Managing Atrial Fibrillation Recurrence After Catheter Ablation

Recurrence of atrial fibrillation after catheter ablation?

Hello, I apologize for the confusion and appreciate this opportunity to ask my questions.
I am 30 years old and was diagnosed with atrial fibrillation at Taipei Medical University.
I take one tablet of Dronedarone and half a tablet of Amiodarone daily.
An echocardiogram showed mild mitral valve prolapse.
Subsequently, I experienced episodes of atrial fibrillation once or twice a month, each lasting about 1 to 2 days before returning to normal.
At 31, after a year, the frequency of episodes increased, and I underwent cryoballoon ablation.
Two weeks post-procedure, I frequently experienced palpitations and brief episodes of fibrillation.
My medication was adjusted to one tablet of Dronedarone, half a tablet of Amiodarone, and one tablet of Sotalol twice daily.
After three months, I occasionally had brief episodes of fibrillation or rapid heart rate.
After three months, my condition improved, and I stopped taking half a tablet of Amiodarone while maintaining the other medications.
However, two days after stopping Amiodarone, I suddenly experienced irregular heartbeats, which have persisted for a month.
During my follow-up visit, I was noted to have palpitations and fibrillation.
Currently, my medication regimen includes one tablet of Dronedarone, half a tablet of Amiodarone, and one tablet of Dronedarone in the morning, and half a tablet of Amiodarone in the evening.
My condition has improved; my heart rate is more regular when sitting, but I experience chest tightness when walking or shopping, and my Apple Watch detects episodes of fibrillation or irregular rapid heartbeats.
I also experience frequent burping and a feeling of fullness in my upper abdomen when walking.

I would like to ask:
1.
Does this indicate that the cryoablation procedure was unsuccessful, or is my heart condition more complex?
2.
Since I started taking medication daily at 30, will I experience other side effects or an increased dosage over time?
3.
Is there a possibility of switching to taking medication only when symptoms occur in the future?
4.
Would you recommend seeking a second opinion from another hospital?
5.
Could traditional Chinese medicine be helpful?

Kai, 30~39 year old female. Ask Date: 2024/03/15

Dr. He Dongjin reply Cardiology

Hello, it is difficult to say if the cryoablation surgery was unsuccessful; a decrease in overall volume could still be considered a success.
2.
Side effects vary from person to person, making it hard to determine.
Your physician should monitor your medication, as increasing dosages should be based on your condition, and the duration of medication use may not necessarily be related.
3.
I do not agree with only taking medication when symptoms arise, as this could increase the risk of stroke.
4.
You might consider seeking a second opinion from another hospital.
5.
I believe traditional Chinese medicine may not be very helpful.
Take care, Changhua Hospital is concerned about you.

Reply Date: 2024/03/15

More Info

Managing atrial fibrillation (AF) recurrence after catheter ablation can be a complex and multifaceted issue, especially for a young patient like yourself. It’s understandable to feel anxious about your condition and the treatment options available. Let’s address your concerns one by one.

1. Effectiveness of Cryoablation: The recurrence of atrial fibrillation after a cryoablation procedure does not necessarily indicate that the procedure was unsuccessful. Atrial fibrillation can be a challenging condition to manage, and many patients experience episodes of AF even after successful ablation. Factors such as the underlying heart condition (like your mitral valve prolapse), the duration of AF prior to ablation, and individual patient characteristics can influence the outcome. It’s important to have a thorough follow-up with your cardiologist to assess the effectiveness of the procedure and to discuss any potential adjustments to your treatment plan.

2. Long-term Medication Use: Taking antiarrhythmic medications like Dronedarone (the drug you referred to as "臟得樂") and others can have side effects, especially with long-term use. Common side effects include gastrointestinal issues, fatigue, and potential impacts on liver function. It’s crucial to have regular follow-ups with your healthcare provider to monitor for any adverse effects and to evaluate the effectiveness of your current regimen. Your doctor may adjust your medications based on your symptoms and any side effects you experience.

3. Symptom-Driven Medication: Transitioning to a symptom-driven approach to medication is a possibility, but it depends on the severity and frequency of your AF episodes. Some patients may benefit from a strategy where they take medications only when they experience symptoms, but this should be discussed thoroughly with your cardiologist. They can help you weigh the risks and benefits of such an approach based on your specific situation.

4. Seeking a Second Opinion: It is always reasonable to seek a second opinion, especially if you feel uncertain about your current treatment plan or if your symptoms persist. A different cardiologist may provide new insights or alternative treatment options that could be beneficial. It’s important to feel confident in your care, and a second opinion can help you make informed decisions about your health.

5. Role of Traditional Chinese Medicine (TCM): Some patients find complementary therapies, including TCM, helpful in managing symptoms and improving overall well-being. Acupuncture, herbal remedies, and dietary changes may offer benefits, but it’s essential to discuss these options with your healthcare provider to ensure they do not interfere with your conventional treatments. TCM should be viewed as a complementary approach rather than a replacement for standard medical care.

In summary, managing atrial fibrillation after catheter ablation requires ongoing communication with your healthcare team, regular monitoring of your condition, and adjustments to your treatment plan as necessary. It’s essential to address your symptoms and concerns proactively, and seeking additional opinions or exploring complementary therapies can be part of a comprehensive approach to your health. Always prioritize open dialogue with your healthcare providers to ensure the best possible outcomes for your condition.

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