Heart damage from oblations

[Modog]

how much damage is done to the heart by oblations? Does it cause any serious problems?

[BobD Volunteer]

Ablation probably causes less harm than un-corrected AF will. The scar tissue is only surface deep unlike cardiomopathy which is a possible result of uncontrolled AF.

[PengieP in reply to BobD]

They told me about 5%. I didn't notice anything afterwards, and I'm pretty sure you can exercise to get that back. I woke up during one of my ablations and I now know what heart pain really feels like. So there's that.

[CDreamer]

Good question & how do you assess? Sorry have no answers.

[jeanjeannie50]

Once when admitted to hospital with fast AF, after having had 2 ablations, a cardiologist said my heart could have become a little stiff because of the scar tissue caused by the procedures. I still went on to have a third ablation and that one really helped reduce my fast heart rate.

Jean

[Cookie24 in reply to jeanjeannie50]

What did he mean by a little stiff? What would be the symptoms of this?

[jeanjeannie50 in reply to Cookie24]

It was a she and I think she meant that was why I was stuck in atrial fibrillation. My heart maybe wasn't so flexible to move from one way of beating to another.

[Paulbounce]

Hi Modog.

As CD say's it's hard to access. Technically speaking it's a fairly new procedure - the first was conducted in 1981. I'll put a link below by Doctor Gupta who discusses ablation and if there is a need to have one. He thinks it very much depends if it will improve QOL (quality of life) or not. He talks about the benefits and may help you to come to a decision. I will point out that the video was recorded in 2016 but there are some very relevant points made and they apply just as much in 2022.

Paul

youtube.com/watch?v=3VOq9BL...(Not working as expected?)

[MikeThePike in reply to Paulbounce]

Good morning! If the first ablation was performed 41 years ago I wouldn't say the procedure was fairly new. Ablation technology is now quite advanced.

[PVSafterAblation]

Very rarely, the scar tissue created by an ablation can become keloid and cause what is called pulmonary vein stenosis where the blood returning to the heart from the lungs through the treated pulmonary veins becomes blocked off. This is probably the most serious long term side effect other than blood clots and can, speaking from personal experience, severely affect quality of life afterwards. It is extremely rare though, so much so that most cardiologists will dismiss the notion that it still happens with current advances in technique and technology.

[Ppiman in reply to PVSafterAblation]

From what I have read, it is rare owing to the doctor now keeping the ablating catheter further away from the pulmonary veins. The issue is still, I gather, that the anatomy of the veins is very varied thus meaning that a less effective PV isolation is carried out. Further issues seem to be the varied anatomy and thickness of the atrial wall, the atrial appendage and the closeness of the oesophagus to the atrium.

Steve

[CDreamer in reply to Ppiman]

Interesting.

[Ppiman in reply to CDreamer]

It's quite difficult to find the truth regarding ablations. I suspect that at some future point the doctors will look back on the technique in some amazement that it was ever done but, for now, it's the best we have. Considering how much knowledge we are still gathering and need about the heart, I still feel caution is a fair response.

Steve

[MikeThePike in reply to PVSafterAblation]

If stenosis is a concern then PFA may be the way to go. It uses a non-thermal energy source so in theory should cause less tissue damage. Early research done using animal hearts suggest that stenosis is less of a risk with PFA.

[Singwell in reply to MikeThePike]

There's a nice YouTube video on this if I recall, delivered by Dr Tim Betts.

[AussieHeart in reply to MikeThePike]

Hi, what is PFA? I have keloid scars from previous cancer surgery causing me no manner of issues so is a cryoablation safe as that’s what I had?

[MikeThePike in reply to AussieHeart]

Hi, PFA is Pulsed Field Ablation. It uses high strength electric fields to kill rogue heart cells by a process called electroporation. It does not use heat energy (RF ablation) or freezing (cryoablation) so it causes less damage to surrounding heart tissue, nerves arteries etc. The technology is still in development but it is already available in select UK centers such as Royal Papworth and Leeds.

[Elli86 in reply to PVSafterAblation]

Hello pvs.

How would a person know they have this and would it show up on a stressed mri? I’m still recovering from an ablation 14 months ago and I know somethings went wrong but feels like I’m being brushed aside.

[PVSafterAblation in reply to Elli86]

Personally, it feels like there is a pressure build up in my chest and I get very breathless but only under exertion. This began as soon as I started exercising again after my second ablation. I found that if my heart rate goes above 95, that’s when it begins and if I stop and let it come down again then the breathlessness passes and I feel fine again. My lung and heart consultants (eventually) agreed to refer me to have a ‘gated’ CT scan that is timed to look at the pulmonary veins and 30min later I had a diagnosis. The key is a CT scan with dye timed for pulmonary veins instead of the standard arterial timing, otherwise the heart can look completely healthy and the damage goes undetected. After that, there is a question around how many and what percentage blocked they are. Typically it is only treated if the overall occlusion across all the p. veins is >50% or a single vein is >75% blocked. I’m happy to share more details but also aware that this is off the original post topic really. The following medical journal really helped me to convince the consultants to investigate this for me: ahajournals.org/doi/10.1161...

[Elli86 in reply to PVSafterAblation]

Thanks for the info. I also get the build up of pressure in my chest. I have this often and my chest aches nigh on constantly. It’s very rare where my heart doesn’t feel extremely sensitive. I have no idea why this would not have been mentioned. I’ve had a stressed mri but it came back as normal. I haven’t had any type of ct scan though. I will look into this. Thanks for the information. Are there any other symptoms that I should be aware of?

[PVSafterAblation in reply to Elli86]

Most common is breathlessness (either at rest or during exercise) along with reduced exercise tolerance and the feeling of pressure build up which can also result in the feeling of needing to cough. These are also symptoms of many other conditions that are far more common that need to be ruled out though hence why it often takes a long time to get diagnosed.

[Elli86 in reply to PVSafterAblation]

I have the reduced exercise tolerance and pressure build up. I also get breathlessness but it would depend on the severity. If I go up stairs too quickly at times my heart will pound in my chest, I’ll get dizzy and get a really strong build up of pressure in my chest, breathless and my heart feels like it’s struggling to regulate itself. There is definitely something wrong i just can’t get to the bottom of it 🤦‍♂️

[MikeThePike in reply to Elli86]

Hi, May I ask what you had the ablation for and why you feel it was not successful?

[Elli86 in reply to MikeThePike]

I had paroxysmal af. I had the ablation to correct it and get off medication. It’s stopped af since February this year and I haven’t been on drugs since then as well but I’ve been left with a whole host of other issues and my heart doesn’t feel like it pumps correctly.

[MikeThePike in reply to Elli86]

Hi again, thanks for responding. That's interesting. Your ablation actually cured the AF. May I ask what type of ablation you had? Also, may I ask what type of issues you are experiencing and why you think they were caused by the ablation? I'm always interested to hear about others experiences with ablation particularly when they are not totally happy with the results.

[Elli86 in reply to MikeThePike]

Not totally happy would be an understatement to be honest. I was much better off before the ablation than after. The only upside is the lack of af and the fact I’m not currently on medication.

To give you the short version my heart is permanently sensitive since the ablation. My stamina is abysmal. My heart rhythm struggles to regulate itself. My chest almost permanently aches. My heart feels like it wants to go but feels like the ablation is blocking it.

I had an cryo ablation and wish I hadn’t.

[MikeThePike in reply to Elli86]

It's entirely possible that the cryoablation caused collateral damage to other structures in your heart. Complications of cryoablation are well documented and EPs should be aware of them and how to avoid them. They should also make patients aware of them before operating.

[mwcf]

A little caution is needed with multiple procedures as a result of which extensive scarring can bring about other more difficult to treat (than AF) atrial tachycardias. Unnecessarily overly aggressive/multiple procedures can bring about loss of atrial function also. Here's an hour long vid - quite technical but well worth a look in my opinion.

 

[Modog in reply to mwcf]

Thanks. Video?

[Cookie24 in reply to mwcf]

Yes, please send video.

[KMRobbo]

Prior to Afib, I used to keep fit (and keep the weight off) by running twice a week, often round a large woodland park near me. I recorded the results. The distances varied slightly owing to fancy and my time varied owing to my natuaral variations, and the weather (eg slower when its muddy or windy of snowy). Typically I was running 5.3 to 5.7 miles. In 2014 prior to AFIb was doing 8.3 to 8.7 minute miles average for the distance .

After recovery from my ablations 12 months after my AF cryoablation and an RF Aflutter ablation *Jan/Feb 2018) in 2019 I was running similar distances in very similar times 8.3 to 8.9 minute miles. all measured on the same Garmin watch with HR monitor./chest belt.

Not a competion runner, but I generally (not always) pushed myself when running to keep me fit. (hence the recording of the times so I could see what I was doing)

But based on that data I would say the abalations did ZERO damage to my heart.

(Ps) I was a bit slower between 2016 and 2018 as I was taking calcium channel blockers (esp when on diltiazem) which restricted my Max Hr a lot to 137BPM. One of the reasons I wanted to be off the drugs!

Unfortunately not running much now, but owing to my knees not my heart!

I was 55 years old when diagnosed in 2016 and 57.5 years old when I had the ablations.

[Speed in reply to KMRobbo]

That’s useful to know. I’m similar age and 12 mths from 2nd successful Ablation for AFL but now aquired AF. My running pace / stamina has slowed over last 10 mths and my HR has slightly risen. I’m wondering if the process of the Ablation has had an impact or if lasting effects from getting Covid 10 mths ago. No beta blockers or other meds as candidates. Interesting to here of a case where ablation has not had an impact

[KMRobbo in reply to Speed]

Was your ablation for right atria flutter? I ask as my flutter ablation was but it was sorted in relatively few minutes and did not think the EP ablated much at all to stop mine so would have thought little damage and as my times show before and after was no difference. Do you have AFib currently when you are running? Are you taking Rate control meds? Either of those will slow you down !

[Speed in reply to KMRobbo]

interesting question - right or left? - I don’t actually know but I think I will try to find out. It did take 2 ablations and I understand maybe 4 to 5 “burns” on 1st but I believe they did 26 on the 2nd to be sure. Of my 3 symptom events of AFib in last 4 mths, 1 was during running and stoped when I slowed but came back when I speeded up, the 2nd was not from running but stress I believe and the 3rd started 30 mins into a run and continued for 7 hrs (I took pip flecainide). Normally I run 3 times a week so nearly all runs are without symptoms but still slow compared with a year ago. I wear a Garmin chest strap HR monitor so am sure I’ve picked any events during exercise. I do take Flecainide 50mg 2 x daily but I am lead to believe this will not impact HR and exercise. I was on this a year ago anyway. I don’t take any Beta Blockers which I can categorically state does impact HR and pace.

I’m still not sure but suspect Covid (mild long) rather than Ablation but always that lingering doubt.

Resting HR appears to be returning slowly to previous norms. Around 47 tonight.

[Janey1955]

my ep said that as I had no very significant symptoms, and the heart appeared to be healthy he was reluctant to carry out an ablation and hasn’t. I suppose it depends on the symptom burden

Jane

[KMRobbo in reply to Janey1955]

I had no symptoms other than the high HR and initially did not want an ablation. But I was always High HR and I did not want to be high HR as i knew it could cause atrial remodelling. However for 20 months I found a way to self convert back to NSR, but that trick stopped working so on my 12th AFib attack I could not get out of AFib and was on high AFib for 8 days at 165 to 195 bpm resting, 5 of those in hospital as they could not convert me either and eventually only got cardioverted by IV flecainide in the coronary care unit. So after that I realised I was progressing to permanent AFib, and the medics put me on daily flecainide and 200mg diltiazem to try to prevent me going into high rate afib again as they were worried how they would get me out. The diltiazem was over prescribed and had some bad side effects and i realised that the AFib was potentially damaging my heart so I pretty much demanded an ablation.I wish i had had one earlier as I would have spent less time in hospital and faffing about with drugs.

But hindsight is wonderful!