Ablation or not

[higgy52]

I am in AF 24/7,  had 2 cardiovestions both only lasted couple of hours, Had AF for years, spoke to EP and he said only 1 in 4 chance of it being suscesfull, does any one think its worth having done, and if it don't work will it make me any worse as AF not to bad, just fed up taking all the pills and side affects. Thanks

[PeterWh]

Personally I would go for the ablation. As has often been said on here AF begets AF. Also long term effects of the drugs is a consideration.

I was in persistent AF and had been for some time. My EP said in MY case zero chance first time but hoped I would last 6 weeks (he brought forward 3 month review that is normally the case). I had an ablation.  In the event I lasted under 72 hours and went back into persistent AF. However overall (after a few months) my situation was better than before and some things much more stable.  Some people on here have posted that their symptoms were worse, but I don't recall details except that I seem to recall one person was in persistent AF, had the ablation but then after a period of time had paroxsymal AF episodes or attacks and found them worse. Others have had a second ablation. I am waiting for my second one but delayed because of heart valve issues. 

[Hidden]

May depend on why he thinks you have 1/4 chance of success. I did not have a high chance of success due to fibrosis (something tracked more in US), but I have not had any episodes for 10 months. Still take diltiazem and Xarelto, but able to stop flecainide.

[Barb1]

I would be inclined to seek another opinion. It would be good to have an EP who is perhaps more positive about the outcome.

[PeterWh]

For someone in persistent AF the chances of success first time are, I believe, 25% to 30%. Some quote 1in 3 which is 33%. Therefore EP's number is right in the band. You could look at main AFA website, NICE, and other UK websites.

[Rellim296]

Whilst success is obviously the main goal - we all want to banish AF completely - surely it can be worth having an ablation that may bring about an improved situation (and perhaps the opportunity to give up some medication) even if total success is not that likely to be achieved.

[MS444]

I only had PAF. Not nearly as bad as persistent AF. I think the odds are very misleading. Everybody is different so you never know whether 1 in 4 means it will succeed or fail. The odds of an adverse complication are very low. Less than 5% or 1 in 20. You have to decide, but doctors quoting odds can be misleading as only you can take the risk. Also, the odds of being worse off after the ablation are a different set of odds than the odds of an adverse complication. So you need advice on this. I've never been able to find odds on this.

[cbsrbpm]

I really think we get too bogged down with odds and statistics. You need to asses how you are feeling at the present time and your quality of life and ask yourself if you are happy to carry on as you are or not. I too was in persistent AF before my first ablation last September and I returned to persistent AF in February. I am on the list for a second as I feel my QOL at the moment is unacceptable. Hope all goes well.

B🐝

[Geza10]

if you feel well i would not have it done i had one ablation lasted year i can still do sport not as good but i am happy with that they wanted me to have a 2nd one said no hope you make the decision you want

[JonathanPittsCrick]

We have only had AF ablation (pulmonary vein isolation) available for a few years and before then AF was still treated so the options aren't just [ablation-or-nothing]. The real question is how bad you feel with the AF and why.  

If you feel OK you ARE OK (provided you are on anticoagulation) so ablation isn't needed – and it does carry a significant risk of complications. Many people feel fine on regular medication to control the rate.

If you felt much better when you were in regular (sinus) rhythm or you get bad side-effects from the drugs controlling the AF rate then ask your EP doc about a pacemaker and AV node ablation – which is much simpler and has a nearly 100% success rate (first go and long-term), and provided the pacemaker is adjusted properly should make you feel as good as when you were in normal rhythm (you still need anticoagulants though).

[dedeottie in reply to JonathanPittsCrick]

A very informative and positive reply. I keep reading that long term av node pace and ablate can cause heart failure unless a dual chamber pacemaker is used. If that is the case ,are those pacemakers used as standard practise now? We all want to avoid the possibility of heart failure so it would be good to know. Thank you for keeping a knowledgeable eye on us all.

[JonathanPittsCrick in reply to dedeottie]

Yes there is an issue that a heartbeat caused by a pacemaker is not quite as efficient as a normal natural one but that only seems to be a problem if:

1) you are a child and the heart is still developing

2) your heart is already damaged by some other disease (cardiomyopathy or previous heart attack).

If either of these situations applies you could have a bi-ventricular pacemaker (one that stimulates both sides of the heart, also called CRTP - cardiac resynchronising therapy pacemaker) which is a bit more fiddly to put in but nowadays quite routine.

If you do have a standard pacemaker and then develop heart failure the pacemaker can be upgraded to CRTP.

Some people with AF don't have normal beats naturally (if they have LBBB – left bundle branch block). They are better off with a CRTP than their natural beats if they have heart failure so for them pacemaker and AV-node ablation is actually better than the complex and unreliable PV-isolation-type ablation.

[dedeottie in reply to JonathanPittsCrick]

Thanks so much for that, it is really helpful information and has helped me to rationalise a few things.

Jane

[squady in reply to JonathanPittsCrick]

hi jpc ,im in total agreement with you, after a lot of thought and help from this site I want the pacemaker and ablation I'm getting short of breath from copd bronchiectasis and pav one to many in my books trouble is I have to wait till September for the meeting

[JonathanPittsCrick in reply to squady]

Hi Squady, the breathlessness from COPD is often caused by disordered breathing which you can quite easily learn to control. If you send me your email in a private message I'll send you a leaflet about it.

[squady in reply to JonathanPittsCrick]

hi again jpc that's a kind offer but I have acute bronchiectasis a 2/3 rd right lung lobectomy and last but not least paf which will not respond to drugs I have just got back from the quacks after being tod they have withdrawn my backing for a second rehab as the situation is deemed to dangerous

[RichMert]

Hmm, I believe the success rate on first ablation is 70% or higher. To my knowledge the EP will tell you that there is a good chance that you will need a 2nd or 3rd ablation.

Sounds like the statistics need to be revised.

[PeterWh in reply to RichMert]

Belated comment. Look on the AFA website under publications and also the slides from the 2015 patients day in Birmingham. You will see that the success rate varies from circa 25% first time for those in persistent AF, I think 60% for those with occasional paroxysmal and 90% (though one EP quoted to someone on here 95%) if have flutter.

Within each category it depends on the severity. In MY case my EP thought that there was 0% (ie NO chance) that an ablation would work first time and that it would take 2 or quite possibly 3 attempts. However I still went ahead with one. MY EP brought forward the post ablation consultation from the usual 13 weeks to 6 weeks in the HOPES that I would still be in sinus rhythm at that point so that he could get an echo done in NSR and examine me. In the event I lasted just under 72 hours but I am on list for a second ablation.

[JonathanPittsCrick in reply to RichMert]

"If at first you don't succeed ... re-define success!" – the politicians' motto.

I think most people would count success as not having further attacks of AF for at least a year or preferably long-term, and not needing to take drugs. Only the most enthusiastic (wishful thinking) EP docs would claim that result in 70%+ first attempts – and even then only with paroxysmal AF (i.e. not requiring cardioversion).