HOCM and PAF for hernia repair

Gabrielle Morris

66-year-old man for open left inguinal hernia repair       

Background:

  • Reducible inguinoscrotal hernia. Causing intermittent pain but no hospital admissions.
  • Hyperthyroidism
  • Epilepsy
  • Anxiety/depression

Issues:

  • HOCM – stable disease on medical therapy
  • AICD in situ
  • PAF – Associated increased dyspnoea, haemodynamically stable, severely dilated LA on echo, booked for AF ablation in coming months
  • Commenced on amiodarone but recent device check showed an AF burden of 100%
  • DC Cardioversion recently

Discussion:

Timing of surgery

  • High risk of AF intraoperatively
  • Recent cardioversion and need to cease DOAC perioperatively
  • Should we wait until ablation is performed?
  • Discussed at cardiology meeting and cardiologist feels it would be suitable to proceed but there is a risk of perioperative AF. Ablation success is uncertain in the settling of HOCM, and patient will be more likely to redevelop AF in the 3 months post-ablation
  • On optimal medical therapy
  • Elective surgery – consensus that it would be better to have ablative therapy preoperatively

Plan:

  • Expedite ablation if possible
  • Postpone hernia surgery until 3 months post-ablation