Post-ablation heart function

I read a bunch of conflicting stuff about effect of the scarring produced by ablation on the function of the left Atrium.
I asked doc and she said typically Atrial function improved after ablation, but I am not sure if this might just be an average outcome for people some of whom might have pre-existing heart disease or enlargement of LA.
I have PAF with no abnormal echocardiogram - no enlarged anything.

I guess this is a problem with non-medical people (i.e. patients) reading stuff on Google Scholar.

I've read measurements like LA Ejection Fraction decreased by 14% after ablation - but some other studies show it then improved. If they're just ablating around the Pulmonary veins isn't that muscle that's more part of the atrial wall and less functional?





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Edited 1 time(s). Last edit at 09/29/2012 03:11PM by afhound99.

Hi afhound99,

The studies I've read have shown an overall relatively consistent and marked improvement in EF within 6 months to a year post ablation.

I am just an anecdote of one, but I had severely symptomatic persistent AFIB for the last three months prior to my initial ablation in 2008 following 12 + years of paroxysmal AFIB that had been slowly progressive but more or less well controlled for much of that previous decade before suddenly turning persistent after a pro-arrhythmic episode from taking PIP flecanide when in Holland in May of 2008 .. leading directly to my first ablation in August 08.

My initial ablation was very extensive with LOTS of burning .. thus a lot of added scarring that was easily evident during the ICE imaging and Carto 3 used in my follow up ablation, as was reported within my latest ablation report after this 'touch-up' last month in San Fran.

However, my echo-cardiogram from just prior to my first ablation which showed a low 46 EF while I was in 24/7 rockin & rollin AFIB/Flutter compared to the echo done just this past August 3rd only three days prior to my last ablation which showed my EF then at close to 64!

Not too shabby for a 60 year old guy .. considering... Not to mention that this was also after 13 Electro-cardioversions the prior 15 months for whatever additional scarring that might have added to the equation??

No doubt some of my EF rebound was due to going back to NSR after the ablation from being in persistent AFIB, and thus the expected improvement in overall hemodynamics and cardiac function. However, even before I was in persistent AFIB I had an echo done three years prior to the first ablation that showed an EF of around 56 then and that echo was done about three weeks after my then latest 7 hour AFIB episode at a time when I was getting roughly one to two longer multi-hour episodes a month and a couple much shorter runs in between (but never any episodes longer than 10 hours until I went into persistent AFIB in May 2008).

So considering both my long-standing and at times severe AFIB as well as a lot of ablation burns, my experience still confirms those reports showing favorable improvement in cardiac function and Ejection Fraction .. for what it's worth!?

Shannon

Thanks a lot for that Shannon. I am taking Flecainide as a pill in pocket now but thought the pro-arythmia risk from that drug was limited to people with some kind of ventricular issue. I guess that's another reason to get the ablation.

Can I ask if you had a normal echocardio before the persistent AF ? And has your heart rate stayed about what it was pre-Ablation? That's another worry. I am typically 55 bpm when in NSR and I'd like to keep that way.

You are welcome AFhound99,

Yes I had several normal echos over the years prior to the first ablation, the last of which had the lowest EF but that was after a more active AFIB period the prior six months to a year before that last echo which, in turn, was the last one prior to the one in Austin done in Aug 2008 two days immediately prior to my first ablation and it was that one that showed the very low EF of around 46 to 47 dur to teh prior three month of severely symptomatic persistent AFIB.


And yes I am not basically where I was EF-wise after my ablation history and all the shocks too. MY heart rate after the first ablation went very high for a while... it was 110 six months after hte ablation when I went off the Sotalol which unmasked the higher HR from the very extensive two hours of burning Dr. N had to do to 'cure' the AFIB part of my equation... which so far seems to have worked beautifully ... the left flutter issue not withstanding as I've had no more AFIB... not even 30 seconds of it in over four years as documented fully by my on-board pacemaker.

However, slowly but surely my HR returned to almost normal and it got down to around 65bpm and sometimes even 60bpm by the second year post ablation which was basically what it was prior to even getting AFIB. But keep in mind, its very unlikely you will need as much burning as I did .. assuming you don't wait too long as I also did in hindsight.

Currently, my resting HR after the latest ablation which was not quite two months ago yet on Aug 6th ranges from a low of 70bpm to 82bpm on waking. more in the mid 70s now which is nothing like after the first ablation, but Dr. Natale only had to isolate my Left atrial appendage this time and he gave me a photo copy of one of the 3D images from the Carto-3 machine of my full left atrium and the map of exactly where he burned this time and there are only about twelve red dots around the inner ositium of my LAA and one or two focal dots just inside the opening of the LAA as well and that was it! Nothing else in the atrium proper and no work around the pulmonary veins was requires as everything he had done to stop the AFIB in 2008 was still working perfectly as intended with no leaks at all.

With so little burning he said the impact on HR would be a lot less than my first time and would recover to more or less normal range sooner as well.

Dont let that fear be a barrier to doing what is needed, assuming you have given a diligent effort to subdue this nutritionally and with trigger and life-style modifications and it still is breaking through for you. Your heart will return to a perfectly satisfactory HR after some time. If its a little high for some months afterward and it bugs you, just get a low dose beta blocker or calcium channel blocker ( though a beta blocker usually works better for this application) and take it only when it is fast enough to be a nuisance but not all the time. SOon you will be able to stop that too and be off everything I trust.

Just go to the best ablationist you can arrange!

Shannon

afhound99

Between June 2007 and April 2010 I had 5 ablations for AF and Left Atrial Flutter, a total of 17.5 hours of 'burning time' so my heart probably looks like a baked potato now. I have been arrythmia free since the last ablation apart from a few worrying moments a few months after that last ablation i.e. a few rounds of Bigeminy, Trigminy and Quadegimy.

Somewhere at the start of the AF nightmare I was told my EF was a score of 67- whilst in NSR. Somewhere else down the line (different proceedure) I asked what my EF was whilst undergoing an immediate post proceedure checkup. The Ultra Sound testing nurse said the EF score was 55 to which I said wow thats low and she replied don't worry your EF will be back where it was pre-proceedure within one month.

Regarding the burning around the PVs and that the burns may not really effect the work of the Atrial muscle I would add the following. My first two ablations where indeed just around the PVs with maybe one or two foci found in the Atrial muscle and which were eliminated. Ablation No3 followed 6 days after ablation No2 and took 1,5 hours and this I believe could be called a 'touch up' so no major burning going on there.

Ablation No 4 'cured' me of AF but this ablation included a full burning circle encompassing all 4 PVs within and then a 'linear' burn line over the 'roof' of the Atrium which is very difficult to achieve and thus some major burning at that time.

Ablation No5 was for Left Atrial Flutter probably a direct result of the successful AF proceedure, this called for a 3 hour re-burn along the prevous linear line in the roof of the Atrium.

I look at it this way. The Atrium could be considered the turbo of your heart (forces blood down into the ventricals) and turbos on car engines kick in when rapid power is required immediately other wise it does not kick in. I ensure these days that during exercise I keep well away from 'red-lining' myself so no need for that extra push from the Atria.

Whatever my EF is now I can still do 50 one arm press-ups at the drop of an hat and I'm almost 63, couldn't do those 50 press-ups at 23 though ;-)

Barry G.

Thanks guys, very reassuring. Still scary but I know that is standard. I do have a good doc at one of the foremost centers in the country in Boston so I am sure all will be ok..

Oh I meant to ask you Shannon, why do you feel in retrospect you should have had an ablation earlier? (I mean before it turned persistent)..



Edited 1 time(s). Last edit at 09/30/2012 07:20PM by afhound99.

Once your paroxysmal AFIB turns persistent it typically tends to require more burning to get the job done and almost always more than one ablation...

Shannon

Thanks Shannon . I understand.