Heart Information Center
 
Ask a Heart Doctor
  Back to previous page

 

Help us improve this service.

Your feedback will help guide us in developing this site.

Ask a Texas Heart Institute Doctor 
Informed patients make better patients.

Question:

I have persistent atrial fib / flutter and HCM. Is it better to try a repeat ablation or try new medicines? 

I am a 55 year old female; I had cryoablation pvi locally Oct 2012. For 12 years, I have been under care of a cardiologist for HCM [hypertrophic cardiomyopathy]. Stress echoes normal. Two maternal uncles died from HCM arrhythmia in 1970s. My brother has HCM, atrial flutter, VT, and both my parents have afib. I have experienced intermittent short bursts ( 5 -90 minutes) of SVT [supraventricular tachycardia] for 4-5 years. RVR rate mid 160s always, probably 1-2 times monthly. I am a CV ICU nurse and was able to capture a long run on telemetry strip and short asymptomatic runs captured on a 24-hour Holter monitor. Longer episodes were symptomatic; experienced as profound fatigue with irregular palpitation. I was on Metoprolol for a couple of years. . . . The only trigger I knew was dehydration. I did stop all caffeine and alcohol.  July 2012 it was as if something flipped a switch and I began having 4-20 runs of arrhythmia every day. . . . No effect at all from diltiazem, started on sotalol and anticoagulation with warfarin . . .  with sotalol, I started having chest tightness, dyspnea, and exercise intolerance. I am still on the sotalol 120 mg BID. It did slow rvr rate to 120-130 due to variable conduction. It was then obvious my symptomatic arrhythmia was atypical atrial flutter. . . . Ablation went well. I had no arrhythmia till day 8 then fast symptomatic. I remain on sotalol and warfarin during the blanking period and still having some arrhythmia, improved overall. My symptoms from sotalol have not improved. I do not want to stay on it. I see my EP in 2 weeks and he is planning on output telemetry monitoring. I do not want to take amiodarone and would agree to second ablation before taking it. My questions are: 1. Is it a good idea to try to change meds at this point? If the best thing is to grind through another 3-4 months on sotalol, I will force it. 2. Is it likely to be of benefit to wait 6 months to reconsider repeat procedure? [Edited for brevity.]

submitted by Connie from Ohio on 12/7/2012

Answer:

by Texas Heart Institute cardiologist, Ali Massumi, MD    

Ali Massumi, MDAntiarrhythmic choices for someone with HCM are limited. Dofetilide and an old medicine, disopyramide, can be alternatives to sotalol. Final results of ablation should have been completed in 4 to 6 months. Another ablation is a an option if your arrhythmia is suitable for that. If you don't have prolonged atrial fib for several hours, then the benefits of repeat ablation procedure are questionable.   

See also on this site: 

Has your question or a similar one already been answered?

Search all the Heart Doctor questions and answers.

To search for a doctor or access St. Luke's physician referral service, use the "Find a Doctor" link at the top of this page.


Updated January 2013
Top  
Texas Heart Institute Heart Information Center
Through this community outreach program, staff members of the Texas Heart Institute (THI) provide educational information related to the prevention, diagnosis, and treatment of cardiovascular disease. It is not the intention of THI to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided and THI urges you to visit a qualified physician for diagnosis and for answers to your questions.
Like us on Facebook Follow us on Twitter Subscribe to us on YouTube Find Us on Flicikr Follow Us on Pinterest Add us on Google+

Please contact our Webmaster with questions or comments.
Terms of Use and Privacy Policy
© Copyright 1996-2014 Texas Heart Institute.
All rights reserved.
This website is accredited by Health On the Net Foundation. Click to verify. U.S. NEWS America's Best Hospitals 2013-14