Ask the Doctors June 2017 Issue

Ask the Doctors: June 2017

I had ablation for atrial fibrillation, and it seemed to work. But after a few months, I noticed palpitations starting up again. Does that mean the procedure didn’t work, or is this a new problem? Is it safe to have ablation again?

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

Radiofrequency ablation is a useful tool for the management of individuals with symptomatic atrial fibrillation and as an alternative to antiarrhythmic medications. The usual technique eliminates conduction from the pulmonary veins to the left atrium, since many of these episodes are triggered by electrical activity in this region. Although ablation success rates for atrial fibrillation are not as high as with some other supraventricular tachycardias, results continue to improve with better techniques and experience. A single procedure can eliminate paroxysmal or intermittent atrial fibrillation 70 to 80 percent of the time. But repeat procedures for recurrences are necessary in as many as 25 to 30 percent of individuals, with subsequent long-term success rates approaching 85 to 90 percent. However, initial success rates may be as low as 50 percent in individuals with chronic atrial fibrillation or with underlying significant structural heart disease. Even in these cases, success with repeat ablations may approach 85 percent. If the atrial fibrillation has been constant for more than one to two years, a majority of patients require an additional procedure to restore a normal rhythm.

It is not uncommon for atrial fibrillation to recur during the first three months following ablation, while the heart heals from the procedure. Sometimes just waiting it out is enough. If symptoms continue, it is important to evaluate the recurrent palpitations. Other arrhythmias, such as frequent premature beats or a different arrhythmia arriving from an alternate region of the heart, could be causing your symptoms. Clarifying what exactly is causing your palpitations will help to decide whether to just observe, consider addition of medications, or proceed with a repeat ablation procedure.

My cardiologist is a big believer in meditation, especially as a means of controlling blood pressure. He also told me that acupuncture has helped some of his patients lower their blood pressure. Is there anything to these alternative therapies? I don’t want dismiss them out of hand, but I’m not sure I believe they can help with something like hypertension.

Taking a few minutes to relax each day and release stress could help lower your risk of cardiovascular disease. There are different types of meditation practices using techniques such as deep breathing, sustained focus on a phrase or sound or quiet contemplation to help create a stress-free, relaxed state of mind. Transcendental meditation (TM), in which you allow your mind to focus inward while maintaining alertness to a specific thought or sensation, and mindful meditation, in which you help the mind focus to relieve excessive stress and anxiety, have been associated with lowering blood pressure. Studies have examined the impact of TM, with conflicting conclusions. A recent study from Case Western Reserve University reports a 5 mm Hg reduction in systolic blood pressure using mindful meditation techniques. Studies from Asia and Russia report benefits of acupuncture on blood pressure control. A small study at the University of California using acupuncture sites in the inner wrist and below each knee reported a 6 to 8 mm Hg reduction in systolic blood pressure.

These interventions offer potential complementary approaches to health improvement. However, they are not a replacement for, but an adjunct to, appropriate medical therapies and other important lifestyle changes, such as healthy eating, weight management, salt restriction and regular physical activity. All of these approaches together may help control cardiovascular risk factors such as hypertension, reduce your cardiovascular risk and improve your health.

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