another question--- radio frequency ablation

[cynthiaG]

I know that the first course of action in controlling afib is with medication(s). I know about radio frequency ablation. I had asked my PCP as to why this isn't done in most HCM patients and he said that because of our abnormal muscle tissue and sometimes it affects the electrical pathways (not exact words but basically that). What if there was only one or a few screwy locations where the impulse is going haywire and they can ablate it? why don't doctors want to do this?? What I'm saying is, if that were the case for me and they found out where and it was fixed, I wouldnt have to live with afib.

[Largehearted]

Re: another question--- radio frequency ablation

Hi Cynthia. Please allow me to piggy back on your question. After another bout with a-fib (my fourth), and time in the hospital I too have begun wondering about radio frequency ablation, maze, modified maze etc. Has anyone on this board undergone such procedures? What were the results? How are you doing?

Cybthia, thanks for getting this thread going. I logged on to do just that, but you beat me.

Peace,

Leon

[cynthiaG]

Re: another question--- radio frequency ablation

Hi Leon,
what a coincidence! I had my first afib episode last May...I was having one about every month and a half...sometimes skipping a month. they thought I was having atrial tachycardia as it was never "caught" either on an event monitor or once I went to the hospital because it scared the bezeezus out of me and it stopped by the time I got there! They finally caught it when my husband took me to the ER in early February...I was so down when they said I had afib. I'm currently on 360 mg. of verapamil and see how that does..if I get another episode, I believe they will put me on an anti-arrythimic also. Things were going pretty well, up until now with this. I have a lot of questions!

[Burton Borrok]

Re: another question--- radio frequency ablation

Cynthia and Leon,
If you’ll allow me to throw in my penny and a half, I think chemicals are the first line of defense, and an ablation is only done if or when that line of defense is broached. Also, I believe it would be unrealistic to try to do tissue studies during the procedure to determine where and how much to ablate. They have to go after obvious mal-structures.

I have diabetes and I certainly would not want anyone removing my legs to forestall the possibility of my getting sores that won’t heal, or even gangrene. I’ll cross that bridge if or when that ever happens – but not before every other possible less obtrusive measure has been tried first.

There is a normal progression to our treatment – providing we are being treated by competent professionals. Sometimes we grow impatient with the discomfort and time it takes to find the best remedy, but then it is usually quicker to jump off a bridge then to walk off it.

Just my thoughts on the situation.
Burt

[Chuck B]

Re: another question--- radio frequency ablation

Cynthia,
I had a failed attempted radio frequency ablation. It was discovered that I had multiple sites of origin(polymorphic) and the E P specialist also said that with many HCM patients the walls of the heart are so thick that it is difficult to get to the errant pathway. I have easily stimulated sustained ventricular tachycardia so I had high hopes for a successful ablation and the resultant lowering of the antiarrythmics(amiodarone and coreg), I am not sorry I underwent the attempt but in hindsight I would consult with an E P specialist who had more experience with HCM and get several opinions before I exposed my self to the potential risks. I did get the impression that R F A is more commonly done for A-fib.
Take care,

[Sarah]

Re: another question--- radio frequency ablation

Hi

yes, the reason why pulmonary vein ablation (PVA) aka radio frequency ablation (RFA) are NOT used in HCM patients often or very successfully is because of the heart muscle itself. Since HCM muscle is all confused and jumbled, the electrical signals can go every which way.

People with afib in a normal heart usually have their electrical error going only 1 way wrong, which is pretty easy to go in and fix.

With HCM, you can "fix" one errant pathway, only to have the heart just find another wrong way to go instead of a right one. This is especially true for people who don't have a very stable arrhtyhmia (one that varies).

There is an open heart procedure called the maze where they ablate sections of the heart so the pathway is very specific and almost unavoidable but this has a much higher risk involved.

Cleveland does them and maybe Mayo too.

Ablation is a nice way of saying "kill." because that is what it does. It kills pieces of heart muscle to keep the current from going through the muscle. That is why having multiple ablations and the maze get risky as we don't know how much scar tissue the heart can sustain before it stops working completely.

S

[Lisa Salberg]

Re: another question--- radio frequency ablation

Radio Frequency (RF):
High frequency electrical energy used in Catheter Ablation.

Pulmonary Vein Ablation
A term used to refer to both Segmental and Circumferential Catheter Ablation. It is replacing the term "Focal" or "Focal Point Catheter Ablation."

Pulmonary Vein (PV) Potentials:
An electrical charge or energy (potential) in the Pulmonary Vein openings that can cause A-Fib. A PV Potential can be measured and pinpointed even if you aren't in A-Fib at the time. See Focal Point Catheter Ablation.

Radio Frequency Ablations are not "common" in HCM but many have had successful procedures. This is an older treatment for A/F and works in many people.
What is radio frequency ablation?
Radio frequency ablation (RF ablation) is a non-surgical treatment for people with an abnormal heart rhythm (arrhythmia) in which a long, flexible wire is passed into the heart to ablate (eliminate) the precise area of the heart causing the arrhythmia.
An arrhythmia can at times be controlled by medications, but if these are unsuccessful, or if the side effects of the medication or taking the medication itself become troublesome, radio frequency ablation may be recommended.



A newer procedure is the Pulmonary Vein Ablation:
During Pulmonary Vein Ablation a soft, thin, flexible tube with an electrode at the tip is inserted through a large vein or artery in your groin and moved into your heart. This catheter is directed to the precise location(s) in your heart that are producing your A-Fib. These points are burned off or isolated from your heart. This is a relatively new procedure. (The first journal published report of a successful catheter ablation for A-Fib in humans was done in 1994 in Bordeaux, France.21 The first published studies of Focal Ablation (Pulmonary Vein Ablation) within the Pulmonary Veins came from Bordeaux47 and Taipei.48) Currently, only a few heart centers in the U.S. are doing Pulmonary Vein Ablation (Isolation) of A-Fib on a regular basis. Current Pulmonary Vein Ablation (Isolation) techniques are achieving success rates of 85% in curing Paroxysmal A-Fib with low risk.17,33,34,41 (Check with your particular heart center for its success rate.) "Curing" A-Fib is defined as restoring patients to normal sinus rhythm without dependence on any medications.41 (The other 15%, though not "cured" of A-Fib, may be significantly improved after an ablation. They may have fewer or less intense attacks of A-Fib. Medications that didn't work before may now control the A-Fib. But for some there may not be any noticeable improvement at all.)

if all else fails:
ABLATION OR MODIFICATION OF THE ATRIOVENTRICULAR (AV) NODE AND IMPLEMENTATION OF A PACEMAKER
From a patient's point of view, this is a procedure of last resort. Each heartbeat normally starts in the right atrium where a specialized group of cells called the sinus node generates an electrical signal that travels down a single electrical road (the Atrioventricular [AV] Node) that connects the atria to the ventricles below. By ablating or eliminating this AV Node, your Atrial Fibrillation signals can't get to the ventricles which does stop your heart from racing. But for your heart to beat at all, you must have a permanent pacemaker implanted in your heart for the rest of your life. What's worse, you still have A-Fib and have to forever take anticoagulants to prevent stroke. (Newer pacemakers attempt to pace both the right and left atria as well as the ventricles which may improve A-Fib symptoms.) Also, when you eliminate the AV Node, there is a risk of sudden death because of the ventricles beating too fast.15 If you have a bad Sinus Node and would need a pacemaker anyway, this procedure might work for you.


This has been taken from several sites online, I hope it answers some questions.
Lisa

[Dorothy]

Re: another question--- radio frequency ablation

Thank you Lisa for providing a "down-to-earth" explanation of each of the ablation procedures. I have given copies to my family members wondering why I thought I needed one or two of these procedures. They still don't understand that it wasn't my "thought" to have either the radio-frequency ablation to get rid of the a-flutters, but recommended by top authorities in the field, or the up-coming Pulmonary Vein Ablation to, hopefully, take care of the a-fibs. As I have not been a good candidate for the necessary medications to control a-fibs, it was decided (again by those same "top of the field" specialists) that this would be the best "next-step" in my care.

One of my children even gave me an article about the MAZE Procedure being done for the first time at the hospital at which they work. Funny, it wasn't something I was to be considering; but in their opinion, it could be done at a hospital that may some day do more than 10 since recently starting the procedure! They still refuse to be evaluated by a simple echo; so, I guess, I am the "old fool of a parent" trying something new in their eyes. Wish me luck! Maybe I should be grateful that they won't be with me next week in Cleveland! I may actually recover at a quicker pace.

Happy Easter to All!

[Lisa Salberg]

Re: another question--- radio frequency ablation

Good luck in Cleveland!
If you need us...Tell Dr. Lever to get you a PC so you can log on!

Lisa

[Dorothy]

Re: another question--- radio frequency ablation

Just to let everyone know that I have returned from Cleveland, having had the Pulmonary Vein Isolation Procedure on April 14. As was expected, I experienced a few a-fibs after the procedure; but, three weeks post, I can honestly say I feel GREAT! Of course, the added med (Sotalol) has again sent my system a bit off track. Some days I'm a zombie; others, a bit more normal. Of course, that is not unlike HCM in general Whether it be The Good, The Bad or The Ugly (an old Clint Eastwood movie,) I'm hanging in there, always looking for a better way to deal with HOCM. I return to Cleveland in July for another thorough exam. Getting to be like Burt, looked at, proded, poked and scoped!

____________________________

Youth is a work in progress, Age is a work of ART!

[cynthiaG]

Re: another question--- radio frequency ablation

Dorothy,
so glad to hear you're doing great! I loved your witty post!

[Darren1]

Re: another question--- radio frequency ablation

Wow! Pretty interesting stuff. Glad it has helped. Thanks for sharing with the rest of us.

[Tigger1]

Re: another question--- radio frequency ablation

I'm still new at this HCM stuff. Thanks for all the info...

Tigger1