Ablation without anticoagulation?

Can it be done? What do they do if you cannot take anticoagulation?

[BobD Volunteer]

You would have to discuss this with your EP but even though they can do a TOE before to check for any clots that may be present the act of ablating can cause some debris to occur which could result in some form of stroke I believe.

[PhyllisK in reply to BobD]

Well done Bob, you are unbelievably stoic. 🌟🌟🌟

[Hidden in reply to BobD]

Yes, I’m guessing that they would be reluctant to do the procedure in this way. I can see that the meeting with the EP for assessment is going to be an involved one.

[Hidden]

Do you definitely need to have an ablation ? Presumably you have adopted all the lifestyle changes advocated? Personally I wouldn't want to go ahead with ablation unless I was fully anti coagulated . It will be interesting to hear what transpires in your planned meeting with your EP

[Hidden in reply to Hidden]

I was told by the consultant that I was “still young” (I’m 63), that my episodes seemed to be becoming more frequent and that he was recommending an assessment for an ablation otherwise my heart would “become enormous” and it would “ruin my life”. When I asked if losing weight was a good idea he said that it was generally a good idea but that atrial fibrillation “doesn’t care” if you lose weight.

Not sure if “interesting” is the right word

[BobD Volunteer in reply to Hidden]

B*ll*cks he should read the studies on weight loss and AF. Mind you I'v e lost 1/2 stone this year and made no difference.

[Hidden in reply to BobD]

My original strategy was to make lots of lifestyle changes: losing weight (although I am not really much overweight), cutting alcohol, eating loads of healthy food etc. with a view to delaying the progression of AF- kicking it down the road so to speak (I haven’t really succeeded in making any of the changes so far). But the consultant’s remarks implied that this was wishful thinking. I really don’t know how this will play out. I’m obviously at the beginning of an AF “journey”, but it’s not one I want to embark on.

[Barb1 in reply to Hidden]

My EP is of the opinion that unless your lifestyle is extremely detrimental to health, changes make little or no difference when the AF is inherited

[jillybeanposh in reply to Hidden]

Don’t think much of your consultant. Anything you

Can do to

Make you more healthy is a really good thing. We all know it doesn’t need much to start our AF off so if we can

Make ourselves more healthy it’s got to

Help. Your consultant

Should be patting you on the back for trying.

[Hidden in reply to Hidden]

Don't really know what to say about that ! I've had AF on and off for about 26 years from the age of 48 and recent echo shows heart in" generally good shape...moderately dilated left atrium ".

We are all told that losing weight will help and common sense reinforces that it must do. I've found that it hasn't made any difference to my AF but has certainly made a difference to my general health. ( I am a work in progress....)

[Hidden in reply to Hidden]

My echo indicated the same- mildly dilated left atrium. I gather current thinking on ablation is to intervene early and try to stop the AF taking off. I suppose it’s possible the assessment will not result in a referral for ablation immediately.

[cuore in reply to Hidden]

I was told the opposite by my EP and that I should lose 5kg to 10kg as weight definitely affected af.

[Hidden]

In January 2011 I had an ablation for SVT and was not on anticoagulation at the time. I'd just turned 64.

I had had to drop my betablocker (atenolol) a couple of days before the procedure and my heart was quite unsettled. I spent most of the ablation going into AF and had several cardioversions. In the end, I think they gave up, gave me some flecainide and moved on to the next patient. I took flecainide for the next three years after that and continued without anticoagulation until July 2013.

[pottypete1]

Despite some contrary views I can tell you that I have had a number of ablations and on each and every time I had to prove that I had been anticoagulated for st least 4 weeks prior to the procedures and I had to remain on anticoagulants afterward.

In addition I also had to have TOE scans prior to each procedure. I am being treated at one of the top Specialist Cardiac Hospitals in the UK.

We are all different and so are the approaches from different EPs and hospitals.

You need confidence in your EP and if you don’t have that then it is not a good situation anyway.

Pete

[Kaz747]

Is the ablation for AF? I had two SVT ablations initially without anticoagulants but by the time I had my AF and Flutter ablation I was on anticoagulants full time anyway.

[Hidden in reply to Kaz747]

Yes, for AF.

[SuzieA]

Yes they should do you an ablation. I had one without coagulation because taking an anti coag caused me to have a brain haemorrhage. I had a TOE before the procedure. Good Luck

[Hidden]

Thanks

[MarkS]

Ablations produce very small clots - microthrombi. These can have long term effects on memory so anticoagulation is used to prevent these. I would ask the EP how he will manage this.

[Mike11]

They can just dose you up with a strong anti-coagulant at the start of the procedure. You'll then be kept in overnight to stop you causing any unintentional bleeding.

[Hidden]

Interesting (and worrying). I have made a note of this. Thanks.

[Slim2018]

Complete opposite for me...told to take them as normal with just a small amount of water the morning of the ablation and then two weeks later for the catheter Cardioversion. Have been on them continuously since the end of August and going to be taken off them in three weeks time as I am 0% on the whatever it’s called score thing, says my Consultant. Will be on the Fleck stuff for another three months then hopefully off that too. Got a wisdom tooth extraction before the Rivaroxaban is stopped but having it done by a mate who is the dentist the other dentists send the problems to. She doesn’t see any problem with taking it out, even on Rivaroxaban. Dreading the tooth out more than the ablation or the Cardioversion...go figure how we perceive things?

[Hidden]

When I had my ablation last year here in the US, my EP wouldn’t do it unless I was on Xarelto. Seemed to be a strict protocol.

[Slim2018]

Same way of doing it but one involves the microwaving of tissue the other one is stop / start the heart

[Beckyr86]

I had an ablation in September without anticoagulant so it can be done.

[Hidden in reply to Beckyr86]

Was there any specific reason given for this? Did you have it with sedation or under a general?

[Beckyr86 in reply to Hidden]

No reason was given. I stopped taking anticoagulants earlier in the year and they weren't restarted for the ablation. I had mine under general as I have had previous surgeries on my CHD making ablation more complicated.

[Gwelos]

Hi I am 69 yrs and had an ablation in January so far successfully. I wasn't on anticoagulation only when I got an attack.

I'm not on any anticoag now and EP is happy with that for the moment I don't have any co morbidities. After the procedure at my check up he said that ablation was about 60% of the cure the other 40 was between losing weight and getting my sleep sorted I have Upper Airways Resistant Syndrome. Google UARS for info.

I was on zarelto for about a month after ablation. Your EP may be able to give you something for the short term.

From anything I have read the sooner you have the ablation the better the result.

Best of luck with it all

[theendisnigh]

I'm confused.

Can't or won't take anti whatsits?

Becoming more frequent?

Still young?

Firstly, I'm an Afibrialolic, it been two years now and I got my badge last week.

It happened without warning (although I suspect it's connected with starting on Beta Blockers - that's another story)

Anyway, the one thing (for me anyway) was that all the cardiologists seemed to agree, was that not taking anti whatsits (coagulation medicine) was a big no no. Which is why I asked the first question. Apparently the irregular action associated with AF basically causes blood clots that can end up anywhere, but usually somewhere where they don't do any good.

Becoming more frequent?

As I understand it, Once you become Afibrialolic you are one for life. Even those that have had successful ablations can relapse and become as addicted as before. My AF is constant. It has only stopped for five days following my bypass op, but it returned and is now my constant companion, sitting on my shoulder nagging me not to take my Apixipan.

"you don't need it, give it a miss for a couple of days, you'll be all right."

Like a demon, constantly whispering in my ear, but I can resist.

"Go away," I tell it, "you're just trying to tempt me down the path of clotting."

Oh yes, I'm made of sterner stuff, HA!

So for me the problem is constant and I take my meds constantly. I can see that the trouble with intermittent AF is that not knowing when your body will get "the urge" again, perhaps you want to avoid all the hassle associated with anti whatsits. I don't know if this is wise, but I would have thought the cardiologists would have an opinion, which I for one would research and accept the majority view. (I suspect if it starts and you're not taking them, there' a risk, but I ain't no cardiologist so don't believe me)

Still young?

I took my first Afibrial when I was sixty four. It only took one and I became addicted straight away. I went straight to hospital as soon as I realised something was up. But rather than trying a heart reset with an electric shock they tried to increase my beta blockers (which I suspected was the cause don't forget). It turns out they may have been right not to, because about three weeks later I had a heart attack (the shock could have made things worse I suppose - again my personal theory). Anyway, I was fortunate. I was a mild heart attack, in fact they weren't even sure it was an attack. So they sent me for an angiogram.

That's when the real fun began, but again that's another story.

However, I was surprised to find that I was considered 'young' for bypass surgery. There were others in there in their seventies.

Sorry for the digression. Young you say. I have friends that started in their forties. I now realise I worked for a guy for twelve years not knowing he was one too.

Strangely, people tend not to talk about having an Afibrialolic in their family until they realise you are one too. Following my revelation I was amazed how many people knew of the condition and even confess to being an Afibrialolic themselves - the secrets we hide in our dark and murky lives.

My point being talk to people about your condition. Especially those Doctory types that wear white coats and act all patronising like. Corner as many as you can and seek their respective opinions.

Good luck. Hope things improve.

[Japaholic]

This is odd, I was taken off anticoagulants before my ablation, given a jab of something short lasting during the procedure and back on the anticoagulants once my wounds stopped weeping. For the life of me I can’t remember the name of the drug they gave me, but 24 hours with no noac on the day of the procedure.