Cyclist56, it's my understanding that afib ablations are more complex, therefore it doesn't surprise me that your friend may have had less than ideal results.
GirlinSLO, are you in constant bigeminy 24/7? My heart runs through various patterns at times, bigeminy being one, tri or quadrigeminy as well. Bigeminy is frustrating. I'll be at a computer at work and can feel the bigeminy start, I really start to feel odd while it lasts.
I saw two Electrophysiologists for very frequent PVCs. Both felt that ablation would reduce or eliminate them. The first EP I saw said my PVCs were "probably" in the RVOT. The second EP had the nurse continue to collect my EKG data until a PVC was visible in each of the EKG leads on the EKG print-out. He disappeared with the print-out sheets and returned several minutes later. He said that my first EP was wrong, that the source of PVCs was in the Purkinje Fibers, which is harder to get at, but still possible to ablate. The following demonstrates why the
location of the PVC focus is important, in terms of risks to the patient. www.medhelp.org/posts/Heart-Rhythm/Continious-Bigeminy/show/364485"The RVOT is a straight shot from the right femoral vein to the outflow tract. There are very few impediments to catheter manipulation. The LVOT requires arterial cannulation and the catheter goes up around the aortic arch and then down to the aortic valve. Because of the curve in the catheter, when you turn the catheter counterclockwise, it actually moves clockwise in the heart and vice versa. In short, it is technically more difficult.
The RVOT is thinner and it is easier to achieve closer to full thickness ablation. If your PVCs are coming from the middle or epicardial myocardium, it can be more difficult to ablate from an endocardial approach. There are three "layers" to the heart muscle from inside to out called endocardium, middle or M cells, and epicardium."
Acvording to the above: RVOT catheter is placed in a vein (low pressure) and is a straight shot. LVOT requires access via an artery (high pressure), and the course (route) is more complicated. Also, Infrequently, some patients are not able to be successfully ablated by these routine procedures and doctors may need to employ, during a separate procedure, a technique called epicardial ablation (versus endocardial ablation that you are considering). Epicardial ablation is done with a small incision into your chest, and the catheter is coursed to your heart, and the offending tissue is ablated.
He continues: "The risk of pulmonary embolism is low and small emboli are filtered by the lungs. When you are on the left side, small emboli can cause a stroke or other embolic events. The risk is very low, but never zero."
If you are truly in bigeminy all the time, that will make mapping much easier and increases the likelihood of success."
Blood returns to the heart's right atrium, goes to the right ventricle, to the lungs, through capillaries in the lung, returns from the lungs, to the heart's left atrium, goes to the left ventricles, then out to the body. So, a procedure on the right side of your heart would have any small clots filtered by the capillaries in the lungs, but if perchance anything were dislodged from the left side the clots would flow out to the body.
As was explained, inducing the arrhythmia during ablation is essential to successful mapping and ablation, if you are in bigeminy all the time, this enhances your chance for success.
From another source, the following question/answer emphasizes a point I initially wanted to make in your situation, namely that geminy patterns can be atrial or ventricular in nature, though re-reading your post, I see that you mentioned PVCs as the culprit.
/web-chats/arrythmias-heartbeat-conditions "Question: I was wondering if being in bigeminy most of the day can have a long term effect on your heart? Also can anxiety contribute to bigeminy? What treatment options are available for this arrhythmia? I have had some lightheadedness with this while doing some activities.
Dr_Baez-Escudero: It depends whether the bigeminy comes from the atrium or from a premature ventricular contraction (PVC). Ventricular bigeminy has been sometimes associated with PVC-induced cardiomyopathy. This basically means that the heart can get weak over time if you are in constant bigeminy. Anxiety can be a contributing factor. Catheter ablation of a PVC causing bigeminy can be curative. Consultation with an electrophysiologist is warranted."
Ask your doctor for his/her opinion on the
location of the PVC focus.
Make sure your doctor explains the possible risks of the procedure overall and with emphasis to the specific area that he/she feels is the source of the bigeminy.
And make sure your doctor has fully explained non-procedural options (medications).
Medication of this nature require supervisory hospitalization to initiate, my doctor said I'd need to be in the hospital 48 hours to start the requisite medication (actually he said that several may need to be tried until they found the ideal drug). And there are risks with anti-arrhythmic medications as well even once you're placed on them in a hospital, though with a healthy heart and periodic monitoring and examinations, these risks are minimized.
It is my understanding that patients receiving ablation may require overnight hospital stays for several reasons, but one of those reasons is if the procedure done later in the day and they may want you to stay for observation.
Not every ablation is a success, but so many are. Kitt, a moderator at HealingWell, would explain not to be discouraged by people that post in forums that they had issues with ablations. Rightfully so, she explained that most procedures are successful, these people tend not to show up in forums.
Best of luck, please let the forum know how everything goes.
Post Edited (JungRulz) : 9/30/2014 3:04:01 AM (GMT-6)