Ablation damages the heart

[Slattery]

I just read an article on this site from the daily news on the crystal wand, a new fast ablation. In the article they said this new procedure can stop the damage to the heart that ablation is causing. I am getting ready for my second ablation, My doctor did not tell me my heart was being damaged! I am now thinking of canceling my ablation and wait for this new procedure. What are your thoughts.

[BobD Volunteer]

I wouldn't. Yes a small area of the heart is scarred to stop the impulses but whatever method will do that. Don't read too much into press stories please.

[pottypete1]

As BobD says an ablation involves scarring the heart. The scars are intentional and are designed to disrupt the chaotic heart beats occurring with AF.

I am a bit unusual as I have had 7 ablations but I don’t regret having them and my QOL has been significantly improved as a consequence.

If I were you I would not cancel your planned ablation.

Pete

[pottypete1]

Also beware of newspaper reports they are often inaccurate. For example as BobD mentioned in an earlier post there are errors in the article to which you refer.

Pete

[secondtry]

Once the ablation route is chosen, I would go ahead with a second as hopefully it will be less damaging than the first and more effective......I haven';t had one but just what I have read on this Forum.

[Sfhmgusa]

Damage is a very emotional term for me, I had a Pre cancerous polyp removed from my colon Without question that was “ damage” but it also removed a potentially very serious threat.

I consider my first ablation a modification of the hearts inner surface to try to prevent a more serious nuisance and risk.

Medicine/surgery is about trying to put things that are going wrong ...right, or at leat improving them. I’m certain You would not need an ablation if your heart was in perfect working order.

In the long run it is about the quality of life you want to try to achieve. Ablations are a well understood, regular and mostly successful procedure that for the vast majority of folk improve their QOL so I would not cancel.

And as for a “crystal wand” I think I would prefer a tested method with a track record recommended by a trained cardiologist to a media presented novelty with a cute name

It is up to you of course but I would not cancel

[Ducky2003 in reply to Sfhmgusa]

This was my thought too. "Damage" is a very emotive word. AF will also be causing damage so maybe ablation should be viewed more as damage limitation.

[Hidden]

I would wait for more information on the technique before taking such a decision. And an EP should be able to tell you about it in more detail.

[cuore]

Let me focus on your word "fast." Right now, either radiofrequency or freezing is used. So, the procedure isn't new; it is the catheter for radiofrequency that delivers a higher wattage so the "burning" that can take up to 20 seconds is whittled down to 4 seconds making the procedure faster.

There is a new procedure being trialed -- Pulsed Field Ablation. This procedure does not use radiofrequency and is tissue selective. The buzz is that the procedure will revolutionize pulmonary vein ablations.

You are talking about a second ablation which probably means for you an ablation beyond the pulmonary veins which , at this point in time, Pulsed Field Ablation cannot address. Therefore, it is unwise to cancel your ablation because the waiting time for the trial results will be too long for you, and it is for the pulmonary veins which, for you, have already been addressed.

[Doggiemomma in reply to cuore]

Cuore, one of my friends told me about Pulsed Field Ablation, and says it doesn't "barbecue" your heart like ablations do (her words). The doctor testing this out and perfecting the procedure is Dr. Redey at Mt. Sinai Hospital in the U.S. Apparently Dr. Redey is only doing the veins so those are far away from the "sick sinus syndrome" node, which is one of my friend's biggest fear. I don't even pretend to know what she's talking about but she is brilliant, and well, as for me, I keep learning.

[cuore in reply to Doggiemomma]

Here is a scholarly article on Pulsed Field Ablation:

onlinejacc.org/content/74/3...

and yes, Dr. Vivek Reddy ' name is listed as well as the one who did my ablations Dr. Pierre Jais who told me it was not for me. I was persistent.

But, there is some advancement for persistent:

onlinejacc.org/content/76/9...

I found a site with a good diagram of Pulsed Field Ablation that clearly showed what was being selectively ablated without damage to surrounding tissue but unfortunately i cannot quickly locate it.

If you type in Pulsed Field Ablation in the address bar, you will find a plethora of information. You can definitely keep up with your friend.

[Doggiemomma in reply to cuore]

Thank you so much!!!!!! Dr. Jais is pretty well known too.

[mwcf in reply to cuore]

Hi cuore,

Interesting to see your post as I didn't know PFA was available yet for anything other than index PVI. I (now 61 yrs old) had an index PVI by Prof Jais in 2018 (after 20+ year history of PAF (always vagal/nocturnal - lone/idiopathic (or more correctly its a genetic thing on my mother's side who had PAF from her mid-30s) - my CHADS score is 0).

Always felt the PVI was stage 1 of 2 i.e. a redo would be needed at some point in the next few years. Well after 4 years more or less AF-free its back with a vengeance (after a bad hit of covid...?) I'm here in persistent AF for the last 20 days (not too symptomatic) booked in to visit Prof Jais again early in the new year. Weird thing is I get a fast (110-120bpm) ''very well organised' (Prof Jais' words) atrial tachycardia daytimes and slowish AF night-times. One alternates with the other - one kind of morphing into the other over 15-20 minutes - change over from one to the other is usually mid morning and late evening ! Echo just came in normal and DC CV scheduled for a couple of weeks. How many ablations have you had done by Prof Jais and when ?

Are you in the UK ?

[cuore in reply to mwcf]

Sorry, Haven't been following HealthUnlocked for a few months which is the reason for this late reply. I am in Canada. I have had three ablations. Two were done in 2017 and the third in May 2019. the first was done by Dr. Jais (I believe Dr.Hocini did the second half if it). The third was also done by Dr. Jais. I am mainly AF free, but I am on meds. I highly recommend Dr.Jais. I have the distinction of being one of his most complicated cases.

[Ppiman]

It dawned on me a while back that that is what an ablation is - damage to the heart. In years to come, I feel sure that people will wonder that such a thing was ever carried out, but, for now, for some, it's the best option. In my case, suffering last year with persistent atrial flutter, which no drugs would help, it was the only choice as I saw things. I do wish there were other alternatives, myself, and would think that the day will come when there will be.

Steve

[Singwell]

I'm considering ablation and waiting for an EP appointment on the NHS. Might even pay for it. Yes, you are freezing or burning cells is my understanding but we have a marvelous repair system in the body - the one that allows cuts to heal and bruises to form and go away. Where the damage is done, cells in the body immediately mobilise to get s repair system up and running. My cardiologist told me that this process sometimes has the be temporarily slowed down so that the 'circuit breaker' around the rogue cells isn't breached. Any procedure is dangerous. You have to weigh the balance. I agree with others that taking press articles as reliable medical information is risky.

[KMRobbo]

A Fib damages your heart also, drugs can damage your body.

In fact if you look at it living is dangerous and always fatal!

Its all about Quality of Life. I have had two ablations that have "damaged" my heart in a controlled way that have stopped (so far) AFIb and A Flutter. I have not taken any drugs for almost 2 and a half years. I cant tell my heart is damaged from the abalations, I am as I was before. I am sure it is less damaged that it would have been if I stopped in Flutter at 140BPM for any length of time. The 3 weeks I was in it wiped me out - I doubt I would be here if the ablation had not stopped it.

Anything with a surgical intervention causes damage, but generally if it is decided to do the surgery it is better than the other options.

[Mike11]

Any ablation is damaging the heart - that's the way it works. The problems occur when the heart repairs that damage and AF returns. I'm on my second and am assuming I'll need one every five years to keep myself healthy.

[Cookie24 in reply to Mike11]

I have had the same thoughts.

[CDreamer]

I agree with the others - ‘Damage’ is a very emotive word. Which article, published by whom? Many articles in the popular press are inaccurate and sometimes downright misleading. As others have said - all ablation damages the cells of the heart - it’s the scar tissue that forms over the damage which stops the rogue signals.

The skill of the EP is in ‘damaging’ where it is needed and not where it is not needed and as far as I can see this is another device which is able to ‘map’ where the rogue signals are so they are better able to destroy the cells so scar tissue forms.

My understanding is that some people are a lot more susceptible to fibrosis of the atria than others and this depends upon a number of factors, only one of which will be catheter ablation. Having AF long term also causes fibrosis and the loss of elasticity in the muscle may cause impairment in heart function but there are a lot of maybes and unknowns for any one individual.

I do remember a phrase from Patient Day 2019 when Imperial reported on one of their studies - Ablation burns and patients heal - some much quicker than others. In other words - that’s why some people need more than one ablation - the scars heal.

If your heart is otherwise healthy which may be calculated by looking at a echocardiogram or scan then my inclination would be to go for the ablation sooner rather than later if AF is frequent. The risk of waiting for who knows how long for a new procedure to be rolled out so as to be available for all is probably higher than leaving the AF to develop.

My suggestion would be to talk to your doctor about the state of your heart now, ask about the risks of leaving the AF to develop - with all of the inconvenience of decreasing QOL - against the risks of developing fibrosis after ablation and the impact that may have.

This is the only study I could find with any meaningful information on long term fibrosis after ablation which may inform your conversation with your EP.

Conclusions: The architecture of fibrosis consisting of concentration of fibrosis in one patch is associated with a diminished success of AF ablation at 1 year compared to a scattered pattern of fibrosis. Ablation of the fibrotic patch and reduction of residual fibrosis size increases the odds of remaining AF-free post-ablation.

[KMRobbo]

Initially you could not have paid me to have an ablation , but after 12 Afib episodes, the 12th which lasted best part of 8 days at 130 to 195 , it finally dawned on me that "afib begets afib" means that Afib is damaging my heart. That's what persuaded me to rethink.

The flutter I got after my afib was sorted (for now anyway) was just an encore.

[Slattery]

Thank you all for your comments, you have given me a lot to think about.

[thumpthump]

It’s much needed damage in my opinion - scarring you won’t see, there to disrupt the rogue electrical pathways that would otherwise be allowed to cause AF.