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AF Association
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Difficulties with ablation

I recently underwent an attempted ablation at one of the UK's most famous cardiac hospitals. The insertion of the catheter went well and the EP managed to get it into the right atrium. However he had to abandon the procedure because he found my right atrium was enlarged and he could not navigate the catheter through to the OS and into my left atrium to reach the necessary place to allow ablation to take place. Instead he did a cardioversion which did stop my AF for a whole day! He initially said that ablation of the AV node was an alternative option, but when I visited him a month later he dismissed this saying it would not have any effect on my now persistent AF- a view confirmed by my cardiologist-but no real explanation has been offered for this and I am now somewhat confused, and feel I'm being fobbed off. Any one who has had a similar experience may be able to advise.

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Sounds like a possible run around. Now that they know your cardiac anatomy is problematic they are gun-shy. If it were me, I would find another electrophysiologist, if possible, for a second opinion. I know that may be hard but you are not the only patient who has ever had this problem and, IMO, if they are part of this famous hospital difficult patients should not faze them. I would continue to look further for answers. It may be that the surgeon is hoping you will go elsewhere for answers as a result of his comments and remove the problem from his operating table. Your experience makes me mad because in today's surgical world there are instruments, catheters, equipment, etc to deal with all types of patients, unusual problems, difficult anatomy. I hope you will find an answer elsewhere very soon. And I'm sorry this is so stressful for you. If it were me and he did come up with another solution I'm not sure I would still want him for my doctor. He seems to have a case of "it's not my problem or my heart." Sorry to be so adamant but I don't care for his cavalier attitude. Take care. irina1975 P,S. Maybe this is a blessing in disguise and you will find someone who helps you medically in a more successful way.

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Pace and ablate does not stop AF. All it does is stop the AF from being transferred to the left ventricle and hopefully via the PM ensure a steady ventricular rate at the expense of being PM dependent.

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Bob, if navigation is a concern, isn't there a way of performing an ablation via a different route??

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No. Only option would be open heart maze procedure. In order to access the left atrium one needs to go in to a major vein such as femoral and navigate to the right atrium which is where all veins end up. Then by puncturing the septum between the two atria one gains access to the left . If there is a problem with the septum then you can't do it.

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glad ours were straight forward then

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Oh dear, this sounds like my predicament in many ways. My second ablation was abandoned as the EP went into my aorta instead of piercing the septum between left and right atria. I spent 2 nights in ccu while they waited to see if I would have a massive bleed. A senior cardiologist who came to do numerous heart scans during the night ,said it was just human error ( I dont have a problem with that, doctors are only human after all.)but there was a slight possibility that my aorta was in a slightly different position to normal.

My EP will now not consider another ablation should it be needed.

At Patients day I sought other opinions from eminent EPs who said that they would do it for me under GA so they could put a camera down for extra guidance. Unfortunately I live in South Wales and NHS Wales will not pay for me to have it done in England as it is not a life saving operation.

Even if he changed his mind I would not feel confident for him to do it so it is a catch 22 situation.

My AF is well controlled at the moment so I am trying not to think about it but I know there may come a time when pace and ablate is my only option so I would hate that option to be taken away.

It may be worth requesting an appointment so you can sit down with your EP and get some questions answered it isnt good enough to leave you not knowing what his long term plan is .

I must admit that in my case I do feel that my EP doesnt want negative statistics!

If your persistent AF is the kind with a high heart rate , it would be worth getting a second opinion at least.

Good luck x

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Second opinion. New Doctor. Good advice. This guy is just one opinion. Also there are many degrees of human error. I wouldn't place your experience on the same level as missing an IV vein.JMO! irina1975

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How did someone perform your first ablation if it is not possible for your EP to perform a second?

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Exactly, my feeling exactly! The first was performed by a visiting EP . My own EP did the second and he is the lead consultant who makes the decisions I guess. The first one was infact partially successful in that my AF is under control with reduced medication. X

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If you are at one of the UK's most famous cardiac hospitals and you have complex problems your case will be brought before the Multi-disciplinary team which includes the other EPs on the cardiac team. Your case should be fully discussed and a common agreement formed as to how next to proceed with your cardiac problem. This happened/happens to me as my heart has been a pain in the ass and I have been reassured by the amount of clinical input I have received at one of the country's most famous heart and lung hospitals. Why don't you call up the AF nurse at the hospital and talk it over with her and ask if there has been an MDT meeting to discuss with other clinicians what can be done for you. It may also be a case of fools rush in where angels fear to tread. I do wish you well. It is a worrying and frustrating situation and I do feel for you. Take care and please let us know how you get on. Anne.

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