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AF Association
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To have or not to have Ablation

Hi everyone, had a letter from Cardiologist today re my ablation. It tells about 70-80% chance of success with a 1:20 Chance of major complications. 1 in 20 does that mean then that in 100, 5 get major complications. I still can’t make my mind up whether to stay on meds and only have ablation if I am desperate. What do you all think. I know everything comes with a price but if you could stop things taking place in the first place wouldn’t we be better off? Meaning if all these things might happen why take the chance if you know what I mean.

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I thought I was happy on meds until I had to have an ablation (other option pacemaker + meds) but in spite of minor complications I was very pleased with the result. My AF has returned after two years but much milder than before and I'm on the lowest dose of one medication so far.

Nobody can tell you what your decision should be, you have to weigh the risks against being AF and pill free (hopefully) 💓 / ❤

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Just remember that doctors tell you all the bad things so you can't sue them . I had three ablations before my AF stopped and would have another tomorrow if needed . I always tell people it is a risk/benefit equation and the only correct answer is what it is right for you. I also say never look back and say what if.

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I am most surprised at the statistics of complications your EP has quoted.

I have had 7 ablations with no complications whatsoever and like Bob I would not hesitate to have another one tomorrow if it were necessary.

Whilst part of the message your EP is giving you is to cover himself and to avoid litigation, I would at least ask him to justify those statistics. If necessary get a second opinion.

I am 99% certain I was told 1:1000 and when I probed further I was told that the statistics were global and that at my hospital the incidents were even more rare.

Having said all that there is no certainty either way but in my opinion ablations would not be carried out so regularly if complications were that common.

Pete

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Funnily enough I thought they sounded rather low. X

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I must say that when I first read your post I thought that the stats were very high!

You've obviously been given the top end . It depends who performs the ablation and where.

I had my first ablation in 2009 and guess I must have seen figs like that then as i was very reluctant to proceed . I've since had 2 more with same EP and on the list for a 4th with same guy whom I have complete confidence in.

I understand your reluctance . I was having more frequent bouts requiring ' emergency ' DCCV s and then a bout of heart failure. It was my cardiologist saying to me that I ' would not prolong my life by not having an ablation ' that made me agree to a referral.

If you feel quite happy to stay on your meds and your life is not greatly affected then do not feel pressurised. Sometimes drastic lifestyle changes can make a difference ( i.e. if you haven't already gone down that route)

Sandra

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I have only recently had the conversation with my EP and the 1:1000 stat he told me was death, not complications

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I was taken into hospital by ambulance 11 times from last October to Christmas with a Tremendously fast irregular heartbeat. Atrial fibrillation/flutter. Had to go on Rivaroxaban for a cardioversion, but then hospital error and it wrecked the cardioversion. Was on bisoprolol, losartan, furosemide, and levothyroxine but hospital added flecainide and that one drug was Amazing from Christmas onwards I felt great then time for an ablation came in March and I asked if I actually needed it as I felt so well. I was told yes I did. So took hospital advice and had it. The consultant wanted me to come off the flecainide as obviously didn't know if the ablation had worked. I have felt awful since. Not the terrible fast uneven heartbeat, but almost constant palpitations, tired, weak and generally not well. I have been back on to the hospital, but consultant on holiday for a few weeks. No one else has come back to me despite three emails

So in answer to your query gillybean, you make the decision for how you feel is right for you. I just wish I knew why they wanted me off the flecainide ASAP as I felt good on it and I worry about another ablation, not because of being nervous, but I can't understand how zapping one with a laser helps. It does for a lot of people I guess.

So does anyone know why medics don't want people to stay on flecainide for long especially after an ablation please?

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I dont know but mine wants me to stay on a lowered dose ,he says so that no new electrical connections are made. I think he is being super cautious with me as due to complications with the last ablation, he has said he wont do any more. It kind of defeats the object of having the ablation in the first place but I was on a much higher dose and that wasnt really keeping it at bay. Anyway, I feel great so Im just popping the pills and getting on with life while I can. X

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Hi there, sorry you feel so poorly. I have had 5cardioversions and one ablation been on flecanide and bisoprolol about 18months now and I feel really well. Have really researched flecanide and it is ok if there are not any other irregularities with your heart. The last time I had ablation done I was on amiodarone I think for a few months then was told to stop taking it. I felt then that I needed at least half of one as a safety measure but no was taken off all medication. Was fine for 18 months then had a big upset in my life and my AF all started again. But really unsure about having this ablation done. X

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If you are "feel really well" as you say, why consider an ablation?

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Ablation is the way to go:)

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So roughly 80 people in every 100 ablations are successful, that is great odds to me. I had my cryoablation 13 weeks ago in Edinburgh and feel better than I have felt in years, even before I was diagnosed with AFib (touch wood). Sailed through the procedure and wouldn't hesitate to have another. Don't stay on meds any longer than necessary, the side effects can be horrendous and lasting. I have a very talented Electrophysiologist and fully trust his decision and ability. You have to be told about complications in case something may go wrong, MAY not WILL, and to cover all eventualities. Hundreds of ablations are successfully completed every year. I think people have successful ablations but don't report them on this Forum so you tend to hear the odd one or two who have had problems. I hope this helps you to decide and puts your mind at ease. All the best

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Personally, I think 70% success is too low and I believe 'success' according to the medics is no AF for 12 months after the procedure even if it comes back later, which evidently it does with some.

Secondly, if you are asking should I or shouldn't I have an ablation, my decision would be NO as I will only have it when my other options have closed. What isn't mentioned here so often is a postponement, even just a couple of years can bring more experience and new techniques which could well benefit you.

Third and last, it is a very personal decision (i.e. we can't really advise) based on your character & your level of good physicality and you will never be right or wrong as you don't know how the alternative would have worked. Hope something there helps.

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My. EP didnt even mention complications he was so confiident ablation is the answer!

Find a very good EP and according to your AF history he will help you to make a decision

Also one EP I saw he was suffering from AF him self and he said to me (ablation is the cure) in his own words

I guess this helped me to decide then.

All the best

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Hi Gillybean123

Having been faced with the same situation a few short months my view is

1) if you ar suffering the horrible problems of AF then it needs dealing with.

2)the medication to relieve AF symptoms are at least lousy and at worst dangerous if taken for a good length of time and can do real life altering damage.

3) yes there is a risk but if you are otherwise fit and healthy and the consultant is giving you the OK then go for it.

Had mine five months ago and whilst I tried to do to much to soon( the op. Is a serious affair and you must give your heart time to heal)

The only lousy problem I am dealing with is those brought on by coming off the medication,which tells you how dangerous the medication is in the first place.

Finally must add, the medication of which I speak is Ammiodarone.

Hope this helps and best wishes.

Gribbo

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Hi Gillybean, I have read reports on the effects of bouts of A Fib on the heart, and the fact that it alters the structure long term, with enlargement of the atrium eventually leading to heart failure etc. This alone made me choose ablation, not to mention the long term toxic effects of drugs and perhaps the need to increase doses if the condition got worse. Apparently, the most effective ablation are those undertaken soon after diagnosis therefore so delaying the procedure as someone suggested may be counterproductive. Only you can know what is right for you. So, wishing you the best whatever you choose to do.

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Lots of points here.

Firstly, what are 'major complications'? Something life changing? Something that happens during the procedure that gets resolved without further problem? Something that keeps the patient in hospital for a day or two and clears up in days, weeks or months?

What is success? Complete? A slight improvement, a significant but not total one?

Do you delay in the hope of future improvement in technique or go ahead lest you deteriorate while you wait?

How brave are all concerned? I know of someone who, when in his early nineties, persuaded his enormously reluctant surgeon to proceed with delicate surgery that had a 75% risk of death. It went perfectly and he had four quality years as a result.

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So many differences in stats. I think it is a very individual choice and you need to be sure in your mind that this option is for you. There are major complications and a few posters have had complications such as phrenic nerve damage but as far as I am aware, they recovered in time.

No matter what the stats are - they cannot predict what will happen to you - only be indicators of what can happen for learning purposes. The longer term affects are only just being researched and some of them are also serious. If you have faith in the skill of the EP and you think it will benefit you then you will tend to go with ablation, but it is a benefit:risk analysis.

I had complications and at the time, I was all for ablation and it did give me 3 years of life AF free - but the sedation and anaesthetic caused a flare of a then undiagnosed underlying disease. No-one can tell you what will happen so my thinking is that at the time I decided - my life was SO miserable I would have tried anything. Longer term, now the condition is better managed and my AF is much, much less symptomatic I have no regrets but I needed 2 ablation as the first ablation made me a lot worse so I ended up in ACU.

Ask how many ablations your EP performs per year. The more the better and if it is less than 50 - I would be wary. Check out his success rate and check against the best - depending upon where in the world you are. Then think about what if you don’t..what would that mean for you longer term.

Hope that helps CD

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Hello Gillybean :-) there is another recent thread here on a similar topic...

healthunlocked.com/afassoci...

I have decided against having an ablation at this time for the reasons stated in the other thread...

We are all different, I suggest read all you can on the subject and listen to your doctors who know you to help you decide what is best for your circumstances

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When I had my open heart surgery I was told that there was a 5% chance of complications, i.e. 1 in 20., but if you look at it from the other point of view that gives you a 95% success rate. So I went for it.

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Initially I was hesitant to go the ablation route. I was having episodes every few weeks. When the frequency and duration of those episodes increased, I became less hesitant. It’s all about quality of life. Mine was becoming much less acceptable. I had an ablation May 14. I had a couple of minor episodes within a week. Since then only a few twinges and twitches. My quality of life is great! I’d do it again. The relief from the anxiety was worth it.

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I had 2 ablation this year, 1 for AF then one for flutter. I am off all drugs since may15 and now feel nearly (99%) normal again. No brain fog nor " special" tiredness, no exercise intolerance no stress with taking the meds. It's brilliant!

The actual two ablation for me were no problem. I would have another tomorrow if I had to to avoid rate control meds!

Odds on something bad happening? I thought were qute low plus I was quite fit and 57 years old.

Also I have a daily 105 mile commute on the m60/m62. I am probably more at risk there!

Additionally " af begets AF". The more you have it the more you will have it. This happened to me demonstrably over 2 years - it evolved and went worse which needed more drugs which was worse qol. I felt that it was better to stop the development asap before I got older and my heart possibly more damaged (remodelled).

Best of luck whatever!

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Thanks for replying, you saying brain fog. I put mine down to getting older but thinking about it could be my flecanide. Am waiting for G P to call me for a chat also specialist. I am 68 years old quite healthy so I need to say yes or no to myself because I am only waiting for the appointment now.

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I am going through the same thoughts re whether to have ablation or not. My Q O L is good at the moment (just completed 100 mile bike ride), I seem to tolerate the meds (Bisoprolol and Warfarin) ok and I am not aware of any major AFib attack in the last couple of months. I had 7 which lasted more than 5hr in the previous 4 months and many more short lived episodes of palpitations. I am on the list and expect a call up in the next month or so. I am leaning towards ablation as the last time I had one 7 yrs ago with the same EP it was a success.

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I’ve had one shock treatment....two ablation. First ablation lasted 3 months...2nd, after 4+ months, still holding. The ablation was not a big deal, for me, except for one bladder infection.😬

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I’m in the same place as you. As BobD always says: is your QOL affected? How bad is your AF? I have AF attacks every couple of weeks but I must say I stopped taking all meds except for the anticoagulant and my attacks are sooooo much more manageable. This I can deal with. I don’t know if I want to basically gambling that there won’t be any complications having an ablation and my QOL could be worse.

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Im in same boat and have same thoughts. I only take anticoagulant and so far it has been 4 mo since a fib last visited. My QOL is good, Im 65. If ablation would cure my arthritis, I would do it😂

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I know arthritis is so awful. My hubby has it. The morning is especially terrible. He is 64. Really sucks getting old. And they say these are the golden years. I don’t think so....lol.

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Yes

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For me, I said 'yes' and would do it again if they come back. The freedom is worth it.

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