Posted by steve giddings on February 06, 2002 at 08:11:01:
In Reply to: 18 Week Update - Mini-Maze III at Cleveland Clinic posted by Jim Roff on January 31, 2002 at 14:24:10:
Jim:
It sounds like from your description that you are progressing, albeit more slowly than you would like, to more and longer periods of nsr and fewer, shorter periods of atrial fibrillation ?flutter.
A major fraction of folks who have the MAZE have periods of atrial fibrillation post op, and these may recur for several months after surgery. They occur because of changes in the intrinsic conducting characteristics of the heart musle cells of the atria when they are injured by whatever means. It takes a while for those to go away.
A couple of comments on your transient arrhythmias, extra beats or runs of extra beats. PACs are pretty much normal. They occur in just about everyone, and are more likely to occur when the heart muscle is "excited" by caffeine, fatigue or the underlying heart rate is low. In normal hearts, where all of the atria are directly connected and not interrupted by scar lines, the normal sinus beat suppresses surrounding heart tissue from firing spontaneously. If the sinus signal takes longer to get to the surrounding heart muscle becasue it has to follow a longer route, you may get an extra beat, or if it has been irritated by surgery, you may be more likely to get an extra beat. The important thing is these extra beats are now less likely to start off atrial fibrillation, as they did prior to surgery.
PAT, paroxysmal atrial tachycardia, is typically caused either by a re- entrant pathway between the atrium and the ventricles (bypassing the AV node) or by one irritated focus in the atrium fring retpeqtedly, instead just once, as occurs with a PAC. It is unlikely that you have an accessory pathway, as this would have been looked for before you had the maze. So your runs of PAT should be getting less sever with time as you heal as well.One final note, it is very difficult distinguish PAT from atrial flutter, sometimes even with a multilead EKG, so what you might be self diagnosing as flutter, may be PAT instead. Again, if that is the case, it should get better with time. If you are haveing episodes of flutter, that may need some attention, but that is fixable as well. That's all I know