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Cardio version / ablation

Good morning ,AF friends, reading all the comments, can somebody explain how the doctors choose cardio as oppose to getting Ablation, I am booked in for Cardio after coming home from Malaysia,to me reading this site, ablation sounds to be a more permant result? ...

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Hi Harrycat

Yes they are completely different, cardioversion (CV) is a minor procedure albeit with a general anaeshetic in which they shock the heart back into rhythm, whereas ablation is a more involved procedure in which they usually insert a catheter into the groin and then up into the heart, and then make scars trying to put the electrical pathways back in order and restire NSR.

CVs seldom last too long, unless you are very recently into AF and usually also younger, but they do give an indication of how easily NSR can be restored.

But you need to think about a treatment pathway ideally, it's likely to be a series of procedures maybe CV and then several ablations to get everything covered. Your Electrophsyiologist (Not cardio please if you are with a cardiologist ask to see an EP) should explain all this to you.

Be well

Ian

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Cardioversion is sometimes offered so that a patient can see if they feel better being in sinus rhythmn ( for those who get no symptons with AF) as it then is easier to see if ablation would be worth the risks attached- as ablation may well last longer than cardioversion but may not completely stop AF.

It's best if you discuss the options carefully with you doctors as each patient is different so you may have personal factors which led to this advice

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OK this is easy. When people first present with AF and drugs do not help it is common for cardioversion (DCCV) to be tried. This shows doctors if you can or can't be put back into NSR (normal synus rhythm). For some people who have their first event , perhaps due to binge drinking this can work for some time, even many years. IF the DCCV fails to do this then one would be considered to be permanent AF . If NSR can be established then it does show that an ablation may be successful even if the DCCV fails in a very short time.

The other point to remember is that there are not that many electrophysiologists about so in many cases you will only see a general cardiologist who either does not do ablation because he is not trained in electophysiology or who doesn't want to pass on your case to one who does. I know of some general cardiologists who seem to think of EPs as something from the wild west to be avoided at all costs and yes it is really quite new science.

Regarding ablation, although a great fan of this I have to warn that in many case several attempts may be needed to gain full control (in my case three) although many people do get greatly improved QOL after the first procedure.. Long term data is still hard to find but I understand that fifty percent of patients with successful ablations may have a return of AF within five years. I'm now at seven and every second has been worth it. I would go again at the drop of a hat should I need it and my EP be prepared to perform it.

Hope that helps.

Bob

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Yes Bob, it is, I leave on Thurs for 3 weeks in Malaysis, hope not too many AF episodes ! Will be drinking gallons of water, that seems to be essential temp there 40 deg.....

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Presumably you have your warfarin sorted and your INR in range? This would be normal for a DCCV.

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Yes Bob, have been on Warfarin for 7 years, I am on 2 mg, INR's range 2/3, I also get it changed in Malaysia, with the difference 7 hours difference and 13 hours flight, it's difficult to keep to the normal time here for medication. My son lives on a golf resort, and there is a doctors surgery in the clubhouse, so go my blood checked every week, and adjust my Warfarin when needed.thanks for your prompted reply, mich appreciated.....

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Hello Bob, when I asked my GP is there a EP or nurse in my area, she looked me gobsmacked, she hasent heard of one! Being a GP, you would expect them to have access to this, but apparently not!!! Thanks.

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Is there a list available of experienced EPs who have successful performed Cather ablation for AF ?

Many thanks

Susie

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If you go to the main AF Association website there is a list under Patient Information of EPs by area.

Bob

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It does Bob, you always give the answers when needed, but I don't think there are EPs in Aberdeen, it's always been the cardiologist or his resident. When I asked my clinic doctor about EP, she looked vague, and almost dismissed it, so I was left thinking I was a bit stupid so just dropped it. Appreciate your information.....

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Cardioversion can be chemical or electrical, very different from ablation. Complex algorithm when deciding if/when for ablation. Seems to be a fine line between trying a few meds and seeing if this is sufficient vs. someone in permanent afib who waits years to try ablation. There is a theory that cardiac MRI can measure how much atrial fibrosis and be categorized into four classifications possibly relating to potential ablation success. This is out of Utah CARMA facility. I only had a moderate prediction of success, but my EP is internationally-known and has done hundreds of ablations. He differs from some cardiologists, believes I would have been in heart failure in 10 yrs. if I relied on meds and skipped ablation. Heart fine so far 3 1/2 wks. post-ablation. Able to stop flecainide.

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Hi Harrycat. I had 2 failed cardioversions as the cardiologist/electrophysisist wanted me to experience how much better I would feel before I had an ablation. He has now decided that I should go ahead with the ablation which I am doing in a couple of weeks and I am hoping it will work and I will be pleasantly surprised at the improvement in my quality of life. I really want to get off at least some of the drugs I am on.

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