A question about angiogram/ablation

[Pdotg]

I have had AF for at least 15 years, controlled by bisoprolol and increasing doses of flecainide. For reasons not quite clear to me I'm now booked in for an angiogram. My GP followed it up and tells me it's because I said I'd think about an ablation. It's hard to know who said what when all appointments are by phone these days so all a bit of a surprise to me. My question: Is an angiogram always required before an ablation?

[BobD Volunteer]

No but an angiogram assesses the condition of the cardiac arteries supplying the heart which is important when considering some drugs such as flecainide. It can also rule out angina .

It is not a normal precursor for ablation although a cardiac CT scan to map the heart has been known. This can be overlaid on the main screen in the cath lab to aid navigation.

Please ubnderstand that with the best will in the world GPs seldom know much about AF and its treatment so best not to take too much notice . Your EP (electrophysiologist) will be the person to ask.

[Pdotg in reply to BobD]

Thanks BobD. That's a good idea - I will phone the cardiology department to ask. As I've only had a phone consultation in the past couple of years and have been switched from one hospital to another I have no idea whether I have an EP or a Cardiologist.

I have no symptoms of anything except some AF episodes last year.

Would an angiogram be a routine investigation after years on Flecainide?

[BobD Volunteer in reply to Pdotg]

Not really.

[etheral]

Sounds totally unnecessary and invasive to me,unless you are having angina symptoms or abnormalities on your EKG or Echocardiagram that need explained. There are certainly less invasive imaging studies that could be used. Personally I would get a specific reason from your EP before getting the study.

[Ducky2003 in reply to etheral]

CT angiograms are non invasive. I had one last Thursday and requested that rather than the traditional one.

[jeanjeannie50]

I wonder if it's a CT angiogram? I had one of those before my very first ablation. They don't actually go inside your body, but scan your heart from outside just to check that all is well and that the access to and inside the heart is clear and structured as it should be.

Jean

[BobD Volunteer in reply to jeanjeannie50]

see my reply above.

[Lilypocket in reply to jeanjeannie50]

I had a CT scan before my ablation and I was injected with highlighting fluid - is that injection also called an angiogram , Jean?

[Ducky2003 in reply to Lilypocket]

That's a CT angiogram. I had one last week. 😊.

[jeanjeannie50 in reply to Lilypocket]

Sounds like it was a CT cardiogram/angiogram.

[Jalia]

No, they are not normally required before ablation. I've had 4 ablations by same EP and asked him if I needed an angiogram. His reply was much the same as etheral s post , that it was not necessary as I didn't have angina symptoms etc

[pottypete1]

I have never had an angiogram yet I have had 7 ablations.

Bob sums it up well as usual.

Pete

[Buffafly]

I had an angiogram before I was put on Propafenone (same class as Flecainide), this was because I had chest pain, then diagnosed as coronary artery spasm ie my main arteries weren’t blocked but the spasms mimicked angina. I assume you must have some sign of possible coronary artery disease so the angiogram is a precaution.

[Lilypocket in reply to Buffafly]

That makes sense

[CDreamer]

I think it may depend upon your overall medical notes as my husband had an angiogram to assess future treatments but he had problems with valves so not straightforward. I’ve never had angiogram and had 2 ablations.

I agree it would be a good idea to get more information as to why it was suggested?

[Hms03049]

Hello,

My cardiologist scheduled a ct angiogram and a echo prior to my ablation. I was told I wasn't a candidate for an ablation until structural issues or CAD were ruled out first.

All was good and only then was an ablation offered. It was successful.

Maybe they want to ensure a higher rate of successful ablations by screening candidates first.

HMS

Boston, MA

[Lilypocket in reply to Hms03049]

HiI was reading your posts and it seems you had a bumpy ride after your ablation. How long before things settled down? It is only out of interest - so far so good after mine 4 days ago but I know it's early days!

Take care

[Towne]

I Had a CT angiogram a month before my Cryoablation on the 18th of May My Consultant recommended this because exercise brought on episodes of AF which he suspected could be caused by narrowing of the Coronary arteries & wanted to rule this out as a safeguard. I was given the all clear for the ablation as he found

only negligible coronary disease - but Incidentally found an enlarged aorta which is now being monitored. (Would have otherwise gone undetected)

The only invasive part of the CT angiogram was cannula in my arm and injection of iodine solution for contrast which was painless.

[Lilypocket in reply to Towne]

I came over all warm during mine like I was sunbathing in a hot country . Why do they call it an angiogram when they are just injecting contrasting fluid? I always thought an angiogram was more invasive?

[Buffafly in reply to Lilypocket]

A physical angiogram is!

[Towne in reply to Lilypocket]

I understand a CT angiogram is the less invasive version of the traditional angiogram whereby the catheter is inserted further into a vein to inject the contrasting dye.

[Towne in reply to Towne]

Apologies- it’s into the affected artery - not the vein!

[Ducky2003 in reply to Lilypocket]

I felt like I was on fire, head to toe and that I was about to pee myself, which thankfully, I hadn't.

It's still an angiogram as its checking the state of the blood vessels. I was told the CT version was not quite as easy to check so if my CT one shows the slightest ambiguity, they will have to do a full on one.

[Poochmom in reply to Ducky2003]

Lol Ducky. I had ct scan contrast before my WMM a couple weeks ago and I got that same feeling like I peed myself completely but thankfully I was warned ahead of time so knew what to expect. Strange feeling wasn’t it?

[Ducky2003 in reply to Poochmom]

Very strange feeling and I was only warned about feeling flushed not the peeing sensation.😁.

[Hidden]

it isn't usual as far as I know. An angiogram is invasive and carries a low but significant risk (I'm supposed to have one on August 1st and am not looking forward to it). I would ask your GP to explain the reasoning behind the decision. If it turns out one is necessary, it's possible that a CT scan plus a profusion test could be done instead-these are less accurate diagnostically, but less invasive.

[Ducky2003 in reply to Hidden]

I had a CT angiogram last week as I specifically asked for the non invasive version.

[Hidden in reply to Ducky2003]

I was told that if I wanted a CT angiogram +profusion test I would have to see the consultant again to discuss. This wouldn't be until late August. *If* he agrees then the wait could be 3-4 months. The invasive angiogram has one of the shortest waiting lists (I'm not surprised!). The risk from the latter seems to be small but not trivial.

[Ducky2003 in reply to Hidden]

I don't know if it depends on why you are having it?Mine was because I'm on the list for mitral valve repair and Cox VI Maze surgery and when the surgeon said about having an angiogram prior, I asked for the less invasive option as I was fed up with being poked and prodded. He graciously agreed and it was 2 months from referral to procedure.

I'm just hoping that the images are good as otherwise I will need to have the other one,

[Hidden in reply to Ducky2003]

I imagine the CT scanners are used to scan other parts of the body and so are more in demand-your 2 month wait is quite good. In my case, I have had chest pain on walking a few hundred metres which stops when I rest. This sounds like classic angina, but what is confusing is that there is tenderness on palpation of the chest wall, which isn't typically heart related. So there are two inconsistent symptoms which they are trying to get to the bottom of. I have two friends who have had invasive angiograms and say they were fine, but I m not keen because of the risk involved. They only have to get air in the catheter or scrape off plaque from an artery and you are in serious trouble.

[2learn]

No. my understanding is an angiogram is to find any blockages/potential problems in your veins and arteries, Ask GP why they think its necessary.

[BlueINR]

I had an ablation about 2 years ago and I have never had an angiogram. I have had a cardiac CT, and that was a good year or so after ablation. I was in the hospital for abib, when an EP came in to meet with me and he thought ablation was a good idea, so I agreed and it was done 2 days later.

Don't expect it to eliminate all afib episodes, as I've still had them. I think that's just the way it is and does not mean the ablation was a failure. My current cardiologist does not think I should have another ablation.

[Tantaanna]

Had four ablations - last one had the CT scan like others never an angiogram that goes inside

[Pdotg]

Thank you for all these helpful comments. I have “postponed” the angiogram. I will try to see a cardiologist privately to find out why it was suggested in the first place. A recent echocardiogram showed no abnormalities and I have no symptoms of anything, as far as I know.