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Recurrent atrial fibrillation after ablation with apical HCM
Heart Rhythm Conditions | Last Active: Apr 28 8:49am | Replies (6)Comment receiving replies
hi linhtheban
Your father does seem to have more than his share of cardiac issues. @gloaming does have much knowledge regarding AF and treatments, but I have to disagree with his opinion that the arrhythmias have caused the hypertrophy in his left ventricle. I have Apical Hypertrophic Cardiomyopathy with AF with rvr (rapid ventricular rate). The Apical HCM diagnosis preceded the AF. AF is common in Apical HCM and is caused by the increased left atrial pressure and ventricular diastolic dysfunction. NSVT is also an issue with ApHcm.
My AF presented as persistent although I must have had episodes prior that didn't last long and never showed up on holter monitor. I was in Af six months before it was rhythm controlled with medication. I see a genetic cardiologist at Mayo Clinic in Rochester and an electrophysiologist in the heart rhythm clinic. He recommended medication to begin with. Ablations often take two or three with Apical HCM (Af is less tolerated and harder to treat when you have ApHcm) When in Af I have terrible fatigue and my heart feels like it is pounding all the time and heart rate often goes to 175 and is rarely below 115.
If possible, your father should first find a HCM specialist who would deal with the ApHcm and see that he could get the proper treatments for his arrhymias. I did some research and their are HCM specialists at Vinmec Times City International Hospital in Hanoi. This hospital is connected to Cleveland Clinic in the United States. Perhaps you could start by contacting this hospital.
As far treating AF when you have ApHcm, I can only relate my experience. Rate control meds were tried until I could see a doctor in the rhythm clinic. Unfortunately these meds did nothing for the AF, but increased my fatigue and lowered my blood pressure too much. Rhythm medication has been mostly successful. I was loaded (three days in hospital of get the drug) with Dofetilide (Tikosyn) and it was great for 10 months. Then I started having occasional breakthrough espisodes that would self convert back to sinus rhythm. When the episodes started getting closer together my Hcm cardiologist prescribed Jardiance to help lower my filling pressures and "fine tune the diastolic dysfunction." This has actually performed as he hoped. I have not had a breakthrough since the Jardiance took effect.
As ApHcm is a genetic disease and a child has a 50% chance of also having it, I would suggest you be screened for it. ApHcm can present at any time in your life. I was actually diagnosed at age 78 although I had an abnormal ECG at age 65 and it was missed. Wishing you good luck in finding appropriate treartment for your father. I know he has other issues beyond the Hcm, but if it is treated correctly, his quality of life should greatly improve.
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@emo44 Thank you very much for this very thoughtful and detailed reply. It was especially helpful to hear from someone who also has apical HCM with AF.
Your explanation makes a lot of sense to me, especially the point that apical HCM may come first and that AF can be a common consequence of the increased left atrial pressure and diastolic dysfunction. This is very relevant for my father, because we are increasingly concerned that his underlying apical HCM may be a major part of the overall problem, not just the recurrent AF itself.
I also appreciate your point that he may need to be evaluated first by an HCM specialist, and then by an electrophysiologist who understands AF in the setting of apical HCM. That is one of the main questions our family is struggling with right now: whether we should prioritize the strongest HCM center, the strongest EP center, or a place that is strong in both.
Thank you as well for mentioning Vinmec Times City. We are in Vietnam, so that is a practical suggestion and I will look into it more carefully.
Your comments about medications and how AF can be less tolerated in apical HCM were also very helpful. My father’s symptoms during arrhythmia episodes are quite severe too, with fatigue, chest discomfort, shortness of breath, dizziness, and sometimes low blood pressure, so your experience helps me understand this disease combination better.
And thank you for the reminder about family screening. I will keep that in mind.
I am truly grateful that you took the time to share your experience and advice. It has been very helpful for my family.
May I ask two more questions?
In your experience, if someone has apical HCM with recurrent AF and one documented episode of NSVT, would you personally prioritize seeing an HCM specialist first, or an electrophysiologist first, if you could not see both immediately?
Also, do you know whether Mayo tends to prefer trying rhythm medications first in patients with apical HCM and AF before considering repeat ablation, especially if the first thermal ablation was very difficult for the patient?
Thank you again for taking the time to share your experience.