Heart cat scans after ablations as protocol???

I recently read a couple of posts here on the afib forum in the states that said at 2 of the leading hospitals for cardiac care that as a matter of protocol 3 months after ablation the patient returns and has a cat scan of heart done to check for pulmonary vein stenosis that can happen up til 3 or 4 months after ablation without having any symptoms. Does this sound like a bit of overkill (pardon the expression). . I had my 1st ablation at a top hospital here and this was not ever mentioned to me. I would think one would have plenty of symptoms before ordering such a test. Any feedback on this? I have never read any such practice where you all are across the big pond.

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  • Eliza2 I am in the states and had my first ablation on June 30 this year. I had a phone checkup last week and will have my 3-month appt on Sept. 30. Nothing has been said to me about a CAT scan.

  • Never heard of it tbh. Usually do an echo during or immediately after to negate bleeding into the sack around the heart, the pericardium. I would imagine you have had one previous in the build up to ablation to rule out causes etc. I wouldn't expect another.

  • My cardiologist wants me to have an ablation but I am to frightened I am taking warfarin and don't want to come off it for the surgery I have had af for 15 yrs a had a Tia 2years ago th stroke doctor told me that I should of been given warfarin when my af was diagnosed I mentioned this to my cardiologist he just said well your taking it now so I really don't have any trust in him

  • Get an ablation if it's offered it can greatly reduce or even stop your Af(not cure I'm afraid) and you DO NOT have to stop the warfarin for the procedure...at least I didn't have to just had to keep INR no higher then 3. Good luck and I wish you well!

    Chris

  • Again I did NOT stop warfarin and they would not of done my ablation if I had stopped warfarin. In my case they wanted the INR range to be 2.5 to 3.5 on the morning of the procedure and in the three weeks previously.

  • I turned down an ablation last year as I was not taking warfarin at the time. The EP said it did not matter and they would still do it. I said No thanks. When I told my GP he said that he had never had a patient have an ablation without being on it.

  • Someone I met said that years ago they did stop warfarin a few days beforehand (probably 5) and he had injections but not sure if it was heparin or clexane or something else.

    BobD will probably enlighten since all his ablations were years ago.

  • Hi

    I was kept on Warfarin throughout my ablation din't miss a dose/day and my range increased to 2.5-3.5 (from 2-3) for the 4 weeks pre and post ablation; no lower than 2 no higher than 4 on the day. If you have been offered an ablation and want it I wouldn't see this being an issue.

    Jo

  • I had my second ablation on the 30th June and not had any appointment date or phone call. Val

  • Never heard of it in UK, but then I would imagine that NHS would not pay for any investigations or tests that were not absolutely necessary - i.e.: for diagnosis after showing symptoms or life threatening trauma.

  • Call me a cynic but sounds like overkill and a chance to make money. Never heard of this in UK where treatment is seldom cash driven.

  • Yes, I'm in the UK (Newcastle) and I am having a CT coronary angio to look for pulmonary vein stenosis just as you mentioned. In fact I'm having it on Tuesday. I had an attempted one a few weeks ago but my HR wasn't slow enough for them to visualise the vessels. (Often have to be given extra beta blocker or gtn during the procedure). Apparently it's rare, but unfortunately it does happen and particularly if they have ablated a large area (like in my case) and around the coronary sinus. I'm hoping against hope that it is normal as I can't cope with yet another complication but will just have to wait and see.

    R

  • Sorry it's the posterior descending artery they are particularly looking at. A small % (I think around 4/5%) of people do get stenosis which can then lead to angina further down the line.

  • Did you have symptoms? Was there a particular reason why they are giving you the test?

  • Is stenosis going to show up that soon after an ablation??

  • My ablation was 6 months ago. I'm still awaiting a third one potentially. So the timing for CT cor angio is about right. Massive dose of radiation though which is also a consideration in all this and would go against just screening everyone especially if they are completely asymptomatic.

  • I e never heard of anyone having a cat scan after ablation unless there was another problem they are looking for. My daughter worked in the heart center for 8 years. She has never heard of it either. Get second opinion.

    Good health to u.

  • Rachel, why are they doing the test? Are you having symptoms or is it just routine?

  • No routine CT scan after ablation here in Germany as far as I know.

  • Thanks nettecologne one reads so many things on forums it can make your head spin.

  • Eliza, I know that there is a small risk with every ablation of this happening, over here you have to sign that you were told about this (amongst a heap of other risks). But when I asked about this they told me in front of witness (yes, I found this is important) that they did not ever have the stenosis in the hospital I had the ablation done. So should be rare then (one hopes).

  • Yeah. U sign your life away, but let me tell u. They chipped 3 of my teeth during my ablation and that is on the consent that it "could" happen- but it doesn't say they don't have to pay for it anyway. I am going to Refuse to pay my anesthesia bill down to the cost of what it takes to get my teeth fixed.

  • I had some intermittent chest discomfort post ablation and PM insertion which I put down to the pacemaker leads and I'm still breathless on exertion but then I haven't done any form of exercise for over six months and also just to complicate things, my pacemaker is set slightly non physiologically which we think also exacerbates my breathlessness. Anyway once the possibility of angina had crossed my EP consultant's mind, (although he admits that he really doesn't think that this is likely) because he had ablated such a huge area he wanted to rule it out once and for all. He didn't want to put me through angiography so an alternative is the CT version of it as a non invasive option. There are several case reports on this risk but I had never heard of it so confess was surprised when it was mentioned. Apparently not everyone is symptomatic but clearly screening everyone post ablation would be impossible so probably in the uk it is done based on suspicion or wanting to rule it out.

    Hope this helps somewhat.

    Also am genuinely hoping that my scan will be ok...

  • Had my ablation in March and no one ever mentioned a ct scan post op. I have had my follow up and told to see the doctor in a year for checkup but nothing else.

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