How medications are handled around the time of ablation differs according to the treating physician. Most commonly, antiarrhythmic drugs are stopped, so that during the procedure, your doctor can identify sites within the heart that give rise to the arrhythmia. Taking antiarrhythmic drugs such as sotalol could mask the arrhythmia. Coumadin is commonly stopped prior to the procedure to allow the blood to return to normal clotting at the time your doctors place the catheters in your blood vessels. You are then given blood thinner intravenously during the procedure. There is an increasing trend to do the procedure without stopping coumadin, as some information has suggested that the risk of bleeding during the procedure is not increased, and the risk of blood clotting may be reduced.

Drugs such as metoprolol and diltiazem are often used as initial treatment for AF. Their main effect is to slow the pulse, which often results in patients feeling fewer symptoms if AF recurs on treatment. They are not very effective in preventing AF episodes. They are typically considered "benign" in that they have few serious side effects. What you describe, however, are very common side effects, particularly in younger people . While not serious, these side effects are very disruptive, and may be worse than the problem they were meant to treat. While it is reasonable to take these drugs if you can tolerate them, and they make AF easier to live with, they are not for everyone. If you have had only a single episode of AF, the best option may be to take nothing. As many as 50% of patients with a first episode of AF will not have another for several years. Another option is to take drugs intermittently - only when an episode of AF actually occurs. You need to discuss with your doctor what options are best for your specific circumstance.

In general, the pulse during AF is irregular, which is more easily noticed at slower rates. The ability to recognize an irregular pulse does to some extent depend on the experience of the individual taking the pulse. Occasionally the irregularity is relatively small, and can only be recognized on a ECG. It is important to understand that not all irregular pulses are due to AF, and can also be caused by premature atrial or ventricular beats.

The answer to your question requires more details than you provided. While it is possible that the clot found in your foot came from a clot in your heart that formed during atrial fibrillation, you would need to know if the clot removed from the foot was found in an artery or a vein. You need to discuss this with your physicians.

There is no good way of answering your question without knowing the specific details of your heart problem, the circumstances under which the VT occurred, and the type and duration of VT that was seen. Your speculation that the VT could have been brought out by the adrenaline used during the procedure could be correct. In general, ablation of AF should not involve lesions placed in the ventricle and the ablation itself would be an unlikely cause of the VT. If the bottom part of your heart (the ventricles) is normal, and you have never had VT outside the laboratory, then its occurrence during the procedure is not likely to be important. Again, only someone very familiar with all the details of your condition and procedures can give you a good answer to your questions.

There is no good way of answering your question without knowing the specific details of your heart problem, the circumstances under which the VT occurred, and the type and duration of VT that was seen. Your speculation that the VT could have been brought out by the adrenaline used during the procedure could be correct. In general, ablation of AF should not involve lesions placed in the ventricle and the ablation itself would be an unlikely cause of the VT. If the bottom part of your heart (the ventricles) is normal, and you have never had VT outside the laboratory, then its occurrence during the procedure is not likely to be important. Again, only someone very familiar with all the details of your condition and procedures can give you a good answer to your questions.

No matter what kind of treatment you have for AF, you may have occasional recurrences. Whether recurrences are too much depends in part on what you as the patient feels is acceptable. If the recurrrences are brief, and not disruptive to your life, and are a nuisance but nothing more, you may quite reasonably decide this is acceptable. There is some correlation between the duration of AF and the risk of stroke, but equally or more important is whether you have additional stroke risk factors such as heart failure, diabetes, hypertension or a prior history of stroke. If you have these risk factors, but are on coumadin with levels (INR) within the therapeutic range (2-3), occasional recurrences of AF should not significantly increase your risk of stroke. There are no absolute right answer to your question, and what is right for you is worth further discussion with your doctors, depending on your specific circumstances. Your question regarding the meaning of specific recurrence rates that are quoted to you is a very good one, and you need to ask your doctor what exactly he meant. A common way of describing risk of recurrence is the percentage of patients who will have at least one episode of AF during treatment over a specific time period (such as one year). For some patients, one or two short episodes of AF within a one year period may be very acceptable.

A minority of AF patients have their episodes exclusively at night. Many physicians feel this is due to the effects of the vagus nerve which may predominate during periods of rest or inactivity. AF can often be silent no matter what the pattern of occurrence.

A pacemaker does not usually prevent atrial fibrillation, unless the rate during the normal rhythm was unusually slow. It is unlikely that your pacemaker will prevent atrial fibrillation, but it will prevent you from having symptoms due to very slow heart rates.

Atrial flutter is a more organized rhythm than atrial fibrillation, and often involves more localized areas of the heart. However, the two rhythms are closely related, and are often present at different times in the same patient. Atrial flutter after an ablation is a special situation that may be related to the type of procedure performed; this should be discussed with the patients physician.