Route to Ablation

[Alan_G]

I am encouraged by the apparent number of success stories reported here with regard ablations. What is the usual route to having one though? Does your GP need to agree to send you to see an EP and if he/she recommends an ablation, then you are put on a waiting list, assuming NHS. Are you guaranteed to get the EP for the procedure that you saw for the consultation?

If you get the consultation privately, can you by-pass the GP in the first step?

I was lucky enough to have Private Medical Insurance through my job when I had my consultation a couple of years ago (through my GP) and I got the impression I could have picked my date if I'd been recommended to have one there and then.

Is there generally a big waiting list for the on the NHS and are GPs being 'pressured' to try and keep patients on pulls instead to keep the costs down for the NHS? At least my GP has on record from the EP I saw that I am a future candidate for one, so hopefully that will help.

Sorry so many questions, but fore warned is fore armed.

Alan

[BobD Volunteer]

An interesting conundrum that.  A recent video from Prof Schilling showed that ablation is only  available for improvement in quality of life. He stated that it   is not a life saving procedure and that if drugs are working to control the AF then ablation may not be offered.

On the other hand, NICE guidelines are such that if diagnosed by your GP, you must be referred to an arrhythmia specialist within four weeks although that specialists could be an arrhythmia nurse consultant . The usual route is diagnosis in A and E followed by referral to a cardiologist (not an arrhythmia specialist ) who will prescribe drugs , most likely bisoprolol to keep your heart rate down during events, hopefully asses you for stroke risk and prescribe anticoagulants if appropriate , maybe do the correct ECGs and echocardiogram tests plus bloods to check for thyroid problems and then discharge you back to GP. At this point if your symptoms continue to be problematic than you can demand to see an EP.

Many people short cut this by a private  appointment with an EP of their choice although sometimes a GP referral is asked for at that time.  The EP may not decide that ablation is appropriate although it has been said that if you go to see a carpet salesman he will sell you a carpet. Many here have taken that route and then gone on to have ablation on NHS . Waiting lists vary greatly throughout the UK from three months to six or even a year in some places.  When I had my first there was a legal maximum time between the EP agreeing to do it and the actual procedure which I think was six months but that may just have been that hospital. In fact for one of mine the EP actually rang me and told me I had to be with him by the next Wednesday or I fell out of the system and would have to go onto another EPs list. I was there !

NHS states that care should be patient centred so in theory doctors can't refuse on cost grounds. Not everybody is suitable for ablation nor apparently wants one judging by our members. 

Hope those facts help.

Bob

[Alan_G in reply to BobD]

Thanks for the detailed response Bob. I've been through all those initial steps and so appear to have gone through the system correctly so far. It also re-assures me that the relationship with my GP is working at the moment. I'm now in the "let's wait and see how this develops" category. Apart from the sheer annoyance I feel when an episode starts it really isn't giving me much grief at the moment and so I guess they'd be reluctant to put me forward for an ablation at the moment.

With regard bisoprolol, I understand the bit about it keeping the heart rate down during an episode. My ECG the other week during an episode recorded a rate of 74. However, I was under the belief that it was also meant to help prevent the onset of AF by blocking adrenaline or something. Is that correct or does biSop do nothing to prevent the onset of an AF episode?

thanks,

Alan

[Buffafly in reply to Alan_G]

Just a short addition to Bob's excellent summary - QOL covers unacceptable side effects from drugs as well as the effects of AF. Also an ablation may be offered if the drugs cannot be used safely eg I was offered an ablation because Diltiazem was slowing my heart too much generally and causing pauses when my heart went into quick/slow mode occasionally.

Also in that case my cardiologist and EP decided between them that ablation was the the only way to go so I never had an EP consultation at all!

[BobD Volunteer in reply to Alan_G]

It may well slow adrenaline but that isn't why AF starts so it has no anti- arrhythmic qualities to speak of. For that you need something like flecainide or propafanone. Bisolprolol is purely a rate control rather than rhythm control drug.

[Barry24 in reply to Alan_G]

Hi Alan,

BobD is absolutely right in that beta-blockers have no anti-arrhythmic qualities.  However in people with paroxysmal atrial fibrillation beta-blockers may assist in maintaining the normal rhythm or even assist in returning the heart to its normal rhythm.

Kind Regards

Barry

[Sebhel in reply to BobD]

Thanks, Bob, for helpfully addressing most of my concerns and helping us understand

Thanks everyone for sharing and being helpful with experience and info

Best wishes and more to all 

Seb