66-year-old man for open left inguinal hernia repair
- Reducible inguinoscrotal hernia. Causing intermittent pain but no hospital admissions.
- 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
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
- Expedite ablation if possible
- Postpone hernia surgery until 3 months post-ablation