Talk on ablation by Dr Saba for Surrey ASG

As promised,because we couldn't record , I will try to summarise the main points of the talk we had on Wednesday evening.Please note you are relying on my short notes and memory (!) so I cannot be held responsible for any errors.Please do not rely on this post for making any decision re ablation- please ask your GP or EP for further information.!! We always remind people at our meetings that the speakers are just giving their individual opinions and patients should ask their own doctor who can advise in the light of their individual health situation.

John went away yesterday but I hope he will add/ correct anything here when he is back- if any other forum members who attended spots any slips please dive in too!!

We looked at a lot of the studies about ablation versus/ with drug treatment for AF.

Recent work is comparing results from just isolating the pulmonary veins or ablating further areas of the heart. Interestingly, it may emerge that ablating the extra areas doesn't effect outcomes much but this is still being assessed.

The timing of ablation, which we often debate, was discussed and I think the view was that IF it is the right course to take it is better done sooner - however, it should only be done if the symptoms warrant it.He mentioned that patients might want to try drugs first but if they don't work after a few months it might be worth considering ablation if very symptomatic.

He also said anticoagulation should continue after ablation because AF may still occur and may not be noticed as it is much milder when it presents.

This timing advice is because, as we discuss on the forum, extra fibrosis can then be avoided. However, if the patient already has a lot of fibrosis ablation is less likely to be successful. I asked how we can judge this when we are not routinely offered MRi scans before ablation and he said a good guide to likely amounts of fibrosis is the size of the heart- how much enlargement has occurred.

He felt EPs don't really know why some groups of people have extra fibrosis when they are diagnosed and then fall into the second group of people who have less satisfactory results from ablation.So I would say he seemed to suggest ablation was good for those who are very symptomatic- AF really affecting lifestyle, and

and that results were good if there is not too much existing fibrosis.

I asked about those people who have been told by their EPS that further ablation won't help because of "extensive electrical disease" and he confirmed this would be because of the extent of fibrosis seen during the procedure.He confirmed what we know already that it is very common to require a second procedure to close any gaps in the ablated circle around the pulmonary veins.

He didn't talk a lot about risks but seemed to think 1/2 to 1% of patients suffer a serious complication.Also he mentioned that when some extra areas of the heart( in addition to the pulmonary veins) were ablated they have to be very careful so I felt he was saying this was more risky.

We asked about the discussion on the forum about whether you should take extra medication when having Flecanide and he confirmed that you should take , preferably, a beta blocker with Flecanide but if beta blockers don't suit he said channel blockers are also suitable ( check with your doctor before changing anything to do with medication)

Our next meeting is on September 2nd and we have another consultant from St Georges who has kindly agreed to talk to us about 'Arrhythmias and cardiac disease.'

Have a good summer everyone!!


20 Replies

  • Good summary I think Rosemary. As far as I know, NICE guideline is that ablation can be offered when two different drug regimes have failed to control symptoms and when the patient is highly symptomatic. This would tie it with the comments above. I doubt too many GPs understand the full implications of course.


  • Thank you, Rosemary for such a comprehensive review. It answers an awful lot of questions and, in my case, dithering about taking drugs rather than asking for ablation. Good too to have the role of a beta blocker confirmed re Flecainide.

    Have a good summer too.

  • Hi Rosemary,

    Thank you for going to so much trouble to produce such a comprehensive summary. I found it very helpful, especially the details about fibrosis and the milder AF post-ablation. This is my exact experience.

    Very best wishes.

  • Yes, thanks for that informative summary. All information like this is really useful. I may be looking at a 2nd round as there have been a few minor breakthroughs since ablation nearly 2 years ago. At the moment very few symptoms and very short runs (minutes) so ep keeping an eye on this.

    Again, thank you for taking the time to do this.

    Hope you are well


  • I hope all goes well Marie- sounds as if there may be small area that needs filling? This is what Dr Saba expects and made the point that his success rates were for 2 ablations and the 2nd one was much shorter, just to fill gaps

    All good this end- am keeping eye on potassium in food and magnesium and it seems to help a lot!!

  • Thank you so much for reporting back, it has helped to see things more clearly, Much appreciated, Best wishes, Kath

  • Thanks Rosemary. Very informative and helpful.xx

  • Thanks Rosemary. I am taking Flecainide on its own, and Beta blockers are not appropriate as I have lowish blood pressure, was it mentioned what advantage Channel Blockers offer?

  • This is completely counter intuitive but the Bisoprolol I took with Flec helped my low BP. I REALLY didn't want to take it but my GP insisted it would be ok and as far as the BP was concerned, it helped - still had all the other regular issues re breathlessness though.

  • Thanks Cdreamer, my pressure is not low enough to warrant action.

  • I asked about this as there had been discussion on the forum and also our medical director had explained that flecanide on it's own can be dangerous. Beta blockers are best to prevent the dangers( see the link someone posted explaining how flecanide can change AF and the ventricles can bs affected ) but Dr Saba confirmed channel blockers are also ok if beta blockers are not suitable. Do ask your doctor about it but it does look a if flecanide needs an accompanying drug

  • Thanks Rosy very useful, I will discuss with my cardio.

  • Hi Rosemary. Thank you for taking the time to do this for us. Very informative and an excellent précis of the meeting.

  • Thank you Rosemary.....very interesting ! Sandra

  • It's good to know the latest thinking as things change all of the time, thank you Rosy.

  • Thank you very much for taking the time to pass on this information . It had enlightened me further. Mary .

  • Thank you so much for this and asking my specific question. Much appreciated.

  • How do you get to go to these talks ?

  • Thanks for the feedback

  • Everyone is welcome. Details are on website Surreyasg

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