Posted by steve giddings on April 09, 2002 at 07:59:17:
In Reply to: Return to Cleveland --- Post-Maze Ablation? posted by Henry Alken on April 08, 2002 at 21:57:02:
Henry:
I wouldn't get too rattled at the thought of having a post maze ablation. The "circuits" that form in the atria that allow atrial flutter are physically bigger around (they have a longer path) and are physically and electrically more defined than those for a fib. For this reason, even in hearts that haven't been scarred by the maze, there are only a few ways in which they can form. That is why flutter pathways are more amenable to RFA than a fib. They are easier to find because the ep folks know where they are likely to be. In post maze patients, as far as I know, there are even fewer possible pathways (because the maze lines have already interrupted most of the potential circuits) and I believe virtually every post maze flutter pathway that has been defined byh ep has gone through that one spot I described to you. An experienced invasive cardiologist can get a catheter to that point with relatively little difficulty. I'm not going to tell you their job is easy, or there would be one on every street corner. However, it is extraordinarily unlikely that they will have to go across the atrial septum, and unlike the situation with focal point ablations for af, where they have to spend a long time with a sensing catheter waiting for aberrant beats to occur and then map them before ablating, they already know where to look in this case, so the procedure should take much less time than your pre- maze ablation. My pre-maze ablation took about 11 hours (and I was back in af the next day). I have not had a post maze ablation, but have had a single, sustained episode of flutter that required dc countershock to terminate. This occurred 1 and a half years after my surgery. I discussed post maze ablation with the folks at Georgetown, where I had my surgery, and was told the whole procedure would most likley take less than an hour. Again, I'm not going to describe someone else's work but, it is a distinctly different situation than a premaze attempt at ablation of focal points for treatment of a fib.
I decided to wait and see if it happened again. I wasn't put on any meds except coumadin for a short period (a couple of months). It has now been 19 months since that episode. I haven't had a recurrence and have had cardiac function overall return to better than pre-maze. I think it is reasonable to wait a defined period of time to see if the problem resolves as the heart continues to recover (perhaps 6-12 months post op). However, if I had it recur once or at most twice again, personally, I would go for the RFA.Steve Giddings