I 'm trying to make sense of what I read in a number of posts about ablation compared to what I am told cardiologists and EP. I have read postss that indicate people have had ablations and come off all types of medication. Ablation seems to be described as a cure.
In my search for clarity I have moved from Welsh NHS to England . The picture I have is that ablation can reduce symptoms but does not eliminate risk of stroke.
I am interested in the views of other folks as I have discounted ablation and also found that drugs do not control arrythmia. Just therefore taking blood thinners.
kind regards
I am not
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There are different types of ablations for different types of arrhythmia. There are also different types and sources for AF.
The stroke risk aspect is completely different. Some people have successful ablations which stop arrythmia. However it appears that current thinking of many EPs is that the stroke risk of someone who has had AF does NOT drop back to that of a normal person. However there are definite studies.
Hi thanks for your post . I think I can live with symptoms but the issue of stroke risk to me dominates the decision making as ep emphasised that there could be risk of damage resulting from the ablation procedure .
Ablation can be an effective way of reducing or removing symptoms BUT it must be viewed as part of ongoing treatment. If like me you get seven or eight years symptom free then it is a good result although I do have other arrhythmias, just not AF thank goodness. Cure is an emotive word and frankly I wouldn't use it. Richard Schilling stated recently that there is no life benefit in ablation other than stopping symptoms if drugs can be used instead. Many people find the drugs ineffective or unbearable and for those we have ablation.
You are correct in my view in thinking that ablation does not remove stroke risk although there are some doctors who would not agree. The general consensus is that the risk remains due to changes within the atrium causes by both the AF and also the ablation process itself. It is for this reason that many propose continuation of anticoagulants (not blood thinners please -- they don't) even after successful ablation. People are quite at liberty to ignore this advice as many here do but as I always say, you can always stop anticoagulants but you can't undo a stroke.
I have just been watching some U Tube clips with Richard schilling and in one he says that ablation is a cure. it is from 2010 maybe his opinion has changed
Look in most dictionaries and you'll see 'cure' defined as "successful remedial treatment; restoration to health; a means of correcting or relieving anything troublesome or detrimental:
It doesn't say it has to last for life! A cure can be just for Christmas or two...
As a teenager I developed pneumonia. Thankfully, I was cured. But that doesn't mean I will never get pneumonia again, does it? Why should AF be any different?
I used to have paroxysmal AF. From time to time, though increasingly more frequently towards the end, my heart used to beat irregularly and this brought all sorts of nasty symptoms because hearts are supposed to beat a regular rhythm. My body just wasn't getting the proper amount of oxygenated blood it required. Breathlessness, tiredness, lethargy and various rotten feelings we can all relate to. It was also doing physical damage to my heart , albeit slowly, by increasing the size of the left atrium.
I had an ablation a year ago and my heartbeat has been entirely normal since. As a direct result of having a normal heartbeat , all - yes all - the nasty symptoms have disappeared and there is no further damage being inflicted on my heart - in fact it seems likely that my slightly enlarged atrium may well be repairing itself and returning to normal size.
How is that not a cure? Of course it's a cure. Will I ever go into AF again? I hope not but I might and if I do, I'll have another ablation to cure it again. Because being cured of AF is absolutely fabulous - everyone deserves it.
There's ongoing debate about the hidden risk of stroke and whether a return to a steady heartbeat really does reduce what was an enhanced risk. Intuitively, one would imagine it would but until they get to the bottom of that I will keep taking the anticoagulants (apixaban) - and why not? Life's wonderful now - why risk having that taken away?
A very well put together post but there are some flaws. I would put together a more detailed response but I am in hospital and restricted to my iPhone.
A dictionary definition is per se a general one and not specific to a procedure or type of procedure. For instance using the definition above it would probably be the case that 99.9% of all DCCVs are successful because the person is returned to NSR. However the reality is that over 90% are classified as being a failure because the person lapses into AF some minutes / hours / days / weeks later (or it is not a treatment). Similarly using the above nearly all ablations are successful first time. This is not the case!!!!
The key element missing is duration and then also QoL.
Got blue lighted on Monday lunchtime. So far tests inconclusive but couple of other things surfaced and I did pass out after blood taken. Mind you I have had weekly tests for 16 months!!
I will post in the next few days when I get home to seek thoughts from you all.
Hi thanks for this and your analysis to include duration and QOL. I suppose what I also bear in mind is that there is a risk to ablation. This is a procedure which EP was clear to emphasise could go wrong , and I do find that this bears down on my assessment of whether procedure is the right way to go for me.
Look at previous posts and in particular the comments made by BobD volunteer where he states that the risks that are highlighted are made to cover themselves in the very unlikely event something happens. Also look at comments re statics and how conservative they are in medical situations (I have made these as well as others).
thanks for your thoughts on this matter. You certainly which make a powerful argument for ablation. I also appreciate your views on continued use of anti coagulants.
If you think about it we're all ill constantly but our white blood cells deal with it. Ablation may not be a complete cure but it's usually a very good way of reducing the problem to a similarly unnoticeable level.
Similarly everyone is at risk of stroke, but the more regular the heart rate is obviously the less chance of a clot appearing.
I think you may have gathered by now that the issue is about as clear as mud.
I believe there was once a medical definition of 'cure' as a treatment which allieviated the illness and which did not recur within 5 years?
There are no guarantees with any treatment - always a risk:benefit - would you be better or worse with the treatment? is, I find, a more useful question. I was worse after the first but 2nd eliminated AF but the treatments I received aggrevated a latent condition, but still very grateful to have had the ablation and don't miss the AF one little bit. I came off ACs but will go back on them next month because I will have reached the magic age 65 which increases my risk factor for stroke and probably then stay on them for life.
Peter - sorry to hear you are in hospital, can't think of a worse place to be when you are feeling rough but hope you get some answers and back home soon.
Hi thanks you for this post and the formulation of the question. Your comments are helpful in considering the balance between risk and benefit but also highlighting that there are unknown unknowns in this scenario. I am not clear why 65 is such a significant age .It is on my mind however as I have a few but not many years before I hit this. Is this based on stats?
As commented in many previous posts it is an arbritary number and is not absolute for every individual. Therefore for some it will be earlier others later. Otherwise it would mean at 64 years 364 days 23 hours 59 minutes 59 seconds zero and then 2 seconds later the score goes up to 1 for a man. There just has to be some sort of rule as the age of a totally personal assessment is years away. However if there is another factor then some will recommend Anticoagulation anyway. If you look up NHS England you can still have anticoagulants if score is 1 (or even zero).
Still in hospital. Unfortunately laboratory messed up test by exposing to sunlight and another cannot be taken. Going to do an alternative today. Thanks for asking.
Well I was actually very calm and collected when the doctor told me. I could tell how frustrated he was but there was nothing that could be done. As he said a lumbar puncture done for nothing is frustrating.
It is the age and it is the stats. All risk factors are based on 'herd statistics' i.e. - how many percentage people with these risk factors would have a stroke - on the CHADSVASC2, which is the latest scale analysis, you gain a point for reaching 65, I am female so I now score 2 points 1 for being female with PAF + 1 for age.
0 means Anticoagulation is optional, 1 = optional but advisable, 2 + = advisable. This is always set against the HASBLED analysis which calculates your risk factors for an internal bleed so that people with high risk factors for internal bleeds are often not prescribed ACs because that risk is considered a higher one.
There is a link on the AFA site which enables you to score yourself on both analysis.
Hope that helps your understanding, please keep asking questions, there is usually someone here who will try to help but also do your own research and keep reading.
Hi thank you for clarification through your reply and the encouragement to continue to ask questions . That is possibly the most useful comment /advice of all!
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