Ablation offer withdrawn: When I was... - AF Association

AF Association

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Ablation offer withdrawn

Samazeuilh profile image

When I was diagnosed with PAF around three years ago the consultant at my local hospital immediately recommended an ablation. I had an appointment at St Barts where the consultant agreed that I should have one, stressing the desirability of intervening early. I opted to postpone the procedure until my retirement which they said was fine. However, in Feb 2020 (just prior to lockdown) I was told that as I was relatively unsymptomatic it wasn’t necessary to have an ablation . A few weeks ago, I had a further phone assessment, at my request, where it was pointed out that “all ablations have risks” and that my last echocardiogram showed the left atrium size was normal (earlier it was enlarged). I will have another echocardiogram to confirm this. An ablation was not proposed. I was, at one level, pleased to be told this, but I cannot help wondering if this was dictated by the situation in the NHS, where there is a large backlog of cases. Has anyone had a similar experience?

84 Replies
BobD profile image

As ablation is just for quailty of life in most cases, your AF burden very low and your heart in good mechanical condition this would I think be a fairly normal strategy. I'm sure that Covid has sersiously damaged the NHS this last year but waiting lists for ablation have always been extremely long and probably not that much affected. Remember that there are probably 1.25 million people in U K with AF and 5-6000 ablations done every year and you can understand the problem. (caveat I have no current numbers but this is in line with data I had a couple of years ago,)

Physalis profile image
Physalis in reply to BobD

What is the opposite to quality of life? Is it early death? About seventy per cent of ablations are successful so getting rid of AFib and not having to take any medications is important.

It makes life better from not having the side effects of the drugs. It makes things better for the NHS not having to provide those drugs and also not having to provide continual hospital appointments.

Maybe there should be a scale showing how the EPs prioritise people for ablations. How symptomatic, how frequent, etc. Should they put forward people for ablations when they know they are likely to end up being one of the 30% failures?

I think some doctors emphasize the risks when they want to put people off.

BobD profile image
BobDVolunteer in reply to Physalis

There is no need to convince me of the benefit of ablation (I had three before my AF was terminated) but ALL treatment for AF is only about QOL. It is not generally a life ending condition.

In answer to the question do EPs select patients well some do expecially if they are faced with an obese person where is is well known that weight loss will drastically improve QOL and likely negate the need for the ablation. Yes again if a younger otherwise fit person presents as these people may well benefit long term.

It would be wonderful if the NHS had facilities to treat every single condition and individual but regardless of how much money was available there would still be people for whom some treatments were unsuitable.

I do not think EPs over state the risks by the way although I concede that ordinary cardiologists who do not have the ablility to do ablations may prevaricate.

Physalis profile image
Physalis in reply to BobD

It's the 'mainly for quality of life' that always bothers me. As well as making people feel better, you have to take in account the affect on the heart of all those rapid heart beats.

If there are a million or more people in the UK with AFib then they are probably mostly asymptomatic unlike the people here. If they are mainly being given bisoprolol and sent away by their GPs then they have probably never heard of ablations. Bisoprolol is alright for those with a high heart rate but for those of us with a normal heart rate of about 60 it pulls it down and makes us feel worse for little or no benefit. It doesn't stop the AF and the higher hr of about 130-140 is still going on. If they think AF is doing no real damage to the heart, why do they bother? But what damage does it do?

As far as the NHS goes then there's no point in raising awareness for something they can't supply. Maybe in ten years time the waiting lists will be much shorter.

I was thinking more of the actual AFib symptoms, how often, how long, how bad it makes the patient feel and so on. Also what meds the patient is already on for other conditions.

CDreamer profile image
CDreamer in reply to Physalis

Your last para:- and that’s exactly the point! If you have frequent epsisodes which affect your daily life AND you are someone thought to benefit - you will be offered ablation & exactly what Bob said.

If you are asymptotic & AF does not disrupt your usual daily life - risks of ablation could outweigh possible benefits of ablation.

Purely personal opinion but if we want better healthcare then we need to take more response ability for our own health & be prepared to pay for it & stop thinking of it is a right and much more as a privilege. Amount being spent is not being covered by amount coming in.so we need a to have that conversation- how to we as a country fund fairly healthcare?

Physalis profile image
Physalis in reply to CDreamer

No, I think Bob was saying that it was other things like obesity which would count. You can have very symptomatic obese patients with very frequent episodes or obese non symptomatic patients.

I think we spend quite enough on health care but the NHS doctors seem to want to do everything for everybody. I watch some of these Hospital type TV programmes and feel somewhat exasperated at how much operating time with its corresponding support staff can be spent on one patient. I'm sure if I was that one patient I would be grateful but what about all the others that could be treated quickly instead but keep having their operations put off.

I also get fed up with personalities fighting for free milk, free dinners for schoolchildren, extra pay for nurses etc but the coverage is one sided, the interviewers never ask what will have to be given up to pay for it. Or how much will you be prepared to pay extra in income tax. GB News starts on 13 June. Let's hope it will be better than the BBC or Sky News.

The sensible thing and I have advocated this for a long time would be to put 1% VAT on food. Fruit and vegetables, single items like milk, meat, fish, butter, eggs could stay exempt. The money raised could pay for the cost of diabetes and might just help a bit to lower the levels of obesity in this country. It would take pressure off the NHS budget.

And, while we're at it, why exempt pensioners from paying National Insurance.

I think that ablations will be more widely available but it will take time to build up the capacity.

BobD profile image
BobDVolunteer in reply to Physalis

If you are obese ALL treatment is likely be of limited benefit. Taking responsibility for and control of your own situation is surely a sensible way forward.

Physalis profile image
Physalis in reply to BobD

That may be true but it may not be. I'm thinking more of ranking. Should the obese, highly symptomatic patient who has lots of attacks of AFib be lower on the list than the normal weight patient who suffers just occasionally and not too badly.

I must say that it is more than I can get my head round. There are all the different symptoms people have - spent three days in A&E - and times - last attack in January or 2019 or every week - and drugs of so many varieties. Why are there so many?

Auriculaire profile image
Auriculaire in reply to BobD

I would like to know how it is possible to lose weight when one has a healthy diet. I am obese by BMI and have been for years. Part of the problem was not being diagnosed with hypothyroidism for nearly a decade. I do not eat a lot - can't as it makes me feel uncomfortable and I only eat very small portions of carbohydrate . One dessert a week. I cannot exercise much due to skeletal problems . But I am for the most part metabolically healthy with good blood pressure and no diabetes. My liver tests are normal and I have much better kidney function tests than my husband who is not at all obese. I am not prepared to starve myself in order to reach some theoretically ideal number. There are lots of criticisms of BMI as a measure of health.

CDreamer profile image
CDreamer in reply to Auriculaire

I tend to agree. My BMI is now 27-28. When I put on 5lbs I can feel the difference & feel better at 27 than 28 but as soon as I go lower to 26BMI I feel tired constantly & always hungry & it’s then I crave the sugar & carbs.

I am 5’5” and up to the age of 50 I was perfect BMI but I think with age our metabolism slows & even though we’re eating about 2/3rds of what we were, it’s a lot more difficult to shift weight.

Auriculaire profile image
Auriculaire in reply to CDreamer

I doubt I have ever had a perfect BMI. At 4ft 11ins I have always been overweight. At 16 it was maybe by a few pounds according to the height /weight charts they used before BMI. I went on my first diet (Atkin's low carb style) and lost over a stone in 6 weeks going down to just over six and a half stone. I ate nearly all of back on on holiday in Spain in a fortnight ! I have struggled with my weight all my life despite progressively eating less and less and more healthily. When I went to see a gynocologist to be assessed for an op in 1999 he described me as mildly obese in the letter to my GP. She was incensed as at that time I was dancing a lot and my legs and arms were solid muscle. But he was going by my BMI and not my body composition. I have never had central obesity but since the age of twelve large breasts which just kept getting bigger. On diets I would lose weight everywhere else ! If I could wave a magic wand it would be to drastically reduce them.

There are lots of studies using actuarial data that show that women with BMIs between 25 and 30 live the longest and are healthier than those who are not "overweight ".It's like women who have higher cholesterol than the "norm"- healthier and longer lived. I've given up bothering about my weight . I never weigh myself now . Funnily when I saw my surgeon for the first consultation before my hip op he said the operation should be successful as I wasn't fat! I was astounded but I think he meant I did not have a lot of fat where he was going to make the incision.

I do agree and with hypothyroidism it can be harder to keep weight down. I never had a weight problem until I developed this condition. However its also worth checking if your thyorid hormone levels are optimal. (Ft4 andft3) -the NHS now sems to measure TSH only and directs GPs to treat by this, despite the research that has categorally shown this leads to under treatment! Of course if they checked the actual thyroid hormones levels it wuold cost more......sorry am cynical....but not that much given you can purchase a fully thyroid panel for £27. Hey ho.....

I did take T3 before being diagnosed with afib. The hospital cardiologist said my TSH was too low and I was overmedicated ( despite freeTs being well within range). He carried on as if T3 was cocaine. When I first went on T3 ( in England) I stopped gaining weight though did not lose much of the weight I had piled on during the 7-10 years I was undiagnosed. Since being taken off T3 my TSH has gone up to between 3 and 4 which is too high for me and more weight has piled on. I live in France and here they are pretty much against T3 though I did have a good endo. The cardiologist must have raised hell about the T3 and the low TSH as she seemed nervous about letting me continue on it. She had always been fine about the TSH saying that was normal on combination therapy. I have tried putting up my T4 but I feel that exacerbates my afib. It's a rock and a hard place situation!

Am sorry to hear this Auriculaire. The cardiologist was out of order. On combination thyroid treatment meds that include T3 the TSH always ends up being supressed but so long as the thyroid hormones are in range there is no need to worry. I had a massive arguement with my first cardiologist who tried to insist I lowered my dose of thyroid meds because my TSH is supressed. I refused and my endo supported me. It wasnt pleasent and frankly its not a cardiologist specialism. Luckily for me Im now with an EP who seems far more reasonable.

I could still take it as we import Naturethroid from the US for my husband. However I have become nervous. Part of the problem is that I am sure the afib was provoked by taking Cipro as my first two attacks were after treatment with this antibiotic. Fluoroquinolone toxicity is very tricky as it can leave you unable to tolerate meds you were fine with before and many floxies have thyroid problems and difficulty regulating their thyroid meds. Fluorine and fluoride are toxic for the thyroid.

CDreamer profile image
CDreamer in reply to Physalis

I see things through a completely differently coloured lens. Compassion needs to be at the centre of everything, especially for those in need. Without compassion for those trying to alleviate suffering - what are we?

Physalis profile image
Physalis in reply to CDreamer

Yes, I suppose that everyone wants compassion for themselves and for other people. Do they actually want to pay for it though? They want to keep as much of their money as they possibly can.

Since the sixties I've noticed that most people have much more spending money than they ever did. Not everyone but a lot of them have far more clothes, collectables, clutter, pets and other possessions. They eat out much more often and they drink infinitely more than in earlier years. They eat far too much and don't want to stop.

Yet, you talk about 1% on food and they throw their hands up in horror. Something extra on income tax and they really don't want that.

One day they'll sort out the care system but the government won't want to do anything that makes them more unelectable.

You know, in the sixties on average wages, I couldn't even afford biscuits.

Probably just as well!

Keibval profile image
Keibval in reply to Physalis

I have said for a long time that it really wouldn’t hurt anyone to increase the NI contributions and make sure it goes into the health care system ......as you say, people think nothing of treating themselves to things like an expensive cup of coffee at £2:50 a cup or getting nail treatments at £20 a time ( I knew plenty of people on social security payments even who afforded treats like these on a regular basis ) so no one is so badly off they couldn’t afford a couple of pounds extra going out . We are so very fortunate to have our NHS and all the incredible treatments and centres of excellence in this country and it would be a tragedy to see it change . Yes , Physalis, we also had years of ‘ making do’ even though we had jobs, trying to stretch our incomes to cover the basics .....neither of us smokers . Priorities have changed completely sadly

wilsond profile image
wilsond in reply to CDreamer

Hear hear CD x

Seawalk profile image
Seawalk in reply to CDreamer

Absolutely agree CD

waveylines profile image
waveylines in reply to CDreamer

I agree CDreamer but am sorry to say there are times you have to politely put your foot down. That cardiologist would have got me to reduce my thyroid meds, despite my efforts to explain which would have made me more ill & was not the cause of my palpitations. Mine were caused by successful treatment (chemo, rads and Herceptin) . Not everyone listens to compassion and understanding though I agree it should always be the first approach.

Another was a surgeon who judging by the staff giggling behind his back was soo arrogant that he blew up when I had a preference for a specific type of operation -one he didnt do - so he tried to bully me by shouting and yelling into submission. I quietly politely stood my ground asking him for more infomation, which seemed to annoy him more. I went to another surgeon who was lovely and highly skilled - did the said op with brilliant outcome. I learnt later through a friend that the surgeon I stood up to had butchered her twice with terrible outcomes, then blamed her!! There are good eggs and bad ones.......you have to learn to distinguish between them as much as poss and walk away.....no amount of compassion and understanding will change those outcomes of some poor Practioners. After all it is us who will live with the outcomes for the rest of our lives......not the practioners.

Ger12345 profile image
Ger12345 in reply to Physalis

Hi physalis. I have heard Ukcolumn.org is a fantastic source of non government propaganda.

Jajarunner profile image
Jajarunner in reply to Physalis

When Labour were in power they moaned the BBC was biased against them. Now the Tories say the same thing. Which would suggest they are holding whichever government is in power to account. We certainly don't want a Fox News situation here. Even they had to dial back their position on trump in the end....

Oops sorry, not Afib related...😉

Physalis profile image
Physalis in reply to Jajarunner

That's ok. In the past I can't remember ever feeling that the BBC or the main stream media was particularly biased. It's just been since 2016 when people divided into camps and the BBC and Sky News took it upon themselves to take one side. This has followed on since then. Before then the average person didn't take as much interest in politics. Andrew Neil's piece in the Mail yesterday was balanced and that is what I am hoping to get when GB News gets up and running on 13 June.

Sixtychick profile image
Sixtychick in reply to Physalis

Gb news you mention which starts on 13th June. I’ve not heard anything about that. Who is running that.?

Physalis profile image
Physalis in reply to Sixtychick


Sixtychick profile image
Sixtychick in reply to Physalis

Thanks will look at that. Fed up of the biased news channels we have

CDreamer profile image
CDreamer in reply to Sixtychick

I would say UK press are too selective & parochial rather than biased.

Paradoxically - I now get far more info about world affairs- which the Uk channels are completely ignoring these days - unless it’s catastrophic news - from US press NY Times, Washington Post & Time magazine. I stopped reading all UK papers about 20 years ago.

Auriculaire profile image
Auriculaire in reply to Physalis

There will be no improvement in the health of people who are suffering from the results of poor nutrition till the food industry is tackled. Children need to be taught that it is not possible to be healthy on a diet of processed food and how to resist advertising. Cooking nutritious meals from scratch should be part of education. I was taught to cook at school ( and sew) but this seems to have been abandoned . There should be a sustained health campaign to demonise sweet drinks of all kinds and I would forbid advertising them just like tobacco. But no doubt this would be regarded as politically inspired nanny statery.

Samazeuilh profile image
Samazeuilh in reply to CDreamer

The point is that my symptoms haven’t changed that much over the three years since diagnosis. An ablation was strongly recommended three years ago on the grounds that early intervention is desirable according to research. Yet since last February the assessment has been that the burden is not that great and that ablation is risky. So there are two different judgements about largely the same set of symptoms.

As for lifestyle measures, I consider that I have done a lot in that area. I am not seeking an ablation, but am just looking for an explanation for the inconsistency in the assessments.

CDreamer profile image
CDreamer in reply to Samazeuilh

That seems reasonable to want an explanation of a change of advice.

BobD profile image
BobDVolunteer in reply to Samazeuilh

My reasoning would be that since you declined the ablation route three years ago your burden could not be that bad. If it had been then you would have been begging them like I and many others here were. I always remind people that doctors don't beg. They offer, recommend and then move on.

Samazeuilh profile image
Samazeuilh in reply to BobD

I never really declined it as such. I wanted to wait until I was retired so as to have a long period to recover if it was needed. They agreed that this was reasonable, so it was simply deferred. I always explained to them the frequency was roughly once every two months -although it was much more frequent than that during the first year, because of a) the dose of Sotalol was probably initially too low and b) I hadn’t identified triggers or made sufficient lifestyle adjustments.

Singwell profile image
Singwell in reply to Samazeuilh

Has your burden increased? That's surely the main question to consider.

Samazeuilh profile image
Samazeuilh in reply to Singwell

It hasn’t, but earlier the judgement was made that an ablation was needed based on the symptoms I reported. It’s about the inconsistency of the judgements of the same symptoms.

waveylines profile image
waveylines in reply to BobD

I like that Bob!Sadly my EP is of the wait and watch group.....hes mot sure how well an ablation would work on me but hasnt ruled it out but prefers to keep it up his sleeve. I find this confusing as I thought abaltion was more sucessful if done in the early stages......lol

I really feel for you. Maybe you should seek a second opinion? Clearly there are some complexities to this.

Thanks. I was thinking alongside those lines myself; I may seek a private consultation to discuss. The problem is, the consultant who originally said that an ablation wasn’t needed is one of the top consultants in the country.

Ahhhh thats tricky.......did he/she give the reasons why?

Just that the burden of symptoms wasn’t that great (once every two months).

Well if your case is complex like mine maybe he has to weigh up several other things. I think you need to seek further clarification from him/she. Two monthly is a low frequency but I guess it depends on how poorly each episode makes you and how long it pasts for and if its well managed by meds. I think you need a further discussion so you can understand whats behind the decision. I would try expressing your confusion to his secretary and see if he will talk to you on the phone.

Singwell profile image
Singwell in reply to CDreamer

Absolutely agree

Lilypocket profile image
Lilypocket in reply to CDreamer

I agree. Some people envy the standard of healthcare in France ( where I live) but we pay more at source for healthcare. It's a no- brainer. The NHS is a good system but seriously underfunded.

Cumbremar5 profile image
Cumbremar5 in reply to Physalis

My sentiments entirely my normal hr is 60 bisoprodol does nothing for me and brings me down when hr is normalised my Spanish doc doesn't listen and sends me away with no alternative medication to address the irregular rhythm ie flecainde says I haven't reached that stage yet !

Singwell profile image
Singwell in reply to Physalis

Physalis, I was one of those 'sent away on bisoprolol'! Except by A and E. Being borderline hypothyroid my HR was low, which nobody was interested in, and yup - the BBs did not stop the AF. Thank goodness for this forum, where I gradually got the information I needed to insist on an ablation using the magic words "it is interfering with my ability to work". And lo...

Singwell profile image
Singwell in reply to Physalis

Some very good points here!

wilsond profile image
wilsond in reply to Physalis

I think the comment about comparing quality of life versus early death is a bit off to be honest.Many newcomers on here might be very scared to read that.

Early death is not associated with AFib,it is not life-threatening and many people make big lifestyle changes which actually improve health generally.

Ablation is suitable for those whose symptoms are severe and affect day to day life of course but many take meds ( like me and many on here) with no side effects and good results.

Sam has been advised very appropriately I think .

Physalis profile image
Physalis in reply to wilsond

No I know that AFib isn't responsible for early death. It the assumption that ablation is only for quality of life that gets me. In my case I've reduced my weekly 60 hours a week at an average of 140 bpm to a constant 60 bpm. Presumably that will be beneficial to my heart health over the years I've got left. If left it would have developed into a constant 140 bpm. Maybe that wouldn't have made much difference but I don't know.

What I do know is that that wouldn't have been a 'very good thing' healthwise.

Therefore my ablation is not merely for quality of life or for how I feel.

wilsond profile image
wilsond in reply to Physalis

But you stated "what is the opposite of quality of life? Early death ?"Infers that that is the two options.

For some people yes AFib symptoms are problematic but there are others whose heart rate does not go through the roof even in AFib .

Ablation is not always the answer ..

Medication and lifestyle is just as useful.

As for not wanting to take meds,well I and others already do . We take blood pressure tablets and 'water' tablets etc and will do forever.

The choice is there of course.

I wanted to remark on the Early death comment as it could frighten people.

Unfortunately ablation for Afib is not as successful as you think at least not the first time. It usually takes more than 1 Ablation I even know of people having 4 and it still not worked.

I haven't looked very far on the net but the British Heart Foundation says "Complications are extremely infrequent and for around 90 per cent of those who have it, catheter ablation is successful."

The cardiologist at my local district general hospital wanted to make it quite clear to me that it was 'only' 70% successful. I wouldn't have cared if he'd just said 50%!

Samazeuilh profile image
Samazeuilh in reply to BobD

Yes, but the point is that my symptoms haven’t changed that much since the original recommendation for ablation. The symptoms were originally judged to warrant an ablation but this was withdrawn later.

I would be more than happy to be told ablation not necessary in your situation. Should AF rear its head again you would surely be reconsidered.

Samazeuilh profile image
Samazeuilh in reply to Jalia

I’m relieved at one level. I still have the PAF roughly every two months. Last year was the best year when I had two intervals of six months and five months without PAF. I would be fairly happy if I could maintain that frequency. Of course, the condition can deteriorate over time and, as plenty of people here attest you can suddenly get bouts of PAF out of the blue after months.

momist profile image
momist in reply to Samazeuilh

So glad that your AF has settled into a period of longer times between episodes. I thought mine had as well, but my last two episodes, not very far apart, have hit me very hard. I used to cope well with a bout, even driving and 'carrying on' while in AF. These last two floored me and made me wish for a quick fix. I'm waiting now for my pre-op appointment for ablation perhaps in July.

Hi Samazeuilh - in these times I think many things will be reassessed but for you - things sound as though you have improved, no doubt from all the things you’ve done which have helped your situation and long may it continue. Hang on to that & keep lines of communication open with your EP.

Best wishes CD

Samazeuilh profile image
Samazeuilh in reply to CDreamer

Yes, I think that is the best course. There was some improvement last year in terms of the frequency of the episodes; I have yet to see if that can be maintained this year. I appreciate that my situation is a lot better than for some, but I always have to remind myself that this is a long term condition which can worsen unexpectedly.

Yes I think Im in a simular positon. I recently had an EP consultation in which he told me he is not saying he will not do an ablation - just not yet because most of the time with medication I am doing well. If I worsen he will review.....of couse I know my case is a bit different as the EP said there could be other parts of the heart affected by the cancer treatment so therefore he doesnt know for sure if Ablation could improve things but he isnt ruling it out. Personaly I prefer caution. Its just throws me when I read research telling me that early intervention is more Sucessful. I guess this is research referring to cases that are less complex and that is the difference?

My cardiologist has gone over the various risks and complications of ablation with me recently, and there were some quite significant risks mentioned. He also said that in about 25% of people a single ablation procedure wouldn't be successful in stopping AF completely.

My PAF, which had occurred very occasionally for aboout 15 years, began to occur much more frequently this year, to the point where it was happening about once every 3 days. I'm now taking daily anti-arrhythmic medication in the hope of controlling it and avoiding an ablation.

Unfortunately the PAF is still breaking through occasionally, and I'm not getting along that well with the medication, which is making me feel breathless when I walk up a hill or stairs, so unless things improve in the next few weeks, I'll likely opt to have an ablation despite the risks.

I think if you are only having PAF episodes every two months or so, and you can tolerate the side effects of whatever medication you are on, it might well be better to avoid the risks of ablation. Even though the vast majority of ablations are uncomplicated, an occasional unlucky patient will have a serious complication.

Yes, I agree entirely with what you say here.

Stayhealthee what antiarrhythmic medication do you take ?

I'm on propafenone, and also a small daily dose of diltiazem to prevent a possible side-effect of propafenone.

Thanks I'll talk to my doc about these

Flecainide and a beta-blocker would be the more usual therapy, but both these drugs are contra-indicated for me.

Personally I would have preferred to be on flecainide regularly rather than propafenone, as I think the propafenone makes me feel worse. (I was on flecainide as a pill in the pocket for a number of years previously.)

May push for flecainide then thanks

I am baffled Samazeuilh. Completely. I had infrequent episodes (self limiting after about 8 hours, not a significant burden, no routine meds except anticoagulants) but was offered early ablation. Explanation that although my heart seeemed healthy there would be an underlying reason probably ageing heart and nip it in the bud and more likely to be effective! I can only think that the effects on lists of Covid are (consciously or not) affecting decisions. It is a grey area, to ablate or not. Or maybe the EP had a couple of not so good outcomes influencing the cost benefit. And there are a lot of us!

Buffafly profile image
Buffafly in reply to FaberM

Don’t forget trainee EPs have to practice on somebody! But by now there are probably enough to go around, considering the restrictions with COVID. When ablation was first mentioned to me about 8 years ago my young cardiologist suggested I wait as long as possible ‘because they’ll get better at it!’

Samazeuilh profile image
Samazeuilh in reply to FaberM

I was also surprised to be offered an ablation so readily a few years ago. There was very little discussion of my symptoms-I was just told that early intervention was favoured. I’m wondering if there has been some new research which has caused a revision of the earlier view.

FaberM profile image
FaberM in reply to Samazeuilh

Apparently the research indicates ablation is best early (if indicated), not, as previously thought, to be considered when meds fail. My EP said there would be many reasons to consider ablation but he fast forwards early AF assessment to see if ablation should be quickly offered. I guess I was lucky. The research was posted here, ages ago.

Buffafly profile image
Buffafly in reply to FaberM

If it was ‘ages ago’ maybe thinking has changed in the light of more experience? My understanding is that for ‘lone AF’ early intervention especially for a younger person is recommended but the more comorbities you have the less chance of success, also lifestyle changes may be just as effective. My ablation ‘failed’ after two years but taking all things into account I’m not pursuing another one.

FaberM profile image
FaberM in reply to Buffafly

Ages ago = during lockdown! Early ablation recommended

Polski profile image
Polski in reply to Samazeuilh

Perhaps giving you an ablation now is no longer considered 'early intervention'?

Samazeuilh profile image
Samazeuilh in reply to Polski

I’ve always understood that to mean “before the AF remodels the heart substantially and episodes become more frequent.”

If you are not AF symptomatic why would you want an ablation. How often do you get AF?

Samazeuilh profile image
Samazeuilh in reply to xr1450

I don’t want to have an ablation- I’m just a bit concerned about the different assessment of the same symptoms.

xr1450 profile image
xr1450 in reply to Samazeuilh

How often do you get AF? I ask as I have an extensive 20 year AF history and have had two ablations.

Samazeuilh profile image
Samazeuilh in reply to xr1450

Roughly once every two months. In 2020 I had two long intervals of five months and six months without AF which I attribute to doing a lot of walking (two hours per day). I’m trying to get back to that level of fitness.

It was suggested after my very first event that l should consider it ... l said “no way”. Then my cardiologist said that l did not qualify apparently because my heart wasn’t bad enough. I have zero desire to have an ablation unless things get too bad ... so far this hasn’t happened. I did have a cardio version. It’s a very inconvenient condition. Just when things are buzzing along beautifully ... bamb, it hits! I convert very easily without meds but l always go to emergency when it happens. Five minutes away.

Samazeuilh profile image
Samazeuilh in reply to Janith

This is more or less what occurred in my case. An initial referral for an ablation, which I deferred, was followed by a different evaluation-that ablations are risky and my symptoms are not that bad. The problem with this is that ablations are less likely to be successful when fibrosis sets in, something which is more likely to happen the longer you leave things.. You have probably already seen the APPLE scoring system to determine how likely it is that an ablation will be successful.

Surely QOL is a subjective consideration that the patient must make. I am a fairly fit 75 and have had PAF for 15 years. Currently my episodes are 2/3 weeks apart. The attacks always come at night and lasts 8/12 hours. They are not particularly strong but they do bring with them the need to urinate frequently which disturbs my rest but once I regain normal sinus rhythm, I feel well.

What I now find the biggest problem is the effect it has on trying to plan my life never knowing when the next attack will come. This creates anxiety. Mental problems. This has a detrimental effect on my QOL. So QOL need not be directly related to the severity of the symptoms.

What surprises me is the lack of progress in developing other methods of treating afib. What happened to the use of tVNS for example.

I’m pleased you raised this, Samazeuilh! I was diagnosed with Afib 2 years ago. I was informed of the options such as cardioversion and ablation, but I was reluctant to have any intervention and there was no discussion re pros and cons. I was prescribed anticoagulant and discharged. I was happy with that. I didn’t appreciate how serious a condition Afib can be. I had permanent Afib but my symptoms are relatively mild, mainly breathlessness. I have recently bought a BP monitor. My BP is erratic and on the high side, especially diastolic, which is always above 90 and frequently reaches 100. My resting heart rate is most often 100 -125. However, as the cardio nurse didn’t seem worried, and my GP also, I have just carried on with repeat prescriptions of a/c, assuming - as we’re often told - that Afib is not life threatening. THEN I read the ‘AFIB Cure’ by cardiologists John D Day and T Jared Bunch. Now I’m worried!! Basically it says that medications have their place but are not the long term answer for most people. That Afib puts great pressure on the heart and causes fibrosis and a weakened heart. Afib begats Afib. And a weakened heart can eventually lead to heart failure! The writers promote ablation at the earliest opportunity, before fibrosis sets in. They also promote lifestyle changes, particularly weight loss, but I have never been overweight and I have a healthy diet. I’m now quite worried and wonder if I should now seek an ablation? I have contacted the GP (hardly ever the same person) and asked to be referred back to Cardiology (at Kings London). She wasn’t prepared to do this (understandably at this stage) and said (rightly) not everyone is suitable for ablation. She did, however, refer me for ECG (8th June) and blood tests. Sorry for long post, just thought I’d add my experience to the discussion..

Sam. You might be right with that assessment. Same here in NZ. I was offered Pace and ablate but the waiting list is getting longer. Fortunately for me the arrythmia went about 6 weeks ago. I dont know how or why but im pleased. most of all other symptoms have gone to. Echo showed I had a severely enlarged left atrium. I was so badly affected and drug and excersise resistant that i didnt hesitate to say yes to the procedure. I am back at the gym and improving every week. I will hold back though and get fitness back ultra slowly. I have no drugs except the blood thinner rivaroxaban. I was on 30mg Diltiazem pill in the pocket approach. Hope yours will go away. Stay positive.

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Samazeuilh in reply to Alphakiwi

Thanks. My left atrium was enlarged but seems to have gone back to normal, so its possible yours will too.

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Alphakiwi in reply to Samazeuilh

I guess when im called up for the pacemaker to be fitted they may find im ok and will do another echo to check the atrium. heres hoping.

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