I had my follow up appointment with my EP Cardiologist this morning as a follow up to my last (5th) ablation September 8th.
My visit did not start well as I could not get into the car park and had to park about ½ mile away on a 2 hour parking bay. When I got to the outpatients department I found they were running about an hour late so I soon walked back to my car and moved it into the hospital car park. Not a good start to a heart consultation.
My EP confirmed that, in his professional opinion, had the ablation in September been successful I should have been AF free by now. As I have had 6 episodes with 2 cardoversions in this time and they have occurred at approximately 2 - 3 week intervals the conclusion is that it was not a success.
Contrary to statements made on this forum before my EP consultant stated categorically that, with modern technology, if AF does not stop within 3 months of an ablation then he would not consider it to have been successful.
The options for me are now as follows:
One more ablation (number 6) with only a 25 - 30% chance of success.
A pacemaker and AV node ablation.
Put up with my Paroxysmal Atrial Fibrillation - with an ever increased frequency.
I have opted for one more ablation as I am highly symptomatic in AF and the fact that there is an outside chance this might work for me. Unfortunately, I am not too confident given that non of the previous 5 ablations have been a success.
I am very reluctant to have an AV node ablation and pacemaker as I know that the Atrium will still fibrillate even thought the heart rate will be controlled. I am also concerned that with my immune system being so sensitive there could be a chance of an allergic reaction. I am concerned that as there is no way back from this procedure and that, should I get a reaction, this would result in a living hell. The doctor did, however, say that he was unaware of anyone having a allergic reaction to a pacemaker. I will have to think long and hard about this option.
Interestingly he said that should I eventually decide to have the pacemaker then they would install the pacemaker first and not do the AV node ablation until about 6 weeks had passed and the effectiveness evaluated.
He also advised me that the conduction within my heart was not as he would like and that I may well need a pacemaker anyway to control my normal heart rate in the not too distant future. This was a bit of a shock. He has taken me off Bisoprolol as this drug slows the heart and my heart is not fast enough anyway. I have been taking Bisoprolol for about 20 years combined with Flecainide.
Apparently the 25 years of AF I have suffered has resulted in heavy scarring of my heart. I thought this note on my previous discharge letter was referring to the scarring caused by the numerous ablations but apparently this is not so and it is scarring from having so much AF over the years.
I am now running out of options which worries me as I am so symptomatic when I go into AF and during these episodes life becomes extremely hard.
I asked about the two 'new' procedures:
1. Low-Level Transcutaneous Electrical Vagus Nerve Stimulation. This is still in the evaluation stage and it is very early days and is not an available solution.
2. Removal of the nerve endings in the heart. This is the procedure pioneered by Dr Sabine Ernst. My EP told me that this is not a common procedure yet and that this procedure is also still in the evaluation phase.
Well there you have it.
My knowledge has increased but sadly all the many hours in the Cath Lab has not yet given me the peace of mind I have wanted for so long.