We often get asked "should I have an ablation?" and from time to time my answer has been "When the pupil is ready the teacher will come" meaning that when the AF is bad enugh you won't need to ask. This happened to me way back along when I declined the first offer of ablation but within six months was begging for it as my AF became so much worse.
This week I remembered that and all my advice when I went to the hospital to discuss my knees and possible replacements. I had a nice long candid discussion with the specialist about expectations, recovery and this brought out the following information which I thought neatly paralleled the conundrum of ablation or not.
Firstly what is the expected recovery time? Answer two years! (Ablation maybe only one but you get the message.)
No it isn't an instant fix and you will feel much worse after the operation for quite some time,
I was offered my right knee in 2010 why not so eager now? Doctors were paid a premium per op back then. (Never knew that here in UK though expected that in USA.)
Do people often wish they hadn't had it done it? Usually the people who had it done too early. When a patient waits till they really need it done ie they are in so much pain that they will do anything to get rid of it, the pain post operation and subsequently is relatively less so it is worth it.
OK since I can actually still walk, albeit not very comfortably, it does not normally keep me awake at nights and in any case my forthcoming pacemaker trumps everything else I have decided to wait and see.
Regarding ablation I think most of us know that many EPs feel that early intervention is the best way forward but what is important is people's expectations of the procedure. Back in 2005 when I had my first I was sold the idea that I would be cured next morning and be dancing the light fantastic out of hospital. When this was not so I was mortified and for a while whished I hadn't gone through with it. Some years later I helped produce the Recovering From Ablation fact sheet to hoepfully prevent others from unrealistic expectations.
Yes for many people it works (NO AF for me since 2008) but it will take a lot more time to recovery than you thought possible and there will be times when you will dispare.
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That is most helpful as an analogy. I saw a new (to me) cardiologist last September and was amazed when he mentioned ablation ( even though only in passing).as I have only had 3 sustained episodes of AF since 2011 and then only for hours not days. At my age unless I really found the episodes unbearable, I too will join the wait and see brigade. Friend had an ablation at 89 preceded by a pacemaker and because of her lifestyle sailed through both procedures, so certainly in sunny Yorkshire age does not seem to be an issue.
I had a phone consultation with a cardiologist following my first episode of AFib & he offered me ablation!
A year on I've now had 5 episodes total. I was complaining to a GP that so far all I've had is two brief phone calls (with cardio) that told me nothing, pretty much. She read out the recent letter from the cardiologist which said that I'd been offered 3 options: medication, 'wait and see' or ablation and that I'm thinking about which option I want to take. I was amazed, a) because it's not true that he's 'waiting on me'....he's waiting for the GP surgery to send him the results of an echo and 24 hr ECG which I'd had done (arranged before my first episode of AFib for other reasons) which has taken a year to happen! And b) the idea that I would accept a surgical procedure on my heart on the basis of ZERO information just really amazes me. The cardiologist (or GP for that matter) have told me a sum total of NOTHING about AFib, what it is, why it occurs, what the prognosis is, what the medication options are, what the ablation consists of....etc etc.
At the moment I'm waiting on a face to face appointment with the cardio and will be asking for a referral to an EP.
George Bernard Shaw "The single biggest problem in communication is the illusion that it has taken place”. Many years ago my father in his 70s attended hospital re a huge inguinal hernia, for which he wore a dreadful truss!! He saw a surgeon and several weeks later his GP rang ( those were the days) to ask why he had refused surgery! He insisted he hadn't!!
Helen that was exactly my experience re zero info except I didn't see a cardiologist for 4 months. The pandemic hit during this time and it was a nightmare getting even to speak with my GP. I'd had to take matters into my own hands just before lockdown and paid a top UK EP for advice. Including better meds, which I persuaded my GP to authorise. I don't know what I'd have done without this forum.
Agreed, Singwell - this forum has been a life saver!
I had my first (very symptomatic, lasted 12 hrs, very alarming) episode in July and my first 'appointment' was a phone call with cardio in late Sept.
Having jumped up and down and banged on a few tables I now have a face to face booked with the cardiologist in late July. My plan is see what he has to say then go for a private EP if I'm not happy with the outcomes of that appointment. In the meantime I'm applying every lifestyle change/option I can find (magnesium etc).
That sounds very similar to what happened to me, Helen. After a second trip to A&E where I was diagnosed with AF last June, following two previous episodes months before, I had a telephone consultation with the NHS EP in November where I was told I was being put on the list for an ablation! Prior to this, the echo I’d had earlier in the year showed I had a leaky tricuspid valve and right atrial enlargement that I was told would be monitored with an annual echocardiogram.
I was quite taken aback that I was being offered an ablation so soon and after so few episodes and that it was offered without a consultation, just this brief phone call. There was no enquiry into my medical history, or whether other factors might be causing episodes, ie sleep apnoea, (which I have). I started trying to ask questions and was told everything I needed to know was on the AF Association website and he’d see me on the operating table in a years time! I don’t think so! When I asked what was happening about the atrial enlargement monitoring, he said he’d ‘have a look’ whilst he was doing the ablation. Having made it clear I really wasn’t keen on having one at this stage, he became what I can only describe as huffy, telling me in that case, I would know I had problems when I couldn’t breathe and I started retaining water!
Needless to say I’ve since paid for a private consultation elsewhere!
Oh my gosh....that's terrible! Our poor NHS, whose praises I've sung for this many a long year (I lived in the US for 15 years) seems to have come down to this 'painting by numbers' approach. Diagnosis...ding!...whirrr whirrr....out comes the standard treatment protocol...ding! Zero effort to look at the patient as a whole person with other conditions and physical attributes and medications.... and preferences, even!
What did your private consultation suggest, if you don't mind me asking, Threecats ?
Unfortunately I think you are right, there does seem to be a tendency to follow the treatment protocol rather than look at each patient as an individual but then, I suppose, that takes time , a scarce resource in the NHS at the moment.
The private cardio was keen for me to try again with CPAP, as my episodes, so far, have only occurred at night. I’d been given a trial of a machine following an NHS sleep study earlier this year but that was a disaster - I’ll spare you the details! Other than that and recommending I continue on the Bisoprolol, he was concerned about a spinal problem I have, kyphoscoliosis , as this can cause problems with the right side of the heart, apparently, as can sleep apnoea. Happily, he is transferring me to his NHS list and is commissioning an echo and ct angiogram before deciding what to do next. The ablation question was kicked a long way down the road!
I do hope you have more joy with your face to face cardio appointment in July.
That sounds good, and thank you :)Re the CPAP, I did read a thread on here the other day where somebody mentioned they'd had a disastrous first attempt with CPAP but subsequently bought their own and were having a much better experience. I can't remember who it was, unfortunately....
Hahahaha - I did wonder, but it sounded like you'd dismissed CPAP as an option whereas the other thread sounded like the poster was having decent results with it.
No, it was only that I was unsuccessful with the trial machine as I didn’t achieve 4 hours usage a night required for me to be able to keep it within the 6 week trial period. The sleep tech kept telling my I only had mild apnoea anyway, so it was unlikely to make a difference. It was only after chatting to the private cardio who emphasised the importance of sorting the sleep apnoea, mild or not, that led to me purchasing my own machine and trying again. Not wanting to jinx anything but…. so far so good!
Thanks for your post Bob! I as you know have very frequent bouts of PAfib nowadays with no real known triggers. I can still have a small glass of réd wine or a beer no problem at all but sitting or leaning over can bring it on (vagal ?). Having started with an episode every six monts in 2012 I now have at least 6 or 7 every month. I 'm pretty much a-symptomatic but still get breathless and a tightening of my chest. Also tiredness probably due to the beta blockers. So I'm not in desperate need of an ablation but have chosen to have one next week. My episodes have suddenly become far more frequent and as I look to thé future I see permanent Afib and more drugs ( that don't work much anyway). I have arthritis and can't take anti inflammatory drugs. My EP thinks as my episodes are lone and self resolving(don't need to go to hospital ) and I have no co morbidities , I am a " good candidate". It's true it wasn't an easy decision but I'm taking a bet on the future and hope it's the right decision! Take care x
I go in on Tuesday as the EP wants me to have a CT scan to check if there are any clots - Phew! Didnt want a TOE. Just hope the EP doesn't get Covid or me for that matter and it gets cancelled! Here in France Covid cases are soaring X
Yes that's à little worry at the back of my mind. AFTERWARDS. Will it make things worse? How do I cope with problems in the blanking period - do I sit out the racing heart that sometimes happens or pop down to the hospital to get it checked? And that really bad migraine that can happen does it need checking out? I'm sure these things are going through my mind now because the ablation is only a couple of days away and I live by myself. But all in all I'm happy about my decision! 🙂
Don’t think it’s bad migraine - more a shortish episode of flashing lights, mild nausea and headache in my case, if it was ‘bad migraine’ I’d get that checked out. Best wishes ❤️🩹
Hi Lilly, it will be 4 weeks on the 7th July. The odd short burst of fluttering but no Af and inNSR still. Phone follow up due in 2 months. The worry is before the procedure, once in hospital you will just go with the flow and all will be fine I promise. All the best !
Second one was RF. After 3-4 days maybe sooner you will probably feel fine but that’s the danger, you will feel like you can do the normal things but this is the time to just relax and give yourself 3-4 weeks before getting back to some normality. X
Not sure failure is the right word but it became obvious a further procedure was necessary after just a few weeks which is quite common. I can only say that the second one was like a top up from the first, and that figures show a much higher percentage of success. Depending on the individuals circumstances. Think positive you will be fine 😊
I am positive but am also pragmatic. No point in thinking I'll pop in and out and Bob's your Uncle all sorted 🙂. I like the idea that it's RF as the EP said he'll check for other triggers and not just assume it's only the pulmonary veins that are responsable. Not sure if that is possible with Cryro. I have to say I would be nervous if I hadn't joined this site and learnt so much. Even though I don't know anyone with this condition I now have Afib buddies on here.
My ablation was not as bad as I expected it to be. Fear of the unknown and a good imagination made it so much worse! Try to relax and think of it as something to help and try not to worry - good luck and best wishes x
I still get bouts of af but they are much easier to live with now, and I use Flecainide as a PIP. It usually starts in the early hours and lasts about 2-3 hours but the last time my heart rate was about 78 as opposed to 120-18 with lots of symptoms before I had the ablation. Not sure if I've beaten it yet but still hoping. I'll be talking about it in a couple of weeks so I'll see whatt the cardiologist says. So really I'm very glad I've had it done although it's taken almost a year to feel really like myself. Hope this helps and good luck!
That's my main fear about ablation. Will it make it worse. Though coming more frequently my episodes are less symtomatic and have always self resolved after 8-12 hours. They are a nuisance mainly. I need to make an appointment to see my cardiologist when we get back from holiday. Bon courage for the 6th!
Thanks! It's the 7th but I go in on the 6th. I get Afib nearly everyday now that still self resolves. So as Afib hasn't remodelled my heart yet and I still convert without going to hospital I have decided to have an ablation as it has a better chance of working. My EP does 600 a year and does RF for first ablations not Cryro. Just hope Covid doesn't crash the party and mess up the recovery! X
I definitely would go for it if I was having afib so often. We have just been down south on holiday and I woke up in afib the first morning - first time it has ever happened away from home. I was a bit cross but just took my extra Nebivolol and carried on. On the bike I was really not aware of it and when we stopped for a drink in the afternoon I had gone back to NSR - but I couldn't say when. I always check my pulse above my ear but impossible to do with the helmet. I never go to hospital after the first time. They kept me on the cardiac ward for several days till my INR started to rise with the Préviscan! Hope all goes well.
What did you have ablated a couple of years ago when you were in hospital, was it flutter? Don't think we've heard why you need a pacemaker. Is your heart rate too slow now?
It sounds like you have a lot about to happen very soon with knee and pacemaker procedures up ahead. Have you any dates yet for either of these? I certainly hope your wait won't be too long and you'll soon be out on a 10 mile run. Take care and wishing you successful outcomes.
Atrial tachycardia Jean . HR averages 85/90 but if we slow it down it drops adn I get pre syncope. 2nd degree block apparently so EP wants me to have PM. Not going ahead with knees right now as I can manage.
Nothing I can say to you about the AF or cardiac side of things as you know. At the time it becomes a dire need regarding your knees I am more than happy to offer an outline of my experience in the hope it offers you some comfort and joy. YOU WILL know when the time is right as you've discussed ...... its the time you go hunting on EBay for a Kalashnikov AK-47 assault rifle or even something better to fix the pain.
😂😂
I have to say it (knee replacement) is the best thing I've ever done - apart that is from listening to both you and MarkS on the present and former (Yahoo hosted) AF Forums.
What is the difference between Atrial Tachycardia and Flutter, Bob? I wish you well for the pacemaker and your knee. We will have to start calling you Bionic Bob .
I can't honestly say that my recovery from any of my 4 ablations was troublesome or prolonged so not inevitable. Six weeks after my third one I was dancing the night away at my sons wedding.....much to my husbands horror 😂
I get what you are saying regarding knee replacement though. I had total hip replacement 5 months ago and really thought I would be feeling better than I do now. It had to be done as I was in alot of pain and sleeping was difficult. In the end I paid privately 14+k and counting.... I also need knee replacement but am holding on as I've heard so many horror stories ! I'm going on the NHS list , which is 2 years long, and hope things don't get too bad before then as pockets are only so deep !
The only person I've known with knee problems had both of hers replaced, she was perfect after recuperation and climbed stairs with no problem. A friend had a hip replacement a couple of years ago, again perfect afterwards, but last year she had the second hip replaced and hasn't done so well and is still walking with a stick over a year later. She was a lot lighter in weight when she had the first one.
Another friend (male) has had hip replacements and I'm sure he said an ankle replacement (must check). Anyway I saw him and a group of others out on a 10 mile walk last week. He's always been a keen walker and was determined not to have to give it up, not an ounce of fat on him though.
There's no doubt that keeping weight down is a great help with any joint replacement! I believe they say that every pound lost is equivalent to 5lbs less pressure on joints. My mother in law was the same as your walker friend.....2 hip replacements, thin as a rake, walked everywhere uphill and downdale and no problems at all.
Unfortunately I have some nerve damage on opposite thigh from the op ( spinal anaesthesia) so waiting for this to clear, hopefully! Gives me something else to think about rather than AF anyhow !
My last ablation was 2017 and that time for Atrial Tachycardia. It took about 2-3 years for my AF and Ectopics to settle down now all very calm.
I do have Bradycardia and like you my EP is of the opinion that I should have a pacemaker in the not too distant future.
Regards Knees.
My wife had a new knee in February. The first 3 weeks after were the most painful. Now she leaves me behind when we are out for our walks and we encounter an incline. The total knee replacement has significantly improved her mobility.
Thanks for all your contributions which are always interesting to read.
When they have a slot yes. 2nd degree block apparently and EP has over ruled me even though it means I won't be able to do electric welding anymore. Turned down a 1st June slot as family were coming so no idea when now.
Bob I had a pacemaker for 2nd degree block, works a treat 👍 I hope you don’t have to wait to long, good luck
I worry a little about whether I should just have an ablation now as they now say it is so much more successful when it's done "early". I have so little afib though, and for the last 3 months, none at all, that I actually worry that by chance an ablation could make it worse. I guess I'll cross the bridge if it comes to it (if my afib comes back with a vengeance) at this point.
There are people who have said their afib went away also through various means and dietary changes etc - and I wonder if that's just possible for some people, something we don't know definitively about what can cause afib.
You must remember that any and all treatment is only for quality of life (QOL) so this must be balanced against how you feel.
Yes diet and life style can drastically reduce AF burden. Less meat a more plant based diet, no processed foods, a low BMI (less than 26) no alcohol/ caffeine etc reduced stress have all been shown to be effective.
Great post Bob, I’ve had major wobbles post both ablations, but if (and when) I get offered a third I’ll be there, because although they’re not a cure, they sure are better than the natural progression 👌🏻. I’m currently just over one year post second ablation and I’m sure I’m still healing. I’m still able to do a physical job, look after a toddler and two teenagers. I have struggled with pvcs for the last couple of months which have triggered one fast heart rate, but this was at a funeral, so stress levels through the roof. The pvcs are dying down now, so fingers crossed there, zero Af for a year and very little since March 2017. I totally agree with your comment of when your Af is bad enough you’ll have an ablation 👌🏻
Yes. Knees are big biz in the US. A few years ago I tried to make an appointment to see a good ortho and asked if they took my insurance (not all doctors in the US take insurance).
They said, they only take insurance if you want to get your knee replaced. Thought about it maybe too long and told her that the problem is with my shoulder so I will pass.
Perhaps it should say that not all ablation patients will feel worse. The challenge for forums is that often the “ successful “ contributors leave so the responses can look a bit one sided.
Well put. I keep postponing my knee op as well. Hip ops are much more straightforward to recover from. Ablation a doddle in comparison to a knee replacement!
Thanks for all your help on here Bob. I was desperate to have an ablation when my af became a real burden, and almost a year on I'm feeling a lot better, but still healing I think, with short bursts of af every so often. 🙂
Had my ablation last Wednesday 29/6. And have to say walked out of hospital in sinus rhythm and feeling better than I had for 3 years. Also astounded at the list of things that have improved that I had no idea were down to PAF.
I had my ablation some eight years ago..thankfully the beast has not revisited to ruin my life,( he says with fingers crossed ) I was led to believe it was an instant fix, not quite in reality..
I had to wait some 18 months before being offered an ablation...most knowledge Id gained has been through this website and other peoples experience's, at the time I was self employed and was unable to work ( london cabbie) as the episodes had increased to 2 or 3 times a week, I was told to stay in bed and it will pass, they lasted on average 24 hours..no one recommended going to A&E for cardioversion I could have died a hundred times over..in hindsight I'd certainly do things a lot differently to day
Really useful post Bob, thank you. Initially I didn't want an ablation- harbouring hopes of getting over it 'myself'. But you just don't realise at first what it means. In case this us of use to others, what tipped the balance for me was being rushed to hospital wuth a horrible BP hypo following a longish episode and then meeting my EP 2 days after. He was pragmatic and clear.
I felt this was a way forward. It was in the height of the Delta wave and I signed the papers then and there.
1st one didn't work due to the sedation issue but it taught me a lot of management and - crucially- the burden of my AF HAD reduced a little.
My arrhythmia nurse encouraged me to go back again, which turned out to be a good move because work on 3 out of the 4 pulmonary veins hadn't held. It was only going to get worse again.
Will I need a 3rd? Maybe. Again my EP is pragmatic - if it takes a turn for thr worse when meds are reduced - we'll do it again.
It's not a one stop shop.
The Mini Maze sounds like it might be a one stop shop but currently not very available in the UK and only via the NHS in certain situations.
I think, at this point in time, if i needed a 3rd I'd take it.
Excellent analogy Bob. And you have your priorities set. Just glad I’m not going to sharing the same house with an immobilised Bob as and when you do have you knees done.
I will say that your advise after the ablation that it takes time to recover and don’t rush things was absolutely right. Nine months on from the ablation I feel much different in a positive way . However, straight after the ablation I felt really good.
I am so thankful to have your factsheets, BobD as I have been given virtually NO information from my hospital about the catheter ablation procedure I'm having on Wednesday.
I've been treated for PAF for years, but last summer it became a problem I had a 48hr monitor in August (it should have been a 7 day one but they couldn't find one that worked!) and eventually I had a telephone consultation with the EP in November. I remember him saying, 'I can't turn you into a 21 yr old (I'm 71! Lol!) but I CAN improve your quality of life.' So I wasn't promised a magic cure exactly, but I did come away from the phone with the initial belief that I would wake up from the op and feel better.
I kept expecting to have some further tests, but only when my legs were swelling badly did anyone check for HF. Fortunately, the blood test and x-ray showed no sign of HF which was a relief.
Waiting, waiting, waiting - and the AF seemed to have settled down so much that I queried with my GP whether I even needed the catheter ablation. She took my pulse and said, 'You're in AF now!' I didn't realise that I was. She said, 'My advice is to go for it! You need it.'
So on Monday I got the call and am having it done on Wednesday.
On Thursday, someone told me that she would send me some information, and she booked me in for a 'pre-assessment' the following day. I was surprised as I thought I had it on Monday when the person asked me every question in the book. What actually happened on Friday was that I had blood taken, an MRSA swab done and a CPR test done. As I was leaving the room, I was told, 'Oh, and you have to isolate FROM NOW until your procedure on Wednesday.' I was given the 'information' letter and eagerly opened it in the car.
It told me nothing! Just the details of where to go, what time and to take in an overnight bag in case I needed to stay. Nadah! Zilch! No information has been given to me regarding the procedure apart from some verbal info over the phone when the consultant rang me 8 months ago. Am I supposed to have remembered all that?
Don't you think I should have received SOMETHING about it in writing? And what to expect in the way of recovery? On Monday I was told that it may take 3 - 6 months before I notice improvement and that I should take it easy for two weeks, but still, no one told me exactly what to expect.
Still, the same thing happened when my husband had his pacemaker. Our local hopital gave him the information letter telling him what he would be having done AFTER he'd had his procedure and was coming home. You couldn't make it up, could you?
When he had his heart valve done by TAVI procedure at another hospital an hour away, he was very well informed about everything so if they can get it right, I wonder why our hospital can't.
Anyway, sorry if I'm ranting. I just get very frustrated at always having to search for info myself instead of the hospital giving it to me at the right time. They just don't seem to realise that how you need to recover affects even the simplest of plans eg will I be able to get my own meals, shopping etc and will I be able to get to the bathroom?
So thank you again for your great fact sheets on preparing for the ablation and managing the recovery period afterwards. I would have gone mad without them!
xx Moy
PS I have every faith in our hospital to do the procedure, it's just basic communication with patients that is sorely lacking.
Glad you found them useful. It was quite a job to compile them and get approval from all the relevant authorities . I know that some hospitals have adopted them but a lot suffer from "Not Invented here" syndrome.
I had my ablation about 2 days after the cardiologist, an EP, told me about it and I don't regret anything. It wasn't painful afterward, just a bit sore in groin area for about a day, no big deal. I've still had episodes of afib, but who knows how many more I might have had if I'd not had the ablation.
When cardiologist first came to my room (I was in the hospital for afib) to explain the procedure, my initial thought was, no way. But as he talked, I could hear and see how dedicated he was to what he does and that he thought this would be good for me, that I agreed. No regrets and I'd do it again if needed.
Sorry, but I have to disagree. I have had 2 ablations and I do not regret it whatsover. I have had no AF episodes for the past 4 years (knock on wood) and I have been doing great. My recovery time was approximately 3 days. I had to change my eating habits and the sports that I used to do, but now I am much happier and healthier.
Great analogy Bob. Puts it in a good perspective!However in my case, 72 year old male, (6'3" 230) i have really no symptoms (a little tired mid day some days) my resting pulse is 60-80 (generally mid to high 60's) don't have really any felt heart issues even when i do strenuous work! Echo shows a strong heart. In persistent A-Fib. one cardioversion that had me back in NSR for about 10 hrs (since so short of a time they would not do any more).
So the question is; My EP says that since i have not had persistent A-Fib for much over a year that I MUST do an ablation soon (now) or very soon for a high percentage outcome (85+% not all that high in my book!) or i will digress to a point where the stats get really bad against me leading to a possible pace maker and Meds (i do not take nor have I been prescribed or recommended to take any meds thus far). He has me scared that i must (should, better) do something immediately! Any consensus you know of for this to be true! I'd like to make it for another 20+ years so want to try to figure out how i can make the right decisions
Any and all treaatment for AF is only ever for qualiity of life (QOL). You are not a cash cow you are a human being. (And that from a great fan of ablation.)
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Do long term use of AF meds cause intolerance to other things
Finally doing it. (1st Ablation on Thursday)
longest bout of AF , am I doing the right thing?
How many people are still on medication (other than anticoagulant) after ablation?
