I recently had a phone call from a major London hospital where I've never previously been a patient, offering me an appointment for an ablation the next day. I was taken aback as I was totally unaware I had been referred for an ablation and have not had AF since a cardioversion a year ago.
To have time to think, I said that I couldn't manage that. A week later I had another call from them offering an appointment in three days time. This time, I told the booking clerk I'd like to get the advice of my AF nurse first - who I have an appointment with on 28 December. The clerk said I would be able to speak to someone there on the day of the procedure. Having possibly only minutes to digest any discussion just before the procedure didn't sound like an ideal arrangement to me.
It turned out that the referral had been from an EP I'd seen over a year ago when I'd gone into AF and had been waiting a long time for an NHS hospital appointment. The EP advised against ablation due to my age, I'm now 77, and he didn't want to do a cardioversion himself due to a nerve problem in his hands. Instead, he said he would make a fast referral for a cardioversion under the NHS.
But he forgot to do anything and had not made any referral, as I found out after calling his secretarial service to ask what was happening. Then, very soon after, as a result of my GP's initial referral, I got to see an NHS AF nurse at my local hospital (but no consultant) who arranged for a cardioversion.
It seems it was only following my phone call that the private EP decided to make the referral for ablation, presumably having also forgotten that he had specifically advised against it.
Which is a long way of saying I'm confused. I first went into AF eight or so years ago and was brought out of it about three months later with a cardioversion. (I've taken Apixaban and bisoprolol ever since.) AF returned for a second time after about 7 years, but I've been fine since the second NHS cardioversion a year or so ago. So I'm not clear on why I need an ablation at this point - though if I refuse it might be a long time until I'm offered one again, if ever.
I've since read the NHS leaflet "Making a decision about further treatment for AF" which says that just 50% of those with persistant AF "feel better and have fewer symptoms" after one left atrial ablation, and 70-80% after two ablations. The number rises to 84% with AV node ablation and a pacemaker fitted.
The clerk I spoke gave no details of the type of ablation they intended to carry out and didn't mention a pacemaker, which is not something I know anything about.
The private consultation with the EP lasted only 10 minutes or so, and he did nothing other than check my blood pressure and pulse. Other than that, I've never seen an EP before and the last time I saw an NHS cardiologist was after had AF for the first time 8 years ago. It all seems a very casual approach prior to an irreversible procedure.
I'd be grateful to learn your opinions, experiences, and thoughts.
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ruffity
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I don't think there is an age restriction on an ablation as a friends husband had one at 84 and I myself would have had one at 77 for persistent AF if things had gone to plan but covid intervened and then as all scans and tests were two years old so had to have new ones done they found that my heart had re-modelled itself so a further cardioversion or ablation would have been unlikely to work . If a cardioversion works for you then it suggests that an ablation would work too and probably for longer - though a cardioversion lasting 7 years is pretty good. I can't believe they would be prepared to do the ablation without doing up to date scans and tests to look at your heart first . I think I would have asked about that too when you spoke to the hospital. If you were able to speak to someone before your ablation at the hospital then you could still refuse. What a shame you can't get to see someone before. Can you telephone your AF nurse for some advice. Mine are available on Wednesdays mornings so if I have any probolems telephone them then - though sometimes they do have to be reminded to give me a call back.
"I've since read the NHS leaflet "Making a decision about further treatment for AF" which says that just 50% of those with persistant AF "feel better and have fewer symptoms" after one left atrial ablation..
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While technically you may be "persistent" (documented afib episode lasting over seven days) in more practical terms you may be closer to "paroxysmal" in terms of outcomes. I say that because persistent usually doesn't become a major outcome issue unless it crosses the long-term persistent threshold which is around a year. Also, arguably had you had a cardioversion sooner, you never would have crossed even the seven day threshold.
That said, even as a paroxysmal, repeat ablations are often necessary. But what strikes me the most is the lack of information you have been given about the ablation. I certainly would like to know a lot more, including what type of ablation would be performed and by whose hands. A rushed decision is often not a good decision.
My head’s spinning just reading this, not surprised you’re confused.
By the time I was offered an ablation I jumped at it, but I’d been on a long waiting list. I knew exactly what to expect, the type of ablation and success rate for persistent AF (which I’d been in for a year).
More importantly I knew (roughly)what kind of shape my heart was in as I’d had an echocardiogram 10 months previously that indicated my heart was otherwise sound.
At age 70 I’m apparently “young” to be having an ablation with my cardio team. Many are over 80. Don’t let age hold you back.
The real issue is whether you are symptomatic and want an ablation to improve quality of life. And if you have persistent the question is more like are you happy to have 2 or maybe 3 ablations. Thats the route I’m choosing and there are many both on this forum and beyond who’ve found it the right choice. On the other hand I’ve a sister with Afib who sees it as a minor irritant in life compared with everything else that life throws at us, and she’s happy to tick along (arrythmically) just as she is.
(I've taken Apixaban and bisoprolol ever since.) AF returned for a second time after about 7 years, but I've been fine since the second NHS cardioversion a year or so ago.
Are you currently in Normal Sinus Rhythm (NSR) or what is your current afib status ?
If it has been awhile, may want to contact your doctor for an evaluation if you think you need. Would not worry about the previous scheduled ablation. Sounds as if the referral was lost in the process.
Are you currently in Normal Sinus Rhythm (NSR) or what is your current afib status ?
Thanks all. Yes, have been in NSR since the cardioversion a year ago. Have had very minor palpitations for half an hour or so when stressed out a few times but nothing more. I regularly go to a “Fitness for Over 60s” class (to keep my wife company) where we are likely the oldest there, and haven’t had any problems. I feel fine.
Suddenly being asked to come in the next day after they’d had a cancellation, for a procedure I’d never considered or ever discussed with anyone, left me too stunned to ask anything vaguely sensible. I assumed the next I would hear from them would be an appointment letter for a consultation of some kind. I didn't expect another phone call for an ablation at short notice.
Very different to when I had AF eight years ago. Then I had any number of scans and tests, and regularly saw an NHS cardiologist both before the cardioversion and for about a year or so after. This time I saw just an AF nurse who decided I should have the cardioversion.
The EP I saw for a few minutes privately hadn't had any access to any of my history when I saw him and did no tests or scans. I took one Kardia single lead ECG showing I was in AF that he glanced at.
It's good to know that I'm not too old for an ablation if needed, though I assume it may bring some extra risk. There was no suggestion during either phone call that they intended to do any tests before the ablation. Just a chance to speak to someone prior to signing the consent form. As I understand it, all they have is the referral from the private EP I'd seen and are relying on his opinion.
Sorry to hear your experience of ablation wasn't positive, JeanJeannie. Does anyone have any knowledge of AV node ablation and a pacemaker?
sounds like it could be a genuine mistake as the private EP had forgotten he had said to your good self that he wouldn’t recommend an ablation , but referred you for one anyway when he realised he had forgotten to do the referral ( that should have been for cardioversion ) .
Gosh, what a muddle. I'd definitely ask for a further consultation before jumping in. It's your heart we're talking about here. It's a big decision. And should be made in consultation with your cardiologist and the EP. I speak as someone who has had 3 ablations and was third time lucky. I'd had AF for 20 years though 🌸
personally, I’d avoid an ablation if a cardioversion works. I had an ablation but had a stroke during the procedure. I’ve got a pacemaker now. I’m a persistent Afiber and I usually have a cardioversion when I go into permanent Afib.
Maybe a silly question but are you sure this is under the NHS? Although I would recommend ablation to most people this would be too much of a rush for me.As for age I was 74 when I had the ablation last year.
How long ago was it you saw the EP? Desanthony in reply to ruffity
Thanks all, and very sorry to hear about your stroke, Sally_Scott. Hope you have recovered well.
The original plan, after feeling seriously rubbish for a long some time while waiting to see someone via the NHS, was to see an EP and have them do the CV privately.
That was all blown out of the water when he told me he had developed a nerve problem in his hands and instead would refer me for an NHS cardioversion, which he said should be quite speedy.
I've every sympathy with him, but it would have been helpful if he'd told me he couldn't do the CV before I saw him, and had done what he said he would.
I've now checked my diary etc. and it all started further back than I thought. Just found an old post here where I asked about having a CV done privately, and that's dated for 2 yrs ago! So I must have seen the private EP shortly after that. When the appointment was offered to me a couple of weeks ago, they said I'd been on their waiting list for over a year.
So the very latest information, if any, about my heart would date from when I had the NHS cardioversion in October 2022, 14 months ago.
It's certainly been an interesting couple of years for us with health problems.
(My wife had an equally strange experience in the summer when she was gasping for breath and was diagnosed with cancer by a young GP. Two weeks later, while still waiting to see an oncologist, she went into tachycardia with an HR of 300bpm. She spent 8 days on a drip in a resus room before learning it had been caused by an untreated lung infection, not cancer, though possibly exacerbated by the shock of being told she might have terminal cancer. Which left the oncologist shaking her head and wondering how any GP could mistake a lung infection for cancer. She had an ablation shortly afterward and has been fine since.)
So thanks to all your help, you've confirmed my thoughts on how to proceed. As it stands, arranging for an ablation before confirming how appropriate that would be, seems very bizarre to me. I appreciate there may have to be some shortcuts to catch up on the post-covid waiting lists, but an ablation is irreversible.
If I have an ablation, I want to first see the EP who will carry out any procedure, have appropriate and up-to-date tests, and then discuss with them exactly what should happen. I'll have a natter with the AF nurse when I see her at the end of this month and see what she makes of it all.
Then I hope to forget about AF and keep well away from hospitals for a while. If I do need an ablation at some point and have to go on another waiting list, then so be it.
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