Ablation choices NHS

[Hallane]

I am due a phone call from our nearest hospital which relates to a possible ablation after two failed cardioversion for persistent AF, 2 years +.

I don’t know how they will assess whether I am suitable, and if I am what type of ablation may be offered.

From what I have read pulsed field ablation is safer.

I would appreciate any experience of how the process for selection works and also what choice there is relating to pulse field option.

I am in Cornwall and the phone call initial appointment is being made by Royal Devon Exeter (Wonford)

Thanks if you can offer your own experiences.

[BobD Volunteer]

To the best of my knowledge Pulse Field is not available at Royal Devon University Health Care Trust. (what we used to call RD and E) The options would be cryo or RF and most likely the former with sedation rather than RF and GA. Its a few years since I last had contact with any of the team there so probabaly all personnel have changed but the main arrhythmia nurse was Lynne Bastable.

[Hallane in reply to BobD]

Thanks for your reply. From your knowledge what would decide whether to do cryo or RF? Thanks

[BobD Volunteer in reply to Hallane]

You wont have an option. It will be whatever the EP does. Cryo is faster but limited in what it can ablate and often needs RF follow up. All mine were RF in Royal Brompton and all with GA.

[CDreamer]

If you are persistent AF did either of the cardio versions result in NSR - even for seconds?

[Hallane in reply to CDreamer]

First cardio put me back into NSR for 5 days, second literally 30 minutes. I have the regular range BPM ( say 45 to 90) irregular AF. So I’ve had this for 2 years. Symptoms some breathlessness on inclines.

[CDreamer in reply to Hallane]

Therefore the cardioversion was successful if your heart converted to NSR even for a few seconds. The fact it didn't last is not significant when assessing the probability of an ablation being effective.

[Rainfern]

Hi Hallane. The cardio team at RD&E are excellent. That’s where I had my ablation (cryo) over a year ago for persistent AF and I’ve been in NSR since. I went to a public talk given by the EP who carried out my ablation on all the latest developments in treatment of AF, shortly after I was diagnosed. Although pulse field is marginally safer and makes the surgeons job easier, it’s really the experience and skill of who’s in charge that keeps you safe. RD&E have a contract with Exeter Heart, based at Nuffield. Despite unfailing loyalty to NHS I booked a private consultation after my persistent AF diagnosis with Dr Lovell (EP) who had given the talk. Having 40 minutes to discuss options and have my questions answered made a huge difference. He also got my medications just right. You don’t get to skip the queue for ablation but you get to see an EP within 2 or 3 weeks. I’ve spoken with people who’ve had ablations with other members of this team who are equally happy.

Assessment for suitability takes account of how bothered you are by symptoms. This is the only advantage of being quite symptomatic! Cardioversion is also used as a marker of potential success. CV didn’t keep me in NSR longer than a week, but that was enough to suggest an ablation stood a good chance of success.

Good luck on your treatment journey!

[Hallane in reply to Rainfern]

Many thanks for your detailed reply. I think I will seek a private appointment with Exeter Heart based on what you’ve said. I need to work out how bothered I am by the AF!

[CDreamer in reply to Hallane]

Even if you only have a consult I think you will find it very useful, they always looked after me very well.

[Rainfern]

The thing with AF is that it doesn’t get better on its own and gets more difficult to treat the longer you leave it. But many people live with it. That’s something to discuss with your EP