Ablations for permanent AF

Firstly cryo balloon ablation can only deal with the areas around the four pulmonary veins so if you have other sites firing off then you would need a second RF ablation to deal with those. Persistent AF is seldom simple. The da vinci robots have apparently not improved results but they do enable the EP to sit down outside the cath lab which means that their exposure to X ray is reduced and they have a better working environment. This should in theory allow improved outcomes.

My personal view has always been that it is better to go the ablation route than spend the rest of your life on drugs which may eventually fail you anyway. Others I know have different views so guess it is just a personal thing.

Bob

Hi

I had perma AF for five years and the eventual (radio frequency, i believe) ablations (3 over 3 years) helped no end, and changed my life (for the better). I am now in snr, have been for a few months. I was in snr after the first ablation for 6 months, then flutter returned, i had another ablation, snr for 1 year, again flutter returned and last year third ablation. I do get ectopic beats or whatever but no long events so far. I can't recommend ablations enuff for anybody, but it sometimes might be a longer road than one would like according to the individual. My advice, as is Bob's, go for it.

Phil

Hi Blooto

The answer I suspect as with so many things around this ruddy AF is it depends, it depends on how long you have been persistent, it depends on how symptomatic you are, it depends on whether or not your left atria is getting larger, it depends on whether you have any other challenges especially cardiac ones.

As I understand it, and I am like you in persistent AF and have been for around 6 years, the chance of success from a catheter ablation for me is probably less than 30%, with repeated ablations this might go up to around 50 - 60 % but probably not much more. The main reason for this, is that the "alternative pathways" in other words the route the signals are now taking is now well worn and established, and even a full and successful pulmonary vein isolation will almost certainly not interrupt those pathways.

If you have been in persistent for a shorter time, then obviously your success rate will be higher, and regretably if longer lower.

If like me then I really have 3 options.

1) Stay as I am, not really many symptoms apart from breathlessness and tiredness hope it does not get worse, and regretably also probably be aware that my life is shortened by maybe up to 5 years as the risk of stroke and/or cardiac arrest is so high. I could come off all drugs now (except anti-coagulants) the very small calcium channel blocker I take makes almost no difference. BUT am I really asymptomatic? I literally can't remember what being in NSR feels like.

2) Go for a Catheter ablation, with a low potential success rate and with some risk albeit small, and also the possibility that it might actually make the AF worse.

3) Consider a surgical ablation (or a mixed surgical and catheter) which is a much bigger operation as it deals with the pulmonary vein from outside the heart with greater risks due to the operation, but also the advantage that they will do a left atrial appendage tie at the same time and reduce the longer term risk of stroke.

I suppose 4 might be to wait and hope that treatment options become better, but that's so difficult to predict is that an option?

My understanding is that there really is little research into the long term effects of asymptomatic AF, mainly because so many of us remain undiagnosed (Isn't it about time we had a campaign to get those ruddy blood pressure machines OUT of doctors surgeries!) I've been told everything from "lucky bugger" through to "your life is certainly shortened by 5 years" so what do you take on board?

I understand Bob's viewpoint, I know him quite well and we have talked about it, and I really understand, BUT 30% or less success rate? doesn't sound that attractive to me, nor does the risk of the AF actually being worse afterwards.

I think now we have some tremendous research going on with regard to PAF, ablations in general, and even causes of AF.

How about some research into us long term persistents please? We get mixed messages and confusing advice.

Sorry Blooto I may have given you more questions than answers

Be well

Ian

Thanks for your replies,

I was offered ablation when the AF was paroxysmal but didn't go for it, I suppose I bottled it & also thought more than 1 ablation could be needed which I didn't want to go through, now the feeling I get from EP's is its best to leave it as it is unless the symptoms are unbearable because permanent AF is harder to treat.

I'm depressed about it all.

I just read this article which looks promising...........

dailymail.co.uk/health/arti...

From what I have seen here ablations are only successful for a time. But data is hard to come by (and we're all different etc). Given this I was thinking of asking for a cardioversion, but again data is scarce and I'm not sure how effective it is against persistent AF. Does anyone know. Blooto have you chosen an ablation or has it been recommended to you?

I had 24/7 AF 10 years ago and it was stopped in it's tracks by a PVI ablation. No AF at all for another 8 years and no drugs either, except anti-coags.

I don't know how long my AF was persistent for, and I would add it was controlled by drugs, so I had few symptoms. But if I came off the drugs it was persistent. So is that persistent? I suppose it's underlying persistent ???

Hope that makes sense!

Koll

I would echo what Ian says. I'm at the moment on the track of just leaving things as the only drug that worked for me was amiodarone which after 6 years I had to stop taking. When I last asked about ablations 5 years ago my EP wasn't positive atand said that they could make me worse off with only a 30% chance of eventual success.

I am essentially asyptomatic now, but there's no certainty that that will be the case in the future.

what I have settled for was a baseline echo to establish where I was a year ago, and if I feel that things are getting worse I'll have another to see if my atrium has dilated further.

if it ha then I suppose I'll seek ablations - but by then the chance of success will probably be worse

so it'sca dilemma...

Lance

Hi , Three years ago most ablations would have been the spot probe type. The latest methods seem to be laser balloon or cryo balloon, which are reported to give more successful outcomes.

The video presentation comments on risk factor management used alongside ablation, which gives a.f. free outcomes after 2 years of up to 90%. From about 20 minutes in are some relevant charts.