Ive had AF for several years now and after trying to control with medication its got to the stage when I think its time for the ablation route.
What are some good questions I should be asking the cardiologist when I meet him on Friday?
Im particularly interested to hear the advice of people who have already had one and what they feel was really important to find out.
Thank you 
Have I left it too late? Ablation is always best early on before the heart has changed to much.
How many ablations do you perform each week? What is your success rate? What are you rates of complications? Ablation is always best done by an experienced EP with a good track record.
Agree with BobD - what a surprise 🙂
I also would ask about Sedation v General Anaesthetic.
We are all different some including my cousin recently , think it is great to be awake throughout and boast about how brave they have been. I am a “woos” so not my opinion .
I had more than one ablation and after having sedation for the first 3 ablations found that laying on a table for up to 7 hours not for me. They understood this and very kindly offered GA for the subsequent ablation’s which for me was much more acceptable.
If you find going to wee difficult (something that sadly never seems to be discussed)then discuss this as you have to lay flat for 2 hours after the procedure. They inserted a catheter for me whilst I was asleep and whilst not ideally in a perfect world I would choose all the same it helped me personally a lot.
Having said all that I recommend ablation as for me the procedures have finally resulted in me being free of AF for the past year the episodes declining since my last ablation in 2017.
I hope it all goes well for you.
Pete
I would want to have a recent echocardiogram (and, ideally, also a cardiac stress MRI) so that the specialist could know a lot more relevant information about the condition of the heart at a cellular as well as electrical level.
With or without those, I would ask questions such as:
- are the valves working well?
- is the left ventricle in good shape and with good output?
- are the electrical systems all working well (i.e. any heart blocks at all)?
- what are the chances a PM might eventually be required?
- what will happen if the ablation goes ahead but fails to stop the AF?
- what are the options if the AF gets worse instead of better, eventually?
Steve
Hi Pima, your questions have gone in a very different direction to what I was thinking which is great and exactly what I was hoping for.
What do you see is the specific benefit of the consultant having this extra info?
I had kind of assumed they would be working with what they have in front of them and perhaps that is naive on my part?
It was just the things I’ve pulled together after my ablation in 2019 when I was too much in a daze to ask much at all.
The heart is incredibly complex and changes with age. More specifically, the left ventricle and the valves can become less efficient; also, the right or left bundle branches can become blocked and affect the conduction and timings of the beats. The heart muscle can atrophy and enlarge, and the blood supply can diminish with natural calcification of the arteries.
It’s not that I’m looking on the black side but just that the chance to have a full cardiac workout if it ever presents itself or can be afforded is an opportunity!
Steve
Thanks for the quick reply. So....If I understand you correctly is this a case of ensuring the heart that is there to start with is in good enough condition to work with and get a successful ablation?
Seems a good question and not one I had considered.
Well, yes and no. The specialist will weigh all the things up before deciding whether an ablation is worthwhile. I saw it as a chance to make sure the future direction of your heart’s health has been well considered and, so far as can be done, looked after. For example, I’ve been given something called losartan, a drug for high blood pressure, even though my BP is never high, as it protects the heart and kidneys from any deterioration.
Steve
What are the chances of me being able to stop the medication 3 months afterwards?
Lots of great responses to your question here already but I would add I find it best to write my questions down as I go blank when facing a doctor x
Am I to have sedation or GA? If sedation ,please ensure it is given!( I had none depute it being discussed before and on the day)
What guarantees are there that you will do it yourself?
( I researched a very good EP and was expecting him. I met the actual EP in the theatre and very nearly got off table lol!All was good but made a mockery of careful checking of experience and success rate)
What are you estimates of success for me and how are you defining that?
i. e No AF,after blanking period, No AF after a year, or just reduced episodes.
Do you subscribe to a recent trend towards staying on antiarryhmic drugs for some considerable time afterwards, thinking is to thoroughly retrain heart into NSR? If not,what do you recommend?
What access to you do I get afterwards before the follow up appointment in casexI am concerned during initial recovery?
If you were me ,would you have ablation?
I am glad I had mine done,NSR for 10 months now apart from one episode with known cause.
To reduce meds in half soon and see if all holds.
Best wishes ❤️
Thank you. Some great questions that had not even crossed my mind.
You're welcome, if I think of any more I'll add x
Thankyou, I note you said u continue to be on meds after your ablation...is this to retrain the heart or another reason?
Also you mentioned you had an episode with a 'known cause'. Would you mind sharing that please?
Thank you for sharing your wisdom and experience
Hi yes my EP Proff Osman ,well-respected, believes that after so many years of messing about that the heart needs retraining in NSR being the true Normal for at least 6 months on existing medication. Then half then quarter.
Now the story goes like thus. I have had mystery back pain for a long time throughout lockdown and since. Much worse after ablation and eventually I spoke to my GP about it as I knew I can't take ibuprofen etc.
He said that as I had tried pain gel,exercises and strong paracetamol, I really needed to take anti inflammatory meds internally.
To do so,I need to stop Flecanide and Bisoprolol as they interact ( I know! I thought)
So to stop straight away. I queried it but he said,your review is in 3 months and what do you think Osman will say? He will want you off meds to see if it's worked. ( I wasn't aware of his actual practice of lengthy period at the time,had just been told to stay on till told )
With misgivings I did that. Within 24 hours had a massive AF and AFlutter attack.
At the weekend of course so I put myself back on,rang Arrhythmia nurse Monday, she was aghast! Told me to stay as I am.All OK then
Fast forward to appointment. Ep was equally annoyed, told me if I hadn't had that I could start next month to reduce( this was in November) but since I had,wait till May and review again.
I was not a happy bunny!
Sorry for epic reply but a lot went on lol!
I asked my EP if he offered a local anesthetic or general for a Cryoablation.
He said it is very uncomfortable if not under general, he said it can cause brain freeze just like eating an ice block as they freeze where the pulmonary arteries enter the heart.
RF ablations may be different.
Ask about recovery period as posts on here show people are not advised or have different views about what is possible. For example, how long before you can go on hoilday, drive, fly etc
What do you think are the chances of this working for ME? (As opposed to generic stats).
Thank you. That seems to be a brilliantly simple question ! It is far too easy to ask what the rates are for an op but as you say based on my info what are the chances.
Coupled with the above question of what is that advice/opinion based on that feels a really important powerful one.
HI
Ablation shouldn't be done until ECHO, ECG, and you see a cardiac specialist and a 24-hr monitor.
We don't know your BP and meds
and
Heart Rate and meds
I went through meds as metropolol .. H/R avge day 186. (47H/R night with 2 pauses x 2 secs at night)
1 yr 3 mths later I had all tests and changed to Bisoprolol .. H/R avge 156. (47) no pauses
A further 9 mths saw a private h/specialist who introduced me to CCB Diltiazem 180mg. On advice of NZ Heart Foundation I was asked to reduce the BB Bisoprolol and separate so 2.5mg PM.
As CCB reduced heart to 51 in 2 hours, twinked I take Diltiazem 120mg AM.
Happily I am now CONTROLLED, Heart Rate and BB Bisoprolol controls BP.
I was classed as Rapid and Persistent AF Heart Rate. Side effects only and I don't feel my heart except sweating and fatigue when uncontrolled.
Ablation for me is out as I have an enlarged LV.
A friend had his catheter ablation many years after and the surgeon found two different AF responses.
My AF was due to Thyroid Cancer which was found on the 4th day after the Ischaemic Stroke (Embolic) in 2019 and 4 months later had thyroid & 12 lymphs right out (2 infected). I was lucky. The carotid scan showed it.
I was not on any meds except B12 for deficiency.
Carefully work with your knowledge, Dr, Specialist, tests and work out what is best for you.
Wait and assess your decision. All decisions have an element of risk.
I declined the usual given RAI Radio Active Iodine and also suppression of TSH as cancer grows on this secretion. But mine was LOW RISK as the surgeon worked well to remove the cancer.
Now 2 years later Low Risk patients should make their own decisions. Good.
Above CCB Calcium Channel Blockers which relax the arteries etc. My carotid arteries were completely clear. CCB work on reducing Heart Rate.
BB Beta Blockers block Adrenaline from entering the heart and work mainly on BP.
And both work on the Rythmn.
Control of H/Rate is below 100 (say under 90)
Control of BP is ultimate BP. 123/80
Mine is now 123-130. over. 68-80. H/R 62-88. with 47 avge at night
Best of British as they say.
Do not rush into anything. Take your name to cross out the challenges that you have won.
cheri JOY. 74. (NZ)
Hi Guitar335
Questions
***I went with results of my Stroke discharge papers, and meds, final letter from Thyroid General Surgeon about my cancer and meds and levels, any letters from public heart specialist.
Luckily I did because the computer was down and he thought I had cancelled. (The 'other' patient had cancelled and was moved to his/her place. He had driven up or flown the over hour to get there.
He read all my information but he had remembered what I had sent in an email.
I was repaid back his fee because of the mix up. My lucky day!
The ?s would be after he had read the above..
He examined me.. I had a resting H/R of over 120. Yes, in AF.
I let him go over my history as history is so important.
The ECHO was important along with ECG and 24-hr monitor.
He gave me the prescription for CCB...
No details about the Bisoprolol though. It had to be reduced like the 1/2 dose of Diltiazem.
The only question I asked was "was I a suitable candidate for an ablation?"
So he wrote to my referral DR and asked her to get me back in the Public system.
He explained that my age, weight (slightly over but lost 6kg in last few months) and timing would be against me.
I used our NZ Heathline on the Sunday for guidance in the low H/R which I followed (reduce the Bisoprolol!) and on Wednesday it went low again I rung our NZ Heart Foundation. I was told to separate the Diltiazem and take it AM also ask my Dr to drop the dose down to 120mg AM and have only 2.5mg Bisoprolol at night.
Which I did. At last I was controlled. It meant I could have the operation to remove Johnson's & J ugly mesh removed as now it was damaging my internal organ.
Since then last year the national Heart Specialist public has told me I have a quiet systolic heart murmur.
Everything updates when a new diagnosis is given.
cheri JOY. 74. (NZ)
Advice from your experience please. 
What is an AF episode? Please describe yours and how you know.
Question for anyone who has had OHS please
Your thoughts please, oh wise ones !
