
period. It helps prevent structural remodeling by
reducing calcium ion accumulation in the myocytes
and the associated oxidative stress. However, like
any drug, flecainide does have the potential for
adverse effects.

Found the abstract. It is AB35-3 during this year's HRS podium presentations. I will try to get an online copy and cut and past it under a new topic as I am sure there are a number of interested persons here.

Miriam and Lisa it's important Tom stay on Flec prior to ablation
More proof

Antiarrhythmic therapy prior to ablation

TSUKUBA, JAPAN. Having been in permanent atrial fibrillation for an extended period is associated with a poorer outcome of catheter ablation. Japanese cardiologists/electrophysiologists now report that extensive antiarrhythmic therapy prior to ablation results in improved outcomes.
Their study included 51 permanent afibbers (7 women) aged between 36 and 74 years. All patients had been previously unsuccessfully treated with class I (flecainide, propafenone) or class III (amiodarone) antiarrhythmic drugs (AADs). The mean duration of AF prior to enrolment was 36 months. Following enrolment all patients were prescribed a combination of amiodarone or bepridil (a calcium channel blocker) and a class I antiarrhythmic such as flecainide or propafenone. The most popular combination was flecainide and bepridil prescribed for 41% of patients.
An average of 1.5 months after initiation of the combined AAD therapy, 65% (33 patients) had converted to normal sinus rhythm (NSR), while the remaining 18 patients remained in afib (AF group). It was noted that fewer members (21%) of the NSR group had been in permanent AF for more than 3 years than in the AF group (44%). It was evident that members of the NSR group had experienced a significant increase in left ventricular ejection fraction, a decrease in left atrial diameter, and a reduction in plasma BNP level due to their successful AAD therapy. However, 4 patients (7.8%) experienced adverse effects from the AAD treatment, notably bradycardia and prolongation of QT interval.
After 3 months or more (average of 6 months) of combined AAD therapy, all study participants underwent a pulmonary vein isolation procedure including a right atrial flutter ablation (bidirectional block line at the cavotricuspid isthmus) and additional lesion sets as required (roof line, superior vena cava isolation, and ablation of complex, fractionated atrial electrograms). In the NSR group only 9% of ablatees required cardioversion at the end of the procedure, while in the AF group 39% needed cardioversion to achieve normal sinus rhythm. No complications were observed during the 14-month post-ablation follow-up period. At the end of follow-up 61% of the patients in the NSR group and 22% in the AF group were still in NSR.
The authors conclude that restoration of normal sinus rhythm in permanent afibbers using a combination of class I and class III antiarrhythmics results not only in an improved ejection fraction, reduced left atrium size, and lower BNP concentration, but also markedly improves the outcome of catheter ablation.
Igarashi, M, et al. Effect of restoration of sinus rhythm by extensive antiarrhythmic drugs in predicting results of catheter ablation of persistent atrial fibrillation. American Journal of Cardiology, Vol. 106, 2010, pp. 62-68
Editor’s comment: It certainly would seem worthwhile for permanent afibbers to consider going on the combination therapy while awaiting their ablation. NOTE: I am not sure why the Japanese researchers classify bepridil as a class III antiarrhythmic. As a calcium channel blocker it would normally be classified as class IV.