Ablation follow up - interesting points from EP

[Olben]

Had my 3 month ablation follow-up with my EP a few weeks back. I tend to ask a lot of questions as I like to know details (how/why) and I did get some interesting feedback on a few topics. Like many on here I have read extensively about AF and ablations but these details were new to me, perhaps then of interest to some others.

1. What causes the stroke risk deriving from the ablation itself and how is post-ablation anti-coagulation regime determined? The ablation-related stroke risk is highest during a 4 day window post procedure. This is because the anti-clotting lining inside the heart is destroyed at the ablation site and it takes around 4 days for this to grow back. During this time clots could easily form without A-C. I was put on Pradaxa 2 weeks prior to the procedure and asked to continue for 3 months post. This 3 month period commonly applied for post ablation A-C is not based on any particular study findings. When ablations first became a common line of treatment for AF, A-C meds were typically taken for a month post op and this has grown to 3 months over time but there is no hard & fast rule. I had stopped after 2 months, with EP agreement, as I didn't tolerate the Pradaxa very well.

2. Is longer term stroke risk affected by an ablation procedure? I imagined ablation causing an irregular surface due to scar tissue which provided more opportunity for clots to form. Was told this is not the case and there is no increased long term stroke risk deriving from the ablation procedure. In the event that my AF doesn't return (fingers crossed...), my stroke risk is the same as the general population. Of course there is a chance the AF will return.

Again, the above comments on stroke risk relate to the ablation procedure itself, not underlying / ongoing risk & management of each individual.

3. Why is there a change in resting heart rate after ablation? As most others have reported, resting heart rate tends to increase quite significantly post ablation, in my case from below 60bpm to around 90bpm initially, falling to around 84bpm over the first month and currently around 78bpm. The reason this happens is the heat from RF ablation destroys part of the vagus nerve complex at the back of the heart. These nerves regulate parasympathetic control of heart function (which I believe applies when we are at rest), leaving the sympathetic nervous system to control the heart constantly. The sympathetic system generally produces a faster rate. The nerves do grow back, at which time the parasympathetic control can recommence. This nerve re-growth can take up to a year. In my case he expected my resting rate will eventually settle at around 70bpm.

[jeanjeannie50]

Interesting facts for us all to know Olben, thank you for sharing.

Jean

[BobD Volunteer]

Interesting take on things Olben. thank you for reoporting . I would not agree with evernytyhing there for example does ablation remove stroke risk? Granted not all EPs would agree on this but the ones I trust would say no. It is not necessarily the AF which causes stroke risk but the company it keeps so stopping the AF may not remove the stroke risk . It is for this reason that so many of use prefer to remain on anticoagulation for life. And well done for not using that horrible term "blood thinner" by the way. Granted a CHDSVASC score of zero would not require anticoagulation and many people only go on these drugs for the period covering the ablation and recovery but there are far more who remain at risk.

[Olben in reply to BobD]

Thanks. My point, perhaps clumsily expressed, was that I am informed there is no long term increased stroke risk from having an ablation. As stated any residual risks (including from as you say the company that AF keeps) remain.

[BobD Volunteer in reply to Olben]

I think there may be mixed views on that but in principle I agree that there may not be any INCREASED risk due to ablation.

[wilsond]

Thank you so much for this post,some of these questions arise in my mind after I saw my EP last week,although I had given him a good grilling about ablation.

Much appreciated. Best wishes xx

[Buffafly]

Thank you, certainly some info new to me.

[Hidden]

Thank you Olben ..very interesting and food for thought !

[jedimasterlincoln]

Very useful questions and answers thank you

[Jomama]

I am going on two years come Feb 8th since my ablation. No AF since thank goodness. Was on Pradaxa prior to ablation and had no problems with it. Was taken off 2 months after ablation. Doc felt that there was no reason to be on Pradaxa any longer. I do take BP meds though, so that reduces my risk of stroke. My last checkup scared me a bit because doc informed me that AF can come back from the flu, or even a bad virus! So get your flu shots, to give yourself the best chance against recurrence of AF.

[Olben in reply to Jomama]

Glad you’re off the Pradaxa, I wasn’t happy on it. In my case my heart is structurally normal and you’d never know I had PAF for around 20 years, my episodes were very infrequent until the last couple of years. I’m lucky not to be on any meds as blood pressure, cholesterol etc are all fine. I understand that there are likely to be very small areas of remodelled atrial tissue from past AF episodes which means my AF threshold will always be lower. Thus one-off episodes such as from “holiday heart” and virus etc, which can occur in anyone, are just more likely in my / our case. My approach has always been to put AF out of my mind as much as possible, I try not to live in fear of another episode and this has become easier over time. The ablation has also really helped with this, still early days but I’m always positive because stressing about these things is counter productive.