Hi all,

In contemplating an ablation for vagal PAF, given my familial PAF - mother and her two sisters from a youngish age - mid 30s in my mother's case) I'm wondering if an ablation would have significantly less chance of success - this being because of a presumably stronger than normal 'hard-wired' predisposition towards PAF might well be harder to ablate against. Has anyone here any views on this? Shannon?? Even better, has anyone here had familial PAF like me for whom an ablation has been reasonably successful? If so, would love to hear from you!

Best to all,

Mike F.

I don't think it matters in the least. A properly done ablation blocks the sources of afib, so what caused those sources isn't particularly relevant. If the errant signals are blocked, they're blocked.

I also think all afib except that due to obvious causes like valvular afib has a genetic component. The fact that your mother and her sisters had it doesn't makes your afib any more or less "hard-wired" than anybody else's.

And yes, my mother and older sister also have afib and I was successfully ablated in August by Natale. How the ablation is done is what matters, not how you ended up with afib.



Edited 1 time(s). Last edit at 11/10/2017 11:56PM by Carey.

Mike,

Shannon's dad & sister had/have it and he's had success with his Natale ablations.

Cheers,

George

My Dad had it at age 51 or 52, I got it at age 41, now mom's got it at 71.

So far, Dad's and my ablations have held up fine. We'll see what happens with mom, but she's got at least two "canaries in the coal mine" that say things will be OK.

Just pair with the best EP you can find (1000+ left-atrial ablations) and you have every reason to believe it will work.

Hi Mike,

Sorry for delay but I’ve had 4 cases I’ve been ushering through the process af St Davids with Dr Natale this week and so not much time to catch up with the forum.

And as always you’ve gotten some great advice and insigh from Carey, George and Wolfpack above!

There is a largely genetic component to the vast majority of afibbers. Though those that have an immediate sibling or parent that have AFIB are 4 to 5 times more likely to get AFIB too at some point in life than if none of one’s immediate family has had the condition.

The genetic link can often skip generations too, so even those with no obvious direct and immediate familial links can still very much be influenced by previous more distant relatives having had it.

What I see, too, that the earlier in life one’s arrhythmia starts the more you can check off a likely strong genetic driver ... and most often with multiple AFIB-related SNPs at work.

Another thing, too, is that a definite genetic pattern with early onset ‘may’ be associated with less likelihood of better success using only life style risk factor and nutritional therapies alone ... say in comparison to a case that has no known familial links and that appears to be a mostly electrolyte depletion sensitive and driven AFIB, that we see more often in the chronic fitness crowd of Afibbers. Although, obviously, we also often see a combined case of electrolyte wasters who are major fitness devotees too, who also have some familial AFIB links giving a kind of double whammy of contributing influences.

There are probably as many shades of AFIB as there are people who have it at all, and each with a somewhat unique history of the condition in the making.

Carey, Wolfpack and George all point to the reality that the main important thing is in choosing the most experienced ablationist one can find to partner with who has a very long track record of success and preferably with many persistent and LSPAF cases too! Such an EP is unlikely to be surprised by whatever your heart might present to them and by choosing an elite level operator who is highly experienced with more challenging complex cases, it gives you a large measure of reassurance that your heart will not likely push them past their comfort zone when you are in their EP Lab.

Always go out of your way to choose among the most experienced EP ablationists that you possibly can access, even if travel is needed, and do not make this key most important choice of your entire AFIB career based mostly on convenience and the comforts of staying close to home as the main criteria.

Best wishes Mike F!

Shannon

Carey, George, wolfpack & Shannon,

Many many thanks for the really helpful responses - much appreciated and most reassuring.

I saw an EP in Leeds UK this week who did greatly impress me in all respects (and I'm not easily impressed). My partner is a top surgeon and is adamant that if she needed an ablation that this guy is who she would be getting to do it. This guy has been doing AF ablations for many years at 5 or so per week (himself - not just his team) and is generally regarded inside the profession as one of the top handful here in the UK. he has worked extensively in the past with Richard Schilling (who he says he'd get to do an ablation for him were he to need one). He does both cryo and RF. My partner is VERY wary of thinking that the more well known an EP is in terms of research and kudos will be the better choice - she prefers the quieter more 'under the radar' kind of EP who just gets the job done extremely well on an every day basis and who isn't looking for the limelight but rather solid results and job satisfaction. He pretty much sticks with PVI in addition to looking for and ablating any other rogue signals that can readily be found. He is well aware inter alia of the ganglionated plexi approach being looked at by Ernst (who he also respects - in addition to Schilling) but says that the jury is still pretty much out on that one at present.

Whilst I take your point as per your last paragraph well enough Shannon, I'm certainly happy to go to Ernst at the Royal Brompton in London if I think that's the better way to go - it is, after all, only 2 hours on the train from York. That said, I do know my partner and her abilities and therefore put a great deal of weight behind her views on this too. As for what I was told this last Thursday, 1000s of AF ablation procedures under his belt, 75-80% success rate with 1 procedure, no strokes or fatalities. As for his recommendation to me, he said whether or not to have an ablation is entirely up to me. With a couple of shortish episodes a year and no problems with Flecainide combined with the fact that one never knows how many years one's ablation will hold, I could wait another year or three before going the ablation route. If episodes become more frequent - say once every month or two - then an ablation is the way to go. He is fully on board with vagally mediated PAF and has found Dispyramide (with its vagolytic properties) very useful in these circumstances. (IIRC Pat Chambers who used to post here a lot in the old days was a strongly vagal PAFr who did very well with Disopyramide before he got ablated - is Pat still in Hawaii and doing well does anyone know??) As such, I could try Disopyramide as an alternative to Flecainide and that is something I will consider. He did, however, emphasise that ablation has a better chance of working on someone who hasn't tried and failed all AADs rather than someone who has - although that said it could be argued that someone who has tried and failed (usually in a shortish period) most AADs likely has more refractory AF (more fibrosis/oxidative stress/inflammation?) anyway.

Many thanks again guys!

Kind regards,

Mike F



Edited 5 time(s). Last edit at 11/13/2017 01:05PM by mwcf.

Mike

I would be very interested to know the name of the EP who has been doing ablations in the UK for almost 20 years. Send it by private message if you prefer.

In 2002 when I first started looking at ablations there were only a couple of people doing them in the UK, and they were just starting out. I finally went to Bordeaux in January 2003 and have been in nsr since then.

Gill

Hi Gill,

Fantastic to learn you're still doing so well after 14 years!

Maybe I was exaggerating a bit at 20 years - but he did say he'd been doing ablations for 20 years so maybe not 20 years for AF maybe - anyway, I edited the post accordingly.

Kind regards,

Mike F