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Medical Forum / General / Cardiology / July 2006Cardioversion question, and recommendation for specialist at Mass General?
Hello: I will be getting a cardioversion done at MGH in Boston. 1. I assume it is one of the best hospitals for this type of treatment? 2. Can anyone recommend a good cardiologist who specializes in it? 3. I have Lone/Chronic AFib, and have probably been in it for 2 years....are my odds of success low? (i am in my 30s and have no other risk factors... i dont even have symptoms). Thanks for all your help Frankly, i am terrified of this whole process. > 3. I have Lone/Chronic AFib, and have probably been in it for 2 > years....are my odds of success low? (i am in my 30s and have no other > risk factors... i dont even have symptoms). One key piece of info....the the left atrium size is below the "cut-off point", according the cardiologist i had last month. : Frankly, i am terrified of this whole process. Based on my experience, I would say there is nothing to be terrified about. The only discomfort was boredom--I was being monitored for two hours before the procedure and three hours after. So take plenty of reading matter. One other piece of advice: If you have hair on your chest or back, have the nurse shave it before the procedure, as the electrodes are stuck on to the skin, and with hair there it would hurt when the electrodes ar removed. > Based on my experience, I would say there is nothing to be terrified > about. The only discomfort was boredom--I was being monitored for two [quoted text clipped - 3 lines] > are stuck on to the skin, and with hair there it would hurt when the > electrodes ar removed. Thanks Edgar....i will shave and bring plenty of reading material :-) Hope your procedure was a success. boston_guy_992@yahoo.com wrote in news:1152212704.255825.131130 @j8g2000cwa.googlegroups.com: > Hello: I will be getting a cardioversion done at MGH in Boston. > [quoted text clipped - 6 lines] > Thanks for all your help > Frankly, i am terrified of this whole process. Cardioversions are done all over and are fairly routine. They are relatively quick and boring. They do usually restore normal sinus rhythm. Staying in nsr is another matter. Teminology can sometimes be confusing. To me Lone AF means from time to time and self-converting whereas Chronic AF means in it all the time, unable to self-convert. (To others they may mean something else.) If you've had Lone for 2 years your chances of converting and maintaining are probably good. If you've been Chronic for two years it could be trickier because of remodeling. There's no reason to be terrified. Anxious, yes, of course but it really is a straightforward procedure. L. > Teminology can sometimes be confusing. To me Lone AF means from time to > time and self-converting whereas Chronic AF means in it all the time, > unable to self-convert. (To others they may mean something else.) If you've > had Lone for 2 years your chances of converting and maintaining are > probably good. If you've been Chronic for two years it could be trickier > because of remodeling. Thanks Listener...i appreciate the words of support. I thought Lone AF just meant AF without signs of heart disease. And that there were 3 "subsets" of Lone AF - isolated, recurrent, and chronic. In any event, my AFib is continuous ... the concern of the cardiologist was that we dont know how long ive been in AFib, since i dont have symptoms and havent seen a doc in years. Although 2 years ago, one of those mobile clinics told me i did have an irregular heartbeat. That's why i say i've had AFib for (at least) 2 years. I assume continuous means the same as chronic. According to him, the left atrium is sized normally.... does that mean it's less likely there has been a lot of "remodeling" ? Thanks! >> Teminology can sometimes be confusing. To me Lone AF means from time to >> time and self-converting whereas Chronic AF means in it all the time, [quoted text clipped - 6 lines] >just meant AF without signs of heart disease. And that there were 3 >"subsets" of Lone AF - isolated, recurrent, and chronic. Lone AF means even more than this, I believe. It means you have NO other medical condition that sometimes causes AF, including such things as a thyroid problem. Also, sometimes mitral valve prolapse or other valve issues can cause AF. I was diagnosed with "lone AF", but mine was paroxysmal (sort of). Paroxysmal means that it quits on its own. Mine started out that way, but then I was prescribed Rythmol to take when the AF started. It performed as a "chemical cardioversion" and put me back into sinus rhythm, usually within about 3-4 hours and never more than 12 hours. As long as I remained in sinus rhythm, I didn't need to take the medication. >In any event, my AFib is continuous ... the concern of the cardiologist >was that we dont know how long ive been in AFib, since i dont have >symptoms and havent seen a doc in years. Although 2 years ago, one of >those mobile clinics told me i did have an irregular heartbeat. That's >why i say i've had AFib for (at least) 2 years. I assume continuous >means the same as chronic. Continuous means you have it all the time. Chronic might mean you have it "most" of the time. >According to him, the left atrium is sized normally.... does that mean >it's less likely there has been a lot of "remodeling" ? Thanks! This is a good thing. Hopefully, your heart will remain in sinus rhythm after your cardioversion. If not, your cardiologist ought to suggest trying some medications (such as Rythmol or Flecanide) to help maintain (or restore) sinus rhythm. It's not unusual for these medications to work well for a few years but then to gradually lose effectiveness. That's what happened in my case. There are then invasive procedures such as catheter ablations and surgical "maze" procedures that have pretty good success at obtaining a cure. I had a so called "mini-maze" procedure a year ago which has apparently cured me in that I've had no AF at all since the procedure. You can't beat that! Your docs also might want you to be on Coumadin to reduce the chance of suffering a stroke. While in AF, blood tends to form clots in the left atrial appendage, a little bag of useless tissue on the left atrium, and these clots may become dislodged and travel to the brain causing a stroke. Depending on whether you or not you engage in active sports or motorcycling, etc, which have a chance of sustaining trauma, you may want to be careful with coumadin as it can cause brain bleeding to occur which may well be worse than a stroke. The AHA guidelines for coumadin recommend it for people over 65 but some doctors seem to enthusiastically recommend it for everyone suffering AF. In my case, I avoided using it because I'm an active skier, fly aerobatic airplanes and ride motorcycles. Also, I was always able to immediately detect when AF started and Rythmol stopped it quickly, not given blood clots much chance to form. You might take a look at http://health.groups.yahoo.com/group/AFIBsupport/. This discussion group focuses on AF. Lots of activity and all of it "on topic". You'll be in my prayers. Blessings, John > Continuous means you have it all the time. Chronic might mean you > have it "most" of the time. [quoted text clipped - 14 lines] > procedure a year ago which has apparently cured me in that I've had no > AF at all since the procedure. You can't beat that! I've heard of this... thanks for the tip.... i will look into it some more. > Your docs also might want you to be on Coumadin to reduce the chance > of suffering a stroke. While in AF, blood tends to form clots in the [quoted text clipped - 19 lines] > Blessings, > John Thank You John. I appreciate the kind words and the info. This is all new to me, and to be honest, ive had very bad experiences with doctors, so i'm researching things pretty thoroughly. Again, thanks! > > Teminology can sometimes be confusing. To me Lone AF means from time to > > time and self-converting whereas Chronic AF means in it all the time, [quoted text clipped - 6 lines] > just meant AF without signs of heart disease. And that there were 3 > "subsets" of Lone AF - isolated, recurrent, and chronic. Lone atrial fibrillation does mean atrial fibrillation without any evidence of any other contributing factors (alcohol or thyroid disease for example) especially structural heart disease. > In any event, my AFib is continuous ... the concern of the cardiologist > was that we dont know how long ive been in AFib, since i dont have [quoted text clipped - 5 lines] > According to him, the left atrium is sized normally.... does that mean > it's less likely there has been a lot of "remodeling" ? No. The "remodeling" is electrophysiological rather than physical/anatomical. > Thanks! You are welcome. All thanks and praises belong to GOD, Whom I love with all my heart, soul, mind, and strength. Prayerfully in Christ's amazing love, Andrew B. Chung Cardiologist, Atlanta, Georgia, USA http://HeartMDPhD.com/TheLife > > According to him, the left atrium is sized normally.... does that mean > > it's less likely there has been a lot of "remodeling" ? > > No. The "remodeling" is electrophysiological rather than > physical/anatomical. Andrew - i am confused. This site seems to say there are 5 physical factors. Can you please explain? (this is not a flame - I've read, and respect your advice in this newsgroup, and am interested in your views): http://www.a-fib.com/BostonA-FibSymposium2006.htm#WilberLeftAtrialRemodeling Dr. Wilber's presentation focused on the structural and mechanical changes that affect the heart in A-Fib, and whether any of these remodeling effects can be reversed by eliminating patients' A-Fib. Some of the remodeling effects associated with A-Fib are: a) Increased left atrial size b) Decreased left atrial contractual and reservoir function (reservoir function refers to the capacity of the left atrium to expand and accept blood flow) c) Pulmonary Vein expansion d) Atrial fibrosis (the formation of fibrous tissue) and scarring e) Increase in Left Ventricle size, decrease in LV Systolic and Diastolic function. > > > According to him, the left atrium is sized normally.... does that mean > > > it's less likely there has been a lot of "remodeling" ? [quoted text clipped - 21 lines] > e) Increase in Left Ventricle size, decrease in LV Systolic and > Diastolic function. It is clear from Dr. Wilber's presentation that he recognizes that there is a disconnect between the structural and mechanical changes that arises with chronic atrial fibrillation and whether the heart will remain in sinus rhythm after cardioversion. The example cited of the left atrium remaining structurally abnormal after an invasive MAZE procedure "curing" atrial fibrillation draws the distinction between the two kinds of remodeling. IOW, the remodeling behind lone atrial fibrillation that makes AF chronic is electrophysiological and not structural/mechanical. Prayerfully in Christ's amazing love, Andrew B. Chung Cardiologist, Atlanta, Georgia, USA http://HeartMDPhD.com/TheLife > It is clear from Dr. Wilber's presentation that he recognizes that > there is a disconnect between the structural and mechanical changes [quoted text clipped - 6 lines] > IOW, the remodeling behind lone atrial fibrillation that makes AF > chronic is electrophysiological and not structural/mechanical. Ok...but i am wondering why my cardiologist said that if my left atrium's size is below the "cut-off point", cardioversion is more likely to be successful? If not, is there anything i can do to mitigate the electrophysiological remodeling that may have occurred? (e.g. i've heard that vit C mitigates the heart's propensity to "remodel") Can remodeling be measured? Thank you and God bless > > It is clear from Dr. Wilber's presentation that he recognizes that > > there is a disconnect between the structural and mechanical changes [quoted text clipped - 11 lines] > likely > to be successful? An enlarged left atrium is a structural abnormality that is associated with decreased likelihood of successful cardioversion. > If not, is there anything i can do to mitigate the electrophysiological > remodeling that may have occurred? (e.g. i've heard that vit C > mitigates > the heart's propensity to "remodel") Can remodeling be measured? No. > Thank you and God bless You are welcome :-) Prayerfully in Christ's amazing love, Andrew http://HeartMDPhD.com/TheLife boston_guy_992@yahoo.com wrote in news:1152220314.319414.156240 @p79g2000cwp.googlegroups.com: >> Teminology can sometimes be confusing. To me Lone AF means from time to >> time and self-converting whereas Chronic AF means in it all the time, [quoted text clipped - 16 lines] > According to him, the left atrium is sized normally.... does that mean > it's less likely there has been a lot of "remodeling" ? Thanks! Why don't you head over to the moderated Yahoo Support Group for afib: http://health.groups.yahoo.com/group/AFIBsupport/ There are a lot of good people there (now over 2700 members!), including myself (under a different moniker of course). Post a message introducing yourself and your situation and you're bound to get some good information and support. L. Hi, I have Afib and have had it for 7 years. I've also had 6 cardioversions. Not much to it. I do get nervous but I'm that way..You won't even know anything..My cardio does mine and I wouldn't want anyone else. It always puts me back in SR. Seems the only way I convert. I stay in the hospital trying but I end up having a cardioversion ....take care...Nel " >>> unable to self-convert. (To others they may mean something else.) If > you've [quoted text clipped - 26 lines] > > L. |
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