It is regularly stated on this forum that ablation for AF is only designed to improve Quality of Life.
I would challenge that statement.
As successful ablation lessens the frequency of AF episodes, the risk of stroke must be reduced. It is said that having AF increases the chances of stroke fivefold.
There is evidence that AF is sometimes associated with the the likelihood of developing dementia. Eliminating or reducing the frequency of AF must help reduce this risk.
I was told that because I have suffered from AF it has caused my heart to enlarge. In any case I have now developed bad conductivity. All because of years of my AF not being resolved. I hsd had PAF for 20 years when I had my first ablation
If AF is treated early enough these risks must by definition be reduced. Add that to a better QOL and it is a no-brainer in my view.
Pete
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pottypete1
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Pete you know that I am a fan of ablation but the reality is that there is no dfference in end result whatever treatment one has for AF other than QOL. The important point here is treatment.
Un-controlled AF can lead to cardiomyopathy and other detremental cardiac issues and lack of anticoagulation increases stroke risk. Anticoagulation is also thought to reduce or even remove the dementia risk which as was recently mentioned results from micro embolii thrown off during AF events blocking very small blood vessels in the brain leading to vascular dementia in some people. Alzheimers is quite a different condition I understand and not so related.
I agree that early intervention of any treatment is important and since ablation stands more chance of working if performed early I agree it best done early in one's AF journey but it is not a cure and as many people find out often needs repeating each time with attendant risks.
I would add that the safety net of anticoagulation is only there for those who take the medication. As our forum will attest many either don’t want to or are regularly seeking a green light to stop taking anticoagulants.
I find it incredible that people are averse to taking anti - coagulant medication ! I was diagnosed 2 years ago , I had dragged my feet for over a year for personal reasons before having EP studies for a planned SVT procedure , which showed that I had AF, I was delighted to be diagnosed & treated to reduce my stroke risk ! Prior to that I had no idea of the risks involved in not being anti- coagulated . I felt I’d been given an extra chance at life 💓
Simple logic doesn't always work in medical matters. There are counter arguments - some of which are referenced by BobD but here are some more:
1/ It isn't necessarily the AF that causes strokes but the company it keeps. See 'Why I don't believe that AFib causes strokes' from York Cardiology (Sanjay Gupta) on YouTube.
2/ As BobD says, it may be anti-coagulation that reduces the risk of dementia
3/ Studies suggest that life expectancy of patients is the same provided AF is rate controlled compared with a rhythm control (ablation etc.) strategy.
4/ The is a small but quantifiable risk associated with ablation.
5/ Ablation tends to be defined as 'successful' if it leads to 5 years without AF. It doesn't necessarily banish AF for life. Usually ablation needs to be repeated (perhaps several times) to control AF.
6/ The heart remodels itself to deal with AF but that doesn't necessarily lead to cardiomyopathy or heart failure.
I'm not knocking EPs or the brilliant work they do. Ablation is great for those people whose lives are severely affected by AF but if, like me, you hardly notice AF, ablation may not be the right route (as per the advice my EP gave me). That is why it is referred to as a treatment related to QoL.
Always good to stimulate the odd controversial discussion.
Couple the complexities of our condition and the complexities of the remedy with the fact that we are all different then we end up with more questions than answers.
I agree that ablation does not cure AF. However I think that to say it just improves QoL is a little simplistic. Improving QoL has many benefits. For example it can improve exercise tolerance and the ability to reduce weight.
There are mixed messages from trials. The CABANA trial failed due to the number of cross=overs which made analysis very difficult. However this trial points to a positive outcome "Ablation increases survival for adults with atrial fibrillation":
I'm glad I had my ablation. I've had a lot of benefits including, for instance, an improvement in kidney function. I'm still on warfarin however, an ablation only reduces some of the risk if at all.
Aside from all the above, there are some very real, very serious complications with ablations. Worst is the esophageal fistula, almost always fatal...and sometimes not apparent for as long as 30 days. At this point, it is too late to intervene. All electrophysiologists will tell an inquisitive, persistent patient that despite the temperature probe dropped down the throat, these things happen as the esophagus moves making the procedure more difficult. This complication is rare but must be considered. As the studies suggest, the actual death rate is closer to 5% than 1%.. so risk/ benefit must be given careful thought.
The figure quoted in the UK by most centres and the BHF seems to be 1 per 1000 or 0.1% very different (50times less) than 5 %. Some studies are skewed to get maximum attention. I think this is alarmist and inaccurate. Prof. Schilling (who publishes his results) has not had a death in the last 7 years (if ever). The same probably applies to most competent EPs.
I believe if you collated the statistics from the hospitals where the most ablations are carried out the rate of death would be very low indeed.
I have had 7 ablations all at the same Cardiac Centre of excellence. On one of these occasions I developed an allergic reaction to steroids that were administering 2 days before the procedure.
The Anaesthetist told my EP that the procedure must not go ahead.
They never took the slightest risk with my life and I would have no hesitation in having a further ablation if the need were to arise.
I read all the pro’s and con’s of ablation for which I am on the waiting list as my episodes started to become regular every two weeks I am still undecided as each time I read why I should,I find another reason why I shouldn’t so I really appreciate everyone’s information.
In the last couple of weeks things have been good so I guess it will be a decision nearer the time
I had a cryoablation 14 months after onset of afib. Flecainide did not work for me. I had a complicated radiofrequency ablation for atypical flutter 19 months after the first ablation. I researched and read everything about ablation including risks.
I'm age 63. It's coming up on two years since I had my first (and only) PVI cryoablation. I've been 100% a-fib free since the procedure. My QoL has improved immensely. I fast-walk 4 miles a day and drink 3-4 bottles of light beer each day. I'm feeling better than I've felt for years. Ablation might not be a "cure" per se, but for me it has been exactly like a cure - it gave me my life back. Without hesitation I'd have another ablation in future should the need ever arise.
I always feel I was incredibly lucky to have the decision made for me. Despite horrible side effects from the meds, only really revealed when I stopped taking, I had no intention of having an ablation until the day I was given a choice of pacemaker plus keep taking the meds or ablation and stop. That truly was a no-brainer. The fact that I still have AF and can’t take effective meds for it doesn’t change my feeling I was pleased I had a go. But if the AF gets worse it may be back to the pacemaker 🤕
As this article asserts early intervention is best. It took 20 years of AF before I had my first ablation for Atrial Flutter. I then had five ablations for AF followed by a final one for Atrial Tachycardia.
I am really very stable now 2 years after the last one but I am sure that had ablation been available when my AF started around 1990 I would have had a better chance of a much better Quality of Life since then and maybe my conduction problem I now have would not have developed.
Sorry for the late reply. Dr. Jais from Bordeaux told me that they started doing the procedure in 1994 (if I remember correctly), so unfortunately you were diagnosed before the time.
Looking at the cup half full, you were lucky you remained paroxysmal during those 20 years. Probably the majority would have gone persistent leading to permanent in 20 years because AF begets AF. In my case, it took me only one year to get to persistent.
By my calculation, you had 7 ablations in 8 years. That's most remarkable that you hung in there , as well as your medical team, rather than give up to hopelessness. Your case is most remarkable and an inspiration to us all, especially since you continuously contribute positive and encouraging posts. May you continue to shatter records.
In fact after my third ablation the Professor that was then my EP told me nothing more could be done and that I would very soon be in permanent AF.
This proved to be incorrect as it was after he retired that those that followed felt that as I was so symptomatic they wanted to continue and help me. This coupled with new mapping technology and the best EP in the world, in my opinion, became the deciding factor. If my current EP was not specialising in rhythm matters he would be well employed in teaching other doctors the art of communication.
I do try to be positive and encouraging it is when it is me having a bad time that like so many others I cannot cope with. However I do try to keep positive.
Wonderful for the great EPs. For atrial fibrillation, when an EP says that "nothing more can be done," the words should be challenged, if one aspires to return to AF. It is sad when a patient hits a cardiologist or an EP who is not up to date with the literature or with the technology.
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Without hesitation I'd have another ablation in future should the need ever arise.
Related to Anticoagulants
Appointment at St Barts
Ablation follow up - interesting points from EP
