Ask The Doctors: April 2013
Can radiofrequency ablation actually cure atrial fibrillation (afib) or does it just keep you from having an episode for awhile? I’ve heard conflicting stories about the long-term effectiveness of this treatment, but I’m willing to do anything to get it under control.
The goal of radiofrequency ablation (RFA), a procedure done by specialized Electrophysiology (EP) cardiologists in a heart catheterization lab, is to prevent atrial fibrillation from occurring entirely. There are different varieties of the technique, which generally involve a catheter which makes small burns on the inner surface of the heart. Some attempt to electically “isolate” parts of the heart which are notorious for emanating aberrant signals that lead to afib. These are known as pulmonary vein isolation, or PVI. Others focus on finding and burning parts of the heart that are currently releasing abnormal signals. The success rate of such procedures depends on several factors, including experience of the operator and duration that the patient has been in atrial fibrillation.
The longer one has been experiencing afib - especially if it has been constant - the more difficult it is to force the heart back into normal sinus rhythm. As such, it may take several attempts to achieve success, but for some patients this is worth the risk if afib is causing them intolerable symptoms. Sometimes, if all else has failed, patients will opt for a procedure in which the electrical connection between top and bottom of the heart (the atrioventricular or AV node) is ablated. This prevents all atrial signals, normal as well as abnormal, from being communicated from the atria to the ventricles, a situation known as complete heart block (CHB). It requires placement of a pacemaker, so that the ventricles will still continue to beat at a normal rate. Finally, there are various surgical procedures to treat atrial fibrillation, including the Cox-Maze surgery which has a very high rate of success. Since most people would prefer not to undergo open-heart surgery to treat their afib, such procedures are generally reserved for those patients that are undergoing other procedures, such as valve surgery or coronary artery bypass grafting (CABG).
I get my cholesterol checked regularly and my levels have been in the normal or healthy range for several years. But the last time I had blood work, my triglycerides were were 400 (usually they’re around 120). LDL and HDL were still in the healthy ranges. I haven’t changed my diet or started any new medications. What might account for such a sudden jump and what should I do about it? How much can your triglycerides vary from day to day?
The simplest explanation for the big jump in triglycerides might be if you hadn’t fasted beforehand, since everybody’s levels go up after they’ve eaten and can take awhile to decline. However, if that is not the case, then there are several possible explanations. Even if your diet hasn’t changed and your medications are unaltered, a rise in your weight or a decrease in the amount of regular exercise you’re doing could lead to the higher levels of triglycerides. Weight loss and exercise are generally the first steps we suggest in order to try and get our patients’ triglycerides down.
Other important issues to address are to test for thyroid, liver, pancreas and kidney abnormalities, as well as the possible development of diabetes. These problems can be easily tested for by blood and urine tests. Recently increased alcohol consumption can also boost your triglyceride levels. If none of these potential explanations appear to be involved, then rechecking the triglyceride levels in 3 months would make sense before considering addition of a new drug to treat them.