RECOVERY FROM PULSED FIELD CATHETER ABLATION – ANYONE HAD ONE YET?

[FindingCaradoc]

Some of you may have seen my recent update post relating to my decision to have a catheter ablation to try and sort out my early persistent AF (which was tolerable in terms of symptoms at the time). The decision was swayed for an active/invasive intervention when I was offered a relatively new procedure called pulsed field (PF) ablation. I continue to do well after the procedure which I had 10 days ago now, I’m apparently still in sinus rhythm (no obvious AF anyway) and have just had a few spells of relatively mild palpitations. The small amount of chest discomfort I had last week seems to have gone away and the catheter entry point is healing well. So, all good so far, although of course it is still early days.

The main reason for this post is that as some of you will be aware, one key advantage of the relatively new pulsed field procedure is that there is less ‘collateral damage’ (although the septum still has to be perforated), which has got me wondering whether the recovery may be less than with radio frequency or cryo procedures, even if the formal blanking period remains the same (3 months?) in terms of initial outcomes (I didn't think to ask this question at the consultation!). From a quick look I haven’t found much online on this particular point (not unexpected at this time as the procedure is relatively new) and UK patient information (even at LHCH where I had the procedure) is catching up. Not surprising as the first UK ablation of this sort was only in April 2022 and it is presently (I believe) being offered at just two centres; Liverpool Heart and Chest Hospital and Royal Papworth Hospital.

The discharge information that I did receive includes a statement under Exercise and physical activity that – ‘resuming your normal levels of exercise should be a gradual approach. You can start to resume your normal activities within a week of discharge and build up to these activities when you feel ready’. So, a bit vague really. I have asked the consultant how long after the procedure should I be able to do something a little more strenuous that raises my heart rate significantly, and the answer I got back via his secretary was ‘should return to an active lifestyle’….

Anyway, although I am feeling OK, I obviously want to err on the side of caution, so my default guidance remains the AFA factsheet, as well as tips I have picked up from this excellent forum.

So, I guess there are two facets to the feedback I am seeking from this post. The first is from the well-informed community who are knowledgeable about the condition and procedure in general terms, so may have a view based on what they know about this new approach, and the second is from anyone on this forum that has had a pulsed field ablation. For the latter I am not necessarily expecting any replies from a UK based group, as I estimate that there will be somewhat less than a hundred people in total who have had a PF Ablation to date in the UK (this is based on being told LHCH had done about 40 since April and assuming RPH have undertaken a similar number).

Anyway, any general thoughts/advice or specific feedback on these initial post procedure 3 months, would be most welcome. Longer term who knows, although I did find some 1 year data online in terms of efficacy. Thanks.

[pottypete1]

Never heard of this procedure. As we all know they are developing new procedures all the time.

Will watch with interest.

Pete

[FindingCaradoc in reply to pottypete1]

I will certainly update the group in two or three months, particularly after I have seen the EP again, if not before.

[Jajarunner]

normal ablation takes me four months before im back to brisk walking , about seven for running. Be very interested to see how this new ine us for you as none if my ablations worked (3 in 20 months)!

[FindingCaradoc in reply to Jajarunner]

I’ll keep the group updated 🤞

[Kingdaddy]

I had PFA in May at the Cleveland Clinic as part of the Affera clinical trial, which uses the Sphere 9 mapping system. I developed AFIB after my Apple Watch notified me on March 8th, and I had jumped right into early persistent. My symptoms were primarily shortness of breath. I had 2 cardioversions and was put on Multaq in April, but AFIB came back about 5 hours after each cardioversion, and Multaq did nothing for me.

In order to better understand AFIB and ensure I and my clinical team were making what I thought to be the right decisions, I developed the AFIB graphic below. It's stratified into 5 horizontal swimlanes and 4 pillars, and is pretty self explanatory. The green lines document my journey.

NOTE: The Affera catheter can actually do both PFA and RFA (Radio Frequency Ablation). The trial is a blind study so you are not supposed to know what you receive, but I know I received PFA. That said, those selected for PFA, like me, may get both - I received RFA on the pulmonary veins and PFA on the posterior wall. You can see a video of Affera's technology here: youtu.be/icyDk1L0ut0(Not working as expected?)

There is another PFA technology called Farapulse, which looks like it was designed for the pulmonary veins. You can see how that works here: vimeo.com/561588879?embedde...

My cardio ablation was on May 25th of this year, and within a couple of weeks after, I could mow my lawn without any issues. I had my 90-day follow-up with the Cleveland Clinic a few weeks ago, and AFIB has remained gone. My doctor took me off of Eliquis as a result.

Best of luck with your ablation - I believe PFA will be the gold standard for the US once it is approved because it does the job of stopping the electrical signals with the least damage to the tissue (instead of killing all the cells, it creates microcellular holes in the cellular membrane).

Steve's AFIB graphic

[FindingCaradoc in reply to Kingdaddy]

Thanks for the detailed information. I will take a look at it in depth when I have a bit more time. Glad to hear you are doing well and even better that you have been able to stop Eliquis (Apixaban). This will not be an option for me due to my inherent CHADS VASC score with other medical issues. As far as I am aware the two centres in the UK that are presently offering PF Ablation are using the Farapulse technology. I have pulmonary vein isolation only as I understand that is all the EP thought was necessary for me.

[BobD Volunteer]

Whilst there is temptation to consider this a new procedure which techinally it is in terms or method, it is still an ablation. Ablation means "to cause not to exist" (look it up) . Obviously a cardiac ablation is nonsense as you need a heart but I think we all know what it means by now.

Interesting aside. When I had my first in 2005 and mentioned it to a local nurse she thought I had varicose veins removed!

So laser, cryo, RF surgical or PF it still means causing scar tissue to block the rogue impulses. That tissue neads time to form, typically three months but can be longer as we explain in our fact sheet.

Fact. Doctors have seldom had the procedure and almost always underestimate how long recovery will be thus giving unreasonable expectation to patients. Hospitals with very few exceptions never took up our offer of the resource so continue to tell people they will be better in a week.

My advice would be to forget how it was done and be guided by the recovery fact sheet whilst continuing to hope that the new method may be more effecient and perhaps longer lasting.

healthunlocked.com/redirect...

[MikeThePike in reply to BobD]

Many thanks BobD for your very sensible advice. PFA seems to be a very promising approach to ablation. I am personally quite excited about it. But as you rightly point out it's still an ablation, the heart will still need time to heal so patients should make sure that they schedule plenty of time to rest and recover.

[FindingCaradoc in reply to BobD]

Thanks Bob. As I mentioned I will be erring on the side of caution so the AF Association guidance is my default. My post was partly out of general interest to see if there was any view in terms of whether the healing may be quicker and partly to hear from anyone else who has had a PF Ablation and has personal experience of recovering from this particular procedure (just Kingdaddy so far who is four months in and seems to be doing well) 😊

[MikeThePike]

Many thanks for your post. I'm glad you did because I didn't know LHCH offered this procedure. I knew that Papworth had performed the first UK PFA but I understood that was part of a trial sponsored by the manufacturers of the technology. I thought that the PFA procedure was not yet officially approved by NICE for the UK. May I ask how you managed to get this procedure? Was it part of a trial? Also, would you kindly say a little bit more about the chest discomfort you experienced and if your heart rate has been affected by the procedure? Thanks.

[FindingCaradoc in reply to MikeThePike]

Hi Mike - thanks for your reply - yes apparently LHCH did a PF Ablation soon after the Royal Papworth 'UK first' in April this year - and using the same technology (Farapulse) as RP. I don't know the details, and you may be correct that the initial procedures were a sponsored trial, but I was not offered the procedure as part of a trial and my understanding is that the NHS (presumably based on initial feedback) have approved the two centres to undertake further PF Ablations (not sure if that means it is officially NICE approved or not yet...). By the way, if you haven't already you may want to read my two previous posts which fill in my own situation and background, as these may be of interest and answer some of your questions.

I am fortunate in having private health insurance, which I still pay for myself after many years (even now I'm retired) partly because I prioritised this over some other things. I did have work based cover for some of my working life but wanted the continuity of having my own. BUT, it is getting to the point where the monthly premium is becoming so large that it will not be affordable for much longer! Anyway the short answer to your question is that my consultation and the procedure was private. Even going private I was lucky to get an early appointment for both.

My post procedure chest discomfort was mild and intermittent and may not even have been down to the procedure itself (see my background information in previous posts).

In terms of heart rate I have been bradycardic for as long as I can remember with a typical resting HR of 45 bpm (I am/was fit and bradycardia seems to run in the family) but my original EP was not concerned. I was put on Bisoprolol in May which reduced my resting heart rate further, but the LHCH Consultant has now stopped this. My resting HR presently seems to have settled down to around 52bpm, so this increase may be due to the procedure in part, rather than just stopping Bisoprolol.

[MikeThePike in reply to FindingCaradoc]

Hi there, many thanks for your detailed reply. It's good to know that the chest discomfort did not last and that your heart rate was not adversely affected. Good luck with your recovery and please keep posting. Thanks.

[FindingCaradoc in reply to MikeThePike]

Thanks-will do