It seems to me that most people here have h... - AF Association

AF Association

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It seems to me that most people here have had one or multiple Ablations of one type or another.

Mrhermyl
Mrhermyl

I have had PAF and Flutters now for over one year. I'm 71 years old and my Cardiologists have never recommended a CardioVersion or Ablation of any type here in the Toronto Canada region. The last time I met with my main Cardiologist he told me CardioVersion is next to useless and Ablations are not far from the same result unless you are willing to have at least 3-4 done.

Now, why is that? Is it age ? Is it that most people here in Canada are on medications or are my Cardiologists including my General Practionioner not doing the job. I honestly wonder what percentage of people on this forum have had these procedures done ( being mostly a British site) ?

In a quick search, I couldn't find much in the number of Ablations done other than these bits.

"Learning in the Past 9 Years

jstage.jst.go.jp/article/ci...

Over the past 9 years we learned that AF is a chronic progressive disease and not curable by catheter ablation. Although the development of efficient ablation catheters and sophisticated mapping systems has improved the outcome of AF ablation, the long-term recurrence rate is still close to 50%. Nonetheless, we were able to evaluate the present results because we performed consistent and steady rhythm monitoring based on the 2012 HRS/EHRA/ECAS Expert consensus statement guidelines."

"In his editorial, Calkins also stresses the importance of operator experience. He highlights a 2013 study showing that more than 80% of 93,801 ablations performed between 2000 and 2010 were done by operators doing less than 25 procedures per year. In that study, annual operator volume (less than 25 procedures) and hospital volume (less than 50 procedures) were significantly associated with adverse outcomes."

This following is dated;

ncbi.nlm.nih.gov/pmc/articl....

"We identified 269,471 adults with AF. The rate of catheter ablation in AF patients increased from 0.06% in 1990 to 0.79% in 2005, (p<0.001 for trend). Compared to those not undergoing ablation, ablated patients were younger (mean age 66 vs. 76 years, p<0.001), more likely to be male"

1990 to 2005, in 15 years, it went up by about 3/4 of 1% !! By now, has it gone up to , say 10% ? Obviously not many people having Ablations, in my humble opinion.

Thank you in advance to all those who respond.

Sam

75 Replies
oldestnewest

You know I don’t look at medical studies, I came here and looked at the success stories. I also trusted in the doctors and nurses.

I don’t like to hear cardioversions and Ablations referred to as next to useless.

Tell that to the dedicated medical staff who perform them and people like me and the friends here who have had them.

I’m not sure what you hope to read in response as it seems like your mind is made up.

I’m not particularly interested in the stats. I care more about getting rid of AF and living my life.

ectopic1
ectopic1 in reply to LordGabriel

"I don’t look at medical studies..."

"I don’t like to hear cardioversions and Ablations referred to as next to useless."

"I’m not particularly interested in the stats."

And then you say "...it seems like your mind is made up."

Jeez, talk about the pot calling the kettle black! :-D

This is begging the question:

I care more about getting rid of AF and living my life.

LordGabriel
LordGabriel in reply to ectopic1

Last time I checked this was a forum for all opinions.

I gave mine.

ectopic1
ectopic1 in reply to LordGabriel

So did Sam.

Mrhermyl
Mrhermyl in reply to ectopic1

Thank you for your kind assistance. Some people prefer to lecture instead of help.

LordGabriel
LordGabriel in reply to Mrhermyl

There was no lecture from me. A response was what you hoped for and I gave mine. I see you don’t agree with it.... no need for any sarcastic comments.

BobD
BobDVolunteer

Hi Sam, it is simportant to understand that any and all treatment for AF is only ever about quailty of life provided that rate is well controlled to prevent left atrial enlargement and the patient is anticoagulated to prevent reduce stroke risk.

Is ablation worth while? From my point of view yes as I had at least ten years arrhythmia free during which time I also had prostate cancer treated by surgery which would not have been countenanced if I had been in AF. That surgery, ten years ago, discovered further cancer which was treated which otherwise would have been missed so it is no exaggeration to say that ablation saved my life.

I can't speak about treatment in Canada but would say that the specialists to see are electrophysiologists not ordinary cardiologists, the electricians not the plumbers.

Am I arrhythmia free, not currently but still no AF.

BobD
BobDVolunteer in reply to BobD

Sorry forgot to cover DCCV. These are not a cure for anything, they are a diagnostic tool and anybody that tells you otherwise is mistaken. IF a person can be returned to NSR by DCCV (cardioversion) AND they feel better for it this guides the doctor as to whether or not to attempt to keep that patient in NSR or merely give rate control . See the first sentence in my orginal response.

Mrhermyl
Mrhermyl in reply to BobD

Thank you Bob for always an informative and measured response. I'm wondering at the differences by countries as well. To add to the issue is this Covid that has put doctors in most countries difficult to access. Yes I know the electrophysiologists are the doctors to see but near impossible at this time. Today we were told that non emergency operations will be put on hold.

CDreamer
CDreamer in reply to Mrhermyl

There are several people posting who live in Canada and as far as I can remember, all report the same so I would suggest it is something to do with the lack of expertise in Canada. There is a lot more recent research than that which you quoted.

There was one person, I’m sorry I cannot remember their name but believe they were a medic of some sort themselves, who posted that their option for ablation treatment was to travel to US or France for ablation - US was too expensive so they went to France and had a successful ablation.

There may be many reasons why people need multiple ablation not least that the scar tissue which forms after ablation and prevents the rogue signals from getting through, heals and stops acting as a barrier.

There is a way of finding other members who live near you when you are in the Members section, you could maybe PM others in Canada to compare? Or just put up a new post - Anyone else in Canada?

Mrhermyl
Mrhermyl in reply to CDreamer

Thank you. I read somewhere that North American doctors make use of pharmaceuticals much more often.

Tapanac
Tapanac in reply to BobD

Sorry I have written about me before, but our computer played up and I lost a lot of content.

I had an ablation at St. George’s tooting a couple of years ago and although I didn’t see the main man before the procedure, but his registrar, I was told that as I had so many spots needed zapping, they would go round the heart in a circle. .

Although I have never been as bad as before the ablation, it has started up again (Afib/tachycardia) but I was transferred from St. George’s to a local hospital as there was so much Covid there.

I saw a consultant who received the notes from St. George’s and he said I had had a right side ablation for atrial flutter...! Different to what I was told. Now though he thinks I need a left side ablation, but said it was very risky with possible heart attack, stroke or bleeding in the p...????

I had to have cardioversion last November, but had another attack a few weeks ago, but the medication through cannulas took a very long time to work and then it went the other way with very low bradycardia, hence the suggestion of the left side ablation.

Have many people had a left side ablation after 2 cardioversions, one right side ablation, and various ambulance trips into hospital with Afib/tachycardia?

After the consultant telling me that it was risky, I’m now afraid.

Thank you sorry for the long screed

Pat x

BobD
BobDVolunteer in reply to Tapanac

AF is always in the left atrium. I had three before my AF as gone. Doctors always tell you the worst so you can't sue them. Cardiologists are not Electrophysiologists and are scared of lots of this stuff.

I think it depends very much on the individual's AF symptom burden. I don't agree that ablation and cardioversion are useless. If I had frequent debilitating episodes such as those described by many on this forum, I would grab at the chance of ablation and a better quality of life. Equally, if my heart rate was stuck at a level where I felt in danger, cardioversion would seem very appealing.

To say that such therapy is useless sounds to me like the proponents haven't a clue about the distress and fear suffered by so many AF people and are merely comparing therapy with cure which seems rather callous. If we are saying that in terms of a cure, they are useless, then yes, I agree - as to date, there is no cure for AF.

I've had AF for about 14 years and for half that time drugs have kept it under control - but I am in the lucky minority.

Mrhermyl
Mrhermyl in reply to Finvola

I totally agree with you.

The quotes you have posted are very out of date. Ablation has progressed dramatically over the past few years. I started having PAF episodes in about 2000 but ablation was not mentioned until 2014 and then with the comment ‘Try to wait as long as you can because they’ll get better at it!’ I had an ablation in Dec 2015 which lasted about two years but did improve my situation so I don’t need a regular anti arrhythmic drug.

Some cardiologists are dismissive of ablation because they are in the business of fixing things for good and often perform life saving operations so procedures that are for a chronic condition and not necessarily a final fix must seem inferior to them - just my opinion of course. But I have read cardiologists saying that their preferred option for intractable AF is pace and ablate which fits with my theory of the ‘fix’ mentality.

Cardioversion is usually only carried out if a patient is stuck in AF or if it is too fast so if that didn’t apply to you then it wouldn’t have been necessary.

Buffafly
Buffafly in reply to Buffafly

Apology : the first report was dated 2019!

cuore
cuore in reply to Buffafly

What an interesting supposition. It never occurred to me to co-relate cardiologist = final fix. My one-time visit with a cardiologist was poor. I felt he had inferior knowledge of AF and how to treat it. It all makes sense. They don't seem to be interested in non-life threatening conditions.

Buffafly
Buffafly in reply to cuore

My cardiologist totally lost interest when he decided I didn’t need a pacemaker. I’ve been referred to cardiology again and asked to see a specific one as I looked up all the cardiologists at my hospital to see who was the most interested in arrhythmia. Unfortunately it turns out he is the top man all round and not working privately at the moment because of COVID. I’ve got a long wait!

cuore
cuore in reply to Buffafly

You certainly have experience to back up your conclusion. I have a friend who was told to get a pace maker. He went somewhere else for an ablation. He is now arrhythmia free with no pacemaker. Pacemakers do have their place and do help a lot of people. The flip side is some cardiologist rush to place them. Hope you keep us updated.

CDreamer
CDreamer in reply to cuore

An EP once expressed exactly that view to me and proposed it was one of the reasons that it was so difficult to obtain funding for AF treatments and advancing them. They called it ‘White Shroud’ mentality = it was an essential procedure to delay death.

I have had one electric cardioversion, for Atrial Flutter when my heart was stuck at 150bpm for 3 days and no drugs could do anything. A continuous fast heart rate can damage the structure of the heart leading to heart failure.

I have had various arrhythmias including AF and have had 4 ablations (2 for SVT, 1 for Atrial Flutter and AF and a second one for AF) and my life has been good since the last one nearly 2 years ago. My life was dreadful for a couple of years - I had a year off work and was in and out of hospital numerous times as drugs couldn’t control my arrhythmias.

I know there’s a high likelihood that AF will return one day but in the meantime I’ll look after myself and get on with life. I’m 56 years old and otherwise healthy. I’m not ready to give up on the life I want to lead.

Would I have another ablation one day if needed? You betcha! And I’m in Australia 🇦🇺 😉

I was offered an ablation (back in 2014) but decided to postpone it and use Flecainide to stop AF, getting my QOL back, whilst I focus on Lifestyle changes. My reasoning the success rate and procedure didn't sound good enough, however my approach would change if the pills stop working. To date all good but acknowledge I am 'playing with fire' as drugs and age are not a good combination. I hope 2021/22 will present an opportunity to very slowly reduce the Flec. Best wishes to Toronto, my daughter lives there now.

Mrhermyl
Mrhermyl in reply to secondtry

Thank you for your response. Toronto is a great city is quickly deteriorating thanks to excessive gun play thanks to a certain sector of the population and a useless prime minister who is taking us into a dictatorship.

cuore
cuore in reply to Mrhermyl

I'm from Canada, too. I second the useless prime minister. But, we had a more useless opposition because with three separate charges of conflict of interest, the opposition (Schear, I think) couldn't get Trudeaux out. Hopefully O'Toole does a better job.

I think each province has its own guidelines for AF treatment; I know B.C. does. Last time I looked, July 2017, the B.C. guidelines were outdated and ,in my opinion, inferior. Then there is the matter of cost. B.C. is stingy for allocating money for non-life threatening issues and ablations are costly. In B.C. the private clinics (not AF but knee surgery ) have lost the right to remain open. Even the guidelines stated that ablation were for the select few , had to be symptomatic, and failed two drugs -- old criteria even at that time.

Some GPs don't refer to cardiologists, such as my case until persistent. Then the cardiologist just wants to keep the patient on drugs rather than immediately referring to the electrophysiologist. Cardioversions are allotted in a stingy manner. Mine lasted three days and there was no talk of a second. A member on this forum had three in close proximity with the third one "taking."

In terms of ablation, due to the lax Canadian system, I had two in Bordeaux, France. I still needed a third. The B.C. electrophysiologist rather than fast-tracking me for a third ablation placed me back on drugs for the problem ( combo rate-rhythm). I was progressing backwards, not forwards. I fast tracked to Bordeaux for a third and now I am in sinus rhythm, albeit with drugs, having to take them probably due to all the mis-management. For three ablations, the total cost for me was $90,000 Canadian including transportation which was worth every penny to be back in sinus. So much for our "free" medical system.

Mind you. If I had had a heart attack, I would have been well taken care of, after all, that's life threatening.

Mrhermyl
Mrhermyl in reply to cuore

Unfortunately not all of us can travel to France and dish out $90,000.00.

Especially when even at this age, I'm a caregiver for my disabled son and no one else to care for him.

cuore
cuore in reply to Mrhermyl

I compliment you on the great job you are doing in being not only a mother but also a caregiver. I am grateful, as a Canadian, for our Canadian Health care system to have allotted funds to address the health needs of your son. And, I would vote that funds go to the disabled before they go to arrhythmia.

My comments were to dispel the myth that healthcare is totally free in Canada. They were also to highlight there could be better management on the huge funds allotted to health care, and specially addressing the "wait times" that create so much worsening of health conditions.

Huge stress in management allowed me to accumulate that $90,000. Stress was a large contributing factor for my arrhythmia. It would have been better not to have had that stress since I don't have that $90,000 but I still do have the arrhythmia lurking for the rest of my life. It. has been a lose-lose situation.

I was merely trying to answer your questions from a Canadian point of view.

Aside from our genetic component, we all make choices and I certainly made mine.

CDreamer
CDreamer in reply to cuore

I think you will find that Mrhermyl is male..... Hope you don’t mind me pointing that out.

cuore
cuore in reply to CDreamer

Not at all. I thank you.

Mrhermyl
Mrhermyl in reply to cuore

No problem !

Found it! I was looking for a reply a few weeks ago from a fellow Canadian cuore

healthunlocked.com/afassoci...

She says (in Canada) 'Since AF is non-life threatening, it is downgraded, and in my opinion, somewhat neglected'. Her experience with AF under Canadian healthcare somewhat mirrors yours - treat with medication and not much else.

I was diagnosed 5 years ago but my AF burden has been extremely light in comparison to many others on here and I get by with a PiP. But I wouldn't hesitate to have an ablation were that to change. Don't forget that often the successes (and there are many) no longer have need of this site!

Mrhermyl
Mrhermyl in reply to irene75359

Thank you taking the time to find that response from "cuore".

Yes, I remember reading it in the past.

I was only diagnosed with AF in August, although I’ve had it for a good few years, but was always ok when I was checked in hospital. I have never been told about ablation or cardioversion, by any doctors, and only found out about about it on this site. Reading what the members here have to put up with sounds much much worse than my situation, and I take my hat off to you all. It’s a horrible thing to have, and you are always here with good advice. Thanks all.

A 50% failure rate is also 50% pass rate. A glass half full.

In response to whether it is a common procedure in the UK I would say yes. I had an ablation 14 months ago and I know 3 other people in my village who have had ablations since then and we are a small village. We have an excellent centre at Papworth in Cambridge and when I was in they were doing 14 a day, every day. So yes, a common procedure over here by very experienced heart specialists. The success rate has improved considerably in recent years according to my consultant so only look at research since 2018.

Mrhermyl
Mrhermyl in reply to mobradley

It seems to me that North American doctors count on drugs as the number one choice . As fellow Canadian has posted in the past, she had to go to France to get her Ablations done.

Thank you.

All medical procedures carry risks. For some, like BobD, its clear the benefits were worth the rush. Others, like secondtry and my wife, are managing with drugs to get a good QoL and so are not chasing ablation yet. Ultimately it's an informed discussion between you and your medical professionals.

As BodD pointed out cardioversion does not cure you, it's just a temporary jolt to get you back in sinus rhythm. They unsuccessfully attempted it in A&E on my wife after she had been in high rate AF for 7 days and the drugs hadn't worked. It made things worse putting her into a more dangerous flutter.

I hope all our shared experiences help you for your future discussions with your doctors.

Mrhermyl
Mrhermyl in reply to DevonHubby1

Thank you for your advice.

My EP referred to it as not a cure but a quality of life issue. My AF became so severe in 2016 that I couldn't hold a conversation for longer than 20 minutes nor climb a small hill before arrhythmia set in. It was also waking me at night and I had to walk around, sometimes for a couple of hours, til my heart went back into sinus rhythm. On the other hand, my cousin.. who was also offered an ablation..... did not find he had problems more than once or twice every few months. My ablation was fast tracked and I am now mostly AF free... with occasional short runs and careful monitoring of eg. alcohol, coffee and stress levels! My cousin did not have an ablation and has carried on with a normal if slightly quieter life. He has had a couple of cardioversions when his AF has suddenly gone into overdrive! But otherwise he relies on bisoprolol. So, everyone is different. I am happy to muddle on with a couple of incidents a year... but would have another ablation if the situation deteriorated again. Note: there is a lot of research that links AF to other lifestyle choices...... when I went for my first assessment I sat in a clinic with a number of very unhealthy people who clearly had other lifestyle orientated health issues. Don't know if ablation would be that helpful for them, sadly. The smaller minority of us with PAF who are otherwise healthy with no comorbidities may just be the best of the success stories.........

Mrhermyl
Mrhermyl in reply to Lizty

Thank you Lizty

Hello Sam, AF can be treated in the longer term by various tablet types. In my own case I have had a cardioversion and two ablations. The second ablation so far has worked and I am back in normal sinus rhythm. This has been for 7 weeks.

The Cardiologist has told me it will probably return at some point, if within a few weeks then she will fit a pacemaker, if after a couple of years then another ablation. I am 75 and play golf 3 times per week walking the golf course.

I have no idea what is available in Canada but in my case ablation has worked. I have seen pictures of my heart chamber which looks like a spot welder has been at play stopping the electrical interference.

I agree with one on here who says see a Cardiologist who is 'electrical' rather than 'plumbing' will be better.

Best of luck

David

Mrhermyl
Mrhermyl in reply to Golfer60UK

Thank you David. This Covid has been and is increasing as a major disrupter to treatments.

Well . . . I can't address your main point but I'd like to correct your impression about 'most people here'. Whilst there are many here who have had an ablation, there are also very many who are still awaiting their first one, or else have only just started on their AF journey. They are the ones to whom the forum is most valuable, and the ones that those who have had an ablation hang around to support. It's enormously valuable that they do.

However, my impression is that 'most people' who have had a successful ablation then tend to either leave the forum, or else stop frequenting it as much. We mainly hear from those where the ablation has failed and, statistically, most are successful.

Mrhermyl
Mrhermyl in reply to momist

You are totally correct. Thank you.

I am 2 years 9 months Post SUCCESFUL AFIB ablation. No AFIB since

No drugs at all in over 2.5 years. ( worth having one for that alone)

As BobD always says QUALITY OF LIFE.

If Afib cones back tomorrow morning I will happily have another ablation tomorrow afternoon for another 2 years 9 months afib and drug free!

And obviously I am still on the forum .

Mrhermyl
Mrhermyl in reply to KMRobbo

Thank you for Sticking around.

Had my one and only ablation in 2013 aged 63. Still free of AF so although it may return I’ve had 7 years of bliss. Mine was severe and very symptomatic so this was the right thing for me.

Mrhermyl
Mrhermyl in reply to lallym

Thank you. Glad for you.

I was diagnosed with AF in April. I am doing ok on my current medication, and have been discharged from the hospital, GP taken over my care. My Cardiologist said if AF was to get worse, I would be put on Flecainide. If things became troublesome (his words) he would consider ablation. At 75 years of age, I am happy with that. Best wishes Marianne.

Thank you Marianne.

If you are symptomatic then I would change your EP as soon as you can. A cardioversion will show if you can be converted. Then an ablation or two can give you many years of relief. I am soon (I hope) to have my 5th. My 4th lasted over 5 years.

Mrhermyl
Mrhermyl in reply to Barb1

Happy for you.

The first time I had AF, in about 1993 my GP said I shouldn't worry about it if it was only once or twice a year. By 1999 AF episodes came more often but while they could occur several times a week I could still go 3-4 weeks without having an episode.

I had a GP appointment about my asthma, and happened to mention the frequency of my heart 'going haywire'. I was told to go to A&E the next time I had an episode. I had to wait about three weeks before that occurred. I was admitted to the hospital and kept in overnight. After loads of IV drugs and a night's sleep I was back to normal and discharged, having to take Amiodarone regularly. Three weeks later I had an echocardiogram which showed my heart was okay, and then I had a long wait (10 months) to see a specialist/cardiologist.

Amiodarone didn't reduce the episodes much, but it did have awful side effects, including anxiety.

My work meant I had to drive on the M62 in West Yorkshire regularly. I lost confidence driving on a busy motorway. One day while near to Leeds on the motorway I felt that I wanted to pass out. I carefully drove to the hard shoulder and opened all the windows. I managed to get off the motorway and within two miles of a hospital before I stopped and called for an ambulance. I was still on Amiodarone and pleaded with my GPs to take me off. They said they couldn't. I didn't drive on the motorway again until I was completely off Amiodarone.

When I saw the cardiologist he said that he didn't like Amiodarone and he put me on Flecainide, starting at 50mg X 2 a day, increasing to 150m x 2 a day.

He mentioned ablation but said he considered it was too early to say whether it was worthwhile. I took Flecainide for 12-13 years, during which time I had only a few episodes, until I was found to be in persistent AF, when I was told to stop taking Flecainide as it had no longer any effect. I'm now in my 6th year of knowing I have persistent, though asymptomatic, AF. I take an anticoagulant daily, Warfarin being my choice.

Mrhermyl
Mrhermyl in reply to Thomas45

Thank you Thomas45. Good input.

My husband has a great cardio team.

Every cardio patient is different. My husband was not a good candidate for ablation. Most of our electrophysiologist patients need more than one ablation and many times as many as 3. The procedure is not without risk and it’s not a precise science yet. While you can see the procedure from the “outside” inside they are effectively destroying nodes that they believe are responsible for the misfiring of signals to the heart which cause the atrial fibrillation or flutters. Recovery time and healing from the surgery and time will be the determining factors of whether one ablation resolves the problem.

CardioVersion is a fairly non-intrusive procedure and it’s the “Paddle and Electric Shock” we’ve all seen in movies or on TV. It tries to shock the heart back into normal rhythm. My husband had this done twice. The first time he was in rhythm for 5 days. The second time after he got into rhythm the cardiologist put him on Amiodarone . He stayed in rhythm but the drug (which is one of the “dirty” drugs in the cardio medical industry) affected his liver within 6 weeks) however he did stay in normal SN.

The final solution was a PaceMaker.

The day after his PaceMaker procedure he woke up, got our of bed and proclaimed “ I feel great”!

The only drug he takes for his AF is Warfarin.

His AF journey started in Jan 2018 and he had his PM procedure in September 2018. Over the course of the last 2+ years with his PM he has only had AF episodes a few times and those episodes have been short - from a few minutes to an hour.

Everyone has a different health history and age, I believe can be a factor.

Sorry for the long post.

Mrhermyl
Mrhermyl in reply to not2worry

Thank you for your story. Good information.

I live in Canada and have Persistent Afib. I have learned a lot about this illness on this site, so I thank you all for your contributions. Like Mrhermyl my cardiologist never mentioned ablation. Instead I am on half of 2.5 mg bisoprolol once a day, Digoxin 125mg and rivaroxaban 20 mg. Also I am a young 😂72 yrs old., still active, going for walks, exercising, dancing, etc. but struggling to lose some weight. When I asked my cardiologist why I was never offered an ablation just recently, he said it was because my QOL of life was not effected much. He said if I was younger and had QOL issues he would have suggested it.

He wanted to know if I had palpitations and I said no, but I do have the occasional slight chest pain if I get stressed or angry. For the most part I don’t feel my PAF. I was on a Holter Monitor before talking to him which showed that My heart rate was under 100 with resting rate in the 60s or 70s. (It has spiked to 120 on occasion when I tried coming off Digoxin)I asked him what I should do during Covid if I do get heart issues like lightheadedness, etc. he told me to increase the bisoprolol to one tablet. I generally like my cardiologist and trust him to make the right decision for me and my circumstances, but would not hesitate to ask for an ablation or go to emergency if I had reoccurring problems that could not be addressed by medication as many of you seem to have. Bob D was the first one to enlighten me that it is all about QOL there is no cure. My one concern would be if my PAF would cause an enlarged heart and lead to other problems later. He said I am due for a full heart assessment next year but my last assessment showed my heart was strong!? I should mention I had an operation and been to hospital three time for unrelated issues and it didn’t trigger an episode.

Best of luck and health to all of you.

Mrhermyl
Mrhermyl in reply to Adasian

Thanks for a fine outline or your experience. Best of luck.

cuore
cuore in reply to Adasian

I can't figure out whether you are near Toronto or near Vancouver. But due to the drugs you are taking I will venture Toronto. Because I also live in Canada, it saddens me that both east and west cardiologist are reluctant to refer their patient to an electrophysiologist. I call it hoarding.

You say you are persistent, but you do not say how long you have been persistent. You also say "you would not hesitate to ask for an ablation."

When you become persistent, there is a time limit that you must have an ablation to avoid having multiple ablations and/or to even be able to return to sinus. In my case, had I not had my ablation at the six month stage I would never have been able to return to sinus. But, I was one of the most complicated cases at the six month stage. You might want to read progression of rotors when. persistent:

afsymposium.com/library/201...

You also say "it didn't trigger an episode." The term "episode " is used when going in and out of arrhythmia while paroxysmal. If you are already persistent, you can't trigger an episode. You may have intended to say that you didn't suddenly become symptomatic.

Current literature advocates ablation even if one is not symptomatic. A trial was devoted to that conclusion. You are welcome to pm (I believe that is the term) me and I will look up the trial.

Adasian
Adasian in reply to cuore

Thanks for your reply. I live in Toronto and do have easy access to a hospital in about 15 mins. My heart specialist transferred to a beautiful leading edge facility, which has an electro physiologist and other heart related specialists, so I don’t think we are backward in trying different procedures. I started out in paroxysmal Afib then went into tachycardia but not symptomatic at this time. We must remember that we are all different with different underlying conditions so we will get a different response from our doctor. Where this forum has helped me immensely is to be able to understand the various alternatives there are for treatment and to be more educated on the topic of Afib, so that I can ask informed questions of my heart specialist. Sorry if my terminology is not correct but I am learning.

cuore
cuore in reply to Adasian

Please Adasian, do take back your sorry. If it needs to be used, I should be the one since I came across too harsh. I was trying to emphasize a time-line when in persistent, and I obviously failed to do that. Do keep asking questions; it is important. And, the answers may help not only you but other members in the forum. I, too, have learned so much not only from members' questions but also answers.

I was correct that you were probably in the Toronto area. I do know that Toronto has a very good arrhythmia clinic and that they are one of the countries that is taking part in the latest Pulsed Electric Field trials that will revolutionize ablation treatment. You are certainly at a good place.

I wrongly picked up that you were seeing only a cardiologist and not also an electrophysiologist. You refer only to a cardiologist, and my understanding is that cardiologists do not do ablations. The common analogy is that the cardiologists are the plumbers and the electrophysiologists are the electricians. I apologize for interfering in your treatment. I had no business doing so. I do wish you well in battling arrhythmia.

Adasian
Adasian in reply to cuore

Thanks for understanding. FYI am not seeing an electrophysiologist, but will not hesitate to ask for one when, or if this dreaded Afib progresses.

cuore
cuore in reply to Adasian

May I humbly say that your AF has progressed because you say you are persistent. It's an important progression to go from paroxysmal to persistent. There is the important saying that AF begets AF; the more you have, the more you will get. The longer you stay persistent, the less you will even be offered an ablation, especially in Canada. Your heart will remodel too much and become too fibrotic that no ablation will return it to sinus.

I was also correct then in concluding that you had not seen an electrophysiologist. Bisoprolol is a beta blocker; diogoxin is a digitalis glycosides which Dr. Google leans towards rate control. As a non-medic, rate control is your regime. Rate control is a regime to live in atrial fibrillation. It is also a regime for permanent atrial fibrillation. From reading the comments of members on this forum, permanent AF has less symptoms than either proxysmal or persistent. So, if you want to become permanent, you are on the right track.

Some cardiologists won't even refer their patients to an electrophysiologist which happened to my friend who is now in permanent AF, no choice of her own.

The bottom line is what you really want to do. When persistent, electrophysiologists do the ablations to try and get the patient back to sinus rhythm. When persistent, cardiologists treat the patient with meds as the patient lives with atrial fibrillation.

My humble apologies if I appear to be interfering in your treatment. I am merely trying to give you some perspective on how this whole scenario works, from my perspective of course, because I have been through the mill. My first error was to place confidence in my GP who treated me with meds to become persistent (in just one year). By the time I got to the cardiologist, I knew the ballgame, and insisted to go to an electrophysiologist when the cardiologist was trying to hold me back. Due to the Canadian system, it was a long, laborious journey to get back to sinus -- and not in Canada but France and for which I paid. I wish you the best.

Adasian
Adasian in reply to cuore

Thank you. You are not interfering but informing. None of us are doctors so we can only talk about what we know. I appreciate you taking the time to explain things to me. Will keep it in mind when next I see my heart specialist.

Mrhermyl
Mrhermyl in reply to Adasian

Thank you.

Mrhermyl
Mrhermyl in reply to Adasian

Actually I'm not in Toronto but near by.

Which facility are you talking about?

Thanks.

Adasian
Adasian in reply to Mrhermyl

One Heart Care1000 Middlegate Road, 2nd Floor,

Mississauga, Ontario

one heartcare.ca

Mrhermyl
Mrhermyl in reply to Adasian

Thank you. Appreciate your input.

try watchman devise it works

I am 71 year old female in Texas. Had a massive stroke one year ago from blood clot from AFib which I didn't know I had. Have a little brain damage, but luckily no other problems....AFib continued to get to where I was short of breath when walking or any kind of activity. Cardiologist sent me to Electrophysiologist who continued medication to see if it would help...Eliquis, Metoprolol, Flecanide. Helped for a very short time so discussed ablation. Had a catheter ablation 3 months ago and I'm so much better..heart rate consistently 50-60s and shortness of breath gone. We'll see how long it lasts. Procedure was a piece of cake..worth it to me. Still take same meds currently.

KMRobbo
KMRobbo in reply to Grannie1948

Sorry to hear you had a stroke to find out you had AFib , there needs to be more publicity on irregular heart rates. However it is brilliant that you have had such a successes with your ablation. Long may it last!

Mrhermyl
Mrhermyl in reply to Grannie1948

Thank you Grannie1948. Sorry about the stroke.

I have been carefully reading the posts here on this subject and am quite surprised, not by the diversity of opinion, but by the vitriol occasionally expressed between contributors. Although I have been a member of this site since early 2013 I very rarely comment as even amongst people of very varying condition my experience is atypical. In 2013 I was admitted for emergency heart surgery following a severe shortness of breath incident and examination by a leading cardiology surgeon (No names no pack drill, but an acknowledged international expert on both sides of the pond) His gloomy diagnosis was heart failure so severe that an operation would be immediately required or my life expectancy was possibly days rather than weeks. I was admitted to his care and subsequently had a replacement mechanical Aortic Valve fitted and a radical myectomy ofobstructing growth within the left atrium.

As I recovered it was evident that I had been left with severe atrial fibrillation and continually going into very fast tachycardia at anything between 160 and 200 beats per minute. The usual plethora of drugs as described elsewhere eventually stabilized matters so I could go home. However within days the the condition deteriorated and I was readmitted and a pacemaker fitted following ablation and cardioversion. The point here being that these radical procedures were necessary to stabilize my condition. They are I believe only done when the other alternatives are counter indicated for the patient. Over the next 6 months I had to return on a number of occasions for further electro-ablations and two more cardioversions before a stable heart rate although a little high at 80 bpm could be established. I was given a diagnosis of Permanent and Persistent Atrial Fibrillation caused by Heart Failure.

Now nearly 8 years later and in my mid 70's I am still here, still swallowing some 32 different tablets every day (I have other conditions) and truly believe that on every single occasion I have been given the right treatment at the right time. I cannot accept that any individual Doctor worth their salt would do otherwise. Of course financial constraints both public and private play a part as does local conditions. I heard it said by my wonderful surgeon that one of the big differences between North American and European practise is to do with concentration of populations. Few people in Europe are further than two hours from a centre of expertise and knowledge, the number in North America is much smaller with perhaps more than half the population needing to arrange to travel many hundred of miles with all the problems of expense and family.

It is unfair to compare as in many ways our infrastructure is so different.

Mrhermyl
Mrhermyl in reply to daithelife

Sorry to hear about what you have been throught. Sadly many of us , in my case since age 38 have been through very serious life saving surgeries. Thanks for putting the various situations and geographic locations that alter our treatment options and results so clearly. Each individual has gone or goes through experiences that are custom tailored to their needs with location and medical services availability being a big factor. Yet some may not comprehend that there are diffent methods for medical procedures because of government standards and budgets.

CDreamer
CDreamer in reply to daithelife

You make an excellent point re: geography and population distribution and infrastucture although travel is often required in UK, probably not the vast distances in US, but still remains a factor. I would also add funding or lack of is a huge influence, no matter which political system,

My father was part of senior management of the NHS for many years and strongly believed that special treatment centres should be regional, not local, as they offered a focus of expertise, made best use of resources and had remarkedly improved outcomes.

Both BobD and myself live several hundred miles from where we had our ablations so did have to factor that expense and inconvenience into our planning. Thankfully, we now have a regional centre of excellence within an hours drive. Unfortunately we also live in an area which has the largest concentration of people 65+ in Europe, many of whom have AF so there are long waiting lists, even before COVID.

It does sound as though you had a remarkable doctor who was in the right place, at the right time for you. Unfortunately I do have experience of doctors not being worth their salt as I have had both excellent experiences and some rather bad experience due to incompetence so I now no longer leave anything to chance and look at all options, including which doctor I want treating me, although I must admit that being an emergency does change everything!

You have come through a lot and I wish you well

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