hybrid ablation

[lakebudd]

I have not posted for lately. I just resigned myself to the fact that I will be in permanent afib forever. After numerous cardioversions and two ablations (which kept me in rythm for about two years only). However, a friend of my son had the hybrid ablation which is particularly good for folks in permanent afib. He had this procedure done a few years ago and is still in rythm. This is the first I 've heard of a hybrid ablation. None of my doctors ever mentioned this to me. Has anyone here heard of it or had it done?

[BobD Volunteer]

Have a look at our fact sheet on ablation (AF Association) .

Briefly a normal catheter ablation and also an external surgical ablation done by keyhole. I am sure we have a couple of members who have had this done but they are probably off enjoying life..

[lakebudd in reply to BobD]

Thank, Bob. I'll have a look at the fact sheet. I like to get as much independent information as possible before advancing further. Most of the info I got so far is from hospitals that perform procedure.

[TrevorJG]

My first stage of a hybrid ablation was abandoned because of severe bleeding, after 6 hours woke in cicu still bleeding!. Recovery complicated by 2.3 litre plural effusion 2 weeks after home with further effusion 2 weeks later. 2 months later first of several admissions with heart failure (great team sorting this ou).

Then 2nd stage (pulmonary vein isolation.. standard ablation) and DC cardio version 1 month later.. sinus rhythm with 1/2ed heart rate and much improved exercise tolerance.

[lakebudd in reply to TrevorJG]

Sorry to hear about your bleeding problem. Is it because you were on blood thinners or did it have something to do with the procedure itself?

[TrevorJG in reply to lakebudd]

Not related to anticoagulant, adhesions in pericardial space.. attempted division then local and generalised bleeding.. entry points(3).. iv & central line back bleeding & drain..settled with fresh frozen plasma..

Very much improved now in sinus rhythm..exercise tolerance improving

Trevor

[lakebudd in reply to TrevorJG]

It sounds like you had a rough time. Glad you're improved and back in rhythm. Enjoy the freedom of being afib free and hope you continue to improve.

[Buffafly]

I am seeing lots of posts mentioning hybrid ablation in the section headed 'Related posts', which on my tablet is top right.

[johnMiosh]

Some of my posts are visible on the top right, or if you want to search. No AF for two years after the first part (minimaze) I had the second parts 6 months later. I am happy to answer any questions.

[lakebudd in reply to johnMiosh]

Glad to hear you have had no AF for two years. I've been in AF for ten years and wonder if the Hybrid ablation would work for someone who has had AF this long. I had two c. ablations two years ago without success. Don't know why my cardio dr. or EP never mentioned this procedure to me. I just called and asked. Waiting for his response. I do have one question. If I already had two ablations and scarring has occurred blocking off impulses, why is the second phase of Hybrid ablation necessary or do they just ablate more areas? Maybe my EP can explain. Always looking for a "cure". I'm just tired of being tired and low energy and I really don't like blood thinners. One more question, are you off blood thinners or are they still necessary?

[johnMiosh]

I dont know whether you will be suitable, 10 years is a long time; you would need to consult a cardiothoracic surgeon.

The hybrid was developed from the success of the maze procedure. Although vety successful even with long term persistant AF, this is full zipper open chest surgery and the risks can't be justified unless the chest needs to be opened for other work, such as valve replacement.

The hybrid consists of a minimaze, which makes lesions on the outside of the heart through a number of incisions in the chest, and a catheter ablation to complete the maze set on the rest of the heart.

The minimaze also involves excision of the left atrial appendage, which grows the majority of clots, so I no longer require anticoagulents. Whether LAA closure is sufficient to prevent stroke is conjecture, so as part of the ongoing clinical trial, I will end up as a statistic on one one side or the other.

On the plus side, I have experienced no AF since the minimaze in April 2017. I was back to exercise relatively quickly and although I am not pushing myself back to competition levels, this is through choice, not cardiologist's advice. I was extremely happy with my progress, b efore my catheter ablation, but there has been gradual but noticeable progress ever since. For example, my resting hr is now down to 64 and seems to be falling by a beat every couple of months.

[lakebudd in reply to johnMiosh]

Thanks so much for your explanation. It seems that the long term effects, good or bad, are yet to be discovered. I have been living with AF for so long without any serious problems, except fatigue which could be the result of drugs. My blood pressure is normal, heart rate in the 75-80, and EF is 55 which is why doctors have not advised hybrid abl. I just don't like being on blood thinners for life. A large portion of my body is covered with bruise-like discoloration (but doctor says is not really bruising) and we don't know why. I can only assume it's blood thinners. Anyway, once I know I have exhausted all possible treatments, I can set my mind at ease and live with AF. It's the constant searching and hoping for a cure that has caused a lot of anxiety. But we are all in God's hands, are we not? I'll leave all my anxiety at His feet and enjoy the life He has given me. Thanks again for your help.

[Desanthony]

After a surprisingly successful cv a year ago - though gone back into AF now and having another ablation on Tuesday I was told I would have been off apixaban had I not been just over 75 at the time of my cv as I was then still on the same risk rate as I had been when first diagnosed with Af so should continue with apixaban. I was not happy with this but would now be back on them anyway. Still, would love to be off them. Pleased to read about this hybrid ablation as I have a friend who has been in Af for a while who is not getting good treatment from her EP and after many years has only just mentioned ablation at all so will mention this to her as it may just be the thing she needs. Who knows I may need it one day too so good to know about it.

[lakebudd in reply to Desanthony]

Whenever I want to get off blood thinners when I'm in rythm (as I was for two years after an ablation) , my cardio dr. says no way because of my age. But I went off of them anyway with his knowledge but not consent. He made a special note in my file that patient insisted on discontinuing blood thinners. I guess it was to protect himself from any liability should I have a stroke. I can understand that. My primary dr. (a GP) says I wouldn't need blood thinners while not in afib. Different doctors, different advice. Confusing. Neither my EP or cardio doc. ever mentioned hybrid ablation. I learned about it from a friend. Can it be because it's risker (it is surgery) and not yet proven for long term results? Who knows. I'm still keeping it in mind. I'll talk to my friend and see how he's doing following procedure.

[Hidden in reply to lakebudd]

Your GP is wrong, it makes no difference being in Rhythm or not, your risk of stroke is the same, and because you have a history of AF your risk is increased by 5 times that of someone with no AF

Check your chads2vasc score mdcalc.com/cha2ds2-vasc-sco..., if you are a zero then no ANTI COAGUILANT needed, score a one and it should be discussed, 2 or more and you take it

[lakebudd in reply to Hidden]

I've had Afib for ten years and it still baffles me. If one is in rhythm then the heart is pumping efficiently and there is no pooling of blood in the LA so no clotting. Risk of stroke shouldn't be any greater than someone without Afib. Even people without Afib may have CHAD2 or greater and could be at risk. A friend had Afib and after going through the usual CVs, ablations and meds, he opted to have hybrid ablation. That was in Oct. 2014 and he's been Afib free ever since and takes no blood thinners after the initial use of blood thinners for 2 or 3 months post operation and he feels great (walks 4 miles a day). But I guess everyone is unique and what is good for one person may not be good for some else. So, blood thinners or no blood thinners? I think this is a question with no definitive answer.

[Hidden in reply to lakebudd]

statisically, if you have had AF you are 5 times more likely to have a stroke.

This does not change if you are in AF or in NSR

Then you multiply your other risk factors from your chads2vasc by 5.

youtube.com/watch?v=CwX7xs_...(Not working as expected?)

[avma]

I had a hybrid ablation almost 3 months ago for my atrial tachycardia. (So I don’t have AF.)

Since the AT was situated along my phrenic nerve, the EP couldn’t proceed with the burning durIng a previous “normal” ablation. So he referred me to a cardio thoracic surgeon who could remove my arrhythmia but by going in from the outside of my rib cage with a camera to burn away the cells of the arrhythmia on the outside of the heart and at the same time an EP went in from the groin with the catheters to map the areas and help when needed.

The surgeon told me that it was a success, but I’m still recovering from the surgery. So it is a long recovery, not always been easy but I take it step by step and like the surgeon said, that I had to “invest” in this so that I could be freed of it in the long term.

You can read my posts on my profile that I posted until now about this topic if you want to know more.

All the best!

Anna

[lakebudd in reply to avma]

I'm still unsure if I should get the hybrid ablation. When I had a "normal" ablation, I recovered very quickly, in 4 or 5 days. Doctors are worried about the groin incision. Too much activity can cause bleeding. But it did feel great not to be in AF -- more energy, no dizziness. Unfortunately, it only lasted about 2 years. My EP does not recommend the hybrid but I really want to get off blood thinners. My friend had hybrid 5 years ago and takes no blood thinners -- feels great. The hybrid does sound like a much more serious ablation procedure and one never knows exactly what effects it can have, even if short-lived. Just don't know what to do. Will see my cardiologist next month and will get his opinion but I'm not hopeful that I'll get a definitive answer.

[avma in reply to lakebudd]

It is true that the operation is much more invasive and the recovery much longer, but finally it is the end result that counts.

If I hadn’t done it I was doomed to take medication for life. The cardiologist also told me that with medication I would have a lot of side effects and I wouldn’t be sure either that it would stay under control. He also found that I was too young (I’m 54) to be on medication for life not knowing what it would give on the long term.

The surgeon said the same thing to me and was very confident that he would have success by operating me. But yes, downside is the recovery. At first I was really impatient to get well again. And then I discovered that I could also be patient and recover at my own pace. So that is what I have been doing ever since. I give myself a year to be the new(old) me again. I guess that is realistic. And after that year I have perhaps won the lottery that my arrhythmia will stay away forever 🤗.

Think it through a lot, discuss it with your cardiologist and go for what you feel is best for you. Good luck with your decision!

Anna

[lakebudd in reply to avma]

It sounds like you have the right attitude. Patience is difficult but very necessary. It's the long term result that really counts and you are definitely too young to be subjected to years of medication and even with that, it doesn't always last indefinitely--afib may rear its ugly head again. The hybrid sounds like a more permanent solution. I'm 73 years old and may still have some good years ahead of me and I don't want to become a cardiac invalid afraid to live life to the fullest. I will discuss with my cardiologist. I wish you the best during your recovery and hope after a year (or sooner) you are able to enjoy life and do all the things you love to do.

[Lisybubbles]

My husband is having : Hybrid Ablation with a triple bypass on the 1st December. Not too sure what to expect. Tried googling but only gives separate procedure not together ;(

[lakebudd]

I don't think Hybrid Ablations are done that often. It's probably a final effort to stop afib if all else fails because it is invasive surgery. But since your husband is having surgery anyway, this should be a good time to have the Hybrid at the same. I just know one person who has had it five years ago and he says he feels great. Hope everything turns out well for your husband.