Hi, I am a fit 57 male and was diagnosed with paroxysmal AF while going for my weekly jog back in Nov 2022. I get weekly episodes so have booked a pulsed field ablation for 4 May 23 under general anaesthetic. Has anyone had pulse field ablation as I am nervous about having it done. Just wanting to know how the overall procedure was. Many thanks
Pulsed Field Ablation: Hi, I am a fit... - Atrial Fibrillati...
Pulsed Field Ablation
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Karykowj1
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BobDVolunteer
Intersting as this is a very new procedure not generally available in UK . Where are you booked to have this?
Royal Papworth Hospital Cambridge UK
in reply to Karykowj1
I don’t know much about the procedure but Papworth has a great reputation so you are in good hands. Can I be nosey and ask if you are having it done privately or on the NHS and if so, is it part of a trial. More importantly, hope all goes well and please let us know how you get on……
Karykowj1 in reply to
Hi, having it done privately, no one has mentioned it as part of a trial but PFA being a novel method they probably will collect data on my progress.
FindingCaradoc in reply to
As I mentioned in my reply to Karykowj1, I understand from my Consultant at Liverpool Heart and Chest Hospital (recent follow up appointment to my own pulsed field ablation last September) that the procedure may be rolled out to further Hospitals (other than the original 2 in the UK - Papworth and LHCH) - I understand at LHCH (and presumably Papworth) that it’s being offered to suitable NHS patients as well as privately.
Hi FindingCaradoc, did you go on the NHS or privately how long did you have to wait to have the PFA procedure done?
I assume you’ve seen my main comment to your OP for a bit of my background… I am fortunate to have private health care, and also I think I was lucky with original appointment/timing/availability, but I had my PFA done at LHCH only 10 days after seeing the Consultant for the first time. As I mentioned the procedure is being offered to NHS patients to. As one of the other comments has suggested you don’t mention if you have a medication only option? My situation was that I could no longer take Flecanide after a heart attack!
No my Consultant also advised against taking Flecainide due to one coronary artery having 50% stenosis. I am on Diltiazem, Apixaban, Rosuvastatin & Lansoprazole. Generally these medications give me bad side effects (dizziness/light headiness) so medication only is not an option. I really would like to stop taking Diltiazem & Lansoprazole and Apixaban if possible after the PFA procedure. Are you still on any medication after your PFA procedure & did you and do you still have any side effects?
Unfortunately yes on the medication front. The Consultant stopped the Bisoprolol (I was on a small dose up to the PFA) as I am Bradycardic (albeit with no specific related symptoms) and it was making it worse. I remain on Apixaban as my ChadsVASC score is 2 and will go up to 3 when I hit 65 in a couple of years time. I am also on blood pressure medication and a high Statin dose. In addition I presently take Clopidogrel and Lansoprazole, related to the two stents I had fitted almost a year ago. I can stop taking these in a couple of weeks which I will be glad about as the Clopidogrel is not agreeing with my stomach, even with the Lansoprazole. Other than these apparent side effects I think I tolerate the other medication OK.
I had a pulsed field ablation (PFA) at Liverpool Heart and Chest Hospital in September 2022 (at the time only LHCH and Papworth were doing this relatively new procedure in the UK - although I understand from my Consultant at a recent follow up that the procedure may be rolled out to 5 more Hospitals I think he said…)
As you may already know, I understand PFA has an even better safety record than traditional catheter ablation from the data available to date and you will obviously be in good hands at Papworth 😀
Provided a general anaesthetic is fine for you it makes the whole procedure (for me anyway) pretty straightforward and the only after effects of note was the bruised groin (normal).
It’s now almost 7 months since the procedure and it has been a success for me so far. Prior to the PFA I had been in early persistent AF for 4 months, but as far as I know, other than some relatively mild occasional spells of palpitations, I have been back in sinus rhythm since 🤞
Best wishes to you.
Try adding coenzyme q10 to stop the palpitations. Definitely worked for me as long as I limit added sugar as well. Post ablation PACs were driving me nuts. Two days on the q10 and they were more or less gone. They generally stay gone as long as I stay away from sugar
I always find it interesting when I read advice about stopping foods we have been merrily eating all our lives. I really wish doctors could get to the root cause of palpitations.
In my opinion inflammation.....sugar drives inflammation.....q10 seemingly lowers inflammation....lots of research on google scholar re this
I understand what you are saying but the point I'm making is that you have likely been eating sugar all your life perhaps since a child and your heart never bothered you. Then one day it did. What changed? Thats the question I would like the experts to answer. Don't offer me beta blockers or tell me to start consuming large quantities of magnesium or whatever or tell me to stop eating sugar or pasta. Just tell me why my heart has suddenly started misbehaving.
In my own opinion, my AFib started a month after I had an anterior hip replacement and there was massive inflammation in my thigh, that was the size of a tree trunk. They cut no muscles, they literally pull them apart, thereby causing the inflammation. And my sugar consumption has always been too high and my blood work has always had markers of inflammation. Just a perfect storm waiting to happen for me
Yes, I have been thinking of trying that, as well as magnesium, but from a quick look online I am not sure where the best place is to get these and also I think I'm right in thinking there are different variants of them? With regard to sugar I am coming to the conclusion that this has been a big factor in my health problems, but the trouble is it is so addictive (not to mention added to so many foods) so although I have cut back it has been with limited success!
My EP said the program body slims is phenomenal. I have not tried it. But it is definitely fresh food with no junk, therefore no cakes, pastries, chocolate, which I love but are not good for me. I definitely use them as soul food and to relieve stress and I have to find another way of doing that, which is something I've done all my life as I don't drink and I don't smoke. We all have a vice, mine is sugar. I do find if I can kick the added sugar totally for a week then I'm well onto success until something stressful comes at me again. I promise cooking from scratch is easy just time consuming. Then at least I know what's in my food. I live in Ireland, great access to fresh food and lots of Irish people cook from scratch. It was the way we were brought up. Good old meat, potatoes and two veg. Diet has expanded here but still very much traditional for most people. I still cook what my dad cooked for me.
So far I have only read about pulsed field ablation for AF and not for SVT.
I would be keen to have something similar for SVT due to the (admittedly slight) risk of damage to the oesophagus from 'traditional' SVT ablation.
You come here for a balanced viewpoint right. If so read on.
At age 60, also fit, I was having 2 episodes a week. I was offered an ablation but wasn't satisfied with the EP's '70% success rate probably require another' comment. So opted for Flecainide (200mgs) on its own coupled with lots of lifestyle changes including an Mg compound & CoQ10 supplements. The next 10 yrs have been AF free (excl 2 very short ones), no known side effects and quality of life/energy excellent.
Of course I may need an ablation tomorrow but just presenting an alternative scenario. My view is when you need an ablation you won't be questioning it or nervous just 'Bring it on'.
secondtry - agree. After 9 years of PAF (starting 1999) - an episode every year or two, I started getting episodes once a month (easily converted with 300mg Flecainide). So in 2008 started Flecainide (100mg BID) gave me 10 good years with only one short AF per year (converted easily in an hr or two with an extra 200mg Flecainide. Then in 2018 episodes started coming once a month and taking way longer to convert so opted for Bordeaux PVI ablation. Just had a second ablation (PFA) in Bordeaux at the start of this year.
May I ask why Bordeaux (I think I know) and how much is the current going rate there? Looks like that may be something for me for the future.
Many of us on here will be interested in how you get on; please keep us informed!
My second ablation in Bordeaux in Jan 23 was mainly PFA (+ RF for right flutter line) - all a doddle just with sedation. In fact, whilst I could really feel the RF, I could not feel the PFA at all. PFA used for ablating an AT and creating posterior and roof lines in the LA. This all done after alcoholisation of the Marshall Vein first.
I was diagnosed with early persistent AFIB March of 2022, and cardioverted twice in April no luck. In May I was able to get into the Affera trial for PFA at the Cleveland Clinic, and it went fantastic. I've been in NSR ever since, and next month is my 1 year anniversary. I believe it will become the gold standard for ablation. Why? Because the technology used doesn't kill all the skin cells as RFA or cryo does, instead, it creates microcellular holes in the cell membranes which stops AFIB migration equally well. So it's a great technology. You just need to ensure it's in good hands, that your EP has a great reputation and has a successful track record.
Good luck!
May I ask which EPs you recommend at Cleveland Clinic for ablation? I was with Dr. Cantillon until he left last fall for private industry. He was amazing. They moved me to another EP but he is rather inexperienced and his recommendations were slightly different than what I was comfortable with having seen Dr. Cantillon.
Thanks!
I had Dr. Taigen, so he is the only one I have personal experience. But in general, the Cleveland Clinic is the #1 heart hospital in the US - so I have to believe they are all good.
Cleveland Clinic #1 heart hospital
Kingdaddy, how many appointments you had with Dr. Taigen before doing the ablation? I am from Florida, does he accept remote appointments?
I first noticed I had AFIB March 8th when my Apple Watch notified me. I went straight into early persistent, no paroxysmal. I had 2 cardioversions locally at Senatara in Norfolk, VA, that were unsuccessful in April, and I wasn't happy with my EP so I fired him. Had I stayed with them, they weren't going to be able to an ablation until September .
My wife and mother-n-law (who lives in Akron) told me about the Cleveland Clinic so I researched them, and I made an appointment as soon as I could, which was July. I went on vacation at the Outer Banks the first week of May and I had just heard about a special program at the Cleveland Clinic where if you call first thing in the morning (by 8am when they open- 216-444-6697 I believe is the number), you can get 1 of 2 set aside appointments for the following week. So I called Monday on vacation, but no luck, already taken. Did the same thing Tuesday. But Wednesday when I called, I was told Dr. Taigen had an opening the next week so I grabbed it. I met with him that next week, and he said I would be a good candidate for the Affera PFA clinical trial. I asked when they could do it, and it just so happened they had opening 2 weeks later, May 25th, which I grabbed without hesitation.
So I'm from VA, but I drove there. No remote appointment - they have to do an EKG and confirm your AFIB firsthand as I understand it. You can go on their website and confirm they take your insurance - for me, my payment was the exact same whether I stayed local or went to Cleveland, so I obviously chose the #1 solution.
Best of luck!
Thanks Kingdaddy, so you had one initial appointment with EKG and second appointment 2 weeks after for the ablation? Did you do any blood tests or echocardiogram in Cleveland?
Hello Kaeykowj1
I have just had the Pulsed Field Ablation (PFA) for paroxysmal AF two weeks ago at Blackrock Clinic in Dublin where they've been doing PFA for just over two years and my EP had done just over 200 PFAs. It's their preferred choice as the risks are lower than the alternatives (apparently related to risks around the oesophagus - maybe other reasons too but that one was mentioned in my consultations) with very encouraging results. What they don't know is the longevity of its effectiveness. It had to be done under GA but given I'm fit, otherwise healthy, relatively young for this procedure (61), my risk analysis was considered low. It was all very smooth and straightforward. My procedure took 4 hours, obviously I don't remember a thing other than being prepped and put under and next thing I was in recovery. I've experienced no pain at all, just some spectacular bruising in the groin and some silly shaved patterns in various locations! I was given a pain management plan but haven't used anything. I had one overnight in hospital and then home where I took it easy for a week and have just been back at work for a week. My episodes previously were roughly once a fortnight lasting between 10 and 17 hours. Although very early days, I've had nothing since the op. I've ditched my Apple watch on the advice of the EP as there could be various irregularities in the heart activity for about three months (blanking period) or possibly longer he said, so monitoring it with my watch isn't helpful and could be stressful as I'd probably misinterpret things. So it has been quite liberating. I'm still on anticoagulants and Flecainide which will be reviewed but most likely on anticoagulants for life even though my CHADS score is 0. Certainly I'd recommend PFA based on my experience. The one thing that the EP re-iterated every time he phoned me (he phoned roughly every two weeks for the preceding two months to simply check in and reassure pre-op) was that I was religiously taking my anticoagulants. That seemed vitally important.
I hope that's helpful and reassuring. Good luck next month. If you have any other questions, feel free to message me.
Pádraig
Pádraig, can I ask who your EP was. I had an rf ablation in Dec with Prof Lyne at the Beacon. Well I assume it was RF, it wasn't cyro. Nearly four months on and I've had one minute of AFib. Compared to ten hours every three days of AFib rvr it's amazing. Best wishes for continued nsr.
Mary
Hi Mary
My EP was Dr. Derek Crinion. He's based at both Blackrock Clinic and the CRY Unit in Tallaght. He was tremendous - very consultative and willing to talk at length on any questions I had.
Great to hear you're doing so well. Hoping I'm in for a long NSR life!
Pádraig
Thanks Pádraig for that detailed reply much appreciated, was wondering if you took Lansoprazole (anti reflux medication) I also take Diltiazem, Apixaban and Rosuvastatin. These medications, think it's the Diltiazem is giving me side effects (dizziness/light headiness) which I would like to discontinue after my PFA so I could return to feeling normal again. Just wondering if you had bad side effects from your medications and if you still have them. Will keep you posted.
Yes, I'm on Pantoprazole (40mg) twice daily for six weeks post op. No new side effects at all. The only side effects I've had from the medication, or maybe it's the condition, is mild fatigue and some hair loss but pretty much functioning as normal. My dosage on Flec is 50mg x 2 and Apixaban is 5mg x 2. The one bonus side effect is that until I experienced AF, I'd been an insomniac averaging 3 hours a night. I now sleep for a solid 7 hours with one pee break!
Hi PCC62 - I appreciate your relating your experience! Something that surprised me, is that you said it was a 4-hr operation. My cryo-ablation in 2018 was about 5 hours, but I had heard that one of the advantages of Pulsed Field Ablation is that it only takes about 20 minutes. I had a stroke (during my first episode of AFib, apparently), so they would like to avoid long periods of General Anesthesia. Consequently, I've been waiting patiently for PFA to be available here. My EP at Johns Hopkins was involved in the PFA trials for 5 years, so he's already had a lot of experience with them.
Can you confirm that you were under GA for 4 hours for a PFA? If so, perhaps my info is wrong.
PFA just passed the FDA here in the US last month, and I have a meeting with my EP next month to see if PFA makes sense for me. I had almost 3 years of no episodes, after settling on 200mgs Flecainide a day, but my lucky streak seems to have run out - 4 episodes in 4 months now.
Hi Ablation627
Thanks for your message. Yes, I was under GA for four hours. I'm not sure how long the actual PFA took as all the pre-op prep and checks were done after I was put under so that would have taken some time before the actual procedure began. But I somehow think it's unlikely that it was 20 minutes. I don't know how complicated my PFA was - I was asymptomatic but having episodes roughly every two weeks, lasting between 10 and 17 hours with might heart rate rising to 230bpm. I don't know whether that suggests a more complicated procedure or not. But it seems further investigation of the length of the procedure is necessary to give you the reassurance you want. Were you on anticoagulants when you had your stroke? My EP was very rigorous about making sure I took my anticoagulants twice a day for the 8 weeks leading up to the op to avoid any risk of a stroke while under GA. Sorry that I can't be more helpful. All the best.
Thanks, that helps. They put me on anticoagulant right after the stroke and I didn’t get the ablation until several months after that (You have to wait 4 to 6 months after a stroke before they put you in GA) I’m pretty sure I will always stay on Eliquis, my anticoagulant, but I’m hoping I can stop the flecainide at some point after a second ablation.
I see my EP mid March, and we will discuss all this. Thanks for your thorough response.
Good luck. Just a note, when you decide to come off the Flec do it gradually. First time I went cold turkey and it wasn't straightforward so discuss that with your EP too when the time comes. Like you I think I'm on the anticoagulants for life - I'd prefer not to be but the risk of stroke doesn't appeal AT ALL!
Hi, I'm fairly fit and in my late 50s and will be having a standard ablation around the same time as you are having your pulsed field ablation. Unfortunately my centre doesn't offer pulsed field ablation yet. My EP did mention that it might become available in my centre within a couple of years, but as my PAF is now breaking through medication for short episodes every day or two I've opted to have what's currently available rather than to wait. Best wishes for your procedure and receovery.
MikeThePike in reply to
I would try to find a center that offers PFA. Not because I think PFA is more more effective than RF or cryo ablation but because it seems to be a much less damaging form of ablation. RF and cryo ablation is not very selective and other heart structures may get damaged in the process. I would never have an RF or cryo ablation. No way.
in reply to MikeThePike
If I had private cover I’d have a PFA, but as an NHS patient I’m not sure that I can go out of area for a PFA.
4chickens in reply to
it’s possible to go out of area for any appropriate treatment, but requires your existing consultant or your GP to refer you, I’m also guessing the wait may be lengthy. I’m going out of area for a hybrid mini maze but it’s not been without its difficulties.
RepublicofFlaxpool in reply to
AXA PPP will not cover my PFA. Deemed an experimental treatment!
My question is the other way around. Who is the best ep for a successful ablation instead of what is the best technique for ablation. PFA is a new technique which carries less risks and shorter time but the track records of the ep is the most critical criteria to consider. The difference between ablation by RF (radio frequency) and PFA is just the tips of the catheter used for ablation, one using RF and the other using electrical blast. Still the same procedure techniques. Make a hole in the septum and do the PVI by making a round line at the opening of the pulmonary veins. If they left a gap between the burning spots, PFA or not Afib will come back.
During my PFA the ep still used RF for other rogue sources of Afib. Only PFA for PVI. It has been 22 months since the ablation and so far still in SR. My ep is Dr. Natale in the states. One of the best who already did thousands of ablations. So ask your ep what is his track record? How many ablations he did a year? And go from there.
I doubt you will back out of your appointment just FYI for people who look for PFA. The skill set or track record of the ep is the critical criteria to consider before an ablation. In good hands PFA is the magic bullet we have waiting for so long.
They might extend the use of PFA for other rogue sources when FDA here approves the new technology. For now only trial run for PVI.
100% agree operator experience is KING.
Natale is totally top tier US and world.
PFA now being used at Bordeaux (at least) for more than just PVI. I know as I had a second ablation there in Jan 23 and PFA was used to create posterior and roof lines in the LA + to ‘touch up’ the RSVP as part of the procedure.
Hello! I understand that you are worried about undergoing PFA. As an engineer who works on PFA catheters for a medical device company, I can assure you that PFA is a safe and effective therapy compared to other treatments like RF or cryoablation. One of the advantages of PFA is that it is a non-heat therapy, which means that side effects are minimal.
It's important to note that every pulse field ablation catheter is different, and there are complex factors that affect the safety and effectiveness of such technologies. Therefore, the PFA device that your doctor uses may be different from others, and its effectiveness and safety may vary.
If you have any concerns or questions about the PFA device your doctor will use or its effectiveness, please feel free to reach out. Your doctor can provide more information about the specific device they will use and how it works.
Stay safe and keep us updated with how it goes 
How interesting that you work on PFA catheters! Do you have access to research that shows the relative safety and effectiveness of different catheters? My EP, Hugh Calkins at Johns Hopkins, was involved in 5 years of an international PFA trial (along with Natale and others) that I believe was the basis for the US FDA application. It looks like they used the PulseSelect Pulsed Field Ablation System; Medtronic. Any insights you can share about that catheter system?
Here's an article about that PFA trial: ahajournals.org/doi/10.1161...
It's surprising to me to hear that there have been PFA procedures already performed here in the US (maybe as part of trials?), as Calkins said he couldn't proceed without FDA approval (I know it's been approved outside the US, for a while). But it just got FDA approval in January, and Calkins says they expect to be offering the procedure at Hopkins within the next 2-3 months. I've just begun to have episodes again after 3 years of effective control with Flecainide, so I'm grateful.
I've also read that the extreme need for extensive operator experience is much less vital with a PFA than the "fire or ice" methods. Your thoughts?
And one more thing: is it true, in your experience, that PFA requires a much shorter procedure time, so less time under general anesthesia? I understand this makes a big difference in safety for those of us who have already had a stroke.
Thanks for any response you can provide, ArmandoEng!
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