2 ablations limit on NHS in UK

[mike1961]

I've heard (no sources I'm afraid - just 'on the grape-vine') that the NHS in the UK now limiting the number of ablations anyone can have to two. Has anyone here run into this issue recently ? Or have I got it totally wrong ?!

[BobD Volunteer]

Never heard any suggestion of that. Much more likely to refuse for those who are obese.

[wilsond]

One of our members had his 3rd only yesterday. I imagine some decisions to limit number of ablation is based on predicted success and also physical condition at the time

[Buffafly]

Somebody posted the info about the latest NHS guidance re AF recently but the post disappeared. It did indeed say that two (unsuccessful I think) ablations would be the limit and that Pace and Ablate would be offered earlier. I’ll see if I can find it.

[CDreamer in reply to Buffafly]

That sounds more likely.

[mike1961]

Google 'St Barts AF Who will get and AF ablation in 2024' (sub-titled 'The NHS Commisioning policy for AF ablation has been approved. We will go through the pertinent changes. ') and have a read. Includes the paragraph

'Regulating repeat procedures

Repeat procedures should only be considered in patients with ongoing symptomatic episodes of atrial fibrillation or atrial tachycardia recurrence after an AF ablation procedure. However, a third ablation attempt will not be allowed. Under exceptional circumstances a peer review of the case, including an opinion from an expert from an external centre.'

[mike1961 in reply to mike1961]

I've already had 2 ablations for AF (first for paroxysmal in Aug 2018 and second for persistent - after covid - in Jan 2023) and am now wondering if I need a third whether or not I'd be able to have it on the NHS or not...... I'm hoping it would be a 'yes' on the basis that I haven't had an ablation 'on the NHS' yet !

Whilst I went private (Bordeaux) for the 2 AF ablations, I'm still getting a few short (10 secs or so mainly but sometimes a minute or two) episodes of atrial tachycardia 2 or 3 times per week after my most recent (Jan 23) ablation. If this becomes persistent then I'll need a third ablation which I'd be happy to get done at Papworth on the NHS if I could. I'm getting older (64 in March) and as such am starting to become more concerned about the possibility of complications which would prove VERY expensive if a few days in ICU etc. were required in Bordeaux.....

[Peony4575 in reply to mike1961]

I guess the issue is the very long waiting lists. I have been told to expect to wait at least 18 months for a first ablation . Some kind of rationing seems inevitable when they seem to be offered to the majority

[Lilypocket in reply to mike1961]

Do you live in France?

[mike1961 in reply to Lilypocket]

No Lily I live in the UK. I chose to go to Bordeaux based on its excellent worldwide reputation and the vast experience of the team there. My ablations were carried by Prof Pierre Jais.

[Lilypocket in reply to mike1961]

Yes it does indeed have a good réputation as the pioneers of this procedure. I live in France and mine was done in Paris as many EPs/hospitals everywhere round the world are now are as good as Bordeaux. However if my condition becomes complicated and another ablation is required I will go there. I am also french now ( inspired by Brexit lol) .

[Buffafly]

Somebody posted the source recently but the post was removed I think. Can’t see why though. You will find it on the bartsaf.com website under ‘Who can get an ablation in 2024’. A very clear explanation of latest NHS commissioning rules re ablation including a link to the ‘Af ablation decision aid’. The main takeaways are that only two unsuccessful ablation attempts are allowed and obesity at a certain level rules ablation out, also persistent AF for longer than two years rules it out, plus various other comorbities. There is a pathway for appeal.

Quote: The newly outlined eligibility criteria are designed to select patients with the greatest likelihood of achieving normal rhythm and a noticeable improvement in their symptoms.

At the end there is a link to the full NHS document.

[jeanjeannie50]

I had 3 ablations and then was told that some people weren't helped by them and I was one of them, so wouldn't be offered anymore. I had my last one in 2016 and do wonder if ablations are more successful now.

The good thing is that I now never really get a high heart rate and the highest mine goes to generally is flitting between 60-90bpm, very rarely it can go to 130bpm for a short while, this rate was caught on an ECG after walking up a very steep hill to my docs surgery.

I'm afraid when the nurse said to me that she needed to talk to a doctor about my rate I answered, quite rudely saying that I wasn't interested in what he thought about it. She must have told him what I said as he told her to refer me back to our main hospitals cardiologist. There, after doing an ECG they took me off of Flecainide and now I just take Metoprolol and an anticoagulant.

Jean

[wischo in reply to jeanjeannie50]

Surely 130bpm after walking up a very steep hill would not be cause for concern?. Flecainide is a bit of a dodgy drug anyway so I would be glad to be off it if I were you.

[jeanjeannie50 in reply to wischo]

That's what I thought too, mind you I had been sat in the waiting room for about 10 mins. I just knew that wasn't my normal heart rate. After being diagnosed with AF for 20 years you come to know what needs attention and what doesn't. These days I'm not the humble mouse in front of doctors, I have opinions which I normally suggest politely. My GP once told me that in all his years he'd never had a patient like me. I don't know what he meant when saying that but he still stops and chats if he sees me in the waiting room.

Yes, I'm so glad I stopped taking Flecainide a few years ago. I have more energy without it.

[wischo in reply to jeanjeannie50]

Once you know how your condition behaves you tend not to listen to some of the twaddle some GPs go on with as to their credit they mostly try to tell you the bits you want to hear and ignore the bits you dont want to hear. Not sure if too much knowledge is a good or a bad thing to be honest.

[JOY2THEWORLD49]

Hi

In NZ my male friend was told NO MORE after 3. Rapid Heart Beat.

It may depend on what they think your heart can manage/

Well. I believe caution to ablations as it scars the heart! Never that part to return.

Yes, obese folk but also how long you have had AF and also that your ECHO shows no

structural abnormality.

cheri JOY 76. (NZ)

[Rainfern]

It would be good to know what they count as “successful ablation”. Mine was successful as I’ve had over a year in NSR. If AF returns next week does that mean it was unsuccessful? And maybe development of procedures such as Wolfe mini maze are considered a better approach for people whose success with ablation is short-lived.

[mike1961 in reply to Rainfern]

In my opinion - and one increasingly shared by many EPs - is that success shouldn't be defined as no AF episodes of 30s or more within 12 months, 24 months or whatever, but rather looked at in terms of a substantial lowering of the time one spends in AF. If prior to the ablation one had 2 x 8hr episodes of AF per week, and after the ablation one has a couple of minutes AF a few times per year, then that is no small measure of success since one's AF burden has been lowered from 832 hrs per year in AF to a few minutes per year in AF.

[Buffafly in reply to mike1961]

I would call an unsuccessful ablation one where AF returns as before soon after the blanking period of two to three months. I think success would be where AF does not return for several years or episodes/severity of symptoms are greatly reduced. The problem arises where the EP considers the result a success and the patient demands that they have no episodes of AF at all.

[OceanPaddler]

I have asked to be referred to a very specialist centre for third ablation. I am discussing this with my consultant in March. I will let you know. I cannot have a third ablation locally and was offered pace and ablate.

[Jenmay]

I’ve just had my 4th one done on the 13th December at the royal Papworth. I was told that if this one doesn’t last the next thing will be a pace and ablate. Let’s hope Trump doesn’t get his hands on our NHS

[Rainfern in reply to Jenmay]

Good luck Jenmay. I think Musk will have bought GB by then and created far right states throughout Europe …… unless we stand firm of course. With hope 😊

[Ppiman]

It seems unlikely as it has recently been suggested that a third might be needed for me following the second I am awaiting. I suspect pace and ablate might become more common from what my cardiologist has intimated, and likely for the best given that ablations do, after all, burn the inside of the heart. My son's colleague, having had five of six ablations, has been told that he can have no more despite both AF and AFl returning at 78.

Steve

[Jajarunner]

Just had my fourth!!!!

[Singwell]

Wouldn't surprise me at all. I was told to go away and get on with my life - in nicest possible way - and discharged. What my EP said was 'I don't think there's anymore that we can do for you at this stage'. Fortunately my AF post 2 ablations is currently.much more manageable and I use PiP as needed.

[DawnTX]

I am glad to see that because I think they are overused and abused strictly for the money. I see on here. There are some people that have had a dozen same with cardioversions. That’s a lot of trauma to the. I was limited with two cardioversions because the second one I almost didn’t come back. I had three ablations and the third one did so much damage and scarring that my new EP would not consider other than when I had my pacemaker done two years ago. My doctor was not always the favorite son at the hospital because of his attitude he said ability to get the right spot is minimal which is why so many people end up disappointed. Hospitals make a lot of money doing them over and over go and because they are not physically that big a deal to us that you would hate to have it done if you thought you had an option to get NSR no one complains. my third one was done using a new procedure by the of the procedure. Everything went very wrong and when it was all over, I could not even get a phone call back from him or his staff. I think he knows what a mess he made. My amazing EP did not say much you could see the anger and when he discovered what a mess I was inside.

don’t forget a lot of of these things are Band-Aids. Some people are very lucky and it takes and will last for them, but there are no as I just think of the trauma and by the time we have these things we have already been through a lot with a fib. I was in heart failure when I got my pacemaker since then my ejection rate has gone from forties to 70s. anyone pacemaker that does not want to take I would suggest you think again they have many wonderful new things. I am so happy with mine and I just met someone on here that has the same one. All I can say is I never thought I could feel this normal again this is in regard to people that do not want to consider a pacemaker. I was one of those people, but had no choice. There were no options. I’m so glad I got mine. Best of luck whatever people get out there just remember a fib does what it wants to do even with a pacemaker. It just can’t damage anymore, but our life has been changed forever and don’t expect having an ablation you’re going to go home and everything‘s gonna be perfect. It doesn’t work that way. I can be blunt and shoot from the hip not everyone likes me for it but if you don’t know this, and you don’t feel right, it could be scary Don’t be afraid it’s gonna be OK.