Ablation and silent A Fib

[F-M-C-MM]

Have just read a recent thread concerning anticoagulation and bleeding risk, and one contributor stated that another risk is atrial fibrillation episodes post ablation and the need therefore for anticoagulants even when an ablation is successful. I think this decision is a matter for discussion between the electrophysiologist/ cardiologist and the patient. I think it is possible in certain cases to stop anticoagulation following a risk assessment. What evidence exists of a large number of silent atrial fibrillation episodes in people with duccessful ablation. Such claims may deter people from choosing ablation as a treatment.

[wilsond]

HiBirmingham University did a study on whether patients should continue with AC after ablation.

Yes they concurred ,not only due to the possibility of AF etc returning silently,but also the fact that AF etc can return suddenly without warning after ablation . It has been proven that AF can cause a clot to form after 20 minutes activity,if not on AC the risk of stroke is there.

I'm pretty sure the study was discussed on here if you'd like to look.

Best wishes

[CDreamer]

My EP looked at many studies after I had 2 ablations as I wanted to discontinue my anticoagulation after 12 months of no AF following successful ablation and VERY reluctantly said that he would research for me. He came back saying he could find only 1 American study that showed people who had successful ablation AND had proven they had no further AF studies after 12 months (through implantable device) had lower incidence of stroke after 12 month follow up. As this was 7 years ago I no longer have access to the study. That study was not a Gold Standard and I think that further Gold Standard studies have now shown the risk continues after ablation.

The absence of evidence is not evidence of absence of the phenomena so I would reverse your question and want to know what evidence is there that stroke risk is reduced after successful ablation?

Most people continue to take Anticoagulation after ablation simply because it has been shown that ablation doesn’t lower the risk of stroke, especially if you are 65+.

Ablation is a treatment for AF.

Anticoagulation is a prophylactic treatment to reduce the risk of stroke and risk is calculated by the CHADSVASC score and the decision balanced by the HASBLED score.

Sorry, I really don’t follow the logic that a statement saying taking A/C’s for life is going to influence anyone thinking about ablation. Two entirely different subjects.

Having had a TIA following successful ablation after discontinuing A/Cs because I had proven I had no AF for over 12 months, I couldn’t get back onto A/Cs quickly enough and will take for the rest of my life, especially in this COVID crisis after the new evidence concerning cardiac complications.

I do, however, think it is absolutely a personal decision, hopefully an informed decision which is what the AFA exist to do - inform. May I suggest that you go to the AFA website and read the Parliamentary White Paper on AF, where you will find overwhelming evidence from various sources to improve access to Anticoagulation for anyone with AF or had had AF.

It is also worth reading the AFA Factsheet on Anticoagulation where you will find an explanation of CHADSVASC score works and below how to calculate your risk.

heartrhythmalliance.org/fil...

Score - 0 = very low risk

1= Think about it and being female = 1

2 and above = Recommended and the higher the score from there on up - the higher your risk.

Calculating risk is not an exact science and identifying those at most risk will only come through personalised medicine - on it’s way but not here yet so in the meantime we need to work with what we have, imperfect as it is.

What you put into your body needs to be a personal decision but one which hopefully needs to be supported by our doctors. None of my doctors have or would support a decision to discontinue A/C’s.

[Hidden]

In my case, when it was discussed with my EP his exact words were, “the jury’s out on this” but recommended I remained on Apixaban. I have also heard at least half a dozen cardiologists/EP’s say the same for people with a score of 1 or more.

I score 1+ (don’t know where the + comes from) on CHADs and since my last ablation, I have had a number of very short runs of AF which have been quickly stopped with Flecainide as a PiP, but I occasionally get even shorter seconds/minutes runs of tachycardia. I have no idea if this happens when I’m asleep but I am told that it’s very likely. Whilst I am well aware of the risks associated with anticoagulants, I am happy with my decision but we are all different so I agree with you 100% that it should be discussed with your own EP. If anyone has, or has a close relative which has a history of bleeds, their bleed risk may be significantly higher and all this needs to be taken into account.

I think it comes over loud and clear on this forum that an ablation is not a cure but that it can be, and thankfully often is, a successful treatment to help control AF symptoms. On the basis that patients would definitely be required to take anticoagulants for life without having an ablation, they may conclude that remaining on them, but possibly significantly controlling the symptoms is worth the risk of having an ablation. That was certainly part of my decision process.........

I think I should add that I had my first ablation nearly 8 years ago and I believe the jury is back in and the verdict is clear.......

[BobD Volunteer]

The plain facts are that ablation does not remove stroke risk. There are many experts who feel that it is not always the AF which creates the risk but the company it keeps. Removing symptoms does not remove risk.