PM & Ablation

An ablation for Atrial Fibrillation

by Gemita - 2023-09-25 04:27:44

You ask an important question Palpations.  How well will an ablation work to control or to stop your palpitations, specifically your Atrial Fibrillation (AF)?  

There is no doubt that some of us benefit immediately from our treatments and an ablation is often more effective than other treatments like medication or a Cardioversion in stopping AF.   (I was told by my EP that medication is around 45% effective, with an ablation as high as 75-80% on first ablation, increasing to around 90% if a second ablation is required).  However AF can be very difficult to cure or to effectively treat.  In fact many say it is not curable, at least not 100% and even after a successful ablation, you may still experience brief runs of AF or other electrical disturbances.

Some members have had good success following an ablation, success in terms of length of time they remain in normal sinus rhythm, but you need to be aware that your AF may require more than one ablation to give you a chance of a long period of respite from your current symptoms.  Before going ahead, I would ask the following question:  how symptomatic am I?  Is my life so miserable living with AF that I am willing to try anything to try to stop it?  If you answer yes, then what have you got to lose by trying an ablation?   

An ablation is normally recommended when our heart rate cannot be adequately controlled with medication or other treatments and when a patient’s symptoms are affecting their quality of life.  Good luck

Perhaps and not very

by crustyg - 2023-09-25 04:33:02

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450284/ is the outcome of the CABANA trial.  In general, ablation for AF (*not* AFlut) is no better than drug therapy at fixing the AF (for a decent duration), but CASTLE-AF showed that ablation is better than drugs for those with significant heart failure and symptoms from AF.

There are a number of contributors here who have had one or more ablations for AF, and their experience seems a reasonable guide.  The sooner after you go into established AF the ablation is done the better the outcome, and the underlying disease process that caused the AF is likely to continue and produce a recurrence of AF.

I can only hope you've discussed this information with your heart team, otherwise you won't really be giving informed consent when you sign the forms for the procedure.  If you're having any sort of ablation, make sure that your EP-doc is planning to use an internal mapping technology to help determine where the focal centre is.

Best wishes.

Find a top hospital and EP too

by Gemita - 2023-09-25 05:19:06

Also, please make sure that you go to an experienced EP, an EP you can trust and work well with and also go to a specialist hospital where they carry out many ablation procedures.  Experience and expertise may just tip the balance in your favour when it comes to treating a difficult arrhythmia like AF.

AND I am assuming you are referring to a regular pulmonary vein isolation ablation, not to an AV node ablation?  Please make sure you understand what type of ablation they are proposing for you?  

Gemita

by palpations - 2023-09-25 09:11:45

Thank you for this information on the two tyes of ablation.  The Dr. never told me but I am ging to ask him.  What is the difference between the two types?  I did read the av node can't be reversed.

Hope this helps

by Gemita - 2023-09-25 09:53:45

See AV Node ablation and pacemaker by Mossy a few posts below yours for details of a possible treatment for your arrhythmias BUT only as a last resort if all else has failed.  You would become pacemaker dependent and your AF would still remain but you shouldn't feel it or be troubled by high heart rates.

They usually try pulmonary vein isolation ablation first and would do an EP study to identify all possible sites that might need ablating.  

The pulmonary vein area is often the place where they can find the trigger for AF so they like to target this area first.  It can be successful unless you are getting arrhythmias from other areas too which is why it can be difficult to stop AF.  There can be so many triggers for AF. 

Am currently travelling so cannot write more for the moment but am happy to answer any further questions when I return home later today

AV Node Ablation

by Gramzo - 2023-09-25 16:09:55

After 32 years with a St. Jude Mitral Valve, 7 years of A-Fib, I just had a pacemaker/ICD installed and an AV Node ablation.

My A-fib was insufficiently controlled through medicine and caused my ejection fraction to downgrade significantly in the last year.  I have had arrhythima for 38 years, atrial fib for 7.  The type of "palpitation" they are seeking to end is important.  The AV Node ablation cuts the ability for the ventricals to receive the signals from the atrial chambers that tell the ventricals how to contract, and how strong.  A-fib can cause the ventricals to beat irratically and sometimes dangerously.  This was what was happening with me.  AV Node ablation causes those getting it be pacemaker dependent.

I am not familier with the ablation they do to try and stop a-fib.  I just know that no doctor felt it would be successful for me, given my history.  Since the pacemaker/ICD install and the AV Node ablation, I still have some PVC's and some short v-tach runs.  I am only 2.5 weeks out from the procedures, so this could change.  I read that pacemakers cannot control PVC's totally. But others may have different.

Best wishes!

Gramzo

by palpations - 2023-09-25 16:26:47

Thank you for your comment.  I am afraid to have my procedure but having it in November.  I just wonder how dangerous this is.  I am afraid of a stroke.  What is your opinion of the procedure.  Do you think it is safe?  I just want another person't thoughts on this.  Thank you.   i am not a young person.

A pulmonary vein isolation procedure is a routine procedure for most Electrophysiologists

by Gemita - 2023-09-25 20:33:31

Palpations, all procedures, like our pacemaker implant, carry some risks, but an ablation around the pulmonary veins is a routine procedure for most electrophysiologists and is not a dangerous procedure in experienced hands.  

What concerns me most is whether an ablation is right for you?  Only your EP and you can determine whether you really need one and whether it is likely to improve your symptoms and quality of life.  You need to ask yourself some questions like:-

How symptomatic are you during AF/other arrhythmias and how often do you need to seek emergency treatment (ER/A&E) during episodes?

How frequently do you get AF?  Are you permanently in AF or are you still in intermittent AF  like once a day, once a week, once a month?  

As I have already mentioned, symptoms (like chest pain, breathlessness, dizziness, palpitations) and an uncontrolled heart rate are the usual indications for an ablation, especially if medication has been tried and has proved ineffective.  In my UK hospital, my doctors only recommend an ablation for "symptomatic" patients who have failed medication treatment, although I realise that depending where we live, an ablation might be offered as a first line treatment, even for patients with infrequent episodes.

Are you already on anticoagulants for AF stroke protection?  If you are, your doctors will make sure that you stay safe prior to, during and after your procedure.  Do speak to your doctors about your stroke risk with AF?

Please have that important discussion with your doctors before any ablation so that you will learn what a pulmonary vein isolation ablation can and cannot do for you.  It clearly isn't always 100% successful after the first attempt for example and even if it is, it is usually only successful for a limited period of time, not a long term cure for a complex arrhythmia like AF.  Therefore you could be looking at more than one ablation in your future to try to keep you in normal sinus rhythm.  Are you prepared for this?  

Remember too, after any ablation, healing needs to take place and the healing period following an ablation can last for several months.  This might mean that during this time your arrhythmias/palpitations could still be present or even worsen before improvements are noticed.  

Please stay in touch and let us know which type of ablation your doctor has recommended?  

Goodnight and we can chat more another time.  It sounds as though you have lots of questions that need answering.