Ablation

[Moonriver]

Are ablations always carried out under generals? Why do they work for some people and not for others? It seems kind of hit or miss. Do you still need to take heart meds afterwards and can you go back to exercising later? How do the doctors get to know which spot to work on? Is there a long waiting list on the nhs to have one? What is the criteria?

[BobD Volunteer]

Starting at your last point normally the criteria is that you have to have failed to respond to two different drug regimes. Waiting lists vary but can be anything up to 8 months I believe.

AF is such a mongrel and complicated condition that there is no knowing if it will work or not. Most EPs will tend to under ablate so as not to upset the heart too much which is why many people (like me) need more than one procedure. Methods vary as do EP's preference. Many use GA whilst other use sedation only. I had GA for all three of mine. Methods have seen some improvements of late with laser and cryo ablation starting to be more common. Meds are usually continued for a period after ablation to allow things to settle down as it takes at least three months for the heart to recover and the scar tissue which blocks the rogue impulses to form. I stopped all my AF medication about eight months after my last ablation some six years ago and have been fine (in that respect ) ever since..

Your last question is more complex. In general it is assumed that the signals are coming from the four pulmonary veins so these are isolated by a ring of dots or using the cryo balloon (read up on ablation on the main website fact sheets) Some other lines may be drawn across the atria as well if it is thought that there may be other signals. The EP uses pulsed X ray TV and often a previously taken Cat scan or MRI scan to position the catheter within the correct area to ablate. Having seen myself some of the equipment and some TV recordings taken during the procedure (and never call it an operation) I can only say what clever so and sos these EPs are.

Hope that answers some of your questions.

Bob

[Moonriver in reply to BobD]

Thanks Bob for such an informative answer. I think I would prefer a GA! Do they do a TOE before the procedure? Does that depend on whether you take warfarin or the new drugs? If they do a TOE is that under GA too? How do they know when to stop the meds after the procedure? I thought they usually stopped them after three months or so? Are the meds after the procedure to lock you into the sinus rhythm?

If you wait eight months for an NHS procedure doesn't the heart remodel in that time if you are still in AF with drugs not working apart from on the heart rate, so making it impossible to return to sinus? Would the NHS then regard it as an emergency?

The other point is how to choose the best EP?

[CDreamer in reply to Moonriver]

Having had 2 ablations with sedation I can honestly say it was much preferable to GA as the meds they give you are just SO good you aren't aware of much and doze a lot and have no memory of the horrid bits, TOE etc. The great advantage is much lower risks associated with GA from being intubated and I was eating a meal 20 minutes after the end of the procedure.

As to EPs the main AFA website have a recommended list so suggest you look at that site.

[Moonriver in reply to CDreamer]

Thanks everyone for all your comments. I wonder why some docs give some patients a GA as opposed to sedation for the ablation procedure?

[Offcut in reply to Moonriver]

heartrhythmspecialists.org/

[Moonriver in reply to Offcut]

Very helpful. Thank you Offcut

[BobD Volunteer in reply to Moonriver]

Obvious;y we are all different as I prefer to be away with the fairies but there is an argument that recovery is faster under sedation.

Regarding stopping drugs. I seem to recall that my REP wanted me to stop much earlier but every time I tried I started getting bad ectopics.. I therefore took to the gradual reduction method rather than cold turkey which worked for me.

TOEs are normally given under deep sedation or GA. Again it depends on your history and the EP concerned I think. My only TOE was for an emergency cardioversion as I am not aware of having any during or pre ablations. I suspect that some EPs., still not confident of the NOACs ,may do this whereas if you have been on warfarin in range for the required four weekly tests then they probably do not. We and the EPs are all differnt remember . The whole process is still very new science and as yet there is no real best practice.

Bob

[Hidden]

I would agree with Cdreamer, having had 2 ablations under sedation & one under GA . All things taken into account think I prefer sedation.

[Offcut]

1) I have had 3 and all have been local and I watched the monitors.

2) They may not have found the trigger point the first time also it might be a different area they are zapping?

3) in My case I am afraid so but I have other problems that are not helping.

4) Exercise at any time (except after Ablation) is not a bad thing but know your limits.

5) By ECG, image work and while they are having a look see inside on the day. On my second he mapped my chamber on the screen were I was sparking and then zapped them I had 38 burns and 7.5 hours he stopped.

6) Depends on your area and amount of people capable of doing them. The person that did my last one was trained by the guy that did my first 2. My first 2 were in Leicester Last one Coventry my home town. When I was first diagnosed with AF in 1992 there was only 2 places in England that did them and they had a 80% failure rate then.

7) Wet your finger and see which way the wind is blowing?

These points are from my experience.

BE Well

[Moonriver]

Can they actually see the rogue heart signals firing off on a ct scan with contrast and use that to map the ablation? Do the signals remain constant or change direction. How long do the pictures of a ct scan remain constant and up to date so that you don't require another ct scan nearer the procedure?

All the decisions you have to make! I don't know whether to go for another cardioversion next week to get me back into sinus because I have been in af for a month now and very draining and in limbo, or to go for an ablation and be brave and decisive! I just want to get off these drugs!

[Offcut]

cv is less time and trouble and might work if not another reason to have Ablation

[Moonriver in reply to Offcut]

If cv doesn't work will have an ablation might as well do it in stages but I guess after the cv you still need to be on drugs to lock you into sinus

[Barb1]

My EP always does a TOE before ablation and in my case found a clot so it was lucky he did and aborted the ablation. Trouble is that I had enough GA in me for a long procedure and had to be brought round after a short time instead! Not recommended.

[Moonriver in reply to Barb1]

Hello barb1 were you on warfarin at time of clot?

[Offcut in reply to Barb1]

I had TOE with first 2 but no the last one was local other was general.

[Barb1]

Moonriver, yes I was on warfarin

[Barb1]

Offcut - what is it like having a TOE under sedation as opposed to GA?

[CDreamer in reply to Barb1]

Can only speak for myself but I wouldn't know as I don't remember anything about it.