Guest guest Posted April 7, 2006 Report Share Posted April 7, 2006 The mini maze procedure, I believe, should be reserved for symptomatic afib, those with difficulties with the medications, those that do not want long term coumadin or those who wish to reduce their stroke risk (the procedure should include ligation or removal of the atrial appendage) and are willing to accept the risks of surgery however minimally invasive it is. The Wolf mini-maze with ganglionic plexus removal has approximately 92-94% success rate in rhythm control. Our institution (St. phs Regional Medical Center in Paterson NJ) still has 100% (15/15) but eventually will be less. We have reserved catheter ablation for those who have comorbid disease precluding surgery or have had previous open heart surgery. Reading the many posts of those suffering with this disease only makes me wonder why more dont opt for surgery sooner- but it is a personal decision. essage: 13 Date: Fri, 7 Apr 2006 07:51:07 -0400 Subject: Re: We are honored! Can I ask a question Good Morning Everyone: I am getting an impression that many of our healthcare provider members wish to only observe. If we do not get replies to any of our inquiries, we must respect their wishes. Personally, I would be delighted in just knowing that they were there; that they were listening to us all; and that just maybe it would give them some real insight into our world as an Afib patient. I'm not quite sure how they actually feel about membership here; and truthfully, I am in awe! I'm not sure if I were in their position that I would put myself out there to be overwhelmed by 2600 Afib sufferers; other than to just sit back and observe. When you think of it, we have a huge wealth of Afib knowledge right here with us. They only need to tap into it ~~~~ and if takes a quiet membership with us ~~~~ I'm all for it! I'm not suggesting that they will not respond, I'm only suggesting that we give them the courtesy of their silent presence. Just my thoughts! Ellen ******************** > > I would like to ask the doctors who are part of our group a question. > What do they think of AV node abalation? I am aware that the group has some > very strong ideas about this procedure. It would be good to hear the > rationale from the other side of the fence. Should it be first line > management of AF or should it only be a last resort considering it is > pallative management? Would love some opinions Regards Lynda > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 7, 2006 Report Share Posted April 7, 2006 Dear Thankyou for your response. Having AFib is very difficult and we are guided by the doctors who are looking after us as to what is the best treatment option. I have an EP who would love to abalate my AV node and an second opinion EP who would love to perform a PVI. My primary care cardiologist would like me to wait and continue with medications. So I have three opinions regarding the one problem. I bet if I went to a cardiac surgeon he/she would suggest an operation. It would be good to have a standard flow chart that would assist us to make decisions. I look to members of this group for opinions and advice because of the confusion. It is good that you give us an opinion as that can only helps us with our difficult position. I am happy that you are a member of this group and are willing to share your knowledge. Thankyou Lynda " DeFilippi, Dr. " defilippi@...> wrote: The mini maze procedure, I believe, should be reserved for symptomatic afib, those with difficulties with the medications, those that do not want long term coumadin or those who wish to reduce their stroke risk (the procedure should include ligation or removal of the atrial appendage) and are willing to accept the risks of surgery however minimally invasive it is. The Wolf mini-maze with ganglionic plexus removal has approximately 92-94% success rate in rhythm control. Our institution (St. phs Regional Medical Center in Paterson NJ) still has 100% (15/15) but eventually will be less. We have reserved catheter ablation for those who have comorbid disease precluding surgery or have had previous open heart surgery. Reading the many posts of those suffering with this disease only makes me wonder why more dont opt for surgery sooner- but it is a personal decision. 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 April 8, 2006 Report Share Posted April 8, 2006 Lynda, on serious drawback of having a catheter ablation (CA) of the AV node is that the procedure does not stop the atria from fibrillationg. It simply prevents the fibrillation impulses from the atria from travelling down to the venricles. Since the ventricles no longer get their signals to contract from the atria, it is necessary to have a pacemaker implanted to stimulate the ventricles to cantract. Also since the atria continue to fibrillate there remains a risk for blood clots to form in the atria, so that it is necessary to remain on a blood thinner such as coumadin to help prevent stroke. In some cases this still may be a decent option in spite or the drawback, depending on your condition. The Pulmonary Vein Isolation and minimaze have potentrial of curing afib by interrupting the irritability in the atria. These options can be attractive for many reasons. Surely it is important to explore options with your physicians and research on line to determine what is the best for you. Best wishes, Lynda Moynahan lyndamoynahan@...> wrote: Dear Thankyou for your response. Having AFib is very difficult and we are guided by the doctors who are looking after us as to what is the best treatment option. I have an EP who would love to abalate my AV node and an second opinion EP who would love to perform a PVI. My primary care cardiologist would like me to wait and continue with medications. So I have three opinions regarding the one problem. I bet if I went to a cardiac surgeon he/she would suggest an operation. It would be good to have a standard flow chart that would assist us to make decisions. I look to members of this group for opinions and advice because of the confusion. It is good that you give us an opinion as that can only helps us with our difficult position. I am happy that you are a member of this group and are willing to share your knowledge. Thankyou Lynda " DeFilippi, Dr. " defilippi@...> wrote: The mini maze procedure, I believe, should be reserved for symptomatic afib, those with difficulties with the medications, those that do not want long term coumadin or those who wish to reduce their stroke risk (the procedure should include ligation or removal of the atrial appendage) and are willing to accept the risks of surgery however minimally invasive it is. The Wolf mini-maze with ganglionic plexus removal has approximately 92-94% success rate in rhythm control. Our institution (St. phs Regional Medical Center in Paterson NJ) still has 100% (15/15) but eventually will be less. We have reserved catheter ablation for those who have comorbid disease precluding surgery or have had previous open heart surgery. Reading the many posts of those suffering with this disease only makes me wonder why more dont opt for surgery sooner- but it is a personal decision. 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 April 8, 2006 Report Share Posted April 8, 2006 > > The mini maze procedure, I believe, should be reserved for symptomatic afib, The Wolf mini-maze with ganglionic plexus removal has approximately 92-94% success rate in rhythm control. Our institution (St. phs Regional Medical Center in Paterson NJ) still has 100% (15/15) but eventually will be less. We have reserved catheter ablation for those who have comorbid disease precluding surgery or have had previous open heart surgery. Reading the many posts of those suffering with this disease only makes me wonder why more dont opt for surgery sooner- but it is a personal decision. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2006 Report Share Posted April 9, 2006 Hi When I asked about ablation the cardio said that it would be done as a last result and a AV node ablation which is the last thing I want. I believe that when I asked they were trying to put me off considering an ablation at the time. I already have a Pacemaker and was wondering if a PVI is an option. I have yet to see the EP specialist. What concerns me is that they would consider the job half done with the pacemaker in place and it would be the easiest option. ine Lynda, on serious drawback of having a catheter ablation (CA) of the AV node is that the procedure does not stop the atria from fibrillationg. It simply prevents the fibrillation impulses from the atria from travelling down to the venricles. Since the ventricles no longer get their signals to contract from the atria, it is necessary to have a pacemaker implanted to stimulate the ventricles to cantract. Also since the atria continue to fibrillate there remains a risk for blood clots to form in the atria, so that it is necessary to remain on a blood thinner such as coumadin to help prevent stroke. In some cases this still may be a decent option in spite or the drawback, depending on your condition. The Pulmonary Vein Isolation and minimaze have potentrial of curing afib by interrupting the irritability in the atria. These options can be attractive for many reasons. Surely it is important to explore options with your physicians and research on line to determine what is the best for you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2006 Report Share Posted April 9, 2006 ine, Thanks for the note. I wish I knew the reason why you have a pacemaker because it would help me to know more about your situation. Also I would like to know does your pace maker work on stimulating the atria or the ventricles? or maybe both - as some do. My guess is that PVI could still be useful to stop the fibrillating in the atria, which would help to prevent clots. If PVI is not a suitable option the doc should be able to explain why. Best wishes, ine pj.gilmartin@...> wrote: Hi When I asked about ablation the cardio said that it would be done as a last result and a AV node ablation which is the last thing I want. I believe that when I asked they were trying to put me off considering an ablation at the time. I already have a Pacemaker and was wondering if a PVI is an option. I have yet to see the EP specialist. What concerns me is that they would consider the job half done with the pacemaker in place and it would be the easiest option. ine Lynda, on serious drawback of having a catheter ablation (CA) of the AV node is that the procedure does not stop the atria from fibrillationg. It simply prevents the fibrillation impulses from the atria from travelling down to the venricles. Since the ventricles no longer get their signals to contract from the atria, it is necessary to have a pacemaker implanted to stimulate the ventricles to cantract. Also since the atria continue to fibrillate there remains a risk for blood clots to form in the atria, so that it is necessary to remain on a blood thinner such as coumadin to help prevent stroke. In some cases this still may be a decent option in spite or the drawback, depending on your condition. The Pulmonary Vein Isolation and minimaze have potentrial of curing afib by interrupting the irritability in the atria. These options can be attractive for many reasons. Surely it is important to explore options with your physicians and research on line to determine what is the best for you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2006 Report Share Posted April 9, 2006 For many of us it is not a case of being able to " opt " for anything. We are often at the mercy of doctors who feel it is their duty and role to decide for us. I had AF for 8 years before I knew ablation even existed. It was never mentioned to me as an option. I finally discovered it when I joined this group. For many people, getting a doctor to agree to an ablation is a major hurdle. Sue > > > > I would like to ask the doctors who are part of our group a question. > > What do they think of AV node abalation? I am aware that the group has some > > very strong ideas about this procedure. It would be good to hear the > > rationale from the other side of the fence. Should it be first line > > management of AF or should it only be a last resort considering it is > > pallative management? Would love some opinions Regards Lynda > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2006 Report Share Posted April 9, 2006 , I agree totally. Even though I have had AF for 16 years, my cardiologist didn't even mention catherer ablation (CA) and minimally invasive " keyhole " procedures until this past November. (All I knew about till then was the standard Maze surgery which requires the chest to be opened and also entails being hooked to a cardiac bypass pump, and this surgery is only appropriate when folks need bypass for other reasons such as valve replacement.) Maybe some of the reason is that much of these less invasive procedures are pretty new, and it takes time for any new procedure to be widely available. Who knows. susan andrews somniacismyname@...> wrote: For many of us it is not a case of being able to " opt " for anything. We are often at the mercy of doctors who feel it is their duty and role to decide for us. I had AF for 8 years before I knew ablation even existed. It was never mentioned to me as an option. I finally discovered it when I joined this group. For many people, getting a doctor to agree to an ablation is a major hurdle. Sue > > > > I would like to ask the doctors who are part of our group a question. > > What do they think of AV node abalation? I am aware that the group has some > > very strong ideas about this procedure. It would be good to hear the > > rationale from the other side of the fence. Should it be first line > > management of AF or should it only be a last resort considering it is > > pallative management? Would love some opinions Regards Lynda > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 9, 2006 Report Share Posted April 9, 2006 Hi I am not really sure what the real reason I had a PM, I Suffered a TIA in July 2003 and was put on Sotalol and Warfarin, I was left on these medications without seeing the doctor for 4 mths, it was only when I had problems with the Warfarin and some internal bleeding I was taken into hospital they realize some problems, I had a holter monitor and was admitted back into hospital because of bradycardia and some 5 second pauses in the heart rhythm. The Sotalol was immediately stopped, the consultant wanted to do a carioversion, but his registrar said it was too risky, the decision on further treatment was left to the specialist heart hospital, they decided on putting a PM in after spending 3 weeks in hospital. The more I read and learn about afib the more I suspect the sotalol was to blame, and it did not help that I was left so long without some kind of observation, before the sotalol I had no symptoms of afib. Now I am in afib 50% of the time, no meds so far has worked for me. What I also don't understand is the fact that they want to treat me with drugs such as flecainide, and amirodrone without doing a cardioversion, what real hope is there that these drugs will work on there own. My Pacemaker is dual chamber it has leads to the atria and the ventricle, it also has an AF suppression setting but that caused more problems where the local cardio did not understand the monitor readings and send me back to the pacing clinic with suspected VT, which it was not, but what was happening was that my heart rhythm was overriding the AF suppression. ine Thanks for the note. I wish I knew the reason why you have a pacemaker because it would help me to know more about your situation. Also I would like to know does your pace maker work on stimulating the atria or the ventricles? or maybe both - as some do. My guess is that PVI could still be useful to stop the fibrillating in the atria, which would help to prevent clots. If PVI is not a suitable option the doc should be able to explain why. Best wishes, ine pj.gilmartin@...> wrote: Hi When I asked about ablation the cardio said that it would be done as a last result and a AV node ablation which is the last thing I want. I believe that when I asked they were trying to put me off considering an ablation at the time. I already have a Pacemaker and was wondering if a PVI is an option. I have yet to see the EP specialist. What concerns me is that they would consider the job half done with the pacemaker in place and it would be the easiest option. ine Lynda, on serious drawback of having a catheter ablation (CA) of the AV node is that the procedure does not stop the atria from fibrillationg. It simply prevents the fibrillation impulses from the atria from travelling down to the venricles. Since the ventricles no longer get their signals to contract from the atria, it is necessary to have a pacemaker implanted to stimulate the ventricles to cantract. Also since the atria continue to fibrillate there remains a risk for blood clots to form in the atria, so that it is necessary to remain on a blood thinner such as coumadin to help prevent stroke. In some cases this still may be a decent option in spite or the drawback, depending on your condition. The Pulmonary Vein Isolation and minimaze have potentrial of curing afib by interrupting the irritability in the atria. These options can be attractive for many reasons. Surely it is important to explore options with your physicians and research on line to determine what is the best for you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2006 Report Share Posted April 10, 2006 ine, it really sounds like you have been through a lot and I imagine that it would be really helpful if your physician would discuss what is going on with you, why you are receiving the meds you're on, and what all of your options. The Sotolol includes a beta blocker, which blocks some of the chemical receptors that are part of the sympathetic nervous system. One of the effects of " beta blockers " is that they slow the heart rate. So when they found you were in bradycardia they probablably stopped the Sotolol at least in part because of its heart slowing effects, but there may have been other reasons as well for stopping it as well. The likelihood is that the Sotolol was adding to your bradycardia, but I imagine that the medicine wasn't the primary reason for your slow heart rate, because if it were then discontinuing the medicine would have solved your bradycardia problem, and I doubt if there would have been no need a permanent for a pacemaker. I hope that things work out well for you. There are so many treatments now for a variety of arrhythmias. If ever there were a good time to have arrhytmia it is today. Please keep me posted. Thanks, ine pj.gilmartin@...> wrote: Hi I am not really sure what the real reason I had a PM, I Suffered a TIA in July 2003 and was put on Sotalol and Warfarin, I was left on these medications without seeing the doctor for 4 mths, it was only when I had problems with the Warfarin and some internal bleeding I was taken into hospital they realize some problems, I had a holter monitor and was admitted back into hospital because of bradycardia and some 5 second pauses in the heart rhythm. The Sotalol was immediately stopped, the consultant wanted to do a carioversion, but his registrar said it was too risky, the decision on further treatment was left to the specialist heart hospital, they decided on putting a PM in after spending 3 weeks in hospital. The more I read and learn about afib the more I suspect the sotalol was to blame, and it did not help that I was left so long without some kind of observation, before the sotalol I had no symptoms of afib. Now I am in afib 50% of the time, no meds so far has worked for me. What I also don't understand is the fact that they want to treat me with drugs such as flecainide, and amirodrone without doing a cardioversion, what real hope is there that these drugs will work on there own. My Pacemaker is dual chamber it has leads to the atria and the ventricle, it also has an AF suppression setting but that caused more problems where the local cardio did not understand the monitor readings and send me back to the pacing clinic with suspected VT, which it was not, but what was happening was that my heart rhythm was overriding the AF suppression. ine Thanks for the note. I wish I knew the reason why you have a pacemaker because it would help me to know more about your situation. Also I would like to know does your pace maker work on stimulating the atria or the ventricles? or maybe both - as some do. My guess is that PVI could still be useful to stop the fibrillating in the atria, which would help to prevent clots. If PVI is not a suitable option the doc should be able to explain why. Best wishes, ine pj.gilmartin@...> wrote: Hi When I asked about ablation the cardio said that it would be done as a last result and a AV node ablation which is the last thing I want. I believe that when I asked they were trying to put me off considering an ablation at the time. I already have a Pacemaker and was wondering if a PVI is an option. I have yet to see the EP specialist. What concerns me is that they would consider the job half done with the pacemaker in place and it would be the easiest option. ine Lynda, on serious drawback of having a catheter ablation (CA) of the AV node is that the procedure does not stop the atria from fibrillationg. It simply prevents the fibrillation impulses from the atria from travelling down to the venricles. Since the ventricles no longer get their signals to contract from the atria, it is necessary to have a pacemaker implanted to stimulate the ventricles to cantract. Also since the atria continue to fibrillate there remains a risk for blood clots to form in the atria, so that it is necessary to remain on a blood thinner such as coumadin to help prevent stroke. In some cases this still may be a decent option in spite or the drawback, depending on your condition. The Pulmonary Vein Isolation and minimaze have potentrial of curing afib by interrupting the irritability in the atria. These options can be attractive for many reasons. Surely it is important to explore options with your physicians and research on line to determine what is the best for you. Quote Link to comment Share on other sites More sharing options...
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