Ablation, fistula fears

[agnostic1]

Hi All,

I have an ablation scheduled in June (PAF 5 years) and my greatest concern is the development of a fistula, which is extremely rare but over 80% deadly. I have read that some places give you Omeprazole just in case- any esophageal lesions would be exacerbated by reflux- sometimes these lesions are slight and heal and sometimes not and then you only know by a median of 21 days after the ablation- by which time almost all interventions are too late. Should I see if I can get an endoscopy soon after the operation? (You cannot get one later as it could introduce a gasbubble in the potential fistula)

[Desanthony]

Try and calm down and stop worrying. This is rare and is unlikely to affect you. though I know now that your brain is saying but it's not rare if you are the one who gets it - and no it isn't. If possible talk to your consultant and cardio nurses about your worry and any of the medical professionals around you at your ablation. I am sure they will be able to put your mind at rest. It is absolutely normal to worry about any upcoming procedure and we always think the worst. When we come out the other side of it we always wonder why the heck we were worried about it. Distract yourself by doing things you enjoy and planning for after the procedure so that you don't have to do so much around the house - like cooking meals and freezing them so that you won't have to cook every day and so on. I find yoga breathing calms me down a lot when I wake up in the wee small hours and those awful worries come back. If that doesn't work I get up and do something - even if it is watching a good programme I have missed on catch up. I usually find that I fall asleep just as the most interesting part comes up!

All the best.

[Jajarunner]

Papworth gave me a card detailing all the symptoms of this. It's very rare though xx

[mwcf]

Very very rare complication. But obviously a VERY serious one if it does occur. When I had a consultation at the Royal Marsden 13 years ago and I asked about this complication, they told me that they'd had 4 oesophageal fistulas in the past (albeit out of 1000s of ablations I'm sure) and that pretty much put me off right there and then.

As always, operator experience is KING here. Only have an ablation by someone who has already done at least a thousand and who does them on a regular (weekly) basis. The trick is using enough energy for long enough to create a durable lesion/scar (to block the errant electrical signals/pathways) BUT without using too much heat or time to risk burning into adjacent structures such as the oesophagus.

That's why I've been to Bordeaux for my two previous ablations to see an EP who has done around 10,000 AF ablations (and never yet had a oesophageal fistula).

One of the reasons Pulsed Field Ablation (PFA) is such a huge step forward over radio frequency ablation (RFA) is that PFA only destroys cardiac cells and NOT any cells in immediately adjacent structures such as the oesophagus. My second ablation was with PFA (well, mainly - the right typical flutter line was done with RF). If you are really anxious (and that is understandable), then maybe try and get referred to a UK hospital where they are routinely using PFA? I know Papworth and Liverpool are now both using PFA (although in the UK so far at least only for index PVI ablations). I've been given omeprazole for one month after both my ablations and would definitely do this whether advised to or not.

[agnostic1 in reply to mwcf]

Thank you so much! I am in Switzerland, experienced EP but no pulse ablation there yet

[MarAF]

I had my abalation 3 weeks ago. They put a temp probe in my esophagus to monitor the temperature during the procedure. Then I was started on Prilosec for a month. No issues and procedure went very well. Walking on treadmill 3 days later. No afib.

[agnostic1 in reply to MarAF]

Great news!

[tomtom222]

Yes, I understand this concern, I don't know if it helps you, but maybe it's possible to get PFA (Pulsed field ablation)? That is a non-thermal ablation and it seems that it does not injure the esophagus.

Wish you the best!

[agnostic1 in reply to tomtom222]

Still rare around here- thank you though