AF & Ablations

[Denboabfib]

Reading through posts from our friends in The States, I was struck by the many references to ablation. I first became aware of having paroxysmal AF in 2011 and was treated with low dose Bisoprolol until I began to feel quite ill in late 2016. My AF has been permanent since then and I take Sotalol, Apixaban and Atorvastatin. I have asked more than once about an ablation and was told that an ablation was unlikely to be beneficial because of the length of time I have had AF. It seems the British medical profession have a different approach to their American counterparts regarding the use of ablations and my GP confirmed as much.

[BobD Volunteer]

Actually I disagree. Ablation has its position in AF treatment

If you have permanent AF the likely hood of ablation success is quite low. You must also understand that ablation is not a cure for AF it merely reduces or limits symptoms. Since any and all treatment for AF is only ever about improving quality of life (QOL) and properly controlled AF is unlikely to shorten life it has been shown that provided rate is controlled and the patient is anticoagulated for stroke prevention there is no benefit carrying out a procedure which is unlikely to help whilst carrying some risks.

[CDreamer]

I’ve had 2 ablations for PAF - I would say the UK were at the forefront of offering ablations - when there is a chance of success. In reality this means people who are 45 years or under and otherwise fit and healthy.

As Bob says - only when there is a chance of success is ablation offered. If you have permanent AF - which means if you & your medical team have agreed your AF cannot be converted to NSR - there would be absolutely no point in offering ablation.

The usual course of action is if drug therapy fails move to Cardioversion to see if there is a chance of restoring NSR - if so ablation may be advised as a possible suitable therapy.

And remember ablation is not a ‘cure’. Many people need multiple ablations and still AF returns, albeit with less ferocity and frequency.

The final therapy option is Pace & Ablate which was the only option left open to me - that wasn’t without it’s difficulties but having had the pacing found I didn’t need the AV node ablation so that has been most successful as far as I am concerned.

Any therapy for AF is for symptom relief & QOL as it is not considered a life limiting condition.

Best wishes CD

[Dodie117 in reply to CDreamer]

I am surprised to see you say that ablation is mainly successful for under 45s. Many older people on here seem to have had successful ablations. I was 63 when I had mine in 2013 and have been free of af since then.

[CDreamer in reply to Dodie117]

That’s not what I meant - I was 57/58 when I had ablations but the chance of success is higher the younger you are & the fitter you are generally therefore the statistical curve will show the % decline of successful ablations at around 45. But we are not just a statistic so there are multiple influencing factors & my then 84 year old husband was assessed for ablation but was advised that as CV lasted for less than 8 seconds & there were other influencing factors it was not a recommended course of action as the risks would clearly outweigh the possible benefits - that’s the equation each has to weigh up. He was very keen - his doctors & I much less so!

[Dodie117 in reply to CDreamer]

Ok. Gotcha!

[Dawsonmackay]

Do you have any relatives in the United States? Friends? Helpers? The reason I ask is because the UK medical establishment, according to BobD and CDreamer, are not going to ablate a permanent Afibber WHILE the United States medical establishment has no such limitation. I had three ablations and was diagnosed in 2007 as being in permanent Afib. I guess my EP wanted a challenge. BobD is right though that the likelihood of a successful ablation is "quite low," but what does that really mean. My third ablation (2019) put me in NSR and I hope that it continues. I will not be running, at any time in the future, to catch a bus.

[Denboabfib in reply to Dawsonmackay]

I might be being unnecessarily cynical here but might it be that the British NHS ‘s attitude could be that ablations for permanent AFibbers are not cost effective whilst Stateside there are no such sentiments- quite the reverse as there are no financial constraints, whatever it costs will be billed to the patient

[Dawsonmackay in reply to Denboabfib]

There are definitely financial constraints - in fact, EP's must get approval before commencing ablation but an ablations typically run $100,000-130K. Pacemakers also run high and would think that NHS are installing more pacemakers than performing ablations. Yes?

[Denboabfib in reply to Dawsonmackay]

I don’t know for a fact but my impression is that pacemakers are relatively commonplace but I have not heard of anyone having an ablation. I understand that pacemakers are not suitable if the heart beats too fast and mine does

[bantam12 in reply to Denboabfib]

I have afib and a fast heartrate and have a pacemaker to allow me to take the meds to slow it down.

[CDreamer in reply to Denboabfib]

I’ve had 2 ablations, the 1st made my AF a lot worse so ended up in coronary care for 3 days, the second worked and I woke delighted but exacerbated an unknown underlying condition. The AF returned after 3 years and as I could no longer take any heart drugs my only remaining option was re-synchronisation pacing therapy which has been amazing for me.

I had both ablations privately as back in 2013 they were not widely available on the NHS or local to me so I had to travel to London. These days they are much more widely (or were until COVID19) at regional centres and London, Liverpool and Birmingham are known to have outstanding centres with world renowned specialists.

Go to the AF website where you will find a full list of specialists.

Persistent AF is different to Permanent AF - persistent is when you have it all the time and permanent is when you and your doctors decide that nothing has worked to return you to NSR. Cardioversion is usually tried prior to ablation to see if you can be converted if you have been in persistent AF for some time. If neither chemical nor electric CV works, then the likelihood of ablation working is basically zero. If it does, and your heart remains in NSR for even for a few minutes, there is a possibility ablation may work - but it absolutely not for everyone and is often a course of treatment and an invasive procedure which many take months to recover from, especially if you are older ie: 45+ so the earlier in the AF process you are, the younger and fitter you are - the more likelihood of success.

The other limiting factor in the UK is that there are about 4 million people in UK with AF and only roughly 1200 Electrophysiologists trained to perform ablations so the NHS is very unlikely to support a therapy financially with little chance of success - as you surmised.

Pacemakers are not normally a solution for AF but may people seem to benefit and find it stops their AF - they are a more expensive option, least mine was much more costly but it does depend upon the type of pacemaker and for what it is treating. I had some complicated issues and was showing signs of an altered QRS pattern.

Best treatment options should always be based purely on clinical need and a balance between risk:benefit taken. Ablation is not without risks.

I think it sad that we have to consider the financial aspect - which we all do despite our political views or the systems we have in the countries we live in - but it is also a reality.

[Bambi65]

Im one of your State side friends. Yes we do some things here very differently. This is from one of the best hospitals in our country for Afib.:

Success Rates for Catheter Ablation at the University of Michigan

We have performed thousands of ablation procedures aimed at curing atrial fibrillation over the past few years. Success rates of left atrial ablation in patients with atrial fibrillation depend on whether the atrial fibrillation is paroxysmal (the kind that comes and goes on its own) or persistent (the kind that has been present consistently for several months to years).

Paroxysmal atrial fibrillation can be eliminated in 70-75 percent of patients with a single procedure. When the procedure is repeated in patients who still have atrial fibrillation after the first procedure, the overall success rate is approximately 85-90 percent.

Persistent atrial fibrillation can be eliminated in approximately 50 percent of patients with a single procedure. In about 30 percent of patients who undergo ablation of chronic atrial fibrillation, the atrial fibrillation is replaced by a different kind of short circuit referred to as “left atrial flutter.” These patients are treated temporarily with medications and the left atrial flutter sometimes goes away on its own within a few months. If it does not, you may need a second catheter ablation procedure to eliminate the flutter. In these cases, the overall success rate is approximately 75-85 percent. If the atrial fibrillation has been persistent for more than 1-2 years, almost all patients will require more than one ablation procedure before a normal heart rhythm is restored.

[Bambi65 in reply to Bambi65]

source: umcvc.org/conditions-treatm...

I dont care for the word they used, "curing" but the goal of " aimed at curing" was palatable .

[Desanthony in reply to Bambi65]

This is what I was told at my pre-ablation talks with the arrhythmia nurses.

[Cookie24 in reply to Bambi65]

That was my experience . Successful cryoablation for afib. Fourteen months later I had atypcial flutter with a second ablation this time radiofrequency. Feeling good.

[Mugster]

I am in Uk and my EP told me an ablatin was on the cards from day one.I had persistent AF. A Cardioversion after an angiogram and scan put me into NSR for two days. The ablation was nearly 2 years ago.No problems now touch wood.

I was 61

[Madscientist16]

I am in the US and ablation was never offered to me. I had to ask for it. It was only performed after the insurance company approved the procedure. No doubt that the recommendation from my EP and the potential for success were factors for their decision. At 53, I only had PAF for 16 months and was otherwise in good health. Medication was not controlling my symptoms and I was visiting the ER often. That was also costing them. Insurance information post-ablation indicated that the procedure cost them $136,000 USD of which I only paid a small percentage due to the amount of out of pocket expense I had already paid for previous hospital visits. I am glad I did it. I am only 4 and a half months post-ablation but doing well and I am no longer on any heart meds.

[Denboabfib in reply to Madscientist16]

Gosh, $136,000 is a staggering amount of money for a procedure. The mind boggles at what , say, open heart surgery or an organ transplant might cost. Over in the UK we find it hard to understand why there is so much opposition to making affordable , or even largely free, healthcare available to more of your citizens. It seems to me that top quality healthcare is available over there but only if you have a fat wallet and there are a lot of people making huge amounts of money from healthcare. The UK national health service is far from perfect but the thought of living in the USA and being chronically or seriously ill would be pretty scary. I have grown up having access to (almost) free healthcare and people in the USA have grown up amid the system over there. That’s the way it is and it doesn’t look like changing anytime soon.

[Madscientist16 in reply to Denboabfib]

I have seen this before, but I believe that the doctors and hospitals charge so much because the insurance goes back to them and offers a percentage as payment. The more the hospitals charge the more money they can get from the insurance company. This only drives the prices higher and higher. Certain procedures are already discounted by the insurance companies, so they try to make up the difference in other ways. A colonoscopy may cost an insured person $1000 USD, but for someone with no insurance, they charge $4000 USD. All I know is that I pay just over $200 USD a month and then have a $2000 USD deductible before the insurance company pays anything, This insurance is considered cheap by most standards since I get it through my employer. I guess you could call it a group volume discount when a company has thousands of employees that purchase the same plan. Politicians have talked about implementing a national healthcare plan, but the hospital systems and insurance companies that profit will donate to politicians to keep the status quo. It's nuts.