Why has an ablation never been offered or suggested to me (I live in the UK)

[cbsrbpm]

I have had AF for 11 years with the last episode lasting 19 hours. Lots of you seem to have been offered ablations is it because I am a NHS patient that this has never been offered to me. Also the request to take one of the new anticoagulants was dismissed by the hospital consultant after my last episode.

[Beancounter Volunteer]

Hi again cbsrbpm

Well the truthful answer is probably I have no idea, it seems to depend on so many things.

Firstly the obligatory warning, I am not medically qualified in any way

However from my reading, I doubt that being NHS has anything to do with it, I think most of us in the UK are NHS with only a few being in private treatment.

Ablation is only one of the treatments potentially possible, I haven't been offered one yet, but of course that may change, there are risks involved with an ablation, but again from my reading these seem fairly small, so it probably depends more on your individual circumstances, whether or not there are other factors for example, or even how "serious" they think your A Fib is. (for example I suspect I will not be offered one, as despite being in A Fib continuously I have almost no symptoms)

Re the anticoagulant, again I do not know the answer but from your previous posts I know you are concerned about warfarin.

Again my reading tells me that the difference between warfarin and others, is that warfarin has a ready "antidote" if that's the right word in case of a serious bleed. The others do not have quite the same available from what I understand. And they are more expensive, but I honestly doubt that would concern the consultant too much if he/she thought them necessary.

Of course have you asked your consultant why they do not recommend an ablation? maybe something to add to your list of questions for the next meeting

Take care and have a restful long weekend

Ian

[cbsrbpm]

Many thanks Ian for your reply. I really do not have a consultant as I have been referred back to my doctor whom it is very difficult to get appointments with unless it is an emergency so hence I feel a little abandoned and that I just have to get on with it. I will try to get an appointment with my GP after Easter and ask him all my questions. Have a good Easter holiday.

Brenda

[nannygoat in reply to cbsrbpm]

yes and my gp here in Ireland told me he must catch me while having an a fib attack before he can send me to the hospital. so i went up myself twice they kept me in and finally caught it but told tablets would work come bak in 6 months tablets dont work now so im hoping i can keep it together untill May untill i see the specialist. . i feel like going back up to the hospital but it will be 2 days in the emergengy dept before they look at me . my a fib at present while on the tablets is 140 down to 35 daily lasting maybe 30 minutes , i have a monitor i measure it myself , i even have it in my sleep. i also have free medical .

[Beancounter Volunteer in reply to cbsrbpm]

Hi Brenda

Just noticed where you live, ask for a referral to Harefield, quite close to you and excellent hospital, it's mainly heart only they do a little lung work but mainly heart only, so makes you feel properly treated by experts

Regards

Ian

[cbsrbpm in reply to Beancounter]

Thanks Ian, I have finally got an appointment with my GP on 19th April, yes I did say the 19th, perhaps he will have the results of my recent echo too as I have not heard from the hospital (Hillingdon) and will also ask about ablation. Have been in SR since my last bout on 1st Feb, a few blips a day but that's all. My original cardiologist 11 years ago also operates out of Harefield but he is the one that referred me back to my GP. I suppose he thought I was doing OK on Meds. I will succumb to the Warfarin when I speak to my GP. All your kind replies have conviced me that this may not be the devil I think it is (Warfarin not AF). Best of Luck

Brenda

[watchdog in reply to cbsrbpm]

I have been on warfarin for the last 5 to 6 years and have had no problems. the gp keeps an eye on my nri results and accasional changes my doseage.

to make sure i am in the range btween 2 and 3.

The reason I was put on warfrin is because I suffer from AF for the last 5 years.

you should have no problems with warfrin so go ahead with it

best wishes

[migmog]

Problems eh! Well I was under GP for quite awhile when AF started it with me 5years ago. Doc decided to eventually send me to local general hospital. - they did not seem to be getting anywhere apart from 2 cardio version which did not touch anything. I asked GP to be transferred to Cardiology Hospital 25 miles away. One cardio version specialist said an ablation was the best way to sort the AF. How right he was - 4 years since still ticking onwards. Chat with GP please for yourself. M

[TheStand]

cbsrbpm,

It may be hard to believe but many Dr's (not so much specialists) are not very well educated on AF. Many GP's and Cardiologists, having their training done many years ago only knew of the ablation in it's infant stage. 10 to 15 years ago most Drs would only talk of ablation in very severe cases. Now it is basically an everyday procedure for some Drs. Not too many years ago, very little was known about what causes AF and possible treatments and now they still don't fully understand the causes but have identified the area of the heart and have an abundance of data on the ablation procedure. Here in the states, the ablation (for many Drs) is the first line of treatment due to the sucess rate and the idea of not having to tie a patient to meds for many years.

You could also use the same reason for the response to the new anticoagulants. These are pretty new to the market and some Drs will take the "wait and see" approach to them. Most prefer Warfarin since it has been used since the 1950's and the good and bad has been well documented. They feel it is much safer to go with whats known

Tim

[cbsrbpm]

Thanks Tim, I will have to see if my doctor will refer me to an speacialist.

[BobD Volunteer]

If you are in UK you can go to Atrial Fibrillation Association website where there is a list of electrophysiologists ( cardiologists who specialise in rhythm disorders) by area and I would urge you so look for one close to you and demand a referral. This is your right! There are many ways to treat AF but being under a GP is not one of them in my view unless you have the luck to be under a GP with a special interest in the subject. I had three ablations under NHS care and nobody questioned it but it is worth mentioning that early intervention has more chance of success. Also this is all very new science and many old school cardiologists still do not consider AF much of a problem. It is only since about 2007 that the link with stroke became widely recognised and we in U K are still way behind with getting at risk patients onto anticoagulants.

As Tim says many GPs (in UK as well Tim) are very ignorant of the latest findings and treatments for AF despite all the work AFA has been doing over the last few years.

In UK, the drugs bill for GPs is very high so they tend to avoid some of the more modern but expensive drugs. Personally I have no problems with warfarin and really do not understand why people are opposed to it. Maybe I am lucky in that my dose and INR have been stable for several years but for sure I would NOT want to take a new drug for which there was no antidote. Remember Thalidomide? Many GPs still prescribe aspirin for patients with AF despite the evidence that this has little value in stroke prevention but similar or worse risks of intestinal bleeding to warfarin.

Do read up from the fact sheets on AFA main website for more information.

Bob

[watchdog]

I am a af sufferer and have been so for 6 years. I have had 4 cardioversion (electric shock treament ) and each time the heart was put back into rythem. however after the treatment I was advised that a pacemaker would help. I am a nhs and privete patient in northern ireland

[TheStand]

watchdog,

Are you on any meds for AF? Have you been on any type of treatment plan for AF? The idea of putting in a pacemaker is rather extreme without trying anything else first.

Tim

[watchdog in reply to TheStand]

hi tim, I am on four types of medication Candersat for blood presure, biosophonol and amiodarone for heart rate. and warfrin. As I suffer from AF on a regular basis and have had 4 cardioversion. it was suggested a pacemaker would solve a lot of my problems