ARRC/AF study

[www.acc.org]

Was this discussed when it came out? I probably missed it. Even if many or most patients were higher risk....I dunno?

Never posted here before that I can recall.

Personally, I don't find the results very surprising. Especially considering that a lot of EPs will put you on an AAD post-ablation prophylactically because a lot of ablation patients will experience arrhythmias for the first month or two even with a fully successful ablation. Better to keep things calm and skip all the anxiety.

Mortality rate seems awfully high.

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Kindog
Mortality rate seems awfully high.

"Among those who underwent repeat ablations, rates of comorbidities during follow-up were highest for OSA, depression, hypertension and valvular heart disease, and event rates of comorbidities were highest for chronic kidney disease, OSA, hypertension and diabetes."

There is an association between all cause mortality and having one or more ablations. However, there is no indication that the ablation caused the mortality. Reading my quote from the paper, there were some sick folks in the the study population & the repeat ablatees commonly had, "body mass index of 30-35 kg/m2."

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GeorgeN
there were some sick folks in the the study population & the repeat ablatees commonly had,"

Perhaps repeated ablations took its toll for a few from all the heart muscle being scarred.

There was an article quoting doctor Jais in France who doesn’t believe in excessive damage to healthy heart tissue in regard to LAA closures. I had an EP who also shared this view in repeated RV ablations and doesn’t recommend excessive scarring to healthy tissue. But some here had 5-(6?) ablations with no problems.

“ In the words of Dr. Pierre Jais of the Bordeaux Group at the 2020 AF Symposium, “We have ablated too much…Those patients when they have the (Left Atrial) Appendage taken out, they have very poor residual LA (Left Atrium) function. I don’t want that to happen anymore. If we can avoid it, I think we should.” Dr. Jais later added, “Sinus rhythm is by definition superior to persistent A-Fib. But the best ablation strategy is the one that restores sinus rhythm at the least tissue cost, thereby preserving as much as possible the LA function.”

[a-fib.com]



Edited 1 time(s). Last edit at 06/03/2025 01:56AM by susan.d.

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If we can avoid it, I think we should.

Of course. But if Dr. Natale had avoided it in 2017 I would today either have a destroyed AV node and a pacemaker or I'd be functionally disabled and probably in heart failure. I agree with Dr. Jais in general that doing the least harm is always the prime directive ("first, do no harm"), but putting someone through an invasive procedure that fails to achieve the primary goal because the EP was too timid or afraid of harming too much tissue is no better and arguably worse. Based on my experience, it's worse.

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GeorgeN

...

There is an association between all cause mortality and having one or more ablations. However, there is no indication that the ablation caused the mortality. Reading my quote from the paper, there were some sick folks in the the study population & the repeat ablatees commonly had, "body mass index of 30-35 kg/m2."

Yes, agreed, and some would have poorly controlled OSA (obstructive sleep apnea) all along, and afterwards, and still have diabetes, sarcoidosis, emphysema or COPD, high levels of creatinine indicating kidney function problems, etc. It's a chicken/egg problem. Does mitral valve prolapse follow long-term AF, or can it be the other way around. Both, it turns out. So, this study just says that those with repeating/recurrence of AF, or needing two or more ablations, tend to also be kinda iffy in the health department generally, and don't seem to do as well as those who just have AF, a single or two ablations, and then go on to live a happy life. Then there are people like Carey with a pretty stark history of AF and treatments, but still doing fine, thanks very much. And Susan who has a lifelong history of several medical issues and interventions (whom I fervently wish for peace and some bright bulb to finally put her right) and who is an inveterate fighter.

Carey, you are very lucky.

On the flip side all I know is that for me failed ablation after ablation did lead to a pacemaker anyway after my SN was heated and I was hospitalized 23 days in one month alone with >190hr flutter. I can’t envision the toll if I had as many ablations as you encountered. You are extremely lucky.

The following (disclaimer) is a doomsday negative as heck well written LONG detailed article about cell death from having AF. There are 209 references, each with their own link to read free full articles. I started reading the references. I think not having any ablations comes with its own long term risks and having too many ablations maybe has its own unpredictabilities.

[pmc.ncbi.nlm.nih.gov]

Dean— you maybe interested in this report because of the AF-GI connection
(Inflammation and AF paragraph:
“ Other chronic systemic inflammatory diseases such as rheumatoid arthritis,145 psoriasis,146 and inflammatory bowel disease147 have all reported high incidences of AF.”

147.Choi YJ, Choi EK, Han KD, et al. Increased risk of atrial fibrillation in patients with inflammatory bowel disease: a nationwide population-based study. World J Gastroenterol. 2019
Link available



Edited 1 time(s). Last edit at 06/03/2025 01:31PM by susan.d.

Having AFIB at age 30, at this point without the more recent ablations and mini maze 18 years ago with LAA closure, I may at this point had heart failure or AV node ablation and pacemaker and likely on a blood thinner for life. o I am soon to be 76. Keep in mind that at 30 I had NO co morbidities. Not on one medication for anything. In those days called "lone AFIB". With the hybrid ablation also being utilized, I understand that it is quite aggressive, and those who are good candidates would likely see the benefit if 2 or three ablations have not worked. Some folks just have stubborn hearts.