When undergoing an AF ablation is it better to be merely sedated or have a general anaesthetic? Depending on which I elect for, is there any affect on the success rate of the ablation? Any views, personal experiences or statistics would be appreciated.
TerryB
I usually prefer being awake and sedated. However of late I have changed my mind on the subject. Personally I would elect for a general anaesthetic for an ablation, go to sleep, wake up with it done. Modern anaesthetics make it more of an easy choice. Maybe your EP has a preference, mine goes for GA.
Hi meadfootThanks for that; I will also discuss with EP once Covid-19 restrictions are relaxed.
GA is best IMHO but recovery may be a few hours longer initially. I think it depends on centres to be honest as some do not use anaesthetist on cost and availability basis. My EP once told me he prefers to have an anaesthetist looking after me so GA the way to go. Cryo may well be done under sedation but RF seldom I think. You may not have the choice.
Hi BobDI had thought the same, but thought it would be useful get the view of others. I intend to go private so I don't think cost should be an issue. You raise another interesting question that has been on my mind, namely which is best burn or freeze? Again the views of others, such as yourself, would be welcome.
Cryo is quick and easier to perform and is often used as a first line attempt. There are limitations in that not everybody has nice tidy pulmonary veins for the balloon to go into and also there may be other areas of the atrium firing which obvbiously the balloon can't deal with. This is why RF is often used second time to deal with such missed areas. Ablations must be considered part of ongoing treatment.
Thanks for the info.
I had an anaesthetist although sedated not GA.
When I had my ablation seven months ago I was injected with Fentanyl. through a catheter on my arm. Five minutes later I walked into the cath lab and they helped me up on to the bed. They then proceeded to put various stickers on to my body. Then, I must have dozed off for maybe half or three quarters of an hour. Came to and could hear the buzzing noise as they zapped the rogue electrical signals. There was no pain, in fact I couldn’t actually feel anything. Then it was done and I walked back into the ward again. It must have taken less than an hour.
I would opt for sedation again, not that I was given the choice. General anaesthetic is best reserved for more serious operations.
Thanks Physalis. When I had my two right ablations under sedation it was pretty uncomfortable and therefore I am leaning towards GA, but I need to find out if the ablation is less successful than if you are just sedated?
I suppose it depends on how your body reacts to GA. My daughter reacts badly.
When I had RF ablation in 2005 in Glasgow ,I didn’t get asked about it ,they told me I’d be sedated a bit but awake , I’ve git to say I’m glad I git to see exactly what they were doing ,,it took away my atrial flutter ,but not my fibrillation which I have to this day , do what you feel best that’s only advice I could say ,
Last summer I had an ablation for AFib & atrial flutter under GA. The procedure ended up being a bit more complicated than was anticipated, as it was difficult to ablate areas located on a right septal pouch. You can request an antiemetic during the procedure to reduce post-procedure nausea, although the following day I did experience some nausea anyway.
It may be rare, but I’ve heard some patients can experience great discomfort with simple sedation. Of course, no one wants to be under GA too long, that has its own risks.
As to cryo vs. RF, my EP said he could do either, although he has found that a repeat ablation may be more likely with cryo.
I had two ablations with sedation and a third one with a general anaesthetic. Would recommend the GA, I felt so much better after having that, no sickness as I did with the first two and a far quicker recovery.
Jean
I am somewhat unusual because unlike most people I had seven ablations in all over a period of 10 years.
I had the first three ablations under sedation. On the last occasion I was awake for the vast majority of the procedure and was very uncomfortable. I believe the amount of sedation I had on that occasion was insufficient and probably isn’t typical.
I then went on to have four more ablations with General anaesthetic and for me this was much more acceptable. My last ablation three years ago took close on 7 1/2 hours. I can’t imagine how I would’ve felt had it been only with sedation.
I believe also that because somebody is caring for your well-being i.e. the anaesthetist the EP can concentrate on carrying out the ablation and I am sure the results are better.
The only thing these days is that anaesthetists are in very short supply because they are being stretched with the demands of the current Covid situation and therefore you are likely to have to wait for very much longer for an ablation under general anaesthetic.
Pete
As you are paying yourself I would have a RF ablation as a cryoablation often needs to be topped up by an RF. If you knew in advance how much work needs to be done it would help to decide whether to have sedation or GA but I don’t suppose that’s possible.
I've had one ablation, and I was under GA. They didn't give me a choice, but that's what I would have preferred anyway.
I've had 4 ablations. First, was for Atrial Flutter. It was done under Valium or similar. It was successful, but I didn't like it. They tell you beforehand not to move, or it will get ugly. When I was in Valium dream state ... I could hear them yelling in my ear "DON'T MOVE! .... STAY COMPLETELY STILL!" and I could feel them turning and jostling me. It was unnerving because you can't see anything ... can barely hear ... and feel like you don't have complete control of your movement.
The rest of my ablations were performed under GA by two of the best EP's in the world. They said they don't even consider sedation. Only general. First time under GA ... I woke with nausea and headache. However, I spoke to future anesthesiologists and they corrected the recipe on my last 2 ablations. Went to sleep ... awoke fine ... quick recovery ... then home.
I won't go back to sedation.
I've had both and given the choice I would have GA, no question. As a previous poster has said, I found it quite uncomfortable during sedation, mind you that was back in the dark ages of 1999. Good luck.
I have had both last year and I was fine under sedation but my second was GA and for me it was even better if ( please not) I need another it will be GA all the way
Steve
I had a GA. I was told by the EP he preferred doing the RF ablation by GA as it gave him extra of time if needed. Absolutely no problems and was successful.
I had a cryo PVI ablation for Afib left atria, under mild sedation. I watched some of what was occurring on the big screen. I found it interesting. I was told what was going on during the procedure. The pain from cryo is not in the chest, it was like the brain freeze of biting into a very cold ice cream. Happens 4 times but not for too long. I felt nothing in the chest. I have had worse at the dentist. I had an RF ablation for reentrant atrial flutter right atria only one month later. Again mild sedation, a bit more pain but not for as long in my case. Not that painful.
The pain for this was felt on the right shoulder again nothing in my chest
On both ablations I was warned when the pain was about to start and how it would feel. I was also advised to let them know if it was too painful and they would up the sedation which was administered through the arm . I never asked.
On both occasions I had a local anaesthetic in the groin at catheter entry and felt absolutely nothing.
I do not remember being given a choice of GA so probably wasn't
However if I need another ablation I would opt for sedation.
I would prefer GA but University Hospital Coventry and Warwick do not offer this only sedation . Bothers me a bit...As you are going to pay I think you should go with your instincts
Best wishes xx
I've had two RF Ablations at Coventry - most recent 3 months ago - both under sedation. Very painful both times. On the second occasion I'd put the degree of pain at 8/9 out of 10. I asked for more sedative both times which dealt with the issue. I just fell asleep - lol.
Sedation or GA? There are risks both ways, so I guess it's a personal preference. I don't really care. I'll go with whatever is recommended by the professionals carrying out my specific procedure.
Eeeek, I am on the list at UHCW and had hoped the sedation would be like when I had my DCCVs .............. the last one in August I was zonked out on Midazolam for about 3 hours lol!!! I don't do pain 😀
The team of staff who completed my Ablation were very nice. They're very professional, and very happy to answer any questions or concerns, and to give you more sedative if you ask.
Good luck, even if I think you won't need it 😉.
Thanks. I have every faith in my cardiologist (he is an EP so I would guess could possibly be the one who does the ablation) as he has always been very helpful and straight with me but I would be flinching if something was painful and probably at an inopportune moment 😁. The first DCCV I had, they didn't give me enough sedation for the first shock and I screamed so loud, other folk waiting heard me. I must have scared the 💩 out of them 😂. Good luck with your recovery.
Interesting to know as I am under UCHW and awaiting a cryo.
Me too. Proff Osman is doing mine as it's for AF and Flutter.Im not keen now hearing about these experiences,plus the change to meds has stopped both ! Even when I was really poorly with d and v....
I will see how things are...long wait anyway at the moment.
Best wishes xxx
Mine was supposed to be being expedited to February as the AF kicked off again in December after they tried halving my Amiodarone dose. However, with all the Covid inpatient increases, I'm thinking its not likely. I'm under Dr Yusuf. I'm not liking the pain with sedation stories either 😳
Hi, I had my first procedure carried out whilst under sedation and i didn’t like it at all.!!! I was aware of what was going on but in no pain. I had my second and third ablation under general and it was a lot better. I just woke up and it was done.
The type of ablation you are having probably determines your choice.
If it is the relatively more simple right sided ablation then sedation could be fine, providing they give you enough sedative. I found it it so painful that I was actually in tears by the end of the ablation. I felt everything.
If however they are piercing through the septum to the left side of the heart, I would recommend GA. I would also advise a good chat with your anaesthetist beforehand. I went into shock after my first GA but after a discussion withe the anaesthetist the second experience was fine. They changed the anaesthetic and also wrapped me an air heated ‘bear hug’ to keep my body temperature stable.,Those cath labs are really cold.
My first ablation was done under sedation. During the procedure I started using deep breathing to help with some discomfort and got told off as this made the EP’s job more difficult. They pumped in a bit more pain killer instead.
My second ablation was done under GA, perhaps because of my deep breathing during the first one. They had some difficulty punching a hole through from one atria to the other and so I’m glad that I wasn’t awake for that!
If, at some time in the future, I were to opt for a third go then I’d ask for a GA for sure.
I had three ablations inBordeaux, the first one even 6-7 hours, all under sedation. All three were comfortable, all three were fine, had no after effects from any of them.
I had an investigation in 2012 which involved putting a catheter into my femoral vein and "tweaking" my heart. The cardio demonstrated that he could turn the palpitations on and off which was interesting. At that time I decided not to have an RF ablation. No need for GA at the time. I did need a bit of sedation for the ultrasonic probe down my throat though.
I had my first and only ablation in Aug. 2018, and I was under GA. Here in Canada, all cardiac ablations are carried out under GA. There are benefits for both patient and EP when the patient is put under GA: First, the patient feels no discomfort during the procedure, and second, GA inherently forces the patient to lie completely still.
My PVI ablation was of the Cryo variety, and it was acutely successful. Almost 2-1/2 years on and I have not experienced even a moment of AF - it's been NSR bliss. 
Best wishes,
Richard
GA for me definately,luckily my EP feels the same. I've had three ablations and 2 angiograms and the very thought of being awake for ablation no thanks angiograms were enough for me. Best of luck.
I had my combined RF and cryo ablation under sedation. That was fine and I'm sure recovery was quicker, with fewer brain side-effects.
I’d prefer to have a general anaesthetic I should have had a second ablation but refused it as I could only be sedated but disliked the experience so much I cannot bring myself to go through it again.
My experience was horrendous- I had insufficient sedation and the local anaesthetic didn’t work. Also they had to abandon the cryo due to my heart anatomy. I am going back to have RF by GA at some point.
That sounds awful, where did you have it done?
Glenfield, Leicester.
Short general anaesthetic 
