Posted by steve giddings on October 05, 2001 at 08:18:48:
In Reply to: maze surgery posted by PAT PAYTON on October 02, 2001 at 22:24:55:
Just a brief comment on late recurrence of atrial fibrillation. There is a small group of folks who have had late atrial tachyarrhythmias (rapid, abnormal atrial rhythms of any sort). The most common is atrial flutter, not recurrent a fib. The distinction is important because flutter rates may be harder to control well (they may be blocked down too slow with meds and are too high left untreated, usually 120-150 at rest if the rest of your conducting system is healthy). The "Achilles Heel" reference is right on. There is a spot on the lower back side of the left atrium where one of the maze lines intersects the coronary sinus. This is actually a vein that carries blood that has circulated through the heart muscle itself back to the right atrium. It runs crosswise in a groove between the atria and the ventricles. This vessel itself can actually conduct electrical impulses and can function as part of a re-entry circuit. It is usually frozen with a cryoprobe at the time of the maze, but if the freeze isn't complete, the end result can be late a flutter.
The reason I know all this-- I had one bout of a flutter a bit over a year ago, 21 months after having the maze. I was cardioverted electrically, was offered AV nodal ablation by my local electrophysiologist- no way. I have not had a recurrent event since, and I have not been on any anti arrhythmics. I chose not to go on coumadin, the reason being that I know when this happens and can get in touch with my cardiologist quickly- and can start sub cu injections of low molecular weight heparin if need be, and get cardioverted.
I chose not to go back to DC or elsewhere to get the appropriate ablation because I thought it might be a very isolated event. These are triggered by a PAC occurring in just the right location at just the right time and under conditions where the rest of that area of the atrium is desynchronized enough to allow the circuis rhythm causing a flutter to establish itself. I haven't had a recurrence, continue to drink too much coffee, and push my heart rate to the max at least weekly with either interval training or racing. And I can say that over the last 2 years and 10 months, the maze has been worth it.
- Re: maze surgery hans koster 04:56:52 10/06/2001 (0)