I finally received a telephone consultation, 6 months after my A&E admission for a fast AF. The A&E discharge report said "AF disorder SUSPECTED", and recommended a 24-hour ECG.
The latest AF is only my second event in 5 years. I had an AF a year after my heart attack (stent inserted); the consultant at Barts said that was due to a viral infection. The latest AF had no apparent cause, but I did have COVID-19 last Easter, which is a viral infection.
The locum cardiologist on the phone asked how she could help, so I said that a diagnosis was perhaps the first thing, (bearing in mind A&E's report), and then maybe an ECG.
"Oh don't listen to what they say, you need to come in for an ablation".
Well, I thought that was a bit of a jump to be honest! I mean, I'd never even met her!
Is this the normal way to proceed? You are diagnosed over the phone, previous observations are ignored, and you rush straight into surgery without any further tests or observations?
I declined her offer. What would you do?
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Same as you !! Sounds like she is jumping the gun somewhat. You should really be seeing an EP..electrophysiologist .....for opinion and decision anyhow.
No chance of that, this was my ration of outpatient follow-up. Very much a 'take it or leave it' situation in the post-pandemic NHS. I only got the the telephone call by being a pain in the a*se!
This will be controversial but I don’t think that some medics who deal with these things day in and day out see an ablation as any big deal. If you have AF, to them the obvious route forward is ablation and they are able to find out everything they need to know once the catheters are in and their screens are working. Barts have an excellent reputation and I think many would be prepared to trust their advice.
If only it were that simple for those of us on the receiving end!
They are under immense pressure at the moment due to a huge backlog of stuff to be done and I have witnessed a much more assertive and frills free approach to what they see as fairly routine procedures. Earlier this year my wife had a colonoscopy and it bore absolutely no resemblance to one that she had several years ago. Although it was a bit of a culture shock, at the end of the day the job got done. I guess over time we will all have to adapt to a different way of doing things but one things for sure, it is likely to keep forums like this busy!
Well, I'd trust a consultant at Barts more than a locum on the telephone passing through Watford General who doesn't even value her own A&E consultant's report! I know it is a routine operation, but one that appears to be only a temporary fix. I read testimonies on this forum charting the multiple ablations that people have experienced; if it's an effective solution, why would you need to have it performed 6 times in as many years, for example? It seems to be the cardiac equivalent of GP's handing out antibiotics or antidepressants: a quick and cheap fix to help clear the backlog. The patient thinks they've received the best and appropriate care, because they don't know any better.
I was one of those here who have had multiple ablations - I had 7.
Believe you me having multiple ablations is nothing like having antidepressants or antibiotics dished out willy nilly.
Each of my ablations was necessary and carefully considered. They each took a team of more than 6 doctors, nurses and anaesthetists. They all lasted more than 5 hours with the longest taking over 7 hours.
I can assure you decisions were not made lightly and the result is that after more than 30 years I am enjoying a significantly better quality of life.
I'm very sorry for you, it sounds like a very traumatic life. I hope you don't have to have it done yet again. Sounds like it's ineffective if it has to be repeated so often.
We may be talking cross purposes here. I think the changes we are beginning to see and hear about are worrying for those who have thus far, benefitted from face to face dialogue with the person who performed the procedure both before and after it happened. The controversial bit is that whilst we may not like it, these changes will happen and it’s up to us to do the best we can to ensure our best interests are served. I assumed from your post the locum cardiologist was a registrar from Barts as there was no mention of Watford General.........
Well, that is exactly the point I've been trying to make John6! If a repetitive, highly invasive, procedure is offered to a whimp like me who has only had two episodes of AF, and is nowhere near as ill as people like poor pottypete1, and I shouldn't be making a fuss at all...what has gone wrong?!
How can the assessment protocols that are in place be trusted? Obviously I don't have much, if anything, wrong with me; AF can happen to anyone for many reasons, just like catching a cold it would seem. Yet I am being urged to rush into the operating theatre surrounded by 6 or 7 doctors, (apparently), for 7 hours (apparently), with very little evidence that I need to do that, or that it would be therapeutic.
Then there is the possibility of going through the same thing another 6 times. Yet we read movingly above how such decisions are 'not made lightly'. Well, I think my experience proves that such decisions are indeed sometimes 'made lightly' - over the telephone by a young locum, and without any tests or observations.
I was curious to find out if everyone receives such considered care as pottypete1, or are others being rushed into hospital without proper assessment? Perhaps it is different in the private sector, and there is time for a more considered approach outside the NHS, (which is under pressure for obvious reasons).
I don't want to upset anyone or belittle their suffering, I just want to know how widespread such practices are without us all getting too emotional about it, even though personal health is an emotive issue.
I have to carry out fact-checking in my job, so it I tend to have a natural curiosity and a yearning for statistical evidence. Obviously online forums are, by their very nature, merely anecdotal, but valuable nonetheless.
The assessment you received seems to me to be cavalier - to say the least!
There is NO WAY that I would proceed without much more detailed hard data from ECG, Bloods and Echocardiogram and consultations and possibly other scans to determine whether or not you would be a likely candidate and with only 2 (known) AF episodes - I would ask for ongoing monitoring and see how you go.
And I’ve had 2 ablations, 1st made things a lot worse, second gave me 3 years free of AF - for which I was very grateful but drugs and sedation left me worse off as they exacerbated an unknown, underlying condition. I ended up with a pacemaker which has improved my QOL no end.
You are wise to go cautiously as Ablation took me months to recover from and I did have to go privately in 2014 as it wasn’t then offered locally.
Ten years ago (2011) I went along for my first ablation like an excited child. This was going to cure me and I wouldn't have debilitating AF attacks ever again. I went into hospital for the procedure the night before and early next morning my EP's Registrar came to chat with me. I asked how long it would be after the ablation that I'd be able to climb mountains again and was told a few days. Life was going to be perfect!!!!
Reality - I was sick after the three hour procedure and continued having attacks of AF, only now they were far worse and lasted longer
Two years later (2013) I had a second ablation, this one was 6hrs long and the person who should have had an ablation after me was sent home. Again I felt dreadful afterwards. Two months later I remember going on a visit to London and being unable to walk as far as everyone else. My AF continued to be bad. On visiting my EP for my first check up which was probably about 9 months later, I was told that I wouldn't be offered any more ablations. I was devastated to have to accept my AF attacks. Once when in hospital with a particularly bad attack, the cardiologist suggested that my heart muscles could be a little stiff because of my two ablations. I can tell you I became very scathing about ablations.
I continued to keep in touch with my consultants AF nurses and at a time when my AF was particularly bad was talking to them often. Three years after my last procedure, suddenly out of the blue one Friday I was telephoned to go for an ablation the following Wednesday, did I want it - yes! Well thank goodness I never gave up on ablations as that third one (2016) really helped and the effects of AF haven't worried me too much since. I believe I'm in constant AF now, but my pulse doesn't go very high and I'm mostly unaware of it. I can live a normal life, take long walks up and down hills, yes I huff and puff a bit and take it slow, but that's because I need to take more walks and build up my muscles and energy levels more.
I stopped recording what beat my heart was doing (it would make me anxious if I did and my erratic pulse would go even higher), changed my diet to a more plant based one and now avoid all food and drinks that contain artificial additives If only someone had told me to do this right at the very start of my AF journey there may have been no need for my ablations.
In your situation, having had few attacks I wouldn't be looking for an ablation at all, but rather at my diet. Strange how that locum who spoke to you suggested one as though they were the easy option. What I would want is a scan of your heart to see that it is functioning correctly, if so then I'd carry on as you are now and see how you get on, but the new diet is a must.
Thank you for your story Jean, most interesting. I'm glad you have regained some quality of life.I agree that it seems odd to rush straight into an ablation, especially as you describe it as not an easy option. I did suggest that perhaps I should first have an ECG, as prescribed by A&E, but the doctor said it there was no point and it would not help.
Without lots of the tests that have been described by others it would in my opinion be totally wrong to progress to invasive treatment.
I think you have done exactly the right thing and hopefully it will be a considerable time before you have any more AF issues.
I had my last episode last October 2020 and I consider that to be a totally acceptable situation in the light of my decades of having AF every week or so.
Hope you can forget about it and get back to living an uneventful life.
It would have been interesting to see if you had said yes whether the ablation would have gone ahead; I am sure with other, more senior colleagues involved, one would hope that they would have been more thorough in their examinations of you and put a stop to it.
Absolutely. A junior locum doctor doesn’t sort the ablation you would have a series of appointments and tests with the consultant team. He’s probably just saying you need an ablation because he thinks that’s the solution. No consultant just pops you in for an ablation willy nilly!! They decide on meds versus ablation in consultation with you.
I would have declined too! There are stages that I would want them to explore - and me to understand -before I signed up for an ablation. And that is exactly what I’ve been doing too. I’ve not heard of this kind of assumption/rush to ablation happening before (in the UK). Though I have come across some very opinionated consultants who seem to know definitively what I need to do re my AF, despite not knowing me, and cardiology not being their speciality!
There’s definitely medical arguments for having an ablation sooner rather than later, but (unless the AF events were increasing rapidly, or troubling me greatly) I personally would make sure I had consulted an EP and had a recent echo, ecg, understood more about the condition and my triggers, and made any lifestyle changes I needed to. I find the AFA website is hugely helpful
You may be able to get an EP referral via your GP if they have now signed you off from the hospital? Hope you can one way or another. Jx
If you have more episodes it’s worth getting a consultation from an experienced EP - it’s worth doing your research and holding out for someone you have confidence in.
Hi, I believe that you will find this video from Dr Sanjay Gupta regarding ablations very useful youtube.com/watch?v=3VOq9BL...
If you are still concerned about your AF then it really is worth seeing an experienced EP privately. If any further treatment is necessary then they can refer you back to the NHS for that. Steve
The link to Dr Gupta's video seems to have failed??? If you go into YouTube and search for "Sanjay Gupta ablation" this will bring up the video.
Umm, nothing would happen - whatever she says! - without scans and tests etc. Early ablation is the new advice if your heart and body indicate it will help. Presumably she is not offering to operate herself tomorrow! It is not a “cheap fix!” The opposite it is highly specialised and expensive and if you have earlyish AF and otherwise heathy it may prevent AF indefinitely. Our local service now advises this and fast tracks certain AF presentations because they don’t want your heart settling into recurrent AF which may then make an ablation less effective. You may have been very lucky and had a recently research friendly locum. Her diagnosis doesn’t undermine the previous ones / if tests show not AF they will not muster a surgical team to do an expensive procedure. The fact that the trigger was viral doesn’t mean it won’t recur. My initial AF attacks were in a severe chest infection. Went away for four years. I am delighted with my early ablation.
Ablation is not for the seriously ill, it is most effective for early onset, better done (if at all) sooner rather than later if suitable. As I said, fast forwarded by our local cardiology service. And I hated the idea of the meds and the threat of an event as the AF became more frequent after a 4 year gap. If your locum is recently trained you might not want her to do an intricate op - not enough experience - but she may be on top of the research and been trained by the best. And you can ask for another well seasoned EP once in the process. There is no way they will take you into an operating room without extensive scans and tests. I suspect she was putting you on a pathway and was clumsy in the call. It was only a phone call. My ablation was in November. Took a couple of hours - in hospital for 4-5 hours - some tiredness etc for two weeks. No AF no meds (except anticoagulant) since. Result.
Good morning FaberM, Nice to read that” Ablation is most effective for early onset” . That’s what my Cardiologist told me too last Friday. I also read the Afib Cure from John Day where he writes about new coming procedures like Electroporation (within couple of years) I am offering an ablation now after 2 episodes PAF in sept20 and April 21/ 4-6 hrs and spontaneous going back in SR. Looking for the research on internet to see what the latest options are and what is wise in the short or long run. I have no other heart issues at all, just becoming older, hopefully wiser and only ‘join’ in this case millions in the AF world. Thanks.
Good luck to you! Sounds as though the advice you were given is the same as that given to me. My cardiologist EP very highly regarded, very keen on early ablation if the heart scans show a good idea and other health issues considered. He also happens to be very nice and super thorough. Spent 45 minutes talking to me and explaining his considerations and process.
I would suggest that the cardiologist is basically inviting you in for an *ablation assessment* rather than making a final decision concerning an ablation.I am registered at St Barts and that is the approach they have used on two occasions. Also, there may be background information (e.g. an earlier heart attack) which has led them to believe that an ablation might be necessary. If you have concerns why not discuss them at the assessment? You are not committing to anything by attending, and might, at least, get useful new information.
I had a consultation with St Barts over the phone last week to determine whether an ablation is needed. The cardiologist said that a key consideration is whether the left atrium is enlarged. As my last echocardiogram showed that it isn’t, an ablation is not currently required. However, they have requested a new echo as the last one is nearly a year old. The main reason given for not doing the procedure was the risk -“an ablation always carries risk”. I was told that there was an 85% chance of success on first procedure with success defined as a resolution of symptoms for at least one year. I was also reminded that ablations are carried out to help with symptoms and that there is no cure (a point often made by BobD). Apparently, there is some new evidence, not yet confirmed, that ablation may reduce stroke risk.
Hi I am quite interested in what you have said in regard to left atrium enlargement. Having had one EP telephone consultation so far regarding AF and potential treatments going forward this factor has not been discussed. Do you have any other information or source material reference on the subject.
In “The Afib Cure” which is written by cardiologists and has been discussed on this forum there is an APPLE score which can be used to determine whether an ablation is likely to be successful. Score one point for being over 65, one point for having *persistent* AF, one point for poor kidney function, one point for a left atrium diameter larger than 4.3 cm and one point for an ejection fraction less than 50%. If you score 0 or 1 then you probably haven’t much fibrosis and you have a very good chance of a successful ablation. If it’s 4 or 5 then you left atrium probably has plenty of scar tissue and your chance of success is quite low. If it’s 2 or 3 you are somewhere between. Of course, you need an echocardiogram to determine the EF and the left atrium diameter. You could also have a look at :
Thank you for taking the time to give me such a comprehensive reply. I will have a look at all the material and this should enable a more informed discussion with my EP going forward.
If it was me, no. I had my one and only ablation in 2013 and was a great success and although starting to see some signs of AF returning, for me it was about quality of life. I was having 4 or 5 episodes per week lasting 5 or 6 hours so was horrible. But yours is a very light load and with good lifestyle it may never get any worse. No medical knowledge here, just what I would do in your shoes.
Many conditions need more than one treatment or operation to offer a degree of success so AF is no different, nor would an invasive procedure, such as ablation, be offered willy nilly. An analogy would be my friend who has had to have 3 knee operations to get normal movement again. He was told at the outset that one operation may not sort it but wasn't going to turn down a chance to be able to walk normally again, so instead of carrying on as he was, he decided to take a punt. As others have said, its a quality of life issue that has made the rest of us choose the treatment path we have.Early intervention does give better outcomes, especially if you are a younger patient but you are right to ignore a phone consultation, with a locum who does not know you and perhaps you are at an early stage in AF proceedings. You may be very fortunate and it does not progress.You need to make a nuisance with your GP to get a referral to an EP. You are entitled to go to any hospital so if you are able to travel to someone whose credentials you feel are better, then you can request that. As others have suggested, a private consultation could be a good start (I think its from £150 - £250) as quite often, an EP will then put you on his/her NHS list following that.
Personally, I held off an ablation for 5 years. Do I wish I'd had it earlier? Yes, even though I'm only 4 weeks post ablation so a while to go yet before the success can be judged.
Hope that you can get sorted and have a proper consultation to put all the available options to you.
Brief background. I had a mild heart attack in October 20' and had 1 stent fitted with subsequent echo in December showing no significant damage to the heart with an EF of 62%. At the same time however I was diagnosed with Atrial Flutter and was listed for an EP telephon appt. In the interim I was asked to send in ECG reports from my Kardia monitor which showed episodes of "possible AFIB" these occur approx. every two weeks and tend to be short lived anything from 5 mins. to 2 hours at the most.
I have now had the appt. with the EP who is saying the Kardia reports are now showing AFIB and not Flutter and has basically offered to change me from Bisoprolol to Sotalol or to put me on the list for an ablation and its up to me which route I go. I am therefore a little confused at the change of diagnosis i.e. Atrial Flutter to AFIB and the apparent quick move to treatment options without much advice. I assumed that the Kardia reports would be the starting point for more in depth investigations at hospital and a more detailed final follow with the EP who would explain the pros and cons of each potential treatment option.
At this stage I haven't been back to him as yet and would be grateful for any thoughts you may have on how to approach this. I should just add that although I get episodes every 2/3 weeks the Bisoprolol does help and the severity at this stage is cope-able and they always self terminate back to NSR.
If you're AFIB doesn't bother you, then use pill-in-pocket to convert it when it arises. However, if your lifestyle isn't so good .... you run the risk of increased cardiac fibrosis which makes a possible future ablation less effective.
Sometimes AFIB makes the decision for you (like mine did). It begins to come sooner and sooner with more aggressive tendencies. Then, you'll wish you had something like ablation to relieve it. One of my ablations gave me 10 years of normalcy and peace for a day's inconvenience. Fantastic trade-off in my book!
Finally, if you do choose ablation (which I would probably do in your situation), find the best EP you can get ... even if you have to fly there. Even though routine, skill varies tremendously among them and your outcome is directly related to their skill, knowledge and experience.
Read the book THE AFIB CURE by EP John Day. It should help you chart a path forward. Good Luck!
Wow! What a strange encounter. I sure wouldn’t proceed w an ablation in that situation. Though, I assume that whoever was assigned to do an ablation would do a lot more testing first. I had an electrophysiology dr who decided to proceed w an ablation within 5 minutes of meeting me. But that was after a full year of working w another EP who just kept telling me there was nothing wrong, despite meds not helping me. so in my case, I was happy to just get on with it. Can you follow up with your GP and get a referral for a real cardiology consult from them?
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