To The Medical Professionals Who Monitor This Newsgroup:

My Dad, 84 y/o, is 12 years post-bypass (bypass had complications
including a lapse into cardiogenic shock for a period, but he recovered
and has been doing well) and has had two MIs (most recent in 1993 during
the bypass) and 2 angioplasties (one of them post-bypass). Also had a
RFA 5 years ago successfully treated Atrial Flutter and has a pacemaker
for subsequent sick sinus syndrome (AFib). Good cardiac output for
someone in his condition (I believe it's up around 40-50%) and on
treadmill walking 3X/week. Hx of superficial bladder cancer ... treated
and under control and also of diverticulitis (infrequent).

He has recently become feeling a bit faint (only in the mornings for
some reason). No symptoms of chest pain that I am aware of. He went to
the cardio last week and based on initial exam, the cardio suspects he
may be having episodes of Afib again. His pacemaker report is going to
be examined tomorrow and he is scheduled now for an echo and a stress test.

My questions are:

1. Is it unusual for AFib to return 5 years after an RFA that appeared
to work (and afterwards, the EP told us that it was "gone and not coming
 back")?

2. What are your thoughts on whether my Dad should submit to another RFA
to resolve the new AFib problem (assuming this is confirmed), given his
age and condition? Is RFA much riskier at 84 than it was at 79?

3. What are the implications for doing an RFA with a pacemaker in place?
 I would assume that during the procedure, the pacemaker would be
turned off and that I can rely on the EP to know to do so.

4. Any other thoughts or recommendations on what should be done at this
point? I obviously cherish having my Dad around and want him to live as
long as possible. I get concerned about procedures being performed on
someone at this age.

Many thanks to all of you in advance who provide your expertise here.

Larry E.