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chronic

FAQs A-Fib Ablations: Feeling Better in Chronic A-Fib

 FAQs A-Fib Ablations: Better in Chronic? 

Catheter Ablation

Catheter Ablation

20. “I’m 80 and been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?”

With Chronic A-Fib of long duration, perhaps not. Although a few centers get very good results when treating Chronic A-Fib even of long duration (the French Bordeaux group achieves an acceptable success rate after 2 ablations), most centers have a success rate of only around 50% for Chronic A-Fib. And although catheter ablation is a low risk procedure, there are still risks.

Many centers won’t ablate patients who are over 80 years old or in Chronic A-Fib for over a year. There is a higher risk of complications in older people, and it is more difficult to ablate Chronic A-Fib. (In Chronic A-Fib there are often multiple spots in the heart producing A-Fib signals. It’s hard to identify and ablate [isolate] them all.)

The Positive Side of being in Chronic A-Fib: Sometimes people feel relieved to be in permanent A-Fib. There’s no longer the fear, uncertainty, and shock of an A-Fib attack. You can adjust your lifestyle to how your heart behaves, because it doesn’t change much. You may be short of breath, somewhat light headed, tired, and unable to work or exercise hard. But you get used to it. You may even feel better than when you had Paroxysmal A-Fib. In addition, an ablation may be only partially successful and have the unwanted consequence of putting you back into Paroxysmal A-Fib.

You still need to take blood thinners to prevent an A-Fib stroke. But if you get the Watchman or Lariat device installed (very low risk), it closes off your Left Atrial Appendage where 95% of A-Fib clots originate. It’s then possible to go off of Coumadin baring other risk factors for stroke.

The Negative Side of being in Chronic A-Fib: The down side of being in Chronic A-Fib is your heart forever and always will not pump properly. Blood flow to your brain and other organs is reduced by about 15%-30%. This can lead to conditions like dementia and Alzheimer’s. (If you are a superior athlete like a bicyclist or runner, your exercise may overcome this reduced blood flow.)

A-Fib is a progressive disease. It tends to get worse even in Chronic A-Fib. Your atria expand and stretch. Your ejection fraction diminishes. Chronic A-Fib produces fibrosis and collagen deposits which stiffen the heart and make it less flexible. All this leads to conditions such as Congestive Heart Failure and Cardiomyopathy

But please weigh the above statements carefully (the author is concerned that they may create unwarranted fear). How do you feel? If you don’t feel any symptoms and your doctor says your heart isn’t enlarging and/or developing poor ejection fraction, etc., then there’s no need to rush out to get a Pulmonary Vein Ablation which does involve real risk.

The Bottom Line: You can be cured of Chronic A-Fib, even at your age. But it will take at least 2 ablations. And it won’t be easy finding a doctor to do it. (There is a short list of doctors at Specialists In Persistent/Chronic A-Fib. You need someone with a proven track record in ablating Chronic A-Fib.) However, an ablation is more risky at your age.

On the other hand, you can live in Chronic A-Fib. Many people do. The key to living a satisfying life in Chronic A-Fib may be good rate control. For example, a resting heart rate of around 80 beats per minute with an exercise rate of 110 is very close to that of a normal person. People with good rate control of their Chronic A-Fib report a good quality of life and seem less prone to develop other heart or mental problems.

What this Means to You: Are you happy or content with your quality of life in Chronic A-Fib? If so, then the added hassles and risks of an ablation are probably not worth it for you. Only you (and your doctor) can decide if it’s better to spend your twilight years in a perhaps reduced but satisfactory quality of life.

References:
•  Haines, D. “Atrial Fibrillation: New Approaches in Management.” Un. of Virginia multi-media presentation, 1999, p.6.
•  The Link Between Infections in Heart Disease. Life Extension Vitamins. Last accessed Feb. 16, 2013. URL: http://www.lifeextensionvitamins.com/cadico6otco.html
•  Peykar, S. Atrial Fibrillation, Cardiac Arrhythmia Institute. Last accessed Feb 16, 2013. URL: http://caifl.com/arrhythmia-information/atrial-fibrillation/
•  Heartscape: The Heart’s Structure. Last accessed Feb. 16, 2013. URL: http://www.skillstat.com/tools/heart-scape.
•  Elias, MF, et al. Atrial Fibrillation Is Associated With Lower Cognitive Performance in the Framingham Offspring Men.  Journal of Stroke and Cerebrovascular Diseases, Vol. 15, No. 5 (September-October), 2006: pp. 214-222. http://www.ncbi.nlm.nih.gov/pubmed/17904078
•  Bunch, J. J., Weiss, P. P., & Crandall, B. G. et al. Atrial fibrillation is independently associated with senile, vascular, and alzheimer’s dementia. Heart rhythm, 2010:7 (4), 433-437. URL http://dx.doi.org/10.1016/j.hrthm.2009.12.004
•  Camm, “Clinical Relevance of Silent Atrial Fibrillation: Prevalence, Prognosis, Quality of Life, and Management.” Journal of Interventional Cardiac Electrophysiology 4, 369-382, 2000, p. 373-376. http://www.ncbi.nlm.nih.gov/pubmed/10936003
•  Un. of Utah Health Sciences, Atrial Fibrillation FAQ, What is Atrial Fibrillation, Risks. http://healthsciences.utah.edu/carma/forthepatient/faqs.html, heart weakness, heart attacks, etc.
• Benjamin EJ, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998 Sep 8;98(10):946-52. Last accessed Nov 22, 2014. URL: http://circ.ahajournals.org/content/98/10/946.full.

Return to FAQ Catheter Ablations

FAQs A-Fib Ablations: Success Rate for Chronic

 FAQs A-Fib Ablations: Success for Chronic

Catheter Ablation

Catheter Ablation

19. “I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?”

This is a question that is currently in dispute among researchers in A-Fib. However, most clinical studies suggest that Paroxysmal is more frequently curable by PVA(PVI) than Chronic.

In fact, the French Bordeaux medical group, considered among the world’s leaders in A-Fib research, now uses a combination PVI and linear catheter ablation procedure for Chronic A-Fib as compared to a PVI ablation procedure for Paroxysmal A-Fib. They only consider patients with chronic A-Fib if they have “symptomatic and complicated AF” because of the following reasons: patients with Chronic A-Fib often have “poor hemodynamic tolerance” (their blood isn’t being pumped out properly), “suspicion of tachycardiomyopathy” (the heart tissue may have been damaged by the rapid, irregular heart beats or fibrillation), and “suspicion of thromboembolic events” (a greater risk of stroke).

Linear ablation techniques, though more difficult to perform effectively, may work better for people with chronic A-Fib and/or structural heart disease. In a Boston A-Fib Symposium 2006 presentation Dr. Jaïs from the French Bordeaux group reported a study in which 95% of Chronic A-Fib patients were restored to normal sinus rhythm.

For someone with Chronic A-Fib, you have a better chance of being cured of your A-Fib if you’ve been Chronic for a short period of time rather than for a number of years. Does that mean that people with Chronic A-Fib have little hope of being permanently cured by a catheter ablation? No. It’s just that right now most major heart centers have a long waiting list and have better success rates with Paroxysmal A-Fib.

References:
•  Adams Jr. H. “How To Avoid Stroke,” The Good Life. Boardroom Inc., 2001, p. 31.
•  Jais, P. “Ablation Therapy for Atrial Fibrillation: Past, Present and Future,” Cardiovascular Research, Vol. 54, Issue 2, May 2002, P. 343.

Return to FAQ Catheter Ablations

FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1. “I have a defective Mitral Valve? Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?

2. “With the recent improvements in Pulmonary Vein ablation techniques, should I wait for a better technique? I’m getting by with my Atrial Fibrillation.”

3. “Are there different types of “Pulmonary Vein Ablation”? Are they different from “Pulmonary Vein Isolation?

4. I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they good or better than the RF (Radio Frequency) catheters for ablations?

5. “How dangerous is a Pulmonary Vein Ablation procedure? What are my risks?

6. “During the ablation procedure A-Fib doctors actually burn within the heart with RF energy. How does this burning and scarring affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?

7. “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.

8. “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?

9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”

10. “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?

11. “Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

12. “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

13. I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?

14. “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?

15. “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin or aspirin?

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which if better—81 mg baby aspirin or 325 mg?

17. Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?

18. “I love to exercise and I’m having a PVA. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?

19. I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?

20. “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

21.“Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?

22. Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib

23. “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?

24. “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. After all, if fibrillation episodes are reduced or eliminated after an ablation, shouldn’t there be even less need for a prescription anticoagulant rather than more?

25. “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

26. “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?

27. “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.

Last updated: Thursday, September 8, 2016

Return to FAQs

FAQs Understanding A-Fib: Questions from Patients

FAQs Understanding Your A-Fib A-Fib.comFAQs: Understanding Atrial Fibrillation

Atrial Fibrillation patients often have loads of “Why?” and “How?” questions. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. Why does so much Atrial Fibrillation come from the Pulmonary Vein openings?

2. Is my Atrial Fibrillation genetic? Will my children get A-Fib too? Updated!

3. Why do older people get Atrial Fibrillation more than younger people?

4. Is Atrial Fibrillation (A-Fib) different from what doctors call Paroxysmal Supraventricular Tachycardia?

5. What is the difference between “Adrenergic” and “Vagal” Atrial Fibrillation? How can I tell if I have one or the other? Does it really matter? Does Pulmonary Vein Ablation (Isolation) work for Adrenergic and/or Vagal A-Fib?

6. What causes Paroxysmal (occasional) A-Fib to turn into Persistent (Chronic) A-Fib?

7. I’ve heard about ‘stiff heart’ or diastolic dysfunction. When you have A-Fib, do you automatically have diastolic heart failure? What exactly is diastolic dysfunction?

8. A-Fib and Flutter—I have both. Does one cause the other?” 

9. “My surgeon wants to close off my LAA during my Mini-Maze surgery. Should I agree? What’s the role of the Left Atrial Appendage?” 

10. “I’ve read about stem cells research to regenerate damaged heart tissue. Could this help cure A-Fib patients?”

11. What is the heart’s ejection fraction? As an A-Fib patient, is it important to know my EF? 

12. “I read that the local anesthesia my dentist uses may trigger my A-Fib. Why is that?”

13. “How can I determine or measure how much fibrosis I have? Can something non-invasive like a CT scan measure fibrosis?

14. “I have paroxysmal A-Fib with “pauses” at the end of an event. Will they stop if my A-Fib is cured? My cardiologist recommends a pacemaker. I am willing, but want to learn more about these pauses first.” NEW!

15. I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate. NEW!

Last updated: Monday, August 8, 2016

Return to Frequently Asked Questions: Coping with A-Fib

FAQs Coping With Your A-Fib Day-to-Day Issues

FAQs A-Fib afibFAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues

Coping with your Atrial Fibrillation means a patient and their family have many and varied questions. Here are answers to the most frequently asked questions about dealing with the day-to-day issues of having Atrial Fibrillation. (Click on the question to jump to the answer.)

1.  I like my cardiologist, but he has not talked about me seeing an Electrophysiologist. Should I ask for a second opinion from another cardiologist?”
2. Is there any way to predict when I’m going to have an A-Fib attack?”
3. Should I exercise when in A-Fib or skip it and rest? Can I damage my heart if I exercise in A-Fib?”
4. How long do I have before I go into chronic or permanent A-Fib? I know it’s harder to cure. My A-Fib episodes seem to be getting longer and more frequent.”
5. They want to do an Atrial Flutter-only ablation, will that help if I possibly have A-Fib as well?”
6.  Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?
7.  “During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. I need a plan.”
8. I have a lot of extra beats and palpitations (PVCs or PACs) They seem to proceed an A-Fib attack. What can or should I do about them?”
9.   “How do I know which is the best A-Fib treatment option for me?”
10. When my husband has an Atrial Fibrillation episode, what can I do for him? How can I be supportive?”
11. How can I tell when I’m in A-Fib or just having something like indigestion?”
12.What kind of monitors are available for atrial fibrillation? Is there any way to tell how often I get A-Fib or how long the episodes last?”
13. I’m an athlete with A-Fib and have a naturally slow heart rate. My doctor says I need a pacemaker because my heart rate is too slow.”
14. Can excess iron in the blood cause Atrial Fibrillation? How do I know? If I have Iron Overload Deficiency (IOD), what can I do about it?”
15. Can too little iron in the blood (Anemia) cause Atrial Fibrillation? What can I do about iron deficiency?”
16.Is it possible to have a single A-Fib attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”
17. “My mom is 94 with A-Fib. Are there consumer heart rate monitors she can wear to alert me at work if her heart rate exceeds a certain number?”
18. Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib, but I don’t always have a rapid heart rate.”
19. I’m in Chronic A-Fib. Can I improve my circulation, without having to undergo a Catheter Ablation or Surgery?”

20. “In one of your articles it said that having an ablation was better than living in A-Fib. I’ve been taking 75 mg of propafenone 3X/day for seven years and have only had 5 A-Fib attacks in 7 years. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.

21. “Both my uncles and my Dad have Atrial Fibrillation. I’m 50 years old and so far I don’t have A-Fib (yet), but I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?

22. In case I have a stroke, what does my family need to know to help me? (I’m already on a blood thinner.)  What can I do to improve my odds of surviving it?”

Last updated: Sunday, March 27, 2016
Return to Frequently Asked Questions

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Bordeaux Five-Step Ablation Protocol for Chronic A-Fib

Catheter inserted into the heart and through septum wall into Left Atrium

Catheter inserted into Left Atrium

By Steve S. Ryan, PhD, July 18, 2007, Updated October 2014

The French Bordeaux group uses a five-step process to treat Chronic A-Fib.

1. They start by isolating the Pulmonary Vein openings. They also eliminate potentials at the base of the Left Atrial Appendage, but do not isolate or electrically disconnect the whole of the LAA which could possibly lead to clots forming in the LAA and A-Fib stroke. (Ablating at the base of the LAA as part of the first step in treating A-Fib is a new approach and may become a very important first step in the ablation treatment of A-Fib.)

2. Next they make a roof line linear ablation linking the Right Superior Pulmonary Vein with the Left Superior Pulmonary vein opening to create complete electrical block

3. They then work in the Inferior Left Atrium and the Coronary Sinus. They make an incomplete blocking line between the Right Inferior and Left Inferior PVs in order to slow down the rapid atrial electrical activity.

They treat the Coronary Sinus as though it were another heart structure or Left Atrium, rather than just another vein opening. They disconnect the CS from the Left Atrium and ablate potentials along the Mitral Annulus. They also slow down Coronary Sinus electrical activity by ablating both inside and outside the CS with a lower wattage power, usually 25 Watts.

Dr. Jais, The Bordeaux Group

Bordeaux Five-Step Ablation Protocol for Chronic A-Fib

Editor’s comment: Treating the Coronary Sinus as another Left Atrium is a new approach. Most current A-Fib ablation procedures tend to stay away from the Coronary Sinus because of the risk of Stenosis (swelling). The French Bordeaux group, by using a low wattage, irrigated tip catheter, ablates within the Coronary Sinus without damaging it.

4. The fourth step is eliminating organized atrial activity in areas such as:

• Anterior Left Atrium & Left Atrial Appendage
• Septum
• Posterior Left Atrium
• Superior Vena Cava
• Right Atrial Septum

5. The fifth step is to create a Mitral Isthmus blocking linear ablation line from the Mitral Annulus to the Left Inferior PV. The goal is to eliminate all potentials along this line.

In practice, even after these five steps, rapid atrial activity often remains. It has to be mapped, traced to its source and ablated. Often the top of the Left Atrial Appendage has to be ablated.

This whole procedure requires a great deal more time, effort, persistence, skill and experience than normal left ablation procedures.

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Last updated: Sunday, February 15, 2015

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