To ablate or not to ablate

That is the question ! I saw my Doctor / specialist on Thursday . I see a different person every time . I'm not really sure of his name even , just that he knows what he's talking about . He began by asking me what I knew and understood about A fib ! Gulp. Let's play heart hangman he says. Not a good start. We go through the workings of the heart like I'm a 4 year old . Then we move to the pc so he can show me the stages of A Fib over a period of time on the heart. He likened it to arthritis , wear and tear . Apparently this damage cannot be picked up by any technology and only by having an ablation will the surgeon be able to determine how much is there and what needs to be done . I was not filled with hope. Plus the success rate he told me is 40-50%. Up to you he said . Another gulp . Harefield seems to be favourite if I decide to ' go for it ' . Any thoughts would be more than welcome !

Lisa

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  • I had three and it sorted my AF out for the last seven years so I think my answer is obvious.

    It may take several procedures but in my view worth it for every moment of teh last seven years.

  • I had a PVI ablation 10 years ago at the QE in Brum, and it worked 100% straight away. Kept me clear of AF and drugs (except anti-coags) for 8 years. Now got something back but controlled by drugs so far :-) , guess I'll have another ablation if and when the drugs stop working? I did have a 2nd one a couple of years back but they aborted as my AF had gone away all on it's own for a while! Typical, like when you take your car in and nothing goes wrong on the day ....ggrrr

    Koll

  • Hi Lisa - It sounds like your Doctor/specialist is brilliant. I would have loved someone who explained A-fib to me as though I was a four year old and who would talk me through it via a screen.

    It's a difficult choice for you to have to make. For those who have had successful ablations I can totally understand them saying, go for it, but let's not forget this is quite an invasive procedure and it doesn't help everyone. Unfortunately, my two weren't successful and I've been told my heart is so scarred inside now that I can't have any more.

    With hindsight I wish I'd gone down the healthy eating route and lost some weight first to see if that helped before making my decision to go ahead with my first ablation. I went into it quite unaware of all it entailed and thought it would cure me and I'd be a normal person able to do lots again. Some hope that was! I get attacks of AF now just as frequently as I did before, but now they last a lot longer. Let's not forget also that ablations damage your heart in order to block the rogue firings. I've been told that my ablations have made my heart stiff, hence the problems with it working properly now. This is just my opinion and I urge you to try the diet way first.

    Wishing you well.

    Jean

  • Lisa, your post answers questions for me. You say that technology cannot pick up damage, only ablation can do that. I have been mightily confused by people talking about various tests and scans. After my ablation the EP said " Given your history we were surprised at what we found." They found severe scarring ( due to radiotherapy?) and a severly dilated left atrium. I was confused that all this had not been evident on the scans pre-ablation.

    You will know when to agree to an ablation -- - - when the AF makes day-to-day functioning intolerable.

    Best wishes.

  • I don't know where you live but our next support group talk at Epsom Hospital is by an EP, Dr Saba and title is "When to consider Ablation' It's at 4.45pm on July 1st and you're very welcome. Our medical lead Richard Bogle usually is there too and they'll both answer questions.

  • PS picking up on Jenny Dog's point I think your need an MRI scan to pick up scarring.

  • Thank you all for the replies . I know I have to ' go for it ' . And I'm pleased that my doctor hasn't lead me down a false path raising my hopes. I'm certainly more knowledgable now and aware of the pitfalls. . He was quite blunt and to the point , but I don't need this condition sugar coated, it is was it is and it will always be there in some form or another. I have persistent AF so I'm under no illusions anymore. thank goodness I'm having a GA , this is some procedure and the worse that can happen is that they 'Nick' a part of my heart that they shouldn't and then they have 20 mins to open me stitch me up and close me up !

    I had a couple of MRI scans and they found a minute hole in my heart, apparently 25% of the population have one ! This guy was full of statistics !

    I'll check my diary for July 1st, that could be interesting

    Lisa

  • Hi Lisa - I also have a hole in the heart - it made it easier to ablate as during the procedure the EP needs to punch a hole through the septum from the right atria into the left in order to do the procedure. I didn't know I had one until the ablation, evidently I should never have been scuba diving, bit late telling me now after 20 years of diving!

    I think in your shoes, with persistent AF, especially if symptomatic, I would go for it as I would hope that there would not be much to lose if it didn't work and a lot to gain if it did. Good luck.

  • Lisa,

    I had persistent AF when I had my successful ablation. When I say persistent I mean it was round the clock 24/7 until it was diagnosed, then I was put on drugs that stopped it. I stayed on those drugs for 2 years, then had the ablation to get off the drugs which were causing serious memory loss. I don't know how long I was actually in symptomatic continuous AF, maybe months I guess? But it was years in underlying continuous AF, but is that relevant, I don't know.

    My EP said that because my AF was constant it would be easy to see if they had "got it" during the ablation, instead of having to wait till afterwards to find out if it came back. He gave me about a 70% chance of success but also said it would probably need another "tweak" in 5-15 years.

    Koll

    PS. I'm not trying to talk you into an ablation, this is just what happened to me so I'm saying it.

  • Hi Lisa, don't know much about persistent AF as I am Paroxysmal AF but the consensus of my experience/medic advice to date, in case it helps, is: AF probably won't go away completely (like you chap quotes arthritis), if drugs or other stabilises the problem then postpone an ablation as long as possible, primarily because success rates/complications are not attractive and technology improves annually.

  • Hi Lisa, I am in exactly the same position as you. Had my EP appointment with Dr Hussain from Harefield/Royal Brompton last week. I have been in persistent AF since mid February and have been offered an ablation which I have agreed to at present but the waiting list is 9 months apparently so plenty of time to opt out if I get too scared. Unfortunately the choice is between the devil and the deep blue sea as I am really symptomatic at the moment, very breathless and can feel my heart banging away most of the time although he did say I would get used to it eventually. Hate the drugs for this condition as they make you feel very sluggish. I was also told that first time success rate was 50/50. I think our choice is really if we can live with things as they are or not, I think not.

    Best wishes with your decision.

    B x

  • I had a first meeting with an EP last week. I'm in persistent AF and, essentially, he said my symptoms aren't bad enough to make ablation a good solution - the risk/reward balance isn't good enough. He doubts whether it ever will be. That was the Bad News.

    The Good News is that he doesn't anticipate my AF or symptoms getting any worse (apart from the fact that we all get older) and that the drugs will continue to work as they are now (Apixaban and Diltiazem).

    So, onwards and not quite upwards - but not too bad :)

  • Hi Lisa. My view (as you said) is to go for it. at least you were given 50:50. I was in persistent AF and in my case my consultant EP said he thought there was NO chance it would work first time since he thought mine was too severe. He was right - I lasted less than 72 hours in sinus rhythm!!!! I had mine at end of March. I am on the list for a second ablation but timing depends on outcome of consultation with a heart valve specialist this Wednesday.

  • Never say never. You will know when it's the right time for you. Had my ablation last July, was successful. I was unfortunate and developed another problem that required a pacemaker last month. Story of my life so far, one problem begating another but don't regret any of the procedures I have had which have prolonged my life. Good luck with whatever you choose. You know there will be support for you here.

  • After several months of progressively worsening af, until finally persistent and debilitating, had a 100% successful ablation and loving my "new" heart without drugs (which hadn't really worked anyway). Considering my brother's experience with severe intermittent episodes requiring 3 ablations, I think the ablation on persistent symptoms may be more successful. Mine took only three hours vs. his five because docs had to keep trying to stimulate af so they could locate areas to ablate, whereas a misbehaving persistent AF takes out the guesswork.

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