A couple of questions from a curious mind

[approaching]

Has anyone done some research or given some thought to 1.why ablations haven't (yet) shown to increase mortality and 2. what the small ganglia that are probably destroyed during P.V.I are involved in?

Thank you for your consideration

[Paulbounce]

Hi app

.......why ablations haven't (yet) shown to increase mortality.......

I think ablations are more about QOL rather than mortality. However if they work, and the heart functions properly, I would assume this could lead to a better mortality rate. Maybe the Jury is still on that one - treatment for afib tends to be about QOL though from my experience. To answer your question directly - afib is unlikely to kill you hence the mortality will be the same - unless you are unaware you have it and suffer a stroke. If AF is picked up by a doctor then there are treatments to help with this. Everyone on this forum knows they have it - they are unlikely to have joined otherwise. We are the lucky ones - plenty of people are walking about with afib and have no idea at all.

........what the small ganglia that are probably destroyed during P.V.I are involved in?........

I`ll be dammed if I know heheh.

Seriously though it`s pretty hard to understand but try......

sciencedirect.com/topics/me...

Have a great day.

Best,

Paul

[approaching in reply to Paulbounce]

Thank you for your reply Paul.

I meant to say decrease (not increase)in mortality rate, which you kindly understood anyway.

I find it strange that the risk of sudden death from stroke doesn't change after successful ablation. Perhaps the jury is still out though. The anticoagulents only decrease it by 60% from what i gather, as they introduce the risk of a bleed.

Thank you for that article of the ganglia, some suggestion of a localised feedback role, i will have a good read. Peter

[Paulbounce in reply to approaching]

Good morning Peter - I always assumed that after an ablation the stoke risk disappeared - it was from this forum that I learnt this is not the case. I was quite shocked as I thought that a successful ablation would be the end of it. This is not the case and many still continue with anticoagulants after the procedure.

When I have the time I`ll do a little research about the role of the ganglia. I like to learn as much as I can about afib which is why I check the forum everyday. Knowledge is power as they say - certainly the case with a medical condition. It`s good when you can discuss things with your cardio and throw a few things in the pot. Certainly new treatments or developments and potential problems with existing ones. They don`t always tell you about these things so it`s good to keep them 'on their toes'

If I find out anything interesting I`ll post back.

Best,

Paul

[Hidden in reply to Paulbounce]

yes, it's not the AF that causes the stroke, but the company it keeps, high blood pressure, age, diabetes etc etc

[approaching in reply to Paulbounce]

Hi , It seems PVI can raise the left atrial pressure ( the ablation causes some stiffening) which in turn has the atrial appendage balloon out and that is where 90% of non-valvular clots come from, perhaps that is partly why there is no clear reduction in mortality.

The newer technique of FIRm ablation is a point to point to another point ablation ( not a line ablation, targaeting aberrant areas, and may reduce the scaring shrinkage and the LAappenage ballooning out.

interesting

Peter

[MarkS]

Taking the question - does ablation reduce mortality, which I think is what you wanted to say, I believe there is some effect.

AF can lead to strokes which can kill you, but a less recognised impact is that AF can also lead to heart failure, and that can also kill you. Ablations reduce the heart rate and this should reduce heart failure and hence mortality.

For more info, read:

ahajournals.org/doi/10.1161...

One graph is particularly interesting which shows mortality in a section of the Minnesota population. After 10 years, 60% of Non AF sufferers are still alive compared with only about 35% of AF sufferers, a lot of this is down to heart failure. It mentions that ablations are considered to reduce mortality.

[Paulbounce in reply to MarkS]

Very interesting link. I've skipped though it but want to read it in detail when time allows.

I think it confirms what I say about the 60 - 100 HR being seen as 'normal'. A resting heart rate of 90 - 100 is to high IMHO. That`s just my point of view but lower is better as far as I am concerned.

Since my CV my HR is about 60 at rest. Before it was around 90 -100 at rest (still within the safe zone). The reduced rate must be better for heart health ?

Best,

Paul

[approaching in reply to MarkS]

Thank you for taking the time to reply.

Yes meant to say reduce mortality..

Am pretty sure my cardiologist said that successful ablation hasn't been show to reduce mortality. I will look into it more.

Peter

[MarkS in reply to approaching]

Yes the standard response is that an ablation does not reduce mortality. However from the papers I've read, I think there is a positive benefit from successful ablations, though not enough to bring the risk down to that of non-afibbers. So I've had a successful ablation and I think my risk of a stroke has reduced because of that, but I still take warfarin.

[Aus19 in reply to MarkS]

Thank you, posters, for this illuminating discussion.

[approaching in reply to MarkS]

You may find this recent article interesting

nature.com/articles/s41598-...

It is refering to how the left atrial appendage balloons out after atrial ablation.

Peter

[MarkS in reply to approaching]

Yes that's very interesting. It raises concerns about the enlargement of the Left Atrial Appendage (LAA) after RF ablation. My take is that it's not such a bad thing if the LAA volume increases as that might stop blood pooling. The LAA blood velocity also increased by about 20% which again should reduce pooling and clotting. However I think it all needs a lot more research.

[approaching in reply to MarkS]

Thank you for your reply.

Have you had an ablation?

Peter

[MarkS in reply to approaching]

Yes, I had one 10 years ago. Successful (other than very occasional short runs).

Mark

[approaching in reply to MarkS]

Do you know what type of ablation was performed on you Mark?

Peter

[MarkS in reply to approaching]

It was a combined cryo and RF. So cryo for 3 of the PVs. The 4th was too big so that was RF. Then RF for some other areas such as the ligament of marshal. My EP is probably the number one in the UK.

[approaching in reply to MarkS]

So you would have had less shrinkage and scaring than a PVI with posterior wall isolation, but risked pulmonary vein stenosis , i think

[MarkS in reply to approaching]

Yes, the cryo balloon would have gone in too far and risked PV stenosis. Fortunately he had the RF option otherwise less experienced doctors might have risked it if they had cryo only. In my view, PV stenosis is more common than currently understood for cryo. A lot of doctors underplay it but it can be very serious.

[approaching in reply to MarkS]

How bad was your Afib before the ablation?

[MarkS in reply to approaching]

I had AF for one day in three, but that increased to near 70-80% by the time of my ablation. Moderately symptomatic.

[approaching in reply to MarkS]

Yes, pulmonary vein stenosis would be a tough diagnosis to take.

Have you been on anticoagulants these past 10 years Mark?

[MarkS in reply to approaching]

Yes every day for the last 10 years on warfarin

[approaching in reply to MarkS]

here is another good article Mark

innovationsincrm.com/cardia...

Peter

[KMRobbo]

If A Fib (generally) does not kill you so why would stopping afib make you live longer?

[approaching in reply to KMRobbo]

I meant to say reduce mortality .

having afib and being on warforin comes with an increased mortality, i think metadata says those on warforin live 10 years less than those who are not, for example.

[KMRobbo]

I had not understood that warfarin reduces your life by 10 years! If that is the case why take it? The potential upsde is offset by the downside surely? Especially if you only think you have 10 years left!

[KMRobbo]

I am not medically trained , however and for what it is worth:, I think the issue you are trying to address is that having afib increases your risk of stroke , but having an ablation reduces or eliminates the afib, but has not been proved to reduce the risk of stroke or death. So ablations improve QAL but do not increase the length of your life?

Well its still worth having the ablation for QAL. That is really what all AFIB treatment is about.

[approaching in reply to KMRobbo]

Yes, you have it in a nutshell really.

there is just so much going on in the heart system and being a closed circuit changing something from the outside has reactionary effects i guess. It sure improves the immediate QOL, no question.

The metadata also said the being on an antipsychotic reduces your life by 20 years!

[KMRobbo]

I better keep off those then! My father was the longest lived male member of our family and he made 79. I am already 59!!

[approaching in reply to KMRobbo]

Thats funny.

Now its probably an associative link rather than a causative link, that is if you get a diagnosis that requires them them you already have problems,