Anyone else see this?
cardiacrhythmnews.com/almos...
Actually glad I didn’t know this at the time of my ablation or it would have consumed my mind for a couple weeks after…
May have reconsidered had I known… - Atrial Fibrillati...
May have reconsidered had I known…
Written by
Jafib
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38 Replies
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Firstly, as with any study, you need to look at the detail of the patients such as age, multi-morbidity etc. I agreed with the EP that it wouldn't be much point in having an ablation at my age. I'm still here, but a 6 in 100, 000 chance of a bad reaction to dronedarone and amiodarone nearly finished me. Talking of risks, apparently 1 in 3 people have a mutation of the gene that metabolises clopidogrel, so that it is less effective: who knew? Clopidogrel is given for strokes and heart attacks!
Clopidogrel is not indicated for strokes. etheral
Clopidogrel is given for haemorragic and and ischaemic strokes in A&E. I was given it after my stroke. Ischaemic stroke survivors will subsequently be prescribed clopidogrel (anti-platelet), whereas haemorragic stroke survivors like me are prescribed an anticoagulant (I'm on dabigatran). NICE are currently funding a study to evaluate the [cost] benefit of gene profiling to establish if a patient has a mutation of the gene, and the expected time to get results from the laboratory.
I've just read your bio Etheral, and I see you are in the USA. NICE is the acronym for the National Institute for Health and Care Excellence and, is the expert body in the UK reviewing evidence based procedures and medication. The CYP2C19 gene metabolises clopidogrel as well as other medications.
I refused ablation due to the potential risks and had I known more at the time I would have refused Lithotripsy for kidney stones as thanks to that barbaric procedure I now have a damaged spleen and artery.
So many treatments are said to be easy and risk free but down the line they discover otherwise.
A sobering read!
My EP told me that he'd never had any patient die through him performing an ablation, this is in the UK. I've never in all my time on this forum heard of anyone dying from one. I've had three and I know people on here who have had lots more - one person has had seven. I dare say that the chance of dying is there and we are warned before having one that they are not always successful, but I just can't believe that the death figure is 1 in 200 in the UK.
Has anyone on here heard of an ablation causing death?
Jean
i agree. Looking at it the results of the research it may not be transferable between countries. Different countries have different systems for decision making regarding ablation. For example here in uk it’s performed in highly specialised units where high volume of ablations are carried out. The research quoted says low volume Centers were included and the risks in those centres was higher. Also the stats are from all paying centers, which could influence the decision making for ablation. Any research we use to help us in our individual decision making has to be looked at carefully to see if it’s really applicable to our individual situation.
Hello there, I am top of the list now for an ablation but to be perfectly honest the actual thought of going is terrifying me. I follow this site and although helpful in many ways for support, etc it has actually made me think twice as to whether I will go ahead with it or not. I know this is solely my decision, but I am having this 'should I/shouldn't I going on inside my head just now and in quite a quandry. I see you have had several Jean so was wondering if you can give me some insight into your recovery, etc. Many thanks.
After my first ablation, I was off work for just over 2 weeks, but I had what was mostly a desk job. After the second I felt drained for many weeks, after my third I felt better instantly and no tiredness at all.
I'll be honest and tell you that the actual ablation procedure for me was no big deal, but the way I felt afterwards for the first two procedures was . You really must rest the first week and then, take it fairly slowly the second. Some days you will feel really well and think you can do anything, but extreme tiredness can hit from nowhere. I would find I'd walk the short distance to my local shop, but suddenly felt too drained to walk back, but had to and it was quite a struggle. So look to just pottering around home for the first few week, with lots of rest and build yourself up to doing more gradually. Your body and how you are feeling will guide you.
Jean
If it was 1 in 200 I would never have had one never mind 4 !!
Nor me.
no. And 1 in 200 seems a lot.😳 I must admit I was rather worried before my first ablation and the EP said in all his years of surgery he hadn’t had anyone pass away.👍 I then went on to have another 2.👍
My takeaway from the article (very interesting) is that an ablation is not a good idea for someone with certain comorbidities and should in any case be performed in a high volume centre. Bearing in mind that the study was done in the USA I think we are probably safer here because ablations are generally only offered to those confidently expected to benefit, and performed in heart hospitals.
Jafib Note this reply "comorbidities". A quick read of the article, I did not see age groups mentioned. Comorbidities is the key which may exist in a large part of the elderly population. Also, as I read the study was from 2010-2015. Much more knowledge now.
When I was first diagnosed by (by chance as I am asymptomatic, but AF in my case is familial and it really was a matter of time before diagnosis). I asked the Cardio if I could have an ablation like my son had (he is a fellow canoeist with my son and had sent him for an ablation a few years before). He looked at me in horror and told me that my son's AF case was quite different, and as I had mild asthma and possible chronic bronchitis, there was no way I was a candidate , so just take the pills ! As it happens the pills work very well, but I felt deflated that I was not good enough to have an ablation, ha, ha, ha.
BobDVolunteer
Like Jean I have never known of anybody who died following an ablation HERE IN UK . I know nothing of data in USA.
When I first met my EP in 2004 he told me death was one risk from the procedure so I asked him when he last killed anybody. Never was his reply. I then told him to put me on the list for the week after he did so I knew he would be more careful. He still hasn't.
By comparison I would have died during a cardioversion had a quick thinking doctor not noticed that whilst the ECG was showing perfect heart beat, my heart was not actaully beating. (Pulseless Electrical Activity) and started CPR. I could therefore suggest that cardioversion was more likely to kill you than ablation from my statistics but that would be to ignore that PEA is a one in five million event. When I asked Prof Camm if he had encoutered it he said not in fifty years in the business.
Here in UK most EPs will be quite choosy about to whom they offer ablation, discounting people who are obese, may drink excessively, have serious other health issues or otherwise be at increased risk. I do wonder if in areas where money talks this might not be the case and therefor distort results.
Spot on again, BobD. EP's in the UK do far more ablations than EPs in the US. The average number of ablation in the US is around 10 p.a. (though I can't find the reference to this). I asked Prof Schilling how many ablations he did - around 200 p.a. and he had been doing these for years. He had just one death - from someone who was at death's door anyway and the ablation was a last throw of the dice.
yes a bit scary but the poor statistics involve people with high co morbidities sadly
Agree that the figures show that the older you are, the more co-morbidities you have and having the procedure done in low volume centre all are important factors in these figures.
Actually I found the study rather reassuring as had other procedures with much higher risks attached. 1 in 200 is 0.5% and when you take out the high risk patients that reduce to 0.25%.
And quote :- “Sepsis and CHF were the leading primary causes of readmission associated with mortality.”
Some good comments above
I'm in the U.S., the land where money has a loud voice in medicine, 70 years old, with co-morbidities (CKD and lupus, and a pig valve, not CHF though). So that article was quite helpful. Thank-you.
While interesting, nothing in that article is news to me. Like everything you have to weigh the pros and cons. What's worse, an ablation or a lifetime of flecainide? They both have potentially serious risks associated with them. In this life our options are limited and we have to make choices and be prepared to live with the results. Any procedure or medication could have unknowable or unforeseen outcomes. Who remembers the case of the woman paralysed after taking a paracetamol? She had a severe allergic reaction which quickly led to partial paralysis. Nothing is certain of success. We just have to do our research and go with what we think is the safest or best option for us. It really is that simple.
I saw this information somewhere back in 2019 when it was first published. Ablation is a comparatively new procedure, the more it is performed the more experienced the EPs become at carrying out the procedure and experienced EPs have been shown to have the best results .
I was first offered an ablation 6 years ago, my local hospital had only just started performing them, my episodes were few , quality of life was good except for AF days and I wanted to try to delay the progression of AF with lifestyle changes so I weighed up the risks and decided at that time Ablation was not for me.
Maybe that was a wrong decision and it is better to have an Ablation early before AF becomes too frequent and harder to deal with, it is all about balancing risk with every patients individual circumstances.
There can come a time where the AF burden becomes high,medication doesn't work, quality of life is poor.. then having an Ablation with a chance of improving quality of life outweighs any risk. I have reached that stage and whatever the risks I am going to have an Ablation.
Well I think it's useful for our US members. I don't feel the findings can be applies to the UK or to other countries in Europe that have public health care systems. Here I felt very confident when my EP told me that I was a highly suitable candidate for ablation. I'd also done my own reading and research plus following this forum.
It is a bit of an eye opener signing the elective surgery consent form, '1 in 1000 risk of death' etc.
But I'm a bit of a risk taker; professional helicopter pilot and technical crewman for 43 years .....(and what ALWAYS happens to the helicopter in a feature film ?.....they ALWAYS crash and burn !)
So I signed before my first ablation in 2020, I thought the risk was worth it to get rid of 2 years of constant AF (walking only, breathless on inclines, 90-150 bpm even on meds).....and the chance to go skiing again ..... (now there's a risky sport !)
Anyway......halfway through the cryo ablation under sedation my heart decided to stop completely (asystole) Dead, basically. ......... fantastic team though......quickly pulled out of the left atrium, got the pacing probe in the correct position in the right atrium........blood pressure returning....phew.....and just under sedation so no help with the breathing......
Procedure cancelled.
Waited 6 months for 2nd ablation under GA (better control if it went pear shaped again)
Happy to sign?..... yes.......'nothing ventured nothing gained'.
2nd ablation......NSR for just 2 weeks........ then....constant flutter
3rd ablation for flutter, 4 months later, in Jan 2021..... Success; NSR and holding.
Holding firm NSR, 2 years later......back flying for a living (air ambulance helicopters) .......AND first time back on skis next week, after 5 years !
Ablation is slightly risky.......but it gave me my (risky) life back!
interesting but as others have said - high comorbidities, older age, inexperienced team / EP. Advice from my very experienced EP in high volume teaching hospital after thorough assessment of me? Early ablation, earlier the better. Pleased I had it.
The report says"Patients who died early following AF ablation were older, and had a higher burden of comorbidities such as congestive heart failure, coronary artery disease, previous placement of pacemakers, pulmonary hypertension, chronic lung disease, chronic kidney disease, anaemia, and coagulopathy than those who survived"
At my ablation discussion appointment my EP told me all the standard statistics of possible death/ other serious outcome, and asked me if I wanted to proceed. However is also told me his opinion that I was a good candidate for a successful ablation. That was the important part so far as I was concerned.
it’s a read and delete job. Looks like those who croaked it were on the way out anyway……
Maybe I misread article but less than 2% seems not bad. I had a stroke within 3 wks with no prior indicators such as high chokestrol etc, could have been worse. Medics said couldn't have been caused by ablation , not sure I believe them. All procedures carry a risk even dentists so what do people expect, to live forever, If so stop driving, don't go out etc etc
What do you correlate a stroke three weeks after ablation to?There is nothing in the procedure that would cause a stroke three weeks later. In fact, the ablation is more likely to prevent stroke in the first place.
If your heart is quivering in afib or aflutter, it is much more likely to create tiny clots in the heart that can move into the lungs or up to the brain causing stroke.
Were you taking a blood thinner following the catheterization procedure? That should have also diminished the risk of forming clots.
It makes me wonder if you have a clotting disorder if you had a stroke while on a blood thinner.
Another consideration is: do you have other comorbidities? If you do, it would be wise to consider whether you are still at risk for having another stroke if the afib is controlled. What other health conditions do you have that could increase your chances of having stroke? Those are definitely questions you should be asking & discussing with your primary.
Good luck in getting your health in order
not sure what you mean by comorbidities and what qualifies as such. Was already on apixaban. Strokes are risk from ablations and apparently as this site has pointed out in the past the risk period is greatest in 1st 30 days following ablation. My stroke was within that period. I am not overweight, diabetic and no high cholesterol. The local hospital, did not do MRI as they said their machine was too old for my recent pacemaker, all other scans were clear. I was told that as I was on apixaban there was nothing else they could do and I have not been seen by any stroke consultant, or had any follow up etc.
Comorbidities are other chronic ilnness diagnoses, like hypertension, hypercholesterolemia, atherosclerosis, coronary disease, coronary artery disease, diabetes, hypo/hyperthyroidism, autoimmune disease, overweight or obesity, COPD, history of DVT or PE.Apixaban is the same bloodthinner as the brand name drug Eliquis. Most people do not take Eliquis or any other blood thinning medications prior to having an invasive procedure like cardiac catheterization or ablation for five days. Once the ablation is performed, they usually resume the Eliquis or other blood thinner.
I would assume the five day period of no Eliquis while the heart is in fibrillation is the highest risk period for developing a blood clot. The blood clot can travel to the brain, causing an occlusive stroke.
Another risk factor is the catheter, which is actually a very long guidewire that threads from the insertion site through the vein to the heart. The guide wire, itself, can possibly dislodge plaque that is built-up on the interior wall of the blood vessel, causing the plaque to travel to the brain causing an occlusion stroke.
And, the guide wire can also act as an irritant on the inside of the blood vessel causing it to spasm, which can cause the blood to move more slowly, giving opportunity for a clot to form & travel to the brain, causing an occlusion stroke.
Without knowing what your stroke was caused by, it's hard to determine if the stroke was caused by any of those things.
There are acute brain bleeds which cause stroke. And, there are spasms that occur in the veins in the brain that can cause an infarct.
A stroke is simple a lack of blood flow to any area of the brain. It can be caused by many things.
I'm sure having had a stroke makes your life more difficult than it was before the stroke. It isn't always possible to determine the cause. Having a cardiac cath/ablation increases the risk of something else happening to your body, but if your body is full of plaque and cholesterol, atherosclerosis, those risks are already there, to be honest.
anytime a medical procedure is performed on the human body or new medication is given to a patient there is a risk of complication or drug side effects.These are evaluated in sophisticated trials and if benefits overweight the risks the procedure or drug is approved.
You can take aspirin first time in your life and die of anaphylactic shock.Does it mean that rest of humankind should not benefit from this medication?Obviously no.At the end of the day it is between your doctor giving you explanation of your options and you deciding your course.One in 200 ablations can have bad outcome but 199 ablations may improve quality of life.
It’s all about making informed choices,nothing is perfect.
Jerry /55zuzanka61
I remember reading that before my ablation but was not put off at all. As others have said the cohort was highly co-morbid. Taking into consideration my own health with zero co-morbidities it was an easy decision to go ahead.
Like many of these studies, sensational headlines get lots of unwarranted attention and publicity. People need to look beyond that and examine the evidence for themselves.
Critical thinking seems to have gone by the wayside these past few years.
In my case the risk vs reward was well worth it. I was miserable and horrible quality of life with Afib. I'd of done it anyway even if I read that article.
I read one study on that topic. It was only looking at those who died fairly soon after having an atrial flutter ablation.
if I remember correctly, those who died early were not taking anticoagulants.
Ha! I guess I wasn't one of the lucky ones. With all I've been through with afib and ablations, death would be a welcome relief.
Jafib,It's good that you're looking at the results of the study. But, it is very important to look at what the <.5% deaths were mainly caused by. It says that within thirty days post ablation, the two main causes of readmit and subsequent death were due to congestive heart failure and sepsis. The study does notihing to define sepsis from what cause.
Firstly, if an ablation was performed in a person with CHF, the load on the heart should be lifted to some degree. Those who died from CHF (not Afib or ablation), had to have had a very, very weak heart before undergoing ablation in the first place. In other words, those hearts were already very compromised. I imagine a cardiologist would have given them some upfront warnings about how effective the ablation procedure might be to their overall heart recovery before performing the procedure.
Secondly, the patients coming in with sepsis could have had an infection from a diabetic foot ulcer that led to sepsis, or a urinary tract infection, or a bad tooth. Sepsis can come from anything. It doesn't relate to the ablation procedure at all. Especially considering the thirty day time frame.
The study says those who died within thirty days of the procedure had many comorbidities, meaning they are already very sick individuals who have lots of health problems. One thing we all should be more aware of post-pandemic, is that "comorbidities" are like debits in your health bank. If you have many comorbidities in your health bank, you might consider that the future of your account is in jeopardy.
This is why prevention is so important! You only get one body in this life.
If we don't take care of the one we have by keeping it strong and building the immune system, there's only one way out.
Finally, ablation is a pretty safe procedure. I've never heard of someone dying from ablation in the fifteen years I have been a nurse. I have heard of people undergoing ablation and going back into Afib, having other heart issues & other problems. But, this study doesn't make a good case for linking ablation to death. What it does a better job of showing is that out of 200 people who have had an ablation, most people have good outcomes and statistically less than one person dies from something like sepsis or heart failure because they already were in very poor health. The likelihood of their demise from the other comorbities was just as likely.
I hope this article doesn't scare anyone out of having a procedure performed that would genuinely help them.
I also hope that people will be very careful and be super cautious about their health, like you are and read important and relevant research that pertains to them.
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