A Fib and Hypertrophic Cardiomyopathy?

Hi Dr. Rich,
I was wondering if you could tell me if you would approach the treatment of Atrial Fibrillation any differently with a patient that has obstructive HCM than you would someone else.
I have read all of your articles on A Fib, and I see that most of the usual methods used to treat it have already been used on my father. He is 69, and seems to been in chronic A Fib. He had a stroke approximately 20 years ago, and has been on Coumadin ever since. Despite the blood thinners, he suffered 2 very small strokes about 2 months ago. He has taken anti-arrythmic drugs since the first stroke, most recently Amiodarone, which he has been on for the past 4 or 5 years. He has been cardioverted 2 times in the last 2 or so years...most recently last week. Unfortunately, although he achieved a normal heart rhythm after last week's procedure, he has now reverted to A Fib.
According to the articles you have posted, the only things he hasn't had done is ablation of the AV node and a pacemaker and/or the MAZE procedure.
Could you /should you/ would you perform one of those procedures on someone such as my Dad? Is there some other avenue that we should pursue? Is it best just to live with the AFib?
Thanks in advance for your words of wisdom.

CYNABURST,
The treatment of atrial fibrillation needs to be individualized, so I cannot offer an opinion on the appropriate treatment for your father.
However, since his case seems to be somewhat complicated, he might do well to see an electrophysiologist - a cardiologist who specializes in the treatment of heart arrhythmias. EP docs know when (and how) to perform ablations, and generally make sure the treatment of atrial fibrillation follows a logical progression.
In general, atrial fibrillation is less well tolerated in people with hypertrophic cardiomyopathy than it is in others - so a more aggressive treatment approach is often called for.
Dr R

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