What's the view out there about repeated ablations?

So. It's a long time since I have posted on here. In 2014 I had a successful catheter ablation for paroxysmal AF. I was 50 at the time and otherwise healthy. I have a ghastly suspicion the discoing frogs are back again...... what are people's opinions on having more than one ablation? My EP said if AF came back he would 'go back in again' but I had hoped the results of the first ablation would last a bit longer. Does one ever get to the stage where an ablation nails the problem once and for all or are repeated ablations storing up future problems?

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  • It's a mixed bag and the final course is uncertain. A friend of mine had 5 over the course of 8 years, but eventually finished up with a pacemaker. However he still manages 50 mile bike rides and lives an active life. So it depends how much your af troubles you .

  • Thank you.

  • I've heard a couple of EPs say that they're always very happy when the first ablation solves the problem for good but generally they expect to have to do two or three in order to get complete success. And by success, they mean a permanent end to AF. It isn't like a cardioversion which lasts for a variable amount of time - when an ablation fixes the problem, it stays fixed for good (or, at least, a long period).

    I'm not a medic but the way they explained it was that the first ablation closes off many of the likely pathways for AF. A second or third ablation just closes off any remaining pathways they had missed previously. Additional ablations don't "store up future problems" they just tidy up any leftovers from the first ablation - and the hope is that they'll "nail the problem once and for all",

    Good Luck!

  • Thank you for this. If you don't mind me asking - Were you treated on the NHS? It seems hard to get in the NHS system for ablutions.

  • I think it's a bit of a postcode and calendar lottery - it depends where you are and whether they can find the beds necessary. I, personally, have never had an ablation but my sister also has AF and she gets a pretty good service from the Northern General Hospital.

  • Hi Scottie. Yes some people manage with one maybe two ablations. In my case it took five ablations and i have now been AF free for almost two years. All five ablations were within a two year period. Seemed tough at the time but I have no regrets now.

    Greg

    New Zealand

  • Thanks Greg. Stay well.

  • I needed 2, nothing to add to what is said other than yes, it may be difficult to get into the system for NHS referral of ablation, quite dependant upon where you live. The major centres are much better served than the regions and it is only going to get worse,

    Our region is experiencing difficulty in obtaining funding for more than a few months at a time, the future doesn't look bright for treatments for none life threatening conditions, unless NHS is much better funded.

  • I have the feeling that EPs tend to be cautious and do too little rather than go too far. My EP told me that at the end of my most recent ablation they set my heart into AF twice and each time it stopped right away and he felt that enough had been done. I'm still getting AF however and a fourth ablation has been offered. They have all been courtesy of the NHS by the way TheScottie.

    My ablations have all been fairly short in duration and each time significant progress has been made, although I think the first was no more than testing the water and finding it too hot. I'd not been diagnosed with AF at the time and they sent me home with some flecainide.

  • Thanks Rellim296 - great to hear a good nhs story too. Good luck with your ablation - hope it goes well and the AF is truly nailed.

  • I haven't said yes - so far. I'm sitting on the fence. It would be (hopefully) an improvement rather than a necessity as I am not doing badly. I have some holidays planned and don't want a procedure ahead to mess up the insurance.

  • I had three up to 2008 and have been AF free ever since BUT I do still get other arrhythmias such as ectopics and short (generally) runs of tachycardia which whilst not as debilitating as AF can be irritating. If the EP is prepared to try then why not?

  • Thanks Bob. Sound advice and common sense as always . Thank you.

  • I don't think anyone can say this is it, all pathways have been ablated and you are now cured. Even if you are AF free for a long period it can break through again so unfortunately it is not a cure. However, if the ablation works for long periods (i am AF free since November 2013 and counting) then every day of normal life is a bonus for which I am grateful.

  • My AF was first detected when I was 50yrs old.My Cardiologist tried me with several Beta Blockers over the next five years or so and then Ablation techniques were introduced into the NHS, but not funded in the area I lived in. So my first Ablation was in the Freeman Hospital, Newcastle, 90 miles from where I live. It was partially successful but manageable for about 5years or so.

    During this time from first diagnosis I was in and out of A&E with uncontrollable AF and would spend a couple of days in the Cardiac ward until they realised the drugs weren't helping and the they had to stop and start my heart.

    Eventually the NHS in our area started an Ablation unit and I was sent for another Ablation.

    The Cardiologist doing the ablation asked if I would let him use a new tool which had a larger surface area than the older ones. He then told me he learned his 'Trade' in Paris where Ablations were used more routinely.

    I was fine for about 5 years and then I started having small bouts of AF and mentioned it to my GP who wasted no time in contacting the Cardiac department at the hospital, where I had another Ablation, this is still ok after 7yrs. My medication is a Warfarin substitute and is just a precaution.

    My message to anyone offered an Ablation, is go for it now! My experiences were during the development of Ablation techniques and they only got better and will continue to improve as time goes by.

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