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Been in atrial fib, had ablation several times. Increased fatigue,reduced threshold for angina. Any suggestions ?

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My husband has been in atrial fib for about four years. He's had ablation several times and has unsuccessfully been tried on the various new drugs. Last year, his cardiologist said at the moment there were no medical or drug therapies available for him.

The last six months he's noticed an increase in fatigue, a decrease in his ability to complete his previous routine at the rec center and a reduced threshhold for angina. What are your thoughts? Is this a typical progression with atrial fib? Are there things we should be watching for, especially alarming changes?


Posted Sat, 23 Jun 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 3 hours later
Hi ,

Thank you for writing in.

I wish there were more patients like your husband who could earn accolade from their doctors for being dedicated to diet, exercise and drugs!

Let me briefly tell you which you perhaps already know.

The output of heart in later years of life is also contributed by atria (upper chambers of heart) apart from ventricles (lower chambers). As the luck would have it, despite maximum treatment atrial fibrillation persisted thus atrial contribution has been deprived. This is leading to present situation of early fatigue and perhaps decreased threshold for angina.

However, I suggest you check with your cardiologist whether potential thus possible occlusion of the other two grafts has got anything to do with angina.

With such conglomeration of diseases (+ variety of treatments) and equanimity with which your husband had tolerated all these, I would say Bravo, keep it up.

But yes, there are chances that his ventricular rate may increase; he may need additional drugs; he may need a pacemaker or even Automated Implantable Cardioverter Defibrillator (AICD) - probability of which I or any other cardiologist can't predict.

Though, in this situation worrying about potential complication is futile. Let us have faith in Almighty, that he will have no more precipitous troubles which competent cardiologists of Michigan cannot handle.

Hope this helps. Let me know if you need any more information.

Best Wishes.

Dr Anil Grover
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Follow-up: Been in atrial fib, had ablation several times. Increased fatigue,reduced threshold for angina. Any suggestions ? 2 days later
As the atrial fib. continues to take its toll, should I anticipate ever-increasing fatigue? Also, although futile to worry, will the progression of the atrial fib lead to death? I'm not being dramatic. We've lived on a roller coaster with Dick's CAD and I find it best to be as knowledgeable and informed as I can be. By the way, Dick has a wonderful cardiologist. However, my latest questions/concerns are too sensitive to bring up when I accompany Dick to his appointments.


Answered by Dr. Anil Grover 40 minutes later
Hi ,

Thank you for your follow-up query. I will try my best to answer it.

To quantitate the heart function, I am sure your cardiologist must be following some parameters / deterioration of which would correspond to decrease in effort tolerance.

Most common non-invasive method is "Ejection Fraction (EF)" of Left Ventricle. Normal is above 50%. And, in chronic patient like your husband, rate of fall will indicate how rapidly his effort tolerance is going down. That is not its only use. At a particular EF say at <35%, if coronary artery disease is not the immediate cause and there is a specific pattern of EKG, cardiologist may decide in favour of biventricular pacing or implantation of combo device that is Automated XXXXXXX Cardiovertor Defibrillator and biventricular pacing combined. In select group of patients, it increases effort tolerance significantly to make the improve quality of life.

I suggest you discuss these scientific interventions with your cardiologist. It may be so, that your husband is not a suitable candidate for these. Though, there are equal chances that may be he is suitable candidate.

The procedure is done under local anesthesia and the device is implanted below collar bone.

"Everything is not so gloomy. It is too early to give up the fight!"

Hope this helps. If you need more assistance, I will be available to help you out.

Best Wishes

Dr Anil Grover
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