Guest guest Posted February 17, 2006 Report Share Posted February 17, 2006 Please can group members advance my sketchy knowledge of these studies. Is everyone who suffers from vagal AF ( like myself) a suitable candidate for pulmonary vein isolation? Is an EP study required to determine this? I understand that such studies form part of a PVI to determine the electrical pathways and subsequently identify the tissue to ablate. However how common is it for these to be undertaken with no subsequent ablation? Can they be used just for their test results? For example, can they be used by cardios solely to advise a patient what other courses of action may be more suitable? AG in Wales Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2006 Report Share Posted February 17, 2006 Hi AG here's my short answers - sorry for the brevity I'm just on my way out > Is everyone who suffers from vagal AF ( like myself) a suitable > candidate for pulmonary vein isolation? No. Usually only people who have failed meds and have intolerable symptoms slide into the candidate group. (and if you truly have vagal AF and suffer from alot of bradycardia a pacemaker might be higher on the list of solutions - or at least on a similar footing to PVI) > Is an EP study required to > determine this? No. > I understand that such studies form part of a PVI to determine the > electrical pathways and subsequently identify the tissue to ablate. > However how common is it for these to be undertaken with no subsequent > ablation? I think it would be extremely unusual to have a EP study in your left atria if the intention at the beginning of the procedure wasn't to do some ablating. (this might not be the case for exploring the right atria where the risks are lower) The probability that you can induce AF in the left atria/PVs in somebody who already has AF is so close to 1 that it's not worth the risk of the study without going in with the spot welding equipment > Can they be used just for their test results? For example, can they be > used by cardios solely to advise a patient what other courses of > action may be more suitable? I think personal history, ECGS/holter recordings are enough information to decide if you want to go on the ablation list and suspect it would be very unusual circumstances for you to undergo an exploratory EP study just to figure out if you are a candidate. just my opinion. -- D Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2006 Report Share Posted February 17, 2006 > > Please can group members advance my sketchy knowledge of these studies. > Is everyone who suffers from vagal AF ( like myself) a suitable > candidate for pulmonary vein isolation? Is an EP study required to > determine this? > I understand that such studies form part of a PVI to determine the > electrical pathways and subsequently identify the tissue to ablate. > However how common is it for these to be undertaken with no subsequent > ablation? > Can they be used just for their test results? For example, can they be > used by cardios solely to advise a patient what other courses of > action may be more suitable? > > AG in Wales > AG: I agree with answers to you earlier except I would take a more liberal attitude regarding your being a candidate for a PVI. Certainly any underlying heart structure damage would limit your ability to have the PVI. If that's not an issue and your age is under 70 and you're having breakthroughs, you might want to consider the PVI sooner rather than later as the afib/flutter isn't going to get any better as you age and you may tolerate the procedure better now than at some future time when you may have other physical limitations that could preclude it. Of course you have to trade the benefits of having it now vs. the improvements both in medications and methods of treatment of the afib in the future. If you decide to pursue the PVI be sure that you're getting the best most experienced EP to do it. Robotics for the procedure are under development but right now the best guys hwith the best equipmentg in the best facilities have the best results. Gordon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2006 Report Share Posted February 17, 2006 Re: EP Studies Hi D That may be the criteria for a ablation in the UK, but it wasn't in my case at the Cleveland Clinic 2 years ago. I was 24/7 AF & had never tried any rhythm control meds. Also, my local card. considered me a-sypmtomatic & suggested I " live with it " . Although I certainly could function with AF, the prospect of coumadin for the rest of my life & the fact my heart would probably re-model (with 24/7 AF)& make an ablation that more probmatical in the future lead me to the CC. I celebrated my 2 year anniversary Feb 13th. (BTW for you superstitious types, my procedure was done on FRIDAY the 13th !) No AF since the procedure. Thor Hi AG here's my short answers - sorry for the brevity I'm just on my way out > Is everyone who suffers from vagal AF ( like myself) a suitable > candidate for pulmonary vein isolation? No. Usually only people who have failed meds and have intolerable symptoms slide into the candidate group. - SNIP - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2006 Report Share Posted February 17, 2006 > Re: EP Studies > > > Hi D > > That may be the criteria for a ablation in the UK, but it wasn't in my case at the Cleveland Clinic 2 years ago. I was 24/7 AF & had never tried any rhythm control meds. Also, my local card. considered me a-sypmtomatic & suggested I " live with it " . Although I certainly could function with AF, the prospect of coumadin for the rest of my life & the fact my heart would probably re-model (with 24/7 AF)& make an ablation that more probmatical in the future lead me to the CC. I celebrated my 2 year anniversary Feb 13th. (BTW for you superstitious types, my procedure was done on FRIDAY the 13th !) No AF since the procedure. > > Thor > good point Thor - I should have mentioned in my earlier post that although my cautious approach is to put off an ablation for as long as possible if you have paroxysmal AF my view is you should consider an ablation before turning persistent (being in AF 24/7 and the remodelling that goes along with this I believe can have a marked affect on the success rate of ablation - although recent results suggest they are getting better at ablating permanent AF). I would still suggest the vast majority of people who have had an ablation have also failed with a couple of antiarrhythmic meds but your case proves there are no hard and fast rules. Good to hear you are still ticking away 2 years on. -- D Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2006 Report Share Posted February 17, 2006 When I went in to see if I qualified for a PVI ablation, I was told that the " perfect " candidate was someone who was young, healthy, no underlying heart disease, no previous heart surgery, and most importantly - still having paroxsysmal afib. Apparently paroxsysmal gives one the best opportunity for success. Certainly young and healthy means quicker recover without complications. It's a fine line between having it while still paroxsysmal, and waiting... the time between paroxsysmal, persistent and finally permanent afib can literally be a heartbeat.. one day you're converting on your own, they next you can't convert at all! And unfortunately with the waits for good surgeons, the time in permanent afib before one could get a scheduled date might make a huge difference in the heart itself and the likely outcome.. it's a gamble. Most doctors still want a person to have at least tried medication to control their afib, but I've seen valid reasons to have an ablation listed such as " the desire not to be medicated for life " ... so perhaps alot of who has one is personal preference as well. I'm choosing to have mine now because I am still young and healthy, and I'm waffling somewhere between paroxsysmal and persistent (hard to tell once you're on medication). My afib progressed recently to the point where I had three cardioversions in a week... .I felt I was on the verge of permanent and once there my changes of good outcome would be reduced. I would have probably liked to wait a while longer to have mine, given the great strides being made, but it's a gamble for me to stick with medications.. I've already had 4 fail, so I'm not inclined to think the last two (other than amiaodarone) will work for long either. If I were someone for whom medication worked, or for whom afib was merely bothersome without being debilitating, I would probably wait as long as I could before considering an ablation. For those who are highly symptomatic, for whom afib is adversely affecting life, who are intolerant of medication, then I say an ablation is probably something to consider. p.s. disclaimer about afib going from paroxsysmal to permanent in a heart beat... it CAN certainly do this... this is not to say it will in most instances... people can go for years and years in paroxsysmal afib without advancing further... _____ From: AFIBsupport [mailto:AFIBsupport ] On Behalf Of Driscoll Sent: Friday, February 17, 2006 11:57 AM To: AFIBsupport Subject: Re: EP Studies > Re: EP Studies > > > Hi D > > That may be the criteria for a ablation in the UK, but it wasn't in my case at the Cleveland Clinic 2 years ago. I was 24/7 AF & had never tried any rhythm control meds. Also, my local card. considered me a-sypmtomatic & suggested I " live with it " . Although I certainly could function with AF, the prospect of coumadin for the rest of my life & the fact my heart would probably re-model (with 24/7 AF)& make an ablation that more probmatical in the future lead me to the CC. I celebrated my 2 year anniversary Feb 13th. (BTW for you superstitious types, my procedure was done on FRIDAY the 13th !) No AF since the procedure. > > Thor > good point Thor - I should have mentioned in my earlier post that although my cautious approach is to put off an ablation for as long as possible if you have paroxysmal AF my view is you should consider an ablation before turning persistent (being in AF 24/7 and the remodelling that goes along with this I believe can have a marked affect on the success rate of ablation - although recent results suggest they are getting better at ablating permanent AF). I would still suggest the vast majority of people who have had an ablation have also failed with a couple of antiarrhythmic meds but your case proves there are no hard and fast rules. Good to hear you are still ticking away 2 years on. -- D Web Page - http://www.afibsupport.com List owner: AFIBsupport-owner For help on how to use the group, including how to drive it via email, send a blank email to AFIBsupport-help Nothing in this message should be considered as medical advice, or should be acted upon without consultation with one's physician. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2006 Report Share Posted February 20, 2006 ,I am lone AF and have been in permanant AF for13 months,had one ablation which cured a flutter ,but not the AF ,then about three months latter permanant AF.Was in line for PVI ,but stopped by cardio when I went in to permanant AF,now down for MAZE procedure in Cardiff.Any other options open to me.I am taking VERAPRIMAL AND BISOPRODAL to control the rate ,but it will not cure the AF Driscoll james@...> wrote: Hi AG here's my short answers - sorry for the brevity I'm just on my way out > Is everyone who suffers from vagal AF ( like myself) a suitable > candidate for pulmonary vein isolation? No. Usually only people who have failed meds and have intolerable symptoms slide into the candidate group. (and if you truly have vagal AF and suffer from alot of bradycardia a pacemaker might be higher on the list of solutions - or at least on a similar footing to PVI) > Is an EP study required to > determine this? No. > I understand that such studies form part of a PVI to determine the > electrical pathways and subsequently identify the tissue to ablate. > However how common is it for these to be undertaken with no subsequent > ablation? I think it would be extremely unusual to have a EP study in your left atria if the intention at the beginning of the procedure wasn't to do some ablating. (this might not be the case for exploring the right atria where the risks are lower) The probability that you can induce AF in the left atria/PVs in somebody who already has AF is so close to 1 that it's not worth the risk of the study without going in with the spot welding equipment > Can they be used just for their test results? For example, can they be > used by cardios solely to advise a patient what other courses of > action may be more suitable? I think personal history, ECGS/holter recordings are enough information to decide if you want to go on the ablation list and suspect it would be very unusual circumstances for you to undergo an exploratory EP study just to figure out if you are a candidate. just my opinion. -- D Web Page - http://www.afibsupport.com List owner: AFIBsupport-owner For help on how to use the group, including how to drive it via email, send a blank email to AFIBsupport-help Nothing in this message should be considered as medical advice, or should be acted upon without consultation with one's physician. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2006 Report Share Posted February 20, 2006 Spot on my AF was interminant one day and permanant the next. " Jarrell, Stefanie " Stefanie.Jarrell@...> wrote: When I went in to see if I qualified for a PVI ablation, I was told that the " perfect " candidate was someone who was young, healthy, no underlying heart disease, no previous heart surgery, and most importantly - still having paroxsysmal afib. Apparently paroxsysmal gives one the best opportunity for success. Certainly young and healthy means quicker recover without complications. It's a fine line between having it while still paroxsysmal, and waiting... the time between paroxsysmal, persistent and finally permanent afib can literally be a heartbeat.. one day you're converting on your own, they next you can't convert at all! And unfortunately with the waits for good surgeons, the time in permanent afib before one could get a scheduled date might make a huge difference in the heart itself and the likely outcome.. it's a gamble. Most doctors still want a person to have at least tried medication to control their afib, but I've seen valid reasons to have an ablation listed such as " the desire not to be medicated for life " ... so perhaps alot of who has one is personal preference as well. I'm choosing to have mine now because I am still young and healthy, and I'm waffling somewhere between paroxsysmal and persistent (hard to tell once you're on medication). My afib progressed recently to the point where I had three cardioversions in a week... .I felt I was on the verge of permanent and once there my changes of good outcome would be reduced. I would have probably liked to wait a while longer to have mine, given the great strides being made, but it's a gamble for me to stick with medications.. I've already had 4 fail, so I'm not inclined to think the last two (other than amiaodarone) will work for long either. If I were someone for whom medication worked, or for whom afib was merely bothersome without being debilitating, I would probably wait as long as I could before considering an ablation. For those who are highly symptomatic, for whom afib is adversely affecting life, who are intolerant of medication, then I say an ablation is probably something to consider. p.s. disclaimer about afib going from paroxsysmal to permanent in a heart beat... it CAN certainly do this... this is not to say it will in most instances... people can go for years and years in paroxsysmal afib without advancing further... _____ From: AFIBsupport [mailto:AFIBsupport ] On Behalf Of Driscoll Sent: Friday, February 17, 2006 11:57 AM To: AFIBsupport Subject: Re: EP Studies > Re: EP Studies > > > Hi D > > That may be the criteria for a ablation in the UK, but it wasn't in my case at the Cleveland Clinic 2 years ago. I was 24/7 AF & had never tried any rhythm control meds. Also, my local card. considered me a-sypmtomatic & suggested I " live with it " . Although I certainly could function with AF, the prospect of coumadin for the rest of my life & the fact my heart would probably re-model (with 24/7 AF)& make an ablation that more probmatical in the future lead me to the CC. I celebrated my 2 year anniversary Feb 13th. (BTW for you superstitious types, my procedure was done on FRIDAY the 13th !) No AF since the procedure. > > Thor > good point Thor - I should have mentioned in my earlier post that although my cautious approach is to put off an ablation for as long as possible if you have paroxysmal AF my view is you should consider an ablation before turning persistent (being in AF 24/7 and the remodelling that goes along with this I believe can have a marked affect on the success rate of ablation - although recent results suggest they are getting better at ablating permanent AF). I would still suggest the vast majority of people who have had an ablation have also failed with a couple of antiarrhythmic meds but your case proves there are no hard and fast rules. Good to hear you are still ticking away 2 years on. -- D Web Page - http://www.afibsupport.com List owner: AFIBsupport-owner For help on how to use the group, including how to drive it via email, send a blank email to AFIBsupport-help Nothing in this message should be considered as medical advice, or should be acted upon without consultation with one's physician. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2006 Report Share Posted February 20, 2006 - have you tried any antiarrhythics, and/or have you ever been cardioverted? From your description of your own condition and the recommendations of your cardio, the only recommendation I have for you is to get a second opinion and perhaps a new cardio. You don't want to be in afib any longer than you have to, and there are several other options out there to get you back in NSR. I wouldn't accept the diagnosis of permanent afib unless I'd exhausted all of them. Re: EP Studies ,I am lone AF and have been in permanant AF for13 months,had one ablation which cured a flutter ,but not the AF ,then about three months latter permanant AF.Was in line for PVI ,but stopped by cardio when I went in to permanant AF,now down for MAZE procedure in Cardiff.Any other options open to me.I am taking VERAPRIMAL AND BISOPRODAL to control the rate ,but it will not cure the AF Driscoll james@...> wrote: Hi AG here's my short answers - sorry for the brevity I'm just on my way out > Is everyone who suffers from vagal AF ( like myself) a suitable > candidate for pulmonary vein isolation? No. Usually only people who have failed meds and have intolerable symptoms slide into the candidate group. (and if you truly have vagal AF and suffer from alot of bradycardia a pacemaker might be higher on the list of solutions - or at least on a similar footing to PVI) > Is an EP study required to > determine this? No. > I understand that such studies form part of a PVI to determine the > electrical pathways and subsequently identify the tissue to ablate. > However how common is it for these to be undertaken with no subsequent > ablation? I think it would be extremely unusual to have a EP study in your left atria if the intention at the beginning of the procedure wasn't to do some ablating. (this might not be the case for exploring the right atria where the risks are lower) The probability that you can induce AF in the left atria/PVs in somebody who already has AF is so close to 1 that it's not worth the risk of the study without going in with the spot welding equipment > Can they be used just for their test results? For example, can they be > used by cardios solely to advise a patient what other courses of > action may be more suitable? I think personal history, ECGS/holter recordings are enough information to decide if you want to go on the ablation list and suspect it would be very unusual circumstances for you to undergo an exploratory EP study just to figure out if you are a candidate. just my opinion. -- D Web Page - http://www.afibsupport.com List owner: AFIBsupport-owner For help on how to use the group, including how to drive it via email, send a blank email to AFIBsupport-help Nothing in this message should be considered as medical advice, or should be acted upon without consultation with one's physician. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2006 Report Share Posted February 20, 2006 Took Amiodorone and it damaged my Tyroid , tried flecanide and that worked for about three months ,but not yet tried Sotolol.Trouble with EP's you never get to see them and the under studies you do see are in the main are not able to change medications.I live in Southwales GB and there is only one EP , if I wanted a second opinion I would have to go outside my trust area and that would not be allowed. " Jarrell, Stefanie " Stefanie.Jarrell@...> wrote: - have you tried any antiarrhythics, and/or have you ever been cardioverted? From your description of your own condition and the recommendations of your cardio, the only recommendation I have for you is to get a second opinion and perhaps a new cardio. You don't want to be in afib any longer than you have to, and there are several other options out there to get you back in NSR. I wouldn't accept the diagnosis of permanent afib unless I'd exhausted all of them. Re: EP Studies ,I am lone AF and have been in permanant AF for13 months,had one ablation which cured a flutter ,but not the AF ,then about three months latter permanant AF.Was in line for PVI ,but stopped by cardio when I went in to permanant AF,now down for MAZE procedure in Cardiff.Any other options open to me.I am taking VERAPRIMAL AND BISOPRODAL to control the rate ,but it will not cure the AF Driscoll james@...> wrote: Hi AG here's my short answers - sorry for the brevity I'm just on my way out > Is everyone who suffers from vagal AF ( like myself) a suitable > candidate for pulmonary vein isolation? No. Usually only people who have failed meds and have intolerable symptoms slide into the candidate group. (and if you truly have vagal AF and suffer from alot of bradycardia a pacemaker might be higher on the list of solutions - or at least on a similar footing to PVI) > Is an EP study required to > determine this? No. > I understand that such studies form part of a PVI to determine the > electrical pathways and subsequently identify the tissue to ablate. > However how common is it for these to be undertaken with no subsequent > ablation? I think it would be extremely unusual to have a EP study in your left atria if the intention at the beginning of the procedure wasn't to do some ablating. (this might not be the case for exploring the right atria where the risks are lower) The probability that you can induce AF in the left atria/PVs in somebody who already has AF is so close to 1 that it's not worth the risk of the study without going in with the spot welding equipment > Can they be used just for their test results? For example, can they be > used by cardios solely to advise a patient what other courses of > action may be more suitable? I think personal history, ECGS/holter recordings are enough information to decide if you want to go on the ablation list and suspect it would be very unusual circumstances for you to undergo an exploratory EP study just to figure out if you are a candidate. just my opinion. -- D Web Page - http://www.afibsupport.com List owner: AFIBsupport-owner For help on how to use the group, including how to drive it via email, send a blank email to AFIBsupport-help Nothing in this message should be considered as medical advice, or should be acted upon without consultation with one's physician. Quote Link to comment Share on other sites More sharing options...
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