How AF develops. An analogy. - Atrial Fibrillati...

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How AF develops. An analogy.

BobD profile image
BobDVolunteer
71 Replies

Thinking out side the box today and came up with this thought re AF and how it develops and why early intervention is important.

Mixing cement. By Hand.

OK so you start with sand and cement and thoroughly mix these two components together before making a well and then adding water. You start carefully moving dry mixture from the outside into the well and then suddenly the water breaks out and rushes out of the well taking cement with it. If you are quick you can dump dry mix onto the escaping water and stop the escape before it is too late. If you are looking elsewhere the trickle becomes a flood until you have several rivers of water all destroying your carefully made well and your mixture is all but lost.

Early ablation is that first spade full of dry mix which stops the rushing escape of water and returns things to normal. Leave it too long and you will never get things right.

As Alexander would say. Simples.

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BobD profile image
BobD
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71 Replies
Frances123 profile image
Frances123

Bob that is a brilliant analogy and one I will definitely use. 😁xxx

7164 profile image
7164

Bob

I would say good advice. Question is how early is early? Do you have to fail two types of pharmacy intervention before your cardiologist will refer. I for one have taken your advice😊😊

Rod

BobD profile image
BobDVolunteer in reply to 7164

I believe that is old advice and that ablation can be a first line now.

Singwell profile image
Singwell in reply to BobD

Its not Bob. I was diagnosed in December. See my response lower down. Living in Wales diagnosis in Hereford hospital.

Desanthony profile image
Desanthony

A great analogy Bob. Waiting to get my ablation as soon as our cardio department is up and running safely again.

Alessa69 profile image
Alessa69

That is a great analogy Bob ! Now I understand why JC want ms to go back in for ablation ,as soon as possible , after recent problems ...... I’m such a weed atm , well have to wait & see what Covid-19 situation brings .......🤞🤞

fallingtopieces profile image
fallingtopieces

Or.... Imagine a garden surrounded by a bushy hedge and one purpose built path leading out of the gate. If one person cut across that garden and pushed through the hedge as a short cut, the hedge would bounce back to it's original position and no one would be the wiser (the odd ectopic). However, if everyone cut across the garden over time, and pushed through the hedge, a worn pathway would form across the grass and the hedge would then have a well used gap with no bounce back.

If the hedge gap was filled and strengthened(ablation), it would deter the short cutters.

However, sooner or later some clever dick will come along and begin the shortcut method again.

Pat.

Lbeat796 profile image
Lbeat796 in reply to fallingtopieces

That's a very good analogy. I have been getting ectopics which sometimes lead to fast heartbeat for couple of hours for about 20 years. But I just take Antenolol have never been referred for ablation

Ochg profile image
Ochg

A great analogy Bob.

I am a really lucky lady, I was only diagnosed a few weeks ago and now have my ablation scheduled in nine days time, so hopefully my 'dry mix 'will work and all will go back to normal. 👍😀x

Belle11 profile image
Belle11

Where would you put cardioversions in this analogy?

BobD profile image
BobDVolunteer in reply to Belle11

you cant. I'll have to dream up another one for that.lol

Belle11 profile image
Belle11 in reply to BobD

:-D

Byke profile image
Byke

That's great, it’s very simple but makes sense and easy to follow.

Singwell profile image
Singwell

I feel quite angry reading this. Ablation was not offered at all. It was mentioned as a possibility if things 'got worse'. Just before lockdown I saw an eminent electrophysiolist who explained it to me and I was considering paying for the procedure. It's taken till mid April and a telephone appointment with my NHS cardiologist to refer me in September hopefully for an assessment but I had the wrote in strong terms to say I couldn't really work with AF. As in unable to work. Since then I've changed my meds and I must say all has been well for three months. I also made major lifestyle changes and dietary. Now I'm wondering if I need ablation. Thanks for this discussion.

Octaviascout profile image
Octaviascout in reply to Singwell

I am in PAF, diagnosed 1 year ago, 2 DC cardioversion later and still there. Heart rhythm all over the place, rate control with Verapamil. Do not consider an ablation as the magic fix. It only has a 52% success rate and there is a high likelihood you’ll need more than 1? It’s all about quality of life, not a cure. My EP did not recommend I have one as my symptoms are small and the risk would outweigh the benefit. So I don’t know your personal circumstances but unless you are short of breath, light headed, no energy etc don’t go there. Statistically your chances of mortality are no less than if you were not in AF, as long as it’s being correctly managed. In some way I was pleased not to be offered an ablation as symptomatically I don’t need one. Sorry about the rambling but hope this helps in your decision making.

BobD profile image
BobDVolunteer in reply to Octaviascout

It must be well understood that any and all treatment for AF is ONLY about symptom control or quality of life (QOL)but for many people it IS the answer to better QOL where drugs are not working or cause greater problems. Any yes there is no cure.

Singwell profile image
Singwell in reply to BobD

Thanks Bob and apologies of I was a little rude- not intended. Just frustrated. I do get that each case is individual. I'm saddened that what you've been saying here about 'earlier is better' only seems to have filtered through to a few places. My own brother has AF, now PAF band has had it for 6 years. He GP has not referred him to a cardiologist. He has never been assessed in a cardiology unit. This is Bristol where there should be access to good cardiology departments. We need this info to get down to Primary care level in terms of best practice, if that's indeed what it is.

BobD profile image
BobDVolunteer in reply to Singwell

No offense taken NICE guidelines are there but GPs are often not in the loop.

Magson profile image
Magson in reply to Singwell

Singwell,

My Cardiologist is RUH Bath and I was referred to an EP at the Bristol Heart Institute. In short I had an ablation at Bristol in late 2018. Great professional team. Never looked back. I hope you get sorted. My GP referred me to Bath and within 3 months I saw a Cardiologist. Change your GP?

Go well.

Singwell profile image
Singwell in reply to Magson

Alas I'm in Wales. Totally different rules for requesting a different hospital for referral. Even if I changed GP if have to make a case for funding outside my catchment area. If I want ablation I'll almost certainly have to pay.

Singwell profile image
Singwell in reply to Octaviascout

That's a very helpful response and I do know about the success rate of ablation procedure. In fact my quality of life is good since I significant changes to my lifestyle and my mental approach to having AF. I'll take the appointment with the EP when it comes so I can make an informed decision. My feeling bat present is - if I can feel this well.bwtqeen episodes and only have them 2-3 times a year, I can enjoy my life. But we'll see - only 7 months in...

Ianc2 profile image
Ianc2 in reply to Singwell

Interesting reply. What changes did you make?

Singwell profile image
Singwell in reply to Ianc2

You could do a search on my posts to get a bit more detail than I'll give here. Things I noticed we're digestive triggers before my AF events. I've had acid reflux for over a decade and suspect I've a hiatus hernia which often results from.long terms GERD

So I put myself on an an acid reflux diet created by a good nutritionist and it's turned my life around. More vitality, no events for 3 months, digestion working better. I've also done some work with a psychotherapist to get my head around things and learned some mindfulness techniques. I am listening to my body now instead of over riding signals

I'm.64 and have cut down my working hours. Life is a whole lot better even in lockdown. Am I still afraid that f AF and high BP - yes, for sure. But I manage it better and so am happier.

RajaRua profile image
RajaRua in reply to Singwell

Can I ask about lifestyle and diet changes Singwell? Sounds like you have this in hand!

Singwell profile image
Singwell in reply to RajaRua

Check my responses here in this thread. But I am not alone in this at all - I got advice from this forum

Check out a thread o out up a whole back on how to distract yourself during an AF episode

.I got some amazing answers and excellent advice

RajaRua profile image
RajaRua in reply to Singwell

Thanks Singwell. I read all that. Very helpful and interesting. Have left a message on that other thread. God bless.

Buffy-1 profile image
Buffy-1 in reply to Singwell

What dietary changes did you make.

Singwell profile image
Singwell in reply to Buffy-1

See above?

Lbeat796 profile image
Lbeat796 in reply to Singwell

Much the same as me. Was told if they become more frequent or feel faint to come back but that I am handling them well and that ablation does have risks.

Foxglo profile image
Foxglo in reply to Singwell

I have just read your comment, I would like to share 2 things with you that may or may not be useful. I have intermittent Af not often but with up till recently many night time palpitations. My cardiologist advised if tablets worked leave ablation at present.

Recently after a hospital visit with a fast Af I have taken extra care with tablet taking.

As well as this I finally managed to get my sinusitis sorted which has improved my breathing and seemed to have helped palpitations episodes. After the last Af I stopped drinking coffee only decaf tea, unfortunately I ran out so for 3 days I drank just water, then carried on as I felt so well. Whether the better breathing or drinking only water has made the difference I don’t know or I could be having a good patch any way. I hardly dare write this down but since these 2 changes I have had no night time palpitations I was having 4 or 5 every night.

It was not a gradual change the first good night I had I thought was a one off but they continued.

Singwell profile image
Singwell in reply to Foxglo

Thank you. I do suspect there are apparently peripheral things that affect our instances of AF. Breathing difficulties or respiratory infections are pretty obvious ones I think. Digestive issues are another big theme on this forum. I haven't drunk coffee for 3 months nor alcohol for almost 4. Episode free for just over three months. Occasional palpitations (if I get them it'll be two or three times in the same week, then none at all) but these calm down if I sit quietly and breathe slowly.

District profile image
District

The only problem is we are in the hands of the health professionals, my Afib is constant yet following a telephone consult in May I'm still waiting for more tests, no date as yet and my next face to face with the Cardiologist is November, my Afib has been diagnosed as chronic. Any energetic activity makes me breathless, I'm terrified my heart is getting damaged beyond repair, the only medication I'm on at present is Apixaban. I realise Covid 19 has caused delays and they may be others out there with more serious problems than me but what more can I do?

wilsond profile image
wilsond

Professor Osman told me ablation is just performed for quality of life,not therapeutic reasons. He said it blocks the signals to the brain that AF causes,but does not actually stop the AF occuring.

For this reason I see no advantage for me ,as when I have AF it is a nuisance in only 1/10 episodes . This is 7 years into AF and Flutter

If it incapacitated me that would be a different consideration .

It is a masking proceedure he said ...

Dodie117 profile image
Dodie117 in reply to wilsond

that is not what happens. Physically, the ablation causes scarring to the inside of the heart which develops scar tissue. This stops rogue electrical signals and thus the erratic beating of the heart. Maybe discuss this with another EP, Kardia/ecg measures this.

cpalmermn profile image
cpalmermn in reply to wilsond

Yeah, this Osman guy is wrong, or you misunderstood. Ablation, if successful, absolutely stops Afib from occurring. My Afib was very symptomatic and noticeable. Since ablation, NOT having Afib has been quite noticeable. And I would do another if I need to.

in reply to cpalmermn

Lucky you! I've had paroxysmal for almost three years and only recently was ablation mentioned as I finally got a (telephone) appointment with an NHS EP at my insistence. Sadly, I had no confidence in him messing about with my heart as he wanted me to take bisoprolol regularly again, the lowest dose of which had brought my heart rate down dangerously low. If there were a higher success rate for ablations (or I could find someone I had confidence in who had a good success rate) I would consider it as my quality of life has definitely been affected!

wilsond profile image
wilsond in reply to cpalmermn

This "Osman" guy is a highly respected Electrophysiologist who was guest of honour at the national Health Unlocked Arrthymia conference here in Birmingham last year. He is Head of a large department at Coventry University Hospital.

I did not mishear him. I also had a companion with me .

I am not going to get into a debate on what I did or did not hear or whether this "guy" got it wrong.

I asked him the question,amongst others,and he answered me.

I am glad you no longer get troublesome electrical signals.

I am happy with the management of my symptoms and with the excellent care I receive from Proff Osman

BobD profile image
BobDVolunteer in reply to wilsond

Wilson, with all due respect to both you and Dr Osman, the way you describe it is not correct. As I have explained before ablation blocks the rogue signals within the heart by creating scar tissue which they should not be able to cross. There is no link with any signals to the brain.

I am really not sure how this "confusion" has arisen but I am sure that is just what it is.

I suggest that you read the AF Association booklet which explains all aspects of ablation for a more full description of how and why..

wilsond profile image
wilsond in reply to BobD

I have read it Bob.. I'm only going on what the Proff said to me at my last consultation ( seems a lifetime ago now although only in August)

I shall ask again for clarity if and when I ever get to see him again!

My companion took notes for me at the time on what was said,as well.

If it does help some people feel better that's good. X

BobD profile image
BobDVolunteer in reply to wilsond

All I can add is that all our fact sheets and booklets have to be passed and approved by not just our medical board but also NHS England to verify accuracy.

wilsond profile image
wilsond in reply to BobD

Please ,I'm not saying they aren't! Just repeating what I was told .

I am due to see him Oct 30th..all being well of course and will bring it up .x

lms0006 profile image
lms0006 in reply to wilsond

I have had 3 ablations...did not work now in permanent AF on med for rate control and blood thinner...no energy most of the time.

maxred1 profile image
maxred1

Early on in my AF journey I had a consultation with Prof Schiiling at the London Heart. He offered me a 30% chance of partial success with an ablation. He gave lots of other advice to me but when asked with those odds what he would do? He stated if it were him he would not do it. Why? The process is irreversible. I did not do it. 5 years on I get on with it, not fantastic, but I am intact. I think everyone who gets to the stage of Ablation really needs to take a long hard look at the pros and cons. Just my 2c.

Jfbould1 profile image
Jfbould1

My concern is with the success rates of ablation being low (70% isn’t that good, is it?) this requiring another and then the potential cumulative damage to the heart muscle.

Anybody have any thoughts?

BobD profile image
BobDVolunteer

Isn't it interesting how threads develop. What started out as a simple analogy has morphed into a pros and cons of ablation which was not what I was expecting. I make it very clear at every opportunity that any and all treatment is only for QOL but for some of us who are/were highly symptomatic then ablation is the only way forward if life style changes do not do the trick.

Singwell profile image
Singwell in reply to BobD

But it's a really helpful thread Bob so thank you! And apologies of I was a bit rude.

KipperJohn profile image
KipperJohn

This is timely and an excellent analogy. After 2 ablations and about 4 years virtually AF free I woke up on Thursday morning in AF and stayed like it until Friday evening. Bit of a shock as I hadn’t changed my diet or medication, although I’ve been exercising a fair bit more during lockdown. Perhaps I need some more ‘dry mix’ ? Having said that my EP said he wouldn’t do another one. Whatever, as far as I’m aware I’ve never been discharged by my EP although it’s been ages since I saw him. No need to panic just yet but my first action on Monday will be to try and have a chat with the arrhythmia nurse if she’s still there. Don’t see much point trying my GP - always deal with specialists if one can.

Looking back it took me 4 years to get referred for an ablation by my GP - I totally agree about early intervention if it’s suitable.

Janey1955 profile image
Janey1955

Because there is some risk and also is not 100% successful and my afib is giving no symptoms as such, my electrophysit is saying wait a while. Don’t know if that’s right or wrong really

Jane

Tomred profile image
Tomred

if i recall right ive heard dr sanjay gupta say that we would still need to carry on taking medications after ablation so obviously not a cure i would hate the thought of damaging my heart any further if it wasnt going to cure me but if i was in permanent af id have to give it serious thought if it was seriously impacting my Qol

BobD profile image
BobDVolunteer in reply to Tomred

If you were permanent it would be too late in most cases.

Tomred profile image
Tomred in reply to BobD

thanks bobd i didnt realize ablations were not for permanent afib

BobD profile image
BobDVolunteer in reply to Tomred

Very low chance of success especially if cardioversion fails to work .

cpalmermn profile image
cpalmermn in reply to Tomred

I have not carried on with meds after ablation, probably depends on each case and each Doc.

Madscientist16 profile image
Madscientist16 in reply to Tomred

I was taken off all meds the day of my ablation (I am in the US). I don't even take anticoagulants as my CHADVASC score is only 1 for being female. It has been 8 months since my ablation and I am doing great. I guess each case is different, however I feel very fortunate.

tunybgur profile image
tunybgur

My understanding is the process after first diagnoses is:

1: Anticoagulant

2: Determine whether AF is paroxysmal, persistent, or long-term persistent. Doctors also categorize AF as either valvular or nonvalvular. This determines the treatment options and can take months.

3: There are then several treatment options which are dependent upon the above...

-Lifestyle changes

-Electrical cardioversion

-Medications to restore heart rhythm and heart rate such as beta-blockers, calcium channel blockers, or antiarrhythmics

-Catheter ablation

-Electrical pacing (pacemaker)

These treatment options generally follow a well trodden path, not quite sure where they fit into your analogy, but as you say it's important to keep the mix from spilling so it requires continuous attention...catheter ablation as I understand it is one of the last options because of cost, risk level and success rate.

It would be nice if the success rate was 95%+, I would love to dump my meds but not prepared to take the risk of ablation at this present time.

Good luck everyone

BobD profile image
BobDVolunteer in reply to tunybgur

In fairness I had ten years meds free (apart of course from anticoagulation) and only occasionally take meds now for a different arrhythmia.

Haymaker42 profile image
Haymaker42 in reply to tunybgur

Ablation is not as scary as it sounds! I have had 2 ablations and waiting for my third. My AF was so out of control that the strongest medication was not keeping me in normal sinus rhythm. I have had cardioversion 8 times. Ablation has improved my quality of life greatly. I would not hesitate to have another ablation. It really is a life changer! Just my 2 cents! Stay well, stay safe!

tunybgur profile image
tunybgur in reply to Haymaker42

My AF is just about under control with flecainide, but in your condition I would not hesitate to go for additional ablation, we are all unique and our conditions are unique....no one size fits all.

A good friend of mine is in persistent AF and awaiting ablation as he has a prolonged QT interval, this precludes many of the normal drug treatments. He has learned to live with his condition and I've just finished 18 holes of golf with him....he is philosophical about it saying things could be much worse, he is a retired GP and has seen some real suffering.

Good luck and make the most of each day.

Jfbould1 profile image
Jfbould1 in reply to tunybgur

You summarize things well. We’re all different and also have physicians with their unique opinions and preferences. Not to mention the vagaries of the health care / insurance complex.

2524-GrannyK profile image
2524-GrannyK in reply to Haymaker42

I am considering an ablation for proximal afib. My heart rate is difficult to keep under130 bpm even with heavy medication during an episode which lasts up full day and happens every couple of months,.

I’ve been told that based on my age & condition the success rate is around 70% and complications around 5 -10% but the vast majority of these are minor like bruising. I’ve also heard cyro ablation is safest but don’t know if that’s true.

Can I ask why multiple ablations are necessary when I hear some say “one and done”?

I would really appreciate any advise on how to locate a experienced skilled doctor and a high volume facility,,

BobD profile image
BobDVolunteer in reply to 2524-GrannyK

Cryo ablation is quicker and easier to do than RF but has limitations. If the pulmonary veins are nice and concentric then a more cpmplete scar can be created within the entrances than maybe a ring of dots as in RF. The big BUT is that few people do have such veins and often an RF ablation is needed later to tidy up any areas missed.

There is also the probability that there may be other areas within the heart firing rogue signals which the cryo balloon is unable to reach and again RF will be needed to deal with those at a later date.

If you go to the main AF Association website there is a list of EPs by area within the patient resources section, or call the office for details.

2524-GrannyK profile image
2524-GrannyK in reply to BobD

Thank you for this information!! I truly appreciate all the guidance I can get. I didn’t know there where limitations on cyroblation.

I have checked multiple resources for doctors and I can get a list of EPs but I’m actually trying to find more detail on the doctor such as number done in a year, patient ratings etc, also success percentages for the procedure, I just have here say.

Singwell profile image
Singwell in reply to tunybgur

Good summary! Thank you. I'm on a calcium channel blocker and currently it seems to be doing the job. Occasionally I get palpitations but always settles if I sit quietly and breathe slowly.

GrannyE profile image
GrannyE in reply to tunybgur

Just thought I would give praise where praise is due. Had my ablation 3 years ago. My A/Fib now comes and goes. Had a few follow ups with the Royal Brompton team and it has been left to me to contact them again if I feel I need another ablation. They actually rang me out of the blue and said that I am still their patient and how was I doing? Also saying again that I can contact them when I feel the need to do so. How about that? All very reassuring.

cali111 profile image
cali111

Well I am in on Tuesday for a second ablation and he will attempt to return me to sinus. I can't say the previous procedures were not helpful and now I take 10mg of Nebivilol I feel better but because of the AF it is not consistent.

Morzine profile image
Morzine

Yes ...” simples”

I’d like to add a bit too......from my experience here......

The extra “ star “ component with the thick mix of cement, as far as I was concerned and I’d reckon so many would agree.....was for me (just starting with that afib label and feeling horrid.....stumbling by chance/ desperation/ totally scared and lost) was to find this wonderful set of supporting group forum we have here! Bob our leader.....and so many regular names I feel have helped me along the way!

Blooming marvelous.........I’d not heard of ablation till I met u....and my wonderful cardio followed soon after.....yes bob sooner that solid thick mix is set in the Better!

Lbeat796 profile image
Lbeat796

Thanks Bob for all your input

I find this site very reassuring as nobody else understands what it is like. And we all have different symptoms

GrannyE profile image
GrannyE

So why do cardiologists leave it so long before they do the ablation?

Dodie117 profile image
Dodie117 in reply to GrannyE

Not all do. I hummed and hawed before seeking help and then took a while with difficult GP etc. When I got to the EP, I was having 4 or 5 episodes a week lasting up to 6 hours. On day one he offered the choice -meds route or ablation. I opted for ablation. I was on bisoprolol for about six months whilst on the waiting list and had the ablation in November 2013. Came off bisoprolol on the day. Still AF free, no meds just anticoagulant.

Eirecara profile image
Eirecara

Very interesting Bob. Also makes me sad,because I was ignored and practically told “it was all in my head” soo many times over the years, because they couldn’t catch it on ecg. I have lost many years of “living life” and instead just existed, trying to deal with this arrhythmia. I so often think “if only they would have believed me”.

I am now awaiting an appointment for an ablation. ☘️

patleit profile image
patleit

Putting it all in a nutshell BobD as usual Thinking seriously about it as I sit here in hospital for the 17th day after coming in through A&E with rapid AF, that was after being relatively episode free for 3 years. Cutting a long story short my infection/inflammation markers were very high so I was scanned, bloodtested, filled with antibiotics, put on beta blockers, feet now bloated with fluid, hopefully going home today and will get in touch with a electrical heart man , cannot stay on those beta blockers as my blood pressure is now seesawing like my heart. I am very grateful to this site and your good self for all the good information I have gleaned this last few years which have helped to keep me sane those days

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