"IS EVERYTHING ALL RIGHT?"

HEARTS - JESSE BARISH

When I went to Auckland before going to Wellington I had an appointment with a heart surgeon who I'd been referred to. After some ECG tests he discussed possible procedures to fix the continual atrial fibrillation I've been experiencing.

He explained Catheter Ablation in some detail.

Ablation for Arrhythmias. Catheter ablation is a procedure that uses radio frequency energy (similar to microwave heat) to destroy a small area of heart tissue that is causing rapid and irregular heartbeats. Destroying this tissue helps restore your heart's regular rhythm.

This is done in a surgical procedure under anaesthesia with, he said, "a minor risk of death during the operation". Oh joy. As my sister, my GP and a local heart specialist  had all suggested the worthwhileness of this I said that we should give it a go. The surgeon then dropped this bombshell:

"The first operation is seldom effective and often two, three or more procedures are necessary"

Great! I asked if there was an alternative which he happily pulled out of his bag of tricks.

"Cardioversion" he beamed. "Cardioversion is a simpler procedure, done under anaesthesia where we give you an electric shock with paddles like you've no doubt seen on TV".

Great! I said that we should give this a go.

"Cardioversion might or might not work though" he said. "Even when it works the beneficial effect is usually only temporary and the atrial fibrillation comes back."

"OK" I said, beginning to see some sort of pattern here. "What else have you got?".

"Flecainide" he answered with what seemed like a bit of excitement in his voice. "Flecainide will help bring the heart beat into a normal pattern and needs to be taken prior to and after the cardioversion procedure".

"Great" I carefully proffered, expecting that there was a negative somewhere ......

"But" he replied "the results will only be temporary"

"Oh" I said and, seeing that I was a bit crestfallen he said that the positive side was that I'd be able to 

experience normal heart rhythm for a while and could then evaluate whether having catheter ablation was worth the risk worth giving it a go.

Here's a summary of his recommendation that he sent to my local heart specialist.

"I have recommended that the best approach at this point in time is to restore sinus rhythm and evaluate his symptomatic status without the presence of atrial fibrillation. In order to do that I suggest he has a cardioversion.  In order to try and maintain sinus rhythm for a period of time after this - and provide a window of symptomatic assessment - I have given him a prescription for Flecainide-CR  and advised him to start this 1 week prior to cardioversion. He should have a Flecainide level 2 weeks after starting this (i.e. 1 week after the cardioversion). If his symptomatic status improves significantly further while being in sinus rhythm this provides additional impetus to pursuing a rhythm control approach in the more medium to long term. I would favour initially continuing with Flecainide and at the point where arrhythmia breaks through this, undertake a catheter ablation procedure at that point. "

So, it looks like I'll be having the electric shock treatment first with the likelihood of the full monty later.  If the cardioversion works and I feel significantly better with a regular heart rhythm I can then consider the ablation operation. If the cardioversion works and I don't notice a significant benefit then it's hardly worth the risk of the ablation. I'd better keep up the Southern Cross medical insurance payments.