Atrial fibrillation ablation results

Very Encouraging Results Selwyn

by IAN MC - 2024-05-28 12:35:11

I often feel that ablations for afib are given an unjustifiably bad press here on the Pacemaker Club with too much emphasis being given to possible complications.

This data suggests that the decision whether or not to go down the ablation route is something of a no-brainer in my view.

It may be helpful to re-phrase the complication rate. It would seem that  98.1 %  experience no complications.

Ian

Ablation for an arrhythmia

by Gemita - 2024-05-28 13:10:53

Thank you Selwyn, I do appreciate that a catheter ablation is far far superior in treating atrial fibrillation and other arrhythmias compared to medication (ablation maybe 75-80% successful I was told, compared to 40-45% for meds).  However, I am not completely confident that an ablation will be a simple fix.

Many patients will need more than one ablation to fix their arrhythmias that may be coming from multiple sites, which will increase their complication risks over their lifetime.  Indeed you have already had a number of ablations yourself and I am not so sure that I would want to go through multiple ablations although I appreciate success is not measured by a 100% success rate or a total cure, but by your overall symptom improvements.  Hopefully on that basis, your recent Flutter procedure was a great success?

Just to come off medication would be amazing though.  

Ablation

by AgentX86 - 2024-05-28 17:45:44

The issue with ablations isn't the risk.  At least don't recall that it's even been an issue in this group. If anything, risk has been downplayed here. Even a 2% risk (define "risk") is higher than I'd have thought.

The success rate for a single procedure isn't all that high though (mid 60 percent, IIRC). I don't remember the numbers but a second puts it up in the 80s. They often don't last forever, due to the scar tissue being bridged over, eventually.  "Touch-ups" are often needed. Nothing is perfect and ablations are far from it.

All that said, yes, ablations are a good way to go for highly symptomatic people, if drug therapy with the more benign drugs don't work right away. For the asymptomatic, treat the side-effects, and ignore the arrhythmia. Hope that it doesn't become sympromatic.

Atrial fibrillation - to have an ablation or not?

by Selwyn - 2024-05-31 11:41:18

`NICE guidance ( updated 30th JUne 2021)  re. atrial fibrillation is :

If drug treatment is unsuccessful, unsuitable or not tolerated in people with symptomatic paroxysmal or persistent atrial fibrillation:

consider radiofrequency point‑by‑point ablation or

if radiofrequency point‑by‑point ablation is assessed as being unsuitable, consider cryoballoon ablation or laser balloon ablation. [2021]

1.7.20 When considering left atrial ablation, discuss the risks and benefits and take into account the person's preferences. In particular, explain that the procedure is not always effective and that the resolution of symptoms may not be long‑lasting. [2021]

( https://www.nice.org.uk/guidance/ng196/chapter/Recommendations).

In my case, I was intolerant of beta blockers. Flecainide was contraindicated due to structural heart disease.

  I had two ablations for atrial fibrillation. I have had two flutter ablations (lower risk). The procedure for flutter and fibrillation is different.  It is now 6 years since my fibrillation ablation - my recent electrophysiology during the flutter ablation shows the pulmonary vein isolation is sound. Although I have had two flutter ablations, the last one is for atypical atrial flutter - the origins of that arrhythmia is in a different place to the original classical flutter ablation ( where the arrhythmia is around the tricuspid valve). I am due to see my cardiologist in 2 weeks for review to see whether my atypical flutter ablation has been effective. 

AF ablation

by Gemita - 2024-05-31 14:31:16

Selwyn, thank you for providing the additional information about focal point to point pulsed field ablation (non thermal ablation technology).  I know on NICE guidance and on symptoms alone during an AF episode, I would be a candidate for an ablation.  

Do you think one of your AFib ablations might have triggered or unmasked your atypical Atrial Flutter?  I believe this can happen with arrhythmias (one can hide behind the other).  I am reassured that your ablation for fibrillation around the pulmonary veins is still sound after 6 years, even though you required two AF ablations. 

During an EP Study in 2017, I was told I would probably need two ablations to fix my AF.  I was in AF for the entire study with very rapid fractionated signals in DCS>PCS.  Despite AAI pacing and 3 x cardioversions they couldn’t stop the AF until they gave me IV Flecainide, so discharged me home on Flecainide.  Unfortunately I hadn’t consented to an ablation, only to an EP Study.  It would have been the perfect opportunity to ablate at that time.

I wonder what they would do with me today.  Perhaps start with a regular PVI ablation for AF, then wait and see what disturbances remained?  I am assuming regular Flutter is on the right side, so I would need at least two ablations.

I hope you get reassuring news when you see your cardiologist for follow up, although I still feel it is early days and you may yet notice additional healing over the next few months and possibly up to a year, but you will have more experience about these things