My EP has booked me in for an ablation within next six weeks (Sept 13) but didn’t explain why I need it. It took my cardiologist a year to consider arrhythmia and a further year for an EP to investigate it via loop monitor. I’ve been told it’s a rhythm and rate issue, it’s PAF, it’s ectopics, it’s SVPT, it’s brachycardia, it’s tachycardia lasting up to 12 hours at over 200bpm. Now they are checking length between pauses (what the!). I understand little except to tell the EP the fatigue on low-dose Flecainide and Bisoprosolol is more frequent though I feel better on it than off it!! My consult was 15 mins. I didn’t get to ask why ablation over BBs… and risks/benefits. I often read here many are chomping at the bit to get an ablation. Any thoughts as I’m dead scared to have it and think I should cancel to get a second opinion.
Ablation advice: My EP has booked me in... - Atrial Fibrillati...
Ablation advice
If you think you need a second opinion for whatever reason, you should get one. Just make sure it's from a different medical center than the one your current doctor works for. If not, they often defer to the other doctor.
Jim
Good point.
One of the issues which make it difficult to comment for me is that I don’t know anything about the Australian healthcare system. Here in the UK, if an ablation is offered by an EP on the NHS then you can be fairly confident that it’s the right thing to do. There are no financial benefits for the EP’s via health insurance schemes as they are salaried and they are encouraged to only offer an ablation if they are confident that it’s the right treatment for the patient. If the health care system in Australia is not insurance driven like it is in the USA but is more like the NHS then it’s important to bear this in mind.
That said, the general thinking is that if ablation therapy is the best route forward, the sooner it’s done the better. It’s commonly accepted that AF is a progressive condition and although lifestyle changes can make a huge difference to a patients AF burden, many are unhappy at the thought of a lifetime of taking potent medication plus the possibility of having to increase doses to keep AF controlled.
Whilst there are of course risks associated with having an ablation, the medics see it as a low risk procedure but patients may have a different view even though their view maybe based on a general lack of understanding about what’s involved. One things for sure, the patient must never feel they are being coerced into doing something they are not comfortable about, so in your case, I would think a second opinion might be a good idea. Personally, I’m pro ablation. I know that it may require more than one procedure to get AF under control and I also know that there are no guarantees because there is currently, no cure for AF but I’m lucky, I have an EP with whom I feel confident.
At the end of the day, only you can make the decision to go ahead, but hopefully others here will share their views and help you to make the right decision for you…..
Hi FJ,I must take slight issue with your assertion the NHS EPs will only offer an ablation “if they are confident it’s the right treatment for the patient”.
I was put on the ablation list following a brief phone consultation with an NHS EP after being diagnosed with PAF in A&E some months previously. There was no mention of trying rhythm control drugs first, or an enquiry as to other factors that might be contributing to the AF in the first place.
As it happens I subsequently discovered I have sleep apnoea and treatment for that has so far, stopped AF episodes. However, it was only through my own research that I found out about the link, that, as you will know, can be a common cause of AF. Maybe it will return, I don’t know, or maybe I could have had an ablation needlessly if the sleep apnoea hadn’t been discovered and treated.
I was probably unlucky and caught the EP on a bad day but I can’t help thinking that perhaps some, at least, are very focussed on what they are trained to do ie. ablation and don’t always look at the wider picture.
I agree, but you did miss out a fairly important word in your quote….”FAIRLY”.
Of course EP’s will very in every respect but they are not motivated by making money if they are working for the NHS………
Thank you FlapJack … our system is similar to NHS but specialists can charge above Medicare rates as they often work between private (like in the US) and public practices so I’m not confident our best interests are always served. My EP said I’d be a week out of action but comments I’ve read here have suggested 13 weeks ! I appreciate your comments. Very comforting Re: sooner rather than later as I’ve read that too but no harm seeking second opinion 
I’ve had AF and flutter for 5 years and any increase in medications failed to control the symptoms. After a particularly bad episode where my heart was jumping around between 130 to 180 bpm for 24 hrs I was taken by ambulance to A & E and the next day given a cardioversion. Four days later I had a ablation for both AF and flutter. Im now 6 weeks post op and have not had any further episodes of AF or flutter. Such a relief. Prior to the procedure I was having episodes at least 5 times a week for 1 to 24 hrs in duration. I’ve been advised to stay on medication until I’m 6 months post op. The ablation has given me my life back. My recovery was, week 1 did nothing apart from read and tv. Week two, dog walking locally and light gardening. Week 3, back to normal life without any heavy lifting. Week 4 fully recovered. Good luck with your decision
Regarding recovery, we normally suggest doing nothing for the first week and not much more for the second then gradually get back to normal but avoid any heavy lifting and excessive exercise. The entry point in the groin is likely to get badly bruised so it’s fairly easy to understand what the inside of the heart must look like so use that as a guide for recovery.
More useful information is available from the “Pinned Posts” on the right of this page headed “Preparing for and Recovering from an ablation”. Good luck.
Thank you, I’ll look into those pinned posts as I’ve concluded I need as much information as I can humanly absorb on ablation procedure. You are all the best. Much appreciated advice
All decisions should be based on Quality of Life and no decision taken before you have all the information you need. This new NHS leaflet may help fill in some gaps api.heartrhythmalliance.org...
That is a comprehensive document that serves to show I know even less about my condition though I’ve worked out some triggers (overdoing things and becoming dehydrated are but two). I imagine stress too as I can become annoyed at little things. I think I need another appointment to find out more and like CDreamer’s document this will help me immensely. Thank you so much. You are fortunate to have such a great service in the UK!
Maybe think in terms of an accumulation tipping you into AF rather than one single trigger. The solution I have found is to address all potential problems. Not easy I know but well worth it.
It sounds as though you have real difficulties with these various arrythmias. It’s a difficult one so one of the questions I would be asking is - what is causing the arrythmias? For some people ablations are the answer but many others do not benefit and knowing what treatment will be best for you is very difficult to establish. Some EPs distinguish between Vagal and none Vagal AF - for more info read richardbogle.com/blog/vagal...
I think it’s interesting that there is so little research as to who would benefit and who not.
Before ANY treatment - look at Lifestyle - worry and stress will always be the biggest antagonist for arrythmias and there are many breathing exercises, relaxation techniques and Mindful Meditations which will always help.
By Lifestyle - I mean:-
Nutrition - looking at supplements such as CoQ10, Magnesium etc.
Moderate Exercise - both too little and too much can trigger arrythmias
Other underlying uncontrolled conditions - High BP, Overweight, Diabetes, Thyroid etc. Autonomic Dysfunction - Treat those and things can improve dramatically.
Sleep - have you Sleep Apnea or been tested? If you have arrythmias at night there is a good chance you may have.
Stress reduction
You may find the book by Dr Day - The AFib Cure helpful - he talks about all of the above and how and when ablation may be helpful but also what to do to ensure arrythmias return - which they often do so people may need 2 or more ablations.
The procedure itself is not as scary as it sounds but to ensure success I would want to know how skilled the EP is and what equipment is going to be used.
It sounds and feels overwhelming I know, having been through the whole gamut of treatments, including 2 ablation, the only thing that worked for me was Pacemaker. Considering the pauses in your heart rhythm - has that been spoken about and if not why not? It sounds as though you have a lot more going on that straight PAF.
A lot to think about but whatever decision you make - we are here to help and support.
Best Wishes CD
I have few answers about all my issues. Flecainide worked for a bit, so did Bisoprosolol and combined I thought I was doing ok but my EP obviously thinks differently. I have had sudden weight loss since taking these BBs. I wasn’t overweight to begin with as on great diet / doing meditation and light exercise so I recently saw a dietician who says I’m underweight and is concerned! I bought a copy of the AF Cure and have been on magnesium ever since. I do think more info is required so the link you’ve provided is very helpful. Thank you so much.
It was Richard Bogle who originally set up the Surrey AF Support Group with Rosemary and I was fortunate enough to have seen him when I was first diagnosed with AF which is how I got involved with the Group when it started. He is a Cardiologist, not an EP and was always open about the comparison between Electricians and Plumbers. I remember when my CV started to show signs of failing after a year, he put me on a maintenance dose of Flecainide which kept me in rhythm but I wasn’t sure what I should do for the longer term. At support group meetings, he didn’t always seem to be pro the ablation route but at one appointment he asked me what I thought I should do. I replied saying that I didn’t know and asked him what would he suggest I do if I was his Dad! He said that he thought I would be a good candidate for a Cryoablation and referred me to see an EP. As they say, the rest is history!
No big deal. I got wheeled into theatre with arrhythmias and got wheeled out without arrhythmias or medication.I'd rather have an ablation before a tooth procedure for sure.
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