From the very start, where it was explained how AF comes to exist, I was trying to understand what possibly is going on when in AF. The uncontrolled behavior of the heart when in AF resembled so very much to the situation when slaughtering the chicken (sorry if you find it disturbing...). When the head is chopped off and there are no regular signals coming from the brain, the chicken is able to jump around using the random signals coming from the muscles, from any available muscle cell.
The behavior of the heart, when in AF, is very similar - when there are no regular signals from the heart control center or when the incoming control signals are wrong, the atria cells start producing "getaway signals" in some cells, leading to the well known symptoms of AF - the heart willing to jump out of the chest.
The problem is that any of the muscle cells are able to take over this production of "rogue" signals, but in the beginning, only a limited number is doing so.
If a patient has had ablation performed, with "accurate tracing the foci of generating rogue signals", where used methods are permanently getting better and better, it only means that the momentarily active foci will be eradicated, while uncountable new foci will remain, to undertake generating new rogue signals. Is it maybe the reason why up to 7-8 ablations are necessary to achieve the success and leave the patient AF free!?
Why do the doctors not burn the whole area where the signals may be generated during the first ablation, so not to expose the patients to unnecessary later interventions?
Would it be too bad for the heart, to burn so much in one pass!?
Would it be inconvenient for the money making process of the DRs?
Firstly 7/8 ablations are extremely rare , at least in UK . I don't think I've heard of one.
Ablating every possible foci at one session sounds very radical, possibly scarring the heart unnecessarily and would doubtless push the mortality figure upwards.
I think the answer is simple - scarring of the tissue has both benefits and risks and the risk of continuing past the reactive area could do far too much permanent damage. I think this is where medicine becomes as much as an art as a science - knowing when to stop!
2-3 ablations are not unusual, 7-8 very rare, I think I’ve remebered maybe 2-3 posts citing that many - of course I haven’t read every post.
If only we could find out what makes those rogue signals kick off! That's the million dollar question that needs to be solved! At one time I did wonder whether the human body was evolving in some way to cope with something like world air pollution.
If they were coming for us i bet they don’t suffer from AFIB.? Imagine a civilisation with millions of years of evolution and science far infront of us.? imagine how advanced they could be.?
I think they would land on earth and first notice that we kick a ball around a field and get excited about it.!!😳. See we kill each other etc.!! Then they would probably steal some water and minerals from us and carryon on their trip until they come across something worth helping.??🤪
It is so sad that, in the 21. century, we still keep killing each other, more and more successfully... The aliens certainly would be upset by what they would find here...
In the UK our surgeons are not rewarded financially for performing ablation. They receive a salary from the NHS. Some of them also do private work in addition. For them to offer an ablation,they have to be able to demonstrate that they believe there is a good chance of successfully relieving the effects of AF,to justify the significant cost.
It is rare for people to have 7/8 ablations!
Cryo ablation is the usual first treatment, and if necessary, a touch up radio frequency ablation to treat areas where the cryo scars have healed and left gaps.
There is a significant amount of success, although for a percentage( 25/30%) it is not.
New techniques such as Minimaze use the same principle of abating the errant cell spots but in a different way.
Some burn more than others. However, a recent study showed that for an initial ablation for someone with paroxysmal afib, that a standard PVI had the same success rate as a PVI with additional burning. More burning causes additional scar tissue and potentially more difficult recovery. So less can be more.
I just had my 4th ablation and the doctor said No More, too much scarring in there already. They need to keep some tissue flexible so the heart can do its job. My 1st ablation was cryo, which Dr. said 'does not cause scarring,' but three other ones definitely did. Same doctor did all four, and now that she's said "that's it," that means no more ablations. On a nice break from AFib now....but fully expect it back.
A friend who has had 3 was told "you cannot have any more".
Where reading about the scarring there is no going back. You have lost that part of the heart.
I can't have an ablation because my ECHO shows abnormal structure - dilated LV and RV regurgilates apparently the latter comes because of the former but systollic is normal and normal pressure.
Told last week H/R rapid is controlled since starting CCB Diltiazem 120mg AM. And BP controlled by BB Bisoprolol 2.5PM.
I take PRADAXA 110 x twice daily.
AF from undiagnosed thyroid papillary cancer. Caused the Embolic (Ischaemic) Stroke. Felt in rapid persistent for 2 years 3mths when I went to a private H/Specialist.
CCB CALCIUM CHANNEL BLOCKER has saved me.
No sweating profusely symptoms or fatigue. Metoprolol gave me breathlessness and pauses.
So I don't get symptoms of a 'headless chicken' and not sure that description is correct.
A friend had 1 ablation haven taken 5 meds for years. Surgeon found two rogue signals and no meds for 2 years.
Keep safe. Make any decision carefully life changing. Always new research equates to newer procedures.
My approach to having procedures and taking meds is to be sure I know something about them and then listen to my inner voice when it says, "I don't like the sound of that!" or, "You're going to do What??"
It has kept me from unneeded meds and ablations for Afib and the unnecessary removal of a kidney, and helped me avoid addictive sleep meds and deleterious laxatives. I did have prostate surgery and have taken many antibiotics and still take Eliquis and other meds, but I make my own decisions about things. I don't blame doctors. They have hard calls to make and limited assurances that a treatment will be successful, often. It really is a "Whom do you trust?" situation and sometimes that person is ultimately yourself.
When my young daughter had cancer, she had horrible drugs administered to her which were very damaging to not only the cancer, but also her body in general, and some of it was lasting. But, they saved her life, and I am eternally grateful for that. There were times when I rejected things for her such as formaldehyde, THC, ill-advised rehabilitation demands and other more minor issues, and there were times when I demanded that she be given treatments such as lipids intravenously when her legs became the size of my wrist. I hope treatments are better now than they were 30 years ago. It can be dangerous to try to play doctor, but it can also be harmful to unquestioningly accept every recommendation. Inform yourself and let your judgment be part of the equation.
I seems as though Afib treatment is still in a fairly primitive stage in terms of finding causes and knowing the right treatments. I hope somewhere doctors are reading this forum and other sources and noting patient feedback. I think they need to. I had to figure out how to resolve my Afib for myself. For me, it was fixing my digestive problems and eliminating trapped gas, as well as avoiding sleep apnea.
Others have more complicated cases, I know, but this forum is highly eye-opening for many of us and helps us be more aware of the need to share in the decision making regarding our treatment.
The head cardiologist at my hospital is old school and thinks patients should do what they are told and take the drugs he has prescribed without question. Because l wouldn't take the old drug he prescribed which gives me bad side effects and is O.K . for a.f but not for heart failure , he virtually had a tantrum. I wasn't offered any of the new drugs. Now 2 years later l want to see a cardiologist so that l can try 1 of the newer drugs which appear to be successful in treating heart.. failure. He is getting his revenge on me now. He wrote a nasty letter to my doctor, of which l have a copy, refusing me an appointment with a cardiologist, although l have no problem with the others. He also refused my request for an echocardiogram although my condition has worsened and l don't know what my e.f. is now.
I don't think the g.p. is allowed to change your drugs for your heart. She doesn't appear to know much about the heart. I have done lots of research and l have been helped a lot by all you lovely people on this forum. I live as healthy a lifestyle as l can but it seems l not allowed to make decisions about what drugs l take to help my condition. What do l do now ?
So sorry that you have such problems with your doctor. To be honest, during my life, during a very long time, I was naive to believe that doctors always know what they are doing, even when prescribing medications. But in the past 15 years, after tens of thousands of read posts of different patients. I have corrected my views. There is a lot of what they do not know, especially when Autonomous Nervous System is in question. After the past 2-3 years, where the DRs acted as it never should be, recommending to the people experimental Jabs, I do not trust them at all! I have been given HBP medication some 5 years ago, but refused to take them. A good friend of mine takes what he got prescribed and feels like drunk and does not function well. If I would start taking the drug and would feel poorly, I would never continue taking it. Well, that's my attitude, not necessarilly to be shared from others. Everybody should decide himself about the medical procedures and about the medication! best wishes! P.
Thank you for replying . Yes , l have known people who take everything the doctors give them without question and end up with a cocktail of pills and a miserable life, feeling worse than they did before going to the doctor. I don't have a choice of consultant as l live in Wales in the countryside and l am on the N.H.S. The younger cardiologists l think are better at listening and cooperating. Unfortunately l have a cardiologist who is middle-aged but acts like the consultants of the 1930s and thinks he is God. Best Wishes to you.
I don't know your situation regarding the availability of other doctors and hospitals, insurance limitations and the rules of your health system, but I would find another doctor and/or hospital or go over the doctor's head and raise a stink. I hope you can find an ally to listen to you and advocate for you. Sometimes persistence in complaining pays off. As to the "black listing" letter from the doctor, I would consult an attorney! In the US, there are patient's rights dictated by law. I am not sure what all they cover.
That kind of autocratic behavior from a doctor would drive me nuts. I "fired" my EP who could not imagine a treatment for Afib that did not consist of Tikosyn, other risky meds or ablations. She finally persuaded me to assent to Tiksyn and after refusing it several times, I let her overrule my warning "voice". It produced a potentially fatal arrhythmia, but after 3 days of intravenous magnesium drip, I survived. Due that and other incompetent behavior, I never went to her again. If I ever need one, I live in a large enough city to find another source. My insurance allows me to change to an entirely different healthcare complex of hospitals and doctors if I choose.
Following the advice of "Doctor" Fibnum (me), I went from Afib episodes every 2 weeks or less to three in the last year. I respect doctors whom I trust and with whom I can negotiate decisions, but I do not tolerate dictators.
Thank you for your reply. I agree with everything you said but because l refused the drugs this is the result. Obviously l am not allowed to have an opinion on what goes into my body. He is a bully who has to have his own way and he has the power to deny me treatment and drugs. I don't like taking drugs but l would like the opportunity to try the new ones as they have been proved to be more effective. I live in Wales and use the N.H..S so l don't have a choice of cardiologists. You seem to have been through a similar situation . I am glad for you that you could change your doctor. Some doctors don't allow for any differences in bodies. We know our own bodies and l think a more holistic approach should be taken. As you say an agreement should be made between you and your doctor , as to the best way forward. Best Wishes.
Thank you. I really wanted to try a drug for the heart failure which was caused by the afib. I need an appointment with a cardiologist to discuss what is the best way forward for me and to find out what state my heart is in now. Best wishes.
Thank you. I really wanted to try a drug for the heart failure which was caused by the afib. I need an appointment with a cardiologist to discuss what is the best way forward for me and to find out what state my heart is in now. Best wishes.
I found your ideas fascinating but I did wonder whether your focus on extremes (and your use of hyperbole) would help you form a useful view of where your own future AF might lead? This was not least because, while the chaos of the atria is well described, the relative calm of the ventricles is surely being overlooked. Thank goodness for those ventricles, eh? They must look upstairs and think, "calm down up there, there's no need for all that!"
Steve, you made me laugh! Thanks for that! But, nothing happens without a good reason. If the atria go mad, in the mode of "slaughtered chicken", than it means they have been given the task they can not handle. I read somewhere, black on white, that AFlutter is developed when the demanded BPM is up to 300, what's too much anyway. If demanded BPM is 300-600, then AF is initiated. In both cases, the demand was too high.
interesting, I have an appointment with Professor Schilling in couple of weeks. Been an Flecainide for few yrs with ok results till earlier in the yr. my autistic/ mentally challenged bro died due to hospital negligence and being his next of kin had a lot of stress over the yrs with ‘care’ etc. 2 day inquest loomed and I went into AF 3x last one 4 days, longest ever😵💫 So consultant decided I need different meds, I refused Amiodarone and he put me on Dronedarone. Which I hate due to investigateing it and side effects.
So ablation was mentioned and I now wait see what the Prof says.
I’m fed up with not being given ‘the facts’ so I can make decisions whether to do this or that. Yes you can pay, as I have, still don’t give you the facts AND will pass you off to someone else so they don’t have to make a decision that could be a problem for them.
My mum would go NO WHERE near drs since having a hand op that ended in her having puss filled huge blisters up her arm! Nurse said ‘dirty needle’! Carried out in an extremely well known hospital.
So, not a lot gos right for me over the years and I may well refuse intervention
I am not sure to have done the right thing writing the above lines... Like everybody, I am trying to understand what's going on with AF and attempts to cure it... Whenever I have read that, after shorter or longer time post an ablation, AF has come back, I considered it to be kinda "normal" on the base how I understood the atria behavior when in AF. If the DRs eradicate only the momentarily active foci and signal paths, there are others which will wake up, sooner or later. Actually, nothing has been done until several ablations have been performed (3 to 8, according to the data given by the patients). I know more than well that there are the patients who have long periods without AF after only one ablation, but it is a different story (the real cause of AF may, coincidentally, disappear after the ablation, looking like the ablation was the cause). If not so, than every first ablation would be a success...
I have Haemochromatisis Compound Variant in the mix, this may well be part of the mix, genetic problem causes iron overload. I am lucky it seems that my liver & heart haven’t significant overload apparently. Also have T2 dire betes as well in the last 2 yrs 😡 diet controlled and 1 pill. May have been caused by a booster injection of certain type.
I’ve had two ablations by Prof Pierre Jais at Bordeaux.
He definitely favours trying to keep lesions to a minimum to preserve as much atrial transport/function as possible. As in do the most good you can whilst at the same time doing the least harm. A large part of why even as a UK resident I paid to go to Bordeaux.
My understanding is that other highly regarded US EPs are far more aggressive.
As and when I’ll likely have a third but no more. And if my AF returns with a slowish rate and relatively asymptomatic I’ll learn to live with it and forego a third ablation.
They don't work because they are burning muscle not nerves. They are trying to reach the outside of the veins but fail that's why they need to do 4,5,6 or more. The problem is on the outside not the inside
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