Post myectomy a-fib?

[progers]

Has anyone had problems with a-fib following their myectomy? I had my first a-fib episode only 8 weeks ago. Although I was cardioverted after 5 days, it has come back (its been over 2 days continual). I am not tolerating it very well and am experiencing a lot of pain in my chest after eating a piece of toast. Walking to the bathroom is excruciating.

I am very frustrated and having enormous amounts of regret about doing the myectomy. Although I had episodes of chest pain and the odd arhythmia before, it was never chronic. Will the a-fib settle down? Or will this continue for ever?

Thanks,

Paul

[Sarah]

Paul

I can't speak to myectomy-induced afib but the first bouts of afib are always the worst and there are lots of medications to try that, with cardioversion, should get you back to normal.

worst case scenario, you can adapt to afib or there are more technical treatments. your doctors can tell you how often this happens and how easy it is to fix.

take care

S

[mtlieb]

Paul,

I am very sorry to hear that you continue to experience problems following your myectomy.

I was told prior to my surgery that about a third of post-myectomy patients experience atrial fibrillation following the procedure, so I was somewhat prepared for that. The literature supports this finding, and there's one article in particular that appears to be of interest but I cannot get my hands on the full-text version. Perhaps Lisa or someone else here can help out with that.

Clinical predictors and consequences of atrial fibrillation after surgical myectomy for obstructive hypertrophic cardiomyopathy. The American Journal of Cardiology, Volume 89, Issue 2, 15 January 2002, Pages 242-244.

Steve R. Ommen, Helen L. Thomson, Rick A. Nishimura, A. Jamil Tajik, Hartzell V. Schaff and Gordon K. Dani

Another article I located here reiterates this finding, putting the figure at about 30% of post-myectomy patients who will experience transient atrial fibrillation immediately following the procedure, with or without prior history of a-fib.

I hope that things start to look up for you very soon,

Jim

[progers]

Hi Jim,

Thanks for the references - I've actually read these. I was told just a moment ago that my a-fib would probably continue for the rest of my life. They will cardiovert me this time but do not want to continue cardioverting me in the future. My cardiologist is talking about a radio frequency ablation, but is not sure this would be that effective in people with HOCM. I am confused and need some advice....

Paul

[NoCrash]

Paul,

You need to discuss this with HCM specialists, perhaps starting with the team that did the myectomy and working onward from there--perhaps calling-in second opinions, as well.

This bout of A-fib may be troublesome now, but don't let that cause you to do anything rash. Go with some medical treatment now and give some medicine a chance to work and get you feeling a little better before jumping off any cliffs!

Good luck and hope you do start feeling better,
Rob

[Sarah]

I suggest you email Lisa and ask her about a referral to an HCM specialist if you are not already seeing one.

My brother has been cardioverted a dozen times. I've been cardioverted four times and my mom probably half a dozen. I can't imagine what they are worried about.

Also, RFA ablation is NOT the same as the alcohol ablation used to reduce septal walls. http://www.c-r-y.org.uk/radio_freque...r_ablation.htm

[Linda]

Paul,

Don't give in to the negative feelings too soon. It's hard to think positive when you are feeling as bad as A fib can make you feel. I think you've also been dealing with this on your own over the wkend, haven't you? That makes it even worse for you.

Jim gave you some good info in the article he referred to. A fib can occur in some people up to a year after the surgery. It's not only HCM'ers affected either. Heart valve surgeries can have the same problem, so it's a well documented situation. My son had one episode just about a yr after surgery. He's not had any since that we know of - 7 yrs later. Let's hope the same for you, once it's all resolved. Best wishes, Linda

[Debbie]

Paul,

I'm so sorry for what you are going through.

From the way I felt when I had Afib, I don't know if I could function at all if I had it all the time.

I will keep you in my thoughts and prayers.

Keep your chin up.

Debbie

[progers]

Thank you guys. I appreciate all your support.
I am back in sinus ryhthm following a successful DC cardioversion last night at the hospital where they did my myectomy. However, they have put me on Amiodarone and even though I am on this I feel terrified that the a-fib will return...

The two episodes I've had so far have been asolutely debilitating and the prospect of having to 'grin and bear it' for the rest of my life (as one cardiologist said to me on Monday) is terrifying. My symtoms with a-fib are much much worse than anything I went through before my myectomy 9 weeks ago. Which makes me wonder if the surgery has done something that will mean that I suffer from this permanently???

Paul

[Sarah]

Dear Paul,

From what I've read, this happens with myectomies but it is just temporary.

Your doctor's don't know everything. Focus on being in sinus rhythm and set aside the other stuff.

take care,

s

[mtlieb]

Paul,

I've done a bit of research on this myself since it was discussed as a potential side effect of my own myectomy. To back up what Sarah said in her post above, as well as to reiterate what I said in my own post... it appears that about 30% of post-myectomy patients will experience transient atrial fibrillation immediately following the procedure. Given that you have no prior history of a-fib, and that your current issues started immediately following the myectomy, this may well be a good sign that it is a temporary event that will run it's course and then go away for good.

Please take care, and continue to keep us posted on your progress.

Jim

[progers]

Sarah and Jim,

Your comments are, as usual, greatly appreciated.

Paul

[Linda]

Paul, (I sent you a PM.)

It can take 6 months to a year for you to realize the full benefit of the myectomy. The obstruction to outflow in the heart has been causing back pressure on the left atrium, probably causing it to stretch and enlarge. The more enlarged it becomes, the more likely you are to have A Fib. As your heart heals and adjusts to less back pressure, the left atrium should decrease a bit in size, making the A Fib less likely. No guarantees on anything in life, but try to focus on the positive and let's hope the A Fib is a temporary thing for you. Best wishes, Linda

[progers]

Linda,

You are exactly right about the back pressure to the atrium causing it to enlarge and stretch. This is why us HCMers are prone to a-fib.

As promised, here is my report on my meeting with my new electrophysiologist, Dr. Joe Morton. He's a young guy (36), but seemed to really know his stuff and even did a PhD on a-fib. He is also part of a team that includes a well-known EP and a-fib specialist by the name of John Kalman. He was sure my a-fib would recur, particularly because my atrium is enlarged (around 56 mm at last measurement). Like my other cardiologist, he believes it may not just the result of my myectomy, though he says this is possible. With this in mind, he discussed all of my treatment options:

1. Rate Control:
Given how symptomatic I am, rate control will probably not be an option (I'm glad).

2. Drug therapy is the first line of attack.
Its up to me, but he asked me if I want to continue taking Amiodarone for a few months and emphasized that this is the most effective drug for a-fib. If my a-fib is under control, I could then swap to another drug such as Sotalol (which I've taken before).

3. Pulmonary Vein Ablation:
He stated that my case would be difficult and that 'not many doctors would take me on'. However, he and his team members are experienced in this procedure and are willing to attempt this. He believes that for me, there is a 60% chance of success on a first attempt. Subsequent attempts (ie more veins) would yield a higher success rate.

4. Maze Procedure:
This option is available with around an 80% success rate. I would obviously be with a different surgical team.

5. ICD

I'm kicking myself because we didn't have time to discuss the new Catheter Maze Procedure or the new the new atrial pacemaker defibrillators (like the one Cheney has) because the main focus of conversation was on my risk of SCD. He mentioned something about the pacemakers but seemed more concerned with ICDs for SCD than for a-fib because of my septum size (around 30 mm) and frequent episodes of pre-syncope and arhythmia. I should have taken a tape recorder in!!

6. He is not keen on AV Node Ablations: obviously a last resort.

I get another chance to ask questions in 2 weeks during another appointment. He will consult with the other EP's in his team about the feasibility of doing Pulmonary Vein Ablation down the line if my a-fib comes back and if I want to do it. He will also try to talk to Dr Maron about my case and particularly whether or not I should have an ICD. I am yet to find out if they are using the atrial pacemaker/defibrillators.

In the meantime he has given me his pager number and told me that if I go back into a-fib, to page him and he would organize cardioversion within 24 hours. This is a relief to hear, given that it took my cardiologist 4 days to organize it last time.

Keep tuned in for more info on the new atrial procedures.

Paul






I did not have the chance to get stats on how many patients with HCM they have treated, but I am going to meet him again in 2 weeks so will ask then

[Sarah]

Dear Paul,

Wow. What a report. I hope you are feeling more positive, even if another bout of afib may or may not happen, it sounds like this guy knows his stuff and isn't going to let afib get you down.

How are you doing?

S