Can An Ablation Make Things Worse?

I have my first ablation scheduled for March 5th with Dr. Natale. Until the past four months or so, I would only have one episode a year. I've had afib since 2006 and I'm 42 years old. Now I have an episode once a week or two. Fortunately, I am able to pop Flecainide and within 6 hours I'm back in NSR.

But here's my #1 concern about having an ablation (aside from the potential pain...I'm a wimp when it comes to pain)...

Will an ablation make things worse? By that I mean, is there a chance that by having an ablation I'll be worse off than I am now - AFTER the 3 month blanking period?

I'm fearful that somehow the ablation will give me more afib episodes long-term or give me other arrhythmias such as atrial flutter or who knows what - or I'll have complications or other long-term side effects from the ablation.

It's not a picnic now what I'm dealing with but at least I am able to manage my afib with Flecainide every week or two. Aside from that, I don't have to deal with blood thinners, daily meds, or other heart issues. What if I have the ablation and it causes more issues than I have now? Is that a possibility?

Travis

Sure I would imagine that there is a risk of that, as there usually is with procedures. But with a top operator like Dr. Natale it's very unlikely.

Travis,

Your significant increase in episode frequency would indicate an ablation is appropriate much sooner rather than later.

Of course anything is possible, but I agree with Johnny, a Natale ablation is your best option.

As it turns out, my best friend from childhood is also scheduled with Natale on 5 Mar.

George

Travis

I have had four ablations. My SVT morphed into flutter into afib throughout this process. Each ablation I feel has helped give me time in between what I would deal with next time. Personally I think the ablation is positive. Not 100% for me and Im still leary about my last one as in how long the positive results will last but Im glad I did it. I think the afib will keep progressing if you do not stop it. At least if an ablation resets it back to a starting point its a good thing.
As far as pain it is nothing to worry about before or during the procedure. There is some discomfort afterwards but you can deal with it.

Travis,

My afib episodes started out like yours about 20 years ago, but continued to become more frequent until I was in permanent afib. Back then ablations were in their early stages. It really wasn't an option. By the time you're in permanent afib it's a more difficult situation. There are no guarantees, but I think your decision to have an ablation now with Dr. Natale is your best bet. At least you have a chance of a permanent cure. Afib, is a serious malady that without treatment will only get worse.

Nick

Travis,
I think you are sweating too much over this and getting yourself twisted in knots, which can't be good for your stress levels or afib. This as I sit here typing with a calm heart wondering where I would be if I didn't get it done, now 20 months out post-op.
Will things get slightly worse while your lesions heal....maybe...will you go into flutter.....slight chance...is Natale aggressive...you bet and you wouldn't want it any other way... now would you.....of course going back for 2-3 more ablations is not something to look forward too! Will you get cardioverted for afib/flutter good chance depending how much burning he does. Hey it's the trifecta every affiber should experience......-afib-flutter-cardioversion

It is truly a gift that you have been given. If you can focus on your gratitude, that will hopefully help calm your nerves. He is one of the very best in the world. There are thousands who would be grateful to be in your shoes.
He is the only EP in the world that says he can FIX you!

McHale



Edited 1 time(s). Last edit at 01/08/2015 10:47PM by McHale.

McHale:

You crack me up. Afib > Flutter > Cardioversion...yahoo!! Something to look forward, I guess.

Please don't mistake my nervousness for being ungrateful. Nothing could be further from the truth. I thank my lucky stars every day that I have been blessed to be treated by Dr. Natale.

I'm just nervous about the decision in general, that's all. I'm so fearful that I'm going to be looking back a few months from now kicking myself for taking such an aggressive approach (i.e. an ablation) to beating this beast. I know deep down it's only going to get worse - which is why I decided to do the ablation in the first place.

I suppose I'm going through what everyone goes through when facing an ablation - the constant second guessing. I have no plans on backing out. I'm all in at this point. I'm just going through a lot of different emotions and thoughts as the day slowly approaches.

Thanks everyone for chiming in and making me feel better about my decision.

Travis

Travis,

Just a question for you:
We're the same age and I've had my afib for as long as you but about a year ago my went to where yours is. I had scheduled an ablation but chickened out and opted to start Propafenone instead.

Curious as to why you chose ablation over daily flec.

Monty

Hi Travis,

I'm here in Magdalena's hospital room at MD Anderson Houston and saw this thread come through my email.

These are the kind of typical bargaining 'what if' fears that most minds naturally engage in when approaching an ablation, or any medical procedure really.

And my buddy McHale had his fair share of 'what ifs' and did his own procrastination dance for a while in his earlier days here, as most all of us have done, and now look at him!

Let's look at the reality of your situation Travis, your case, as with the vast majority at some point, is progressing all on its own already. You will not avoid a more advanced degree of AFIB by allowing the continuing devolution ofyour heart function and peace of mind to go on through pushing things off to another day when you already have a slot with a man as truly talented and remarkably consistent as is Dr Natale.

All procedures have some risks, but with the center and elite EP you have wisely chosen, the risk/reward equation is stacked very strongly in your favor, especially relative to continuing the status quo while both electrical and structural remodeling continue to progressive scar the endothelial tissue and pacing cells lining inside of the left and right atriums.

The odds of you wanting to kicking your own 'okole', as we say in Hawaii, all the way down the road are so vastly much higher if you do bail out now, than are the truly minuscule odds of regretting putting your heart in Dr Natale's hands, after the fact. The dramatically more likely scenario after bailing out now is that in maybe 2 months, 6 months, a year or two or even a bit longer down the road, your AFiB is far more likely to have morphed into a much more intractable beast than you can imagine now. And the longer a progressive poorly controlled AFIB is allowed to continue unaddressed, the greater the odds of you flipping any day into persistent AFIB that can make your ablation process all the more challenging.

There are risks with each choice, like with most decisions we make in life, but this is why I, and so many others here, so strongly advocate aligning with the very best and most experienced Ablationist you can find to stack those odds so high in your favor, precisely as you have done now.

I can't recall any that I know of whose AFIB was made worse after completing a Natale ablation process. Far more often is the case where Afibbers who had less experienced hands for a one or more previous ablations are finally referred to Dr N to fix what had appeared to less experienced EPs to be a too difficult Nut to crack.

I recall one man who had had six ablations by three different EPs and all in the LA area at reputable hospitals, not some podunk small hospital out in the boondocks, before making his way to Natale for his final successful fix.

In spite of having had 6 ablations by three different EPs, two of them of some local repute in the LA region, three of the guys four Pulmonary veins were still conducting!!!

How that is even possible boggles my mind, and while this is certainly an extreme example, it nevertheless just illustrates the AF ablation competency gap still seen in this field between more experienced EPs who only do Transeptal oriented work in their careers every day, and a larger majority who have added AF ablation to a longer list of EP procedures and conditions treated every week.

Some here have managed to gain very good control with consistent dietary, supplemental and life style modifications including addressing high blood pressure, sleep apnea and metabolic syndrome, and while we strongly advocate making each of those steps a major priority even after a successful ablation, and certainly before, nevertheless, a significant majority will still require the skills of a top tier EP to complete an expert ablation process, typically no more than two procedures and increasingly only one, yet more rarely a third small touch up needed...especially for more advanced or long standing cases.

Which only underscores what we are finding in this field. We recommend a total dedication to lifestyle/dietary/Strategy-like supplement protocols and even select cardiac rhythm/rate drugs for at least 6 months and be religious about it so long as your AFIB is not continuing to get worse in the interim, but also to not drag out this process of going only with these more natural means alone when a dedicated protocol of 'do it yourself' fails to achieve anything less than truly excellent control over your AFIB/Flutter within the first 6 months to a year maximum at the longest.

If you still are having relatively frequent breakthroughs like one every three months or more frequently after six months or more of heroic efforts on the life style/ dietary front, then do NOT procrastinate much longer allowing your fear of an ablation in expert hands to insure a greater likelihood of continued progression toward more scarring and persistent AFIB or long standing active paroxysmal AF.

That is my strong recommendation and even after a successful ablation process with Dr Natale, the wise patient will continue on with the positive dietary/supplement and life style changes you have made that can contribute toward better overall health as well as better encourage a calmer heart, even if these adjunctive measures are not a solution for AFIB by themselves without expert ablation help as well.

Best wishes on making a good decision Travis, Magdalena is waking up from a morning nap and time for a short stroll around the nurses station here.

Cheers!
Shannon

(Apologies for typos and spell check gremlins .. No time to edit)



Edited 1 time(s). Last edit at 01/09/2015 11:16AM by Shannon.

All clinical procedures carry some risks, I think you need to weigh the risks of continued progression in your disease and the associated risks from drugs, drug complications, stroke risks and hospitalization versus the risks of ablation. With an elite clinician like Natale, you have taken a big step in minimizing risk and optimizing success. Even in patients that don't get to NSR in the first round, symptoms improve in the vast majority of patients. I think the risk reduction scale in your case heavily favors ablation, especially since you have Natale in your corner. For others that only have access to low volume centers, the answer is a lot more complicated.



Edited 1 time(s). Last edit at 01/09/2015 03:00PM by researcher.

@Shannon - Your responses to my posts and others in this forum always make me feel better. Thank you! And I especially thank you for taking time out of your own hectic schedule during your wife's treatment to respond. I hope she is doing well during her treatment.

@Monty - My local EP's pushed for a daily regime of Flecainide but I had ZERO interest in taking drugs on a daily basis for the rest of my life. If there comes a day where I have no choice but to take drugs daily, fine, but until then I will exhaust all other possibilities - which is why I opted for an ablation. Even if daily Flec worked, how much time would I buy - 3 years, 5 years, 10 years? Then what? From everything I've read these drugs lose their effectiveness over time and can cause additional health problems so you can't count on them as a long-term fix. Once Flec fails, then what? The only option would be an ablation anyway. I figure why not have one now then while my afib is fairly "benign" and I'm relatively young. Even if I need 2 ablations to be "cured" and that cure only lasts 10 years, at least I have 10 years of no drugs.

Travis

tvanslooten Wrote:
-------------------------------------------------------
> @Shannon - Your responses to my posts and others
> in this forum always make me feel better. Thank
> you! And I especially thank you for taking time
> out of your own hectic schedule during your wife's
> treatment to respond. I hope she is doing well
> during her treatment.


You are welcome Travis and yes we are home now and Magdalena is progressing slowly but surely from a major operation but with the wonderful news of it being a benign tumor and not kidney cancer as we were told to expect with 95% confidence. Its very nice to win the 5% lottery from time to time!


>
> @Monty - My local EP's pushed for a daily regime
> of Flecainide but I had ZERO interest in taking
> drugs on a daily basis for the rest of my life. If
> there comes a day where I have no choice but to
> take drugs daily, fine, but until then I will
> exhaust all other possibilities - which is why I
> opted for an ablation. Even if daily Flec worked,
> how much time would I buy - 3 years, 5 years, 10
> years? Then what? From everything I've read these
> drugs lose their effectiveness over time and can
> cause additional health problems so you can't
> count on them as a long-term fix. Once Flec fails,
> then what? The only option would be an ablation
> anyway. I figure why not have one now then while
> my afib is fairly "benign" and I'm relatively
> young. Even if I need 2 ablations to be "cured"
> and that cure only lasts 10 years, at least I have
> 10 years of no drugs.
>
> Travis

Your thinking here is right on the money Travis. The drugs long term are indeed very toxic to the system and almost invariably fail at some point and often are not very effective in preventing ongoing fibrosis in any event, especially when they are only partially effective. Getting an expert ablation by a man as talented as Dr Natale is a far better bet in my book than trying to squeeze the last drop out of the drug route while underlying progression of the structural disease may well be ongoing and unrecognized, even if at a somewhat slower pace than when you had even greater activity without the drugs. It's still not a great bargain long term and can very well wind up with a more difficult ablation whenever the time becomes unavoidable.

If a person can get near total control over their AFIB by natural, life style, dietary or even with combinations of life style, diet and drugs then all power to them, but when there are still even just a modest number of symptomatic episodes (not to mention any asymptomatic silent arrhythmia) it's a losing game to continue postponing an ablation out of fear alone.

This is why we urge people in your shoes to spare no effort to align themselves with the very most experienced EP they possibly can. Stack the odds squarely in your favor as you have done as well as you possible could with the choice you made, and then relax and go with the flow. None of us has had the chance to pick and choose who our AFIB manifest and how aggressive it is for each of us, but after doing everything one can with the natural and/or drugs for 6 months to a year max, if there is still even any periodic breakthroughs, they the wise person will sign up with the best ablationist they can and go for it, knowing the the ablation process can be a two step affair as par for the course.

You will almost certainly achieve a far less total AFIB burden accumulation over the long term following this formula than will those who follow the 'lets exhaust all the drugs and every other means as long as is humanly possible while avoiding an expert ablation like the plaque' route. That only sounds like the prudent program on the surface but most often is the most risky of all.

The one caveat, as Researcher noted, is being very discriminating in who you allow to touch your heart with a catheter. Choose a highly experienced maestro and you can pretty much put it in the bank. Go for a local EP who may be a fine physician and has great bed side manner is light on experience and the odds are not as favorable.

Shannon

Travis, having an ablation makes it easier to get back to NSR if you do go into Afib using the PIP method, and the things that triggered your Afib in the past will most likely have higher thresholds.....however you most likely will have Afib issues again after your Ablation, especially if you don't supplement with lots of Magnesium, but it will be easier to deal with. Now that being said you wanted to know about the pain....hopefully you will be under when they cath you...if not that hurts alot, and after the procedure they take off all of the surgery tape...alot of surgery tape....that really hurts, The post ablation incisions aren't to bad....laying flat for hours post Ablation is not easy. My suggestion is to shave every thing in front that a pair of boxer shorts would cover...might help a little.
Good Luck
Tom C

My AFIB progressed much as yours over 12 years. Flecanide was the best of the 1/2 dozen meds that I tried. Eventually I had repeated break throughs.

I have had 2 ablations by Dr. Saliba at CClinic. Things improved greatly after the first ablation, but then I had to go back on Flecanide until it was apparent after 2 years that a second ablation was needed. Two years later I am still off the meds, but have infrequent brief AFIB episodes that stop after 15 minutes.

There was no pain or complications from the ablations. I think you are worrying too much.

Thanks guys for assuring me I have nothing to worry about when it comes to the pain. My family will be the first to tell you I am the biggest wimp when it comes to doctors, hospitals...and especially needles!

I got an infection in my finger nail last summer and I had to have part of my nail removed. They had to give me 3 shots at the base of my finger. I almost fainted I panicked so much. I also got really sick to my stomach and almost vomitted all over the floor. What's really sad is the shots didn't even hurt! It was just the setting of the doctor's office and the sight of a giant needle that set me off.

I'll be taking Ativan (Dr. Natale's nurse suggested this...lol) leading up to the procedure as I'll be a nervous wreck.

Travis

With any medical procedure there is the possibility of things not going as planned. Ablation is so commonplace now that should you have it done by experienced hands the chances of something untoward happening are something in the order of 1 in 1,000. Those are darned good odds if you ask me and I am literally chomping at the bit to get mine done asap. The side effects from the TIKOSYN are affecting my quality of life bigtime. I am advised an 85% total success rate in my circumstances with max 1 touchup ablation if necessary. Good enough.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.