Ablation whilst in NSR

[El-P]

I suffer with persistent AFib, my last cardioversion was in August 2023, since then I’ve been in normal sinus rhythm, only taking blood thinners. I suffer from symptomatic AFib and I don’t react well to medication. I’ve been on the waiting list for an ablation and it’s now happening in March. I’ve only had cardioversions before to get rid of AFib, is it normal to have ablation when in NSR? Any advice/reassurance gratefully received xx

[Cliff_G]

EPs can provoke AF by various means, even if you're in NSR. A usual sequence is: 1. provoke the fib, if not in fib already, 2. do the ablation, 3. try to provoke the fib again. If it can't be provoked, that's seen as a successful "end point".

The other thing is that a first ablation is most often a PVI which these days is a cryoablation, using balloons placed in the four pulmonary veins, which then have a cold fluid passed through them to electrically isolate the veins. It was found back in the 1990's that the pulmonary veins are a frequent source of errant electrical impulses which kick a-fib off. The PVI (pulmonary vein isolation) is as I say a usual first step. My guess is that this could be done even without being able to provoke fib, as it depends on simple and proven pulmonary vein access, and not so much on being in fib.

The above assumes that your fib was sufficient to justify offering you an ablation in the first place.

Another point is that doing an ablation early in the paroxysmal cycle has been shown to have better results than leaving it later.

[El-P in reply to Cliff_G]

Thanks Cliff, that’s reassuring.

[BobD Volunteer in reply to Cliff_G]

Just to complete your education the "cold fluid " is actually nitrous oxide which freezes as it reverts to gas according to Prof Schilling.

[Cliff_G in reply to BobD]

Thanks.

[El-P in reply to Cliff_G]

The specialist nurses have confirmed I’m getting a catheter ablation with general anaesthetic. So probably not having cryoablation.

[Buzby62 in reply to El-P]

Cryo, RF and Pulsed Field are all done via a catheter through the groin, so all 3 are catheter ablations.

I had a Cryoablation for Paroxysmal AF and was not in AF at the time, this is quite normal I believe.

Both the Preparing for and Recovering from sheets are available on the following link heartrhythmalliance.org/afa...

Best wishes

[El-P in reply to Buzby62]

Thanks Buzby that’s very helpful

[Wishcld in reply to Buzby62]

I’m Poroxysmol, was the ablation successful. I’m thinking about having it done?

[Buzby62 in reply to Wishcld]

I would say yes it is successful in that I don’t have monthly episodes anymore. It’s not a cure but can be an effective treatment is the way to look at it. See my bio by clicking my badge.

Best wishes

[Wishcld in reply to Buzby62]

I’ve had a read, it’s very helpful

Thanks

[Karendeena in reply to Wishcld]

I had an ablation last March using RF which was successful. No episodes since that I am aware of 🤞

[Wishcld in reply to Karendeena]

That’s reassuring x

[Redactrice in reply to Buzby62]

Same here -- cryoablation while not in AF (I had finally cardioverted a few days before the op, after months of persistent AF), but went back into AF while the procedure was underway.

[Karendeena in reply to Redactrice]

I went into AF during the ablation, I heard them say as I was sedated. I also had flutter appear and they ablated that too

[Buffafly in reply to El-P]

GA suggests RF as Cryo often done under sedation.

[El-P in reply to Buffafly]

What is RF?

[Buzby62 in reply to El-P]

See page 24 onwards on this info sheet

api.heartrhythmalliance.org...

RF is Radio Frequency (Heat)

Best wishes

[Ducky2003 in reply to El-P]

Radio Frequency.It's seems you have not been given much info by your EP about ablations.

I would contact he or she to find out exactly what type they are doing and for details of the procedure. Any top info can then be found researching it on here.

[Karendeena in reply to El-P]

Radio frequency in other words 'burn' instead of freeze (which is burn too)

[Karendeena in reply to Buffafly]

My ablation was RF under sedation

[Frances123 in reply to El-P]

I had both my Cryo and RF done under GA. Hope all goes well for you. Let us know how you get on.

[Karendeena in reply to El-P]

I had RF under sedation

[Karendeena in reply to Cliff_G]

I wasn't in AF at the time of my ablation but it was successful I am pleased to say. I did have RF ablation not cryoblation. It was my first one

[Jonathan_C]

Having an ablation while in NSR does make sense / is normal / is not abnormal.

It is not a major procedure. There is some discomfort around the groin afterwards, and most EPs will recommend taking it easy for a while afterwards. Other than the precautions about exercise you will be given, you will be able to resume a normal life within a few days.

[Amiodaroneluck in reply to Jonathan_C]

In my case at least, the worst/most painful part of the entire procedure was the emplacement of an IV in my arm. I was sedated/anesthetized for everything else and didn't feel a thing.

[Desertflowerchild in reply to Jonathan_C]

For me, the worst pain was the sore throat afterwards.

[LordGabriel]

I had mine done while in NSR. No problem.

[Gladstone001]

My EP used to refer to the procedure of catalysing AF during an ablation as "tickling up"......!

[neil73]

Hi,

I can only speak from my own experience. I am currently back in Afib, 4 years after a successful cardioversion. I am very symptomatic with AF.

I am now on the waiting list for a cardioversion, to put me me back in to NSR, prior to going on to the list for an ablation.

Hope this helps

Neil

[Ossie7]

yes , I too was in Sinus rhythm for all 3 of my ablations and not a problem as I soon went into AF with their stimulation . For the last one though I spontaneously converted to AF .

[MaryCa]

Absolutely. They can trigger it and map it. I was in nsr going into and coming out of ablation. They definitely triggered it though as I had to be cardioverted during the procedure

[Redactrice in reply to MaryCa]

Me too, and I was awake (barely) when the cardioversion happened. I came out of my drug fog and said, "What is that? It's so strange," causing some consternation to the team, who thought I was unconscious. It didn't hurt, it was just very odd.

[MaryCa in reply to Redactrice]

No I was definitely asleep. Thank God...got the big pee afterwards though during the lie flat time. Not fun

[Snowgirl65]

I was in NSR for two ablations, and in a-fib for the last one. I don't think it makes much difference, but I don't know for certain.

[Cabinessence]

My EP put me on Amiodarone prior to the procedure to ensure I was in NSR. Then, as Cliff mentioned above, they provoke a response from the usual suspect areas using the same device inserted to cause the scarring. Mine was done using heat to create the scar tissue.

[Amiodaroneluck]

I was in my most recent ablation with NSR. And in fact they could not induce arrhythmia in my heart on the operating table. So they zapped all the usual suspects in my heart. And I'm fine. I'm guessing what they do depends on your case and your electrophysiologist.

[El-P]

I haven’t seen the cardiologist for over a year, and been on the waiting list since then. I have had some contact with specialist nurses recently and they will be back in touch prior to the procedure. Thank you all for sharing your experiences.

[Karendeena]

My EP said it didn't matter if I was in NSR or not on the day and I wasn't but my ablation went ahead with success.