results of ablation followup (4 mos. post-ablation)

The good news is I am feeling great, with no afib since the Oct 23, 2012 ablation. The bad news is, it is not all behind me yet.

I saw Dr Tchou Feb 21, 2013 at Cleveland Clinic (CC) for followup on ablation (4 mos post-ablation), following an EKG and CT scan earlier in the afternoon. He noticed on my CT scan that the smallest of the 4 pulmonary veins (PVs) that he ablated (on 10/23/12) had narrowed by about 60% (stenosis). He showed me on the CT scan – he said the injected dye was getting through the narrowed open so blood was flowing, but it is a significant constriction. He said it is typically these smaller PVs, if any, that have narrowing after ablation. The PVs feed blood to the lungs. Since it is a smaller PV, it may only be feeding a small part of my lungs and may not cause symptoms. He also said he has not had one of these narrowings in 5 years.

I was instructed to stay on Coumadin for now and start aerobic workouts (“get in shape before Yosemite and do some climbing out there”). I think he wants to see if I am symptomatic – i.e., get short of breath under duress. Although I have been walking a lot since the ablation, I have only done two aerobic workouts since then because my gym membership ran out (my excuse), and I noticed no symptoms with either. Tentative plans are for me to go back to CC in June for a stress-test, and if it shows that the subject PV feeds a large part of my lungs, they will go in the next day with a catheter procedure and put in a balloon or stent to open it up. I asked if I did enough aerobics if it would open up on its own, and he said not in the near future but maybe over the next couple years. He said he would have his "intervention guys" (Docs who put in stents all the time) look at the pictures and get their opinion on the stent. He said "They may tell me I’m crazy, if so I will let you know". So I guess there might be a slight chance that I won’t have to go back up in June.

My question is:

Is the risk of a second trans-septal procedure worth it, if I am not having any symptoms? Could such a PV constriction kill off part of my lungs or something? I am concerned that my early migraine symptoms that started after the ablation (ocular migraine, low grade headaches, bright shooters across my field of vision) may be worse after a second septal puncture. From my perspective and with my knowledge at the moment, it appears unnecessary.

I would appreciate the opinions of more experienced and medically savvy folks here. Thanks all.

Are you on blood thinners ? I've heard that stints usually block up over time. But the ballon aproach should be safe.

How old are you ? Reduced lung capacity isn't the end of the world. It just means you can't exert your self as hard as before. Once you know your limits, you can live with it.

I am 60 and on coumadin - Dr wants me on it at least a few more months. I climbed a local mountain yesterday (from 800 ft elevation at base to 2100 ft at top) -- it took about 40 min and my heart was hitting about 120-130 and I felt no shortness of breath whatsoever - in fact, I felt energized and ready to go do more. I don't think a constricted PV is affecting me at all. I suspect the subject PV only serves a small part of my lungs.

I have had low grade headaches (every other day or so), 1 ocular migraine (4 days after ablation), and bright shooters across my field of vision (started 3 mos after ablation) since the ablation. I have read that 8% of patients with trans-septal ablations have ocular migraine in the first 3 months after the ablation. My opthamologist said don't worry about the ocular migraine or shooters, but the headaches are a bit annoying. I never had headaches prior to the ablation ( at least they were very infrequent). I am concerned that another trans-septal procedure might make these symptoms worse.

You may have tiny clots in some vein in your head or neck that can cause the headaches. The procedure may have made some clots that slipped by. But it probably won't get any worse.

Pinched nerves in the neck can cause head aches. After seeing a chiropractor for a lower back problem, he proceded to tell me i had neck problems and cracked my neck for a few sessions. After the first session, i started getting headaches in the temples, and after 3 sessions, i said thats enough. He did more damage than good as these headaches stayed for months. I even think he may have done something to the vagal nerve.