All concepts, explanations, trials, and studies have been
re-written in plain English and may contain errors. I am
not a doctor
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Related to:
http://www.chfpatients.com/CHF.htm#CHF_case_example_2

ABLATION
A 42 year old woman was referred to us for heart transplant.
She had a 10 month history of heart failure with class 4
symptoms. An echo done in may of that year showed an
ejection fraction of 45% ; in July it was 30% ; and in
August it was 15%. A cath showed clear arteries. The
decision was made that she needed a heart transplant.
She and her family requested a second opinion here.
	When we saw her she was very, very ill. After
reviewing her huge medical record and after interviewing
her, the following points were known:

1) She had a 30 year history of bad bronchial asthma. She
   was on multiple meds because of her severe asthma.
2) She had a 4 year history of recurring a-fib. She had
   been treated with quinidine and developed ventricular
   fibrillation. About the time she started getting sicker,
   she went into chronic a-fib and her heart rate was
   under 140 - it was usually 160 beats per minute.

What could we give this woman to control her heart rate?
With her asthma, beta-blockers were not a good idea. She
had a digoxin level of 2.2, so we could not increase that.
So what did we do? We did an AV node ablation and
implanted a pacemaker.
	Her response? Within a week her ejection fraction
averaged 30% and 9 months later it was 45%. At her last
visit, it was 55% and she had no more symptoms. This is
certainly a better outcome and at a lower risk than going
through a heart transplant!