Duration of effectiveness of ablation in pr... - AF Association

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Duration of effectiveness of ablation in preventing episodes in Paroxysymal AF

Hurlingham
Hurlingham
69 Replies

I have had 3-4 episodes AF a year. Recently an episode came sooner and lasted longer. Ablation (cryo or radio) eas recommended. Can people tell me of how long they have been AF free post-ablation? Any other experience welcome.

69 Replies
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JaneFinn

Thanks for this post, Hurlingham - I’m interested in people’s replies too :)

(I’ve just had to delay a scheduled ablation due to a chest infection. But I’m also glad of the chance to take stock and check it really is the best course of action for me right now.) x

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Hurlingham
Hurlingham
in reply to JaneFinn

Thanks Janet

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bantam12

Both Cardio and EP told me ablation was unlikely to stop AF in the long run so I cancelled the procedure.

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Hurlingham
Hurlingham
in reply to bantam12

The evidence supports this. But i am getting long 'pauses' during attacks. The 'pill in the pocket' which seems the way to stop my AF increases the duration of pauses to <5 sec. This risk means i should use it in A&E with monitoring. But my local A&E's do not really like this use of their scarce capacity.

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bantam12
bantam12
in reply to Hurlingham

I also get long pauses and I'm not able to take any meds because of the bradycardia so I'm going for a pacemaker which will allow me to then take the meds to control my rate without dipping to low.

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Hurlingham
Hurlingham
in reply to bantam12

Thanks interesting. I wonder how many people have done this with good effect?

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bantam12
bantam12
in reply to Hurlingham

There are a few on here who have said how a pacemaker has changed their lives for the better, I'm looking forward to having my new friend installed and hopefully being so much better and more able to live a normal life !

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37Polly
37Polly
in reply to bantam12

Exactly the same...pacemaker installed two weeks ago. On low dose beta blocker so far with rhythm med ( been on for two years). So far happy...pacemaker recovery...an easy walk...this from someone who is a very slow healer👍......and so far no afib! And no high rates...good luck. Go for it.

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bantam12
bantam12
in reply to 37Polly

Good to hear, the meds afterwards might be a problem for me as I previously didn't do well on beta blockers and my Cardio wouldn't prescribe them this time round but will have to see what happens.

My one huge worry in the days after the procedure is if I'm going to be able to walk the dogs and do the daily chores with the ducks and chickens, big problem if not ☹️

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Hurlingham
Hurlingham
in reply to bantam12

Bantam, you're a true Braveheart 😉

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bantam12
bantam12
in reply to Hurlingham

😁

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37Polly
37Polly
in reply to bantam12

Limitations after pacemaker are generally about not lifting the left arm or pushing or pulling and reaching. After two weeks (today) I feel so well I am really needing to remind myself those leads into the heart need time to build tissue around them...must not allow them to work loose. But I am doing everything with right arm except heavy lifting. And left arm feels fine....need to move it, just not really use it. I think wit a bit of help and care, you will be fine carrying on.

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bantam12
bantam12
in reply to 37Polly

I had a frozen shoulder for a year so got quite good at not using my left arm so fingers crossed I will manage, thanks for the encouraging recovery report 👍

Take care

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Buffafly
Buffafly
in reply to Hurlingham

My ablation lasted 2 years. The purpose of it was to stop meds because of pauses. I can only take the lowest dose of Diltiazem and if I can't cope with an episode have to go to A&E. So also opting for pacemaker if offered as I don't want another alation and cardiologist doesn't advise it either.

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FlapJack

No simple answers I’m afraid, and be very cautious about anyone suggesting that an ablation will cure your AF. To some extent, any answers you receive will be irrelevant because results are almost entirely personal to the individual and are therefore variable. I had a cryoablation back in 2016 and after 18 months or so episodes returned so I had a second (RF) ablation in 2018. Depending on the outcome of some thyroid treatment, a third is on the horizon and although this may sound disappointing, episodes have progressively become less severe and quickly stopped using Flecainide as a PiP. As said, an ablation is not a cure, it is an effective method of controlling symptoms and improving quality of life. That said, you will no doubt receive a wide variety of answers including many who will say it has stopped their AF for several years.....how long is a proverbial piece of string springs to mind. Personally, I am a great supporter of having an ablation and am very pleased with the decisions made thus far........

I ought to mention that I was diagnosed with persistent AF which is more difficult to ablate and may need 3 or more attempts to get best results.

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Hurlingham
Hurlingham
in reply to FlapJack

Thanks FlapJack, yes I'm balancing how anxious thinking about a heart proceedure makes me feel, versus benefits. I have now had an attack once a month for 4 months, the last one over 14 hours duration. The episodes difficult, but also i'm worried about booking anything e.g. holidays.

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FlapJack
FlapJack
in reply to Hurlingham

It is said that AF begets AF, so generally over time, the sad fact is that episodes get more frequent and longer and at some stage AF can become persistent (24/7) which, ironically many find easier to adjust to. However, when persistent, ablations are more complex, can take longer and you are more likely to need 2 or more. Of course holidays are a consideration, especially foreign ones because being on a waiting list for a procedure can cause problems for travel insurance. Probably a bit premature at this stage, but why not take a look at these two factsheets about factsheets which you might find interesting....

heartrhythmalliance.org/res...

heartrhythmalliance.org/res...

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Hurlingham
Hurlingham
in reply to FlapJack

Thanks Jack

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FlapJack
FlapJack
in reply to Hurlingham

I’m John and I try not to Flap.....😉

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Samazeuilh

I had PAF roughly once a month and have now reduced it to roughly once every two months. I’m also fairly asymptotic when I have episodes.

The EP said this was still too often and that I should have an ablation. The heart is slightly enlarged, and this process will continue unless the problem is addressed. The heart also remodels over time. I’m not any keener to have it than you are!

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Cookie24
Cookie24
in reply to Hurlingham

Yes, I hate not knowing when an episode will hit and have cancelled trips because of this. Like FlapJack, I had a cryoabltion that lasted 14 months. October 2019 I had a radiofrequency ablation for atypical flutter.

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Hurlingham
Hurlingham
in reply to Cookie24

Yes I'm about to cancel a holiday. The not knowing when an episode will hit is as you say hateful. Attending and reattending busy Emergency Departments takes a prize too...

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BobD
BobDVolunteer

After three ablations I have been AF free for eleven years but have other arrhythmia. ( Atrial tachycardia.)

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Lilypocket
Lilypocket
in reply to BobD

Hi Bob

How often do you have episodes of Atrial Tachycardia? Was that something that came after the ablations? Great that the AFib has disappeared.

X

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BobD
BobDVolunteer
in reply to Lilypocket

It was about every two years.

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Lilypocket
Lilypocket
in reply to BobD

Could you tell me what MAT is short for?( mentioned in this post).

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BG2017

As is the case, sometimes it takes more than one ablation; my first made very little difference but my second has improved my quality of life beyond measure. It has been a year so far since that one.

I was having AF episodes every other day, and they were lasting between 2 and 24 hours.

I also had long pauses, and had a pacemaker implanted to stop those.

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Lien-Ju

Hello there, I had my last afib attack on 23/10/2018, my ablation on 28/11/2018 and since I didn't have any episode for now. I am 24 years old and I lift weights and have a cup of coffee 1 time a week. Reduce my amount of stress helped me to calm down my heart rate, I am pretty sure my afib started because of my stressful environment.

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Samazeuilh
Samazeuilh
in reply to Lien-Ju

I think that stress may trigger AF in someone who is already genetically predisposed to it. Like most people I’ve had plenty of stress in my life and strongly suspect that this has contributed to my having AF, but I also have a history of heart disease in my family and am probably predisposed to it. Lots of people

have high stress levels but don’t get AF. An EP told me that AF is increasingly to be found in people in their 20s and 30d. There are insufficient studies as of yet to say decisively why this is so, but the strong suspicion is that it is caused by a bad diet, increased obesity etc.

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Hurlingham

Thanks Bob, I'm guessing atrial tack could be as difficult as AF?

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BobD
BobDVolunteer
in reply to Hurlingham

Different and more difficult to ablate apparently.

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Dawsonmackay

3 ablations - from Oct 2018 to March 2019. Four days after ablation in March went back into Afib, then 28 days later reverted to NSR and still in NSR.

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higgy52

Don't all put a downer on Ablations,

if they didn't work or improve things they would not spend millions doing them,

i know a lady had Ablation in 2,000 and was in NSR till she died few months ago of old age,

and two other people i know are in NSR 4 and 6 years after Ablations,

Think positive.

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Cookie24
Cookie24
in reply to higgy52

Agree, ablations are not cheap inUSA

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Samazeuilh

Sobering" Long-Term Outcomes Following Ablation of Atrial Fibrillation

Michael O'Riordan

January 05, 2011

“January 5, 2011 (Bordeaux-Pessac, France) — New data from one of the groups that pioneered the catheter-ablation approach for the treatment of atrial fibrillation provides a revealing look at the long-term results of the radiofrequency procedure. Arrhythmia-free survival rates after a single catheter-ablation procedure are relatively low at five years, just 29%, but the long-term success increases to 63% when outcomes are measured after the last ablation procedure.

Investigators report that most AF recurrences occur in the first six to 12 months and that there is a "slow but steady decline in arrhythmia-free survival" in the later years. Overall, the group contends that the ablation strategy--with repeat interventions as needed--provides "acceptable" long-term relief from the arrhythmia.”

However, this isn’t the full story. If your heart is enlarging as a result of PAF, it’s advised to have the procedure to stop that process of enlargement- not to do so would mean that you would eventually became more breathless etc.

Also note that this is just one French study that I have come across- there may be other studies with differing findings- this often seems to be the case with AF. I would discuss with your EP.

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cuore
cuore
in reply to Samazeuilh

Data from 2011, especially from Pessac, France, is not up to date. The statistics are very different for 2020.

The ablation procedure was pioneered by Dr. Michael Haisssaguerre and his team at Haute Leveque hospital in Pessac, France starting 1994 ( the date was personally given to me by Dr. Jais who did my third ablation. Dr. Meleze Hocini did my second. ) This team is constantly being innovative plus uses the latest tools and techniques to give longevity to the ablations. Furthermore, this team has now built the research centre Lyric to bring together under one roof clinicians from all over the world who are experts in their field to solve this arrhythmia disease, not only AF but also ventricular arrhythmia.

After my country Canada let me deteriorate to persistent AF with a definite path to permanent, I short circuited this path and went to Pessasc where I had to have three ablations there to get me to some consistent time in normal sinus rhythm. ( I am now eight months post third ablation) I was one of the most complicated cases at the six month persistent stage and had I gone beyond six months I would never have been able to return to sinus. In Canada I was given a 60% figure on the success of a third ablation whereas in Pessac the figure was 85% which so far has held to be true.

You are correct that there are many studies from different places, but the Bordeaux-Pessac group has contributed the most and continues to do so. They have one of the highest if not the highest track record for successful ablations. All ablations today ( if I remember correctly 500,00 a year) stem from the dedicated efforts of this group .

It is great that you came across this Bordeaux -Pessac group and brought some statistics to the forum. I would encourage you to read more of their accomplishments.

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Hurlingham
Hurlingham
in reply to cuore

Wow thanks Cuore, do you have a reference to their most recent papers on follow-up? And do you recommend others going to France as you did?

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cuore
cuore
in reply to Hurlingham

If you Google these three names , Haissaguerre, Jais and Hocini, you are surely able to get their most recent papers. Dr. Haissaguerre and Dr. Jais have given many presentations for the annual AF symposium held in January (this year 23rd to 25th in Washington.) Dr. Hocini did a live ablation a few years ago that was broadcast for the symposium.

Steve Ryan via his blog

a-fib.com/steves-a-fib-blog/

summarizes the presentations of the symposiums and will likely summarize those of Dr. Haissaguerre and Dr. Jais who are presenting this year. For the symposium, Dr. Haissaguerre granted an interview which you should be able to access online.

I absolutely recommend going to Pessac, France. You are guaranteed to have exceptionally experienced EPs, one or more of the latest, if not the latest mapping tools, and proven, successful ablation outcomes. Again, I would not be in sinus had I not gone to Pessac, France.

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Samazeuilh
Samazeuilh
in reply to cuore

I agree with most of what you say here. The study was from 2011 and, doubtless, techniques have improved since then. Furthermore, the study refers to radiofrequency ablation and does not consider the newer cryoablation. Nevertheless, I have not read of any subsequent studies which explain away the figure of 29% or indicate that it is not longer applicable. This doesn’t mean that there are not such studies, just that I haven’t been able to find them!

Nor was I criticising this very eminent group- in fact it is precisely because it is such an eminent group that studies like this should not be readily dismissed

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cuore
cuore
in reply to Samazeuilh

I may be wrong, but cyroablation is done around the pulmonary veins . However, once the AF has spread to other areas, radiofrequency ablation is done. The Bordeaux group also has done ethanol injection of the Vein of Marshal for peri-mitral atrial flutter. Dr. Jais is currently involved in the study of pulsed electric field ablation.

The Bordeaux group does keep track of the outcome of their ablations but I do not know their statistics. Also, the statistics vary according to how long and what frequency you have AF.

I may have come across harsh, but that was not my intention. I compliment you for exploring different topics of AF, and outcome is high on the list.

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Samazeuilh
Samazeuilh
in reply to cuore

I was not offended by your reply. If you know of any recent studies on outcome I would be interested to read them-I haven’t made an exhaustive search of the literature by any means.

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cuore
cuore
in reply to Samazeuilh

After my second ablation (Nov. 20, 2017) that still did not solve the problem, I did some research as to what would be the outcome for a third ablation. So, I typed "recurrence of AF" or "long-term outcomes after ablation."

I just did that right now and the following recent paper contains quite a few statistics:

electrophysiology.onlinejac...

Because it is 8 months of continuous sinus rhythm after my third ablation (may 27, 2019) , I haven't touched the subject recently. Trials are always ongoing so you might want to try adding the date (2020) in your research. There is a vast amount of material out there. Have fun!

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Hurlingham
Hurlingham
in reply to cuore

Thanks, this looks really promising 😀

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Hurlingham

Thanks, i expect i have missed a point. What does the 29% refer to? You also refer to radio and newer cryo. Is there evidence that one or the other is better?

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Samazeuilh

I think that which of the two is better would depend on many factors, including how extensive the area to be ablated is, the precise location of the area to be ablated, whether one is dealing with PAF etc. etc.. As for the 29% figure, see the extract from the

paper “Sobering Long-Term Outcomes Following Ablation of Atrial Fibrillation” posted by me further up the thread.

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Shcldavies

The best advice I can give is to follow the Docs advise, they do not get it right all the time but do get it right far more than any advice on here can offer. Everyone is different. I do believe that any regular/constant arrhythmia damages the heart over time and will likely make the symptoms worst.

All that said I will offer my advice.

An ablation will offer better quality of life for nearly everyone - duration is very individual but nearly always well worth it. Potentially the most important reason for having an ablation is that It is not until the EP does his EP study (to see what is going on with your heart before he ablates) will he know enough about your condition and what can be done - when I had my ablation it was not for what the Doc had expected (he expected Aflutter but he ablated for MAT and found the Aflutter was brought on by my Meds). This EP study not only directs the EP to ablate if necessary but also gives him a better understanding of the Meds to prescribe and the likely future outlook for your condition - this is priceless for your condition and your future quality of life.

The down side is that going for an ablation is not the best, everyones is frightened with their first ablation and unsure if they made the right decision. The waiting in the hospital to go to the EP lab is unpleasant, the prep in the lab is both interesting and worrying, then:

If you are under anaesthetic you will wake up and its all over - it will be some days before your over the anaesthetic.

If your sedated the experience varies from feeling nothing to having a degree of short lived pain when the catheters are inserted in your groin, no other pain when they are moved to your heart or during the EP study. When ablating you do feel a burning in your heart. At any time you can ask for more sedation. When its all over you do not have to recover from anaesthetic.

Ablation recovery can tale longer then expected, mine took many weeks and 3 months before I was near normal.

It does feel like winning the lottery when its all over and you heart is doing what it should, though it will be annoyed at you for burning it for a little while, as it will likely give you a few ectopics now and then - all part of recovery as many on here will testify.

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Hurlingham

Thanks for this detaled explanation. Does EP stand for Electrophysiology?

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Shcldavies

Yes, it is the only way the Doc (EP) will know exactly how the electrical signals of your heart work and hence the best treatment for the condition, its done as part of the ablation procedure.

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Lilypocket

Hi

Very interesting information - thank you.

Was your ablation successful?

X

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Shcldavies

The EP was disappointed that he could not ablate all of the MAT, but was glad that I did not have Aflutter. The MAT is to be controlled with Meds, he put me on Bisoprolol and Digoxin as a starter and asked me to self medicate within certain limits. After some trial and error over the first 3 months my meds settled at a very low dose (1.25) of Bisoprolol only and I have been arrhythmia free for nearly a year. Better still I feel better than I have done for 20 years, not sure if this is a direct result of the ablation or the reduced drugs (I was on 5mg Bisoprolol for 20 years) or my improved diet particularly significantly reduced alcohol and caffeine intake.

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Lilypocket

Thanks for replying. I'm sorry but what is MAT? I have Paroxysmal Afib

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Hurlingham

I wondered what MAT is too.

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Shcldavies

MAT is Multifocal Atrial Tachicardia

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Samazeuilh

“If your sedated the experience varies from feeling nothing to having a degree of short lived pain when the catheters are inserted in your groin, no other pain when they are moved to your heart or during the EP study. “

I thought-obviously incorrectly- that the area where the catheters are inserted is numbed with anaesthetic so that there is no pain on insertion. How much pain exactly and for what duration? Are you aware of discomfort, or any sensation, when they are pushed towards the heart? How long does it take for them to reach the heart?

“When ablating you do feel a burning in your heart. At any time you can ask for more sedation. “

Again, how strong is this sensation? I hope you don’t mind all these questions but I have to have this procedure quite soon and must decide whether to have sedation or a general anaesthetic (although the hospital seems to have assumed that I wil have a general).

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Shcldavies

I know exactly what your going through so please do not be concerned with any questions, if I can I will help.

Yes they do numb your groin area and most do not feel a thing, in my case the numbing did not work as well as it should - I don't know why, it may have been the case of the EP starting before the anaesthetic took full effect, I do know the support staff did not administer the sedation as quick as they should have so this may also have played its part, also the tubes that supplied the sedation were slightly obstructed under my body or arm (can't quite remember which).

Once the catheter is in (through the vein) there is no pain and you don't even know its being moved to your heart, the catheter itself does not go into your heart, its just there means for getting the "probes" in. This happens twice, with each catheter having the facility to insert 2 probes which can be a verity of types from electrical transmitters to receivers to the actual ablating probe itself. With me, when the catheters were inserted there was momentary very sharp pain that made me site up, then nothing, the second catheter was similar but not so severe.

Once the probes are in your heart (you can see them on the monitor - quite fascinating) you do not feel them moving around in your heart. If following the EP study the EP decides to ablate, you will be told when its being done, you will feel a burning sensation in your heart, the severity will depend upon the anaesthetic/sedation you are given, the duration of the burn will vary from around 10 sec up to 20 sec. This is not a pleasant feeling, the level of pain I suffered was just about bearable - I'm a wimp. I think they should have given me more anaesthetic.

My ablation was on the right side of the heart (my right side so they did not have to puncture a hole to get to the left side) and hence a simpler procedure, but it still took nearly 3 hours - you really do not notice time and may well drift in and out of consciousness.

Without doubt I would get it done again, without it they would not have known of my condition or how to treat it properly and over time my heart would have become worst/weaker. Not sure if I would go for sedation though, I would have to speak to the Doc to see if they could improve on the anaesthetic/sedation. Remember most do not feel a thing.

The recovery after was difficult for a few days, then OK for 2 weeks then improved slowly but irregularly with some spasmodic ectopics/arrhythmia for no apparent reason. Went on a family holiday after 6 weeks and was OK - did not do much. Five month after my ablation went on another family holiday and whilst I still had some occasional minor ectopics and one short run of tachycardia (up to 5 secs - could have been multiple ectopics) it was much better than I had expected, even in the heat of a very hot France (last year), it took a day to acclimatise (during which I was tired) then everything really good, even canoed the Loire with my daughter (I did most of the work).

I cannot recommend strongly enough that you get the ablation done, I would take Docs advise if your ablation is on the right side of your heart and defiantly go for being knocked out if it's on the left side. Not nice decisions to make but and it a big but, you will feel better afterwards, maybe straight away maybe in 6 months, no one knows and don't get concerned if your recovery is not as the EP tells you. Keep us informed of you progress.

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Samazeuilh

Thanks for this reply, which is just about the most detailed first-hand account I have read. Its highly informative. The other question which occurs to me is: would it be dangerous if you moved about either during the painful parts (particularly the actual ablation itself) or in anticipation of pain? I’m guessing that the answer to this is “yes”, but I wondered if they said anything to you about this. I suppose everyone would leap on top of you if you did move about too much.

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Shcldavies

Not sure it is too critical as the probes are in your heart which is pumping around once a second anyway. The pain or discomfort on ablating is not sharp to make you stir (like when the catheter was inserted), its builds up to a level and stays at that level until the ablating stop, if it gets too much the EP will stop and give more pain relief.

Star jumps may be a problem but if you do these under sedation there is something very wrong. So worst case scenario - you may get a short sharp pain for a second at the start (twice), you will feel next to nothing for the next hour or so (during this time you will be intrigued looking at the screen, with the electrodes moving around in your heart) then one or more periods (I had 5 I think) with a building burning sensation in your heart that will last between 10 and 20 seconds each

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Samazeuilh

Once again, thanks for this information.

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Roto

Thankfully I've been Paf free for some 6 years ...

recommend getting it done while your in good health ( I hope )

the older we get the more prone to illness we are :-(

Good luck

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7164
7164
in reply to Roto

Roto

No meds?

Rod

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Roto
Roto
in reply to 7164

1x 120 mg Verapamil pd.

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Lilypocket
Lilypocket
in reply to Roto

Wonderful! Do you take any meds ( related to Afib) or are you Afib and meds free?

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Hurlingham

Very good news

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Roto
Roto
in reply to Lilypocket

1x 120 mg of Verapamil pd

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Maggimunro

Hi Hurlington

I have had 3 ablations. The first for right sided SVT (rapid heart in the 200’s, fainting etc). Not had a single episode since the op 3 years ago.

The second and third were for the more complicated left sided A-fib. The last one was June 2017 and not had a single blip since. OK so I had the usual ectopics etc after surgery, but no A-fib.

However, I do take magnesium supplements and have changed to a plant based diet and I don’t have any co-morbidities.

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Hurlingham

Fantastic, i've not heard about Mg supplements. Is there evidence they help?

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BobD
BobDVolunteer

Just a small point here. Three years after my last and succesful ablation I was diagnosed with prostate cancer. Doctors were not keen on operating saying radiotherapy was enough but I insisted that they do. This was 2011. Good for me as they found it had already moved out of the prostate into other parts nearby . They removed all the cancer and a few bits I didn't need and I subsequently had three years of hormone treatment and 33 shots of radiotherapy. I am still here with PSA undetectable. Doctors agree that had I still had AF they probably would not have been persuaded to operate and I would not now be regailing you with this story. However long you are AF free post ablation is well worth it and may just save your life.

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Roto
Roto
in reply to BobD

I had catheter abalation in 2013 the following year diagnosed with prostate cancer had that surgically removed (never saw that coming)

my advice to anyone considering an abalation is to get it done asap depending on your circumstance

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Madscientist16

I had an ablation November 5. I had it done because the meds were hard on me and I would still get AF. I am 53 and otherwise very healthy and active. I like to travel. But most of all, I was afraid that years of AF episodes would enlarge my heart and cause heart failure. I hope my ablations keeps me AF free for years. I would have another one if I needed it in a heartbeat. Pun intended. :)

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