Scar tissue found during PVA

[lidushoe]

HI, Recently, I had a PVA done at the CCF with an outstanding doctor who told me that my PVA was basically unsuccessful.  Reason being,  I had two previous valve surgeries (aortic and mitral) that resulted in a lot of scar tissue.  The Dr did what he could but basically there was too much to have an good outcome.  I know you will probably tell me to speak with my own doctor, which I will be doing in the near future, but I wanted to find out what you might want to recommend.  Funny question but can scar tissue be somehow "melted" or scraped away.  Do you think that there would be another option for me?  Any other type of ablation procedure, maze etc... to rid me of atrial fibrillation?  I am so disappointed to say the least but I still have hope that there is something I could do.  Please lead me in the right direction!  I really appreciate it.  --Lydia

[Cleveland Clinic]

Lydia,

Your CCF electrophysiologist is subspecialized and can present many more options for your fibrillation then I can.  

If this was your first procedure, then there might be an option for a second attempt.  However, it seems there were some specific circumstances that might preclude that.

The options, if ablation are not possible are attempts to keep your rhythm regular using medicines or for you just to stay in fibrillation. Believe it or not, in most -- despite the issues of chronic anticoagulation -- atrial fibrillation is well tolerated with little long term issues as long as the rate is able to be controlled.

good luck

[Erik36]

I would think that the Maze procedure would be a viable option. That procedure doesn't involve the pulmonary veins but the Atria itself. You would need a Cardiothoracic surgeon's opinion on this rather than a EP doctor. They do the Maze procedure less invasively now but they usually do these procedures in conjunction with other cardiac procedures such as Valvular surgeries. It won't hurt to ask. Good luck to you!


Erik

[lidushoe]

First of all , thanks to the Dr for the response.  Dr Natale told me a 2nd ablation is not even something to consider since scar tissue was a problem.  

Erik,  Your suggestion is one that I pondered.  I will definitely ask the EP and also make an appointment with a cardiothoracic Dr and ask about this option and throw many questions around.  Yes I did read that the Maze procedure should be considered if other cardiac work is needed but my mechanical valves are still in great shape and should be good for quite some time.  Believe me, I'm only 41 yo and have had so many surgeries already--what's another one?  It really is no big deal to me.  If I know I'm in good hands, I don't think about the risks.

Erik, I am so sick of being in atrial fibrillation and just want to get help as soon as possible.  I will be cardioverted next Tuesday, the first time after my attempted ablation, to see if I can stay in NSR with the medication that I am on.  Wish me luck.  Thanks so much,  Lydia :0)

[Lexicon154]

What medications are you on?  Have you tried an anti-arrhythmic?  There are several and they work well for many people.

[Erik36]

I wish you the best of luck. I know how you feel. I have A-Fib and it's under good control with medication. When I've been in A-Fib it's the worst feeling ever. If you are suffering a lot then I don't see why a Cardiothoracic surgeon would not perform the Maze procedure. Let us know how you make out.



Erik

[lidushoe]

Hi,  I have been on Amiodarone for quite some time, about 5 or 6 years.  The drug was a miracle drug for me for the first 3 or so years.  No afib, no pvcs, absolute heaven.  From then on the drug started becoming ineffective with breakthroughs of afib.  I stopped taking it about 6 months ago to prepare for the PVA which I had in November.  Even if Amio somewhat worked for me now, I would never go back on it since I developed hypothyrodism and I think formed crystal Amio in the eyes since I had loss of vision.  I need to check that out with my opthamologist.  Its a pretty nasty drug but works beautifully for a lot of people.

Currently I am on Sotalol (Betapace), 120mg 2x/day,  which does not help self cardiovert, therefore the reason for my cardioversion, and coumadin of course.  If I don't stay in NSR, I'll know it doesn't work and have to try something elso.  

What medications are you on for afib?

Lydia :0)  

[Erik36]

Luckily, I am  only on Toprol XL 50mg and Cardizem CD 180mg. I have stayed out of A-Fib for the last three years. I still have short runs (5-15 seconds once a month.) I get PVC's and PAC's often, though. I think my A-Fib was alcohol related and partly from low magnesium for which I now take supplements. You have actually failed drug therapy which makes you a good candidate for Ablation for which you cannot have due to your excessive scar tissue. I am curious to see if a Cardiothoracic surgeon will perform the Maze on you. Let me know.

Erik

[lidushoe]

Hi Erik,  I tried the Toprol XL, but did not do well on it.   I will certainly let you know when I find out about the maze procedure.  It may be a while but check back on this particular post.  

I am so happy that you are doing so well and I hope that nothing changes for you unless by some miracle you get better.  

When I went to the CCF, they actually put me on Tikosyn at a very high dosage, 500mg, and I was thrilled that it converted me to NSR.  They didn;t keep me on it since my qt interval was too long.  They cut it in half and still the same thing.  At that point Drs wanted to try me on a smaller dose but it was time to come back home.  My local hospital may be my next temporary home soon to try a smaller dose.

Take care of yourself.  Lydia :0)

[Erik36]

I heard about Tikosyn. I heard that it is great at converting back to NSR. I didn't know that you could actually take it regularly. Did you have the prolonged QT prior to taking the Tikosyn or did the Tikosyn cause the prolonged QT?


Erik

[pms_barbie]

tikosyn can cause prolongation of the qt interval.  I was put on it back in feb because my ep dr at the time thought it might help with pvcs.  I only took it about a week.  I was in the hospital 3 days and I started getting prolongation of the qt interval so they kept me another day to cut my dose and everything was ok so I got to go home.   However it did nothing for pvcs so off it I came.

[lidushoe]

Erik,  No I had the prolonged QT with the start of the Tikosyn.  I hope, so badly, that if they try me on Tikosyn at a lower dose that it would work.  Still waiting for the doc to see when and if he wants to monitor me in the hospital.  It seems like even the stronger drugs are not helping me and I am running out of options.  But, I am not quitting my search.  Erik, is cardizem an anti-arhythmic?

Barbie,  do you have atrial fibrillation?  It's very strange that your doc would put you on Tikosyn for pvc's only.  I've never heard of that.  Are you on any medications now?  Barbie, if you do have atrial fibrillation, did the Tikosyn work for you at a low dose?  At what dose did your QT normalize when they sent you home?

Thanks guys,  Lydia

[Erik36]

Cardizem I think is considered a class III anti-arrhythmic. I'm not sure, I'd have to look in the PDR but I think it is. It doesn't have Pro-Arrhythmic properties and either does Toprol XL which is a beta blocker but is also considered some class of Anti-Arrhytmic.


Erik

[pms_barbie]

No atrial flutter or fribilation.  I tthought it ways way out there myself.  However tikosyn was initally from my understanding a drug that was being tried for ventricular arrythmias . However it worked for the atrial ones better so they quit doing studies and using it to treat ventricular ones.