Could ablation be the first line therapy for paroxysmal AF?’

Fascinating round table discussion between leading EPs: radcliffecardiology.com/gal...

[CDreamer]

So, what did you make of that?

I agree, very interesting discussion highlighting the complexities and limitations of ablation and the inability to treat a large percentage of the AF community which basically what the EP team I see have been saying for the last few years. Pity that they didn’t actually have an EP who does have AF contributing.

[Hidden in reply to CDreamer]

It was interesting to see that there was some divergence of views on when to offer an ablation as opposed to medication. The treatment options for different types of AF, different ages and so on also varied considerably.

[CDreamer in reply to Hidden]

It just demonstrates to me how there is just so much more to understanding how to treat AF effectively for each individual than merely the skill and expertise of the EP and the equipment.

[cuore in reply to CDreamer]

Agreed. This pontificating ,when no one there suffers from it, is lacking. Plus, the elderly are dismissed as not being good enough candidates. Only the real "easy" ones meet their criteria. On the other hand, a round table discussion is better than no discussion.

[meadfoot]

Very interesting. It would good to have the opportunity to listen to more round table discussions. I recall going to a patients day at the European heart conference in London some years ago, it was absolutely fascinating and lead me to meeting my EP there.

It’s also a good way to see if any of the participants are EPs we feel are the right one for us.

[Mrsvemb]

Yes a very interesting discussion. I have always resisted ablation, because it is not a cure and many people have to have multiple ablations. There are risks to the procedure as we all know. Watching this discussion hasn’t changed my mind.

[sdweller]

However, if the proper EP is chosen to do the procedure, one with MUCH experience and many successful procedures, success is much more probable and makes ablation well worth the minimal risk. I went to the "best" in my area, Cleveland Clinic..and my heart has been good for 14 years, (prior to procedure afib was everyday). It's hard to imagine any drug doing this.

[CDreamer in reply to sdweller]

The discussion seemed to believe that ‘success’ was far more to do with the suitability of the candidate ie: age, lack of co-morbidities and lifestyle factors. It also mentioned that 50-60% was a reasonable success rate for first ablation and that ablation was more about a course of treatments for many people.

What I thought interesting is what was said about missing opportunities in clinic with people in permanent AF to look at causes in sub-strate to be able to identify people for whom ablation may help and those who wouldn’t benefit and that was due to lack of good imaging technology.

One of the team my husband and I have been treated by is a world leader in developing heart imaging techniques and I believe that is where we will see the next big leap and until then ablation may well be a hit and miss affair as even the very best can have off days. I agree with you that much depends upon the skill and expertise of the EP - these EP’s are amongst the most experienced and well known in Europe. My EP was trained by Prof Schilling at Barts.

[Hidden in reply to sdweller]

True, but your experience is arguably not typical. Very many people have to have two or three ablations and find that their AF returns after a few years.

[sdweller in reply to Hidden]

No doubt... but I was mainly talking about how it compares with taking drugs... which rarely seem to work for long if at all. (Although now that Flecainide is being used more extensively it is one drug that seems to be more effective for a longer period for many).

[doodle68]

Hi Sam 😊 thank you for posting that very interesting discussion. There is so much still to learn about treating AF.

If the EPs in the video, some of the best in their field have differing options about the suitability of Ablation for some patients (and even if they would have the procedure themselves) it concerns me that some EPs who may lack the expertise of those in the video offer Ablation to people regardless of their suitability for the procedure.

I have argued some of the points raised in the video with 2 EPs when expressing my reluctance to go down the what could prove to be a long Ablation pathway at my age , I have recently been thinking more favourable about Ablation but the video has confirmed my previous reasons to be hesitant.

[cuore in reply to doodle68]

Just don't get to the persistent stage.

[HiloHairy in reply to cuore]

Do you say that from reading or from experience?

[cuore in reply to HiloHairy]

From experience. I went persistent one year from diagnosis.

[Elephantlydia]

Thank for posting that video.I found it fascinating and very interesting.