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If you are a healthy young individual with normal left atrium, and paroxysmal atrial fibrillation, Cryoablation is a reasonable first step. The work by Dr. Jackman had been fascinating but studies have not provided convincing evidence that ablation of fat pads with ganglionic plexi increase success rates compared to pulmonary veins alone. We have seen significant vagal modification during cryoablation of right sided pulmonary veins without specifically targeting the ganglionic plexi. Whether it is cryoablation or radiofrequency ablation, isolation of the pulmonary veins is the first step that all electrophysiologists agree upon in the treatment of paroxysmal AF.
Atrial fibrillation is a complex disease and requires individualized approach. It is unfortunate that despite 3 ablations you still get frequent AF episodes. It is possible to get better control of your AF with different antiarrhythmic therapy as there are several other medications available to treat your AF. The most important aspect of AF care is to ensure that your stroke risk is reduced with appropriate blood thinners based on your risk profile. If you do not tolerate metoprolol or verapamil, Av node ablation to prevent rapid heart rates may be an option to consider.
This is a very good response considering your daily episodes of AF. There is clear evidence that regular aerobic exercises 20-30 minutes a day x 5 day a week, even modest weight loss, adequate control of BP and diabetes greatly improve the long term outcome of preventing AF. In case of PACs avoiding stimulants such as caffeine and alcohol should help. Small dose of betablockers may also reduce your PACs. High levels of adrenaline after intense exercise may precipitate premature beats. Exercising at 70% of predicted maximal heart rate would be reasonable alternative.
PVCs and AF are different arrhythmias but both may respond to flecainide and metoprolol. It is possible that a higher dose of flecainide and metoprolol may suppress your PVCs and AF better. When we use pill in the pocket approach, the total dose of flecainide including your maintenace dose in 24 hrs should not exceed 300 mg. It is less likely that flecainide is causing your PVCs. If your daily PVC burden is high, then further discussion with your doctor about alternative options including catheter ablation may be considered.
Antiarrhythmics are often stopped prior to AF ablation but not essential. Antiarrhythmics are generally continued for 3 months post-ablation to allow the heart to remodel. If you have persistent AF, it is preferable that you continue the drug post ablation to improve the outcome.
It is Ok to take your antiarrhythmic medication until the night before procedure.. It will not negatively affect the outcome.
Hello! Several other medications have been approved for this use as an alternative to warfarin. The are effective and likely at least as safe. The most common barrier to use is often cost and insurance coverage. Please ask your provider about these alternatives.
Hello! Amiodarone is quite commonly used in this setting, as it is the most potent of our rhythm control medications. This is especially true during the few months after an ablation where the inflammatory phase is resolving. However, toxicities have been very well documented. Usually these are quite rare with short term use. However, long term use can be quite problematic and requires appropriate monitoring. We always recommend that you discuss this with your prescribing physician.
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