Unexpected replies from Prof Schilling & Bordeaux

My Afib episodes, apart from a few weeks in February 2015, have been 2 or 3 a year - until now. Over the past 6 or 7 weeks they've been coming every second or third night. I hoped like 2015 that would revert to a few a year but it's not looking likely.

So time to consider an ablation. I contacted Prof Schilling in London and Prof Jais in Bordeaux. I was expecting that both would map the whole heart and ablate all involved nerves; but no. Both said that that with Paroxysmal Afib the ablation would be just a PVI.

Is it really worth 2 or 3 plane journeys (with aerophobia), sorting out accommodation and considerable extra cost if I can get a PVI done 2 hours away by car with Dr Szeplaki in Ireland. I'll get more information on him shortly but he has done at least a few hundred operations and seems to be quite highly regarded in Ireland.

I've reread the information from Bordeaux and I think I've got it wrong. At first reading it seemed that if the PVI was not completely successful I would have to have another operation but I think it's saying that if the PVI doesn't stop Afib the operation will continue, ablating other areas.

Sam,

A few observations.

Pierre Jais would definitely look for and deal with any other irritable areas in the atria as well as in the PVs as part of any first procedure. Moreover, and to the best of my knowledge, at Bordeaux they keep you and monitor you for 3 or 4 days after the procedure with any touch-up being required in that timeframe being included in the cost of the initial first procedure. Pierre uses RF for ablation not cryo. Schilling is increasingly cryo these days with his stats at London Bridge Hospital saying that his procedure time for paroxysmal AF is now down to 60 mins average. This to my eyes at least from a logistical viewpoint means that in that timeframe you would get a cryo PVI and not much, if anything, else, since I can't see that 60 mins is enough time to do a cryp PV, then pull all the cryo gear out and go back in with RF gear to look at the rest of the atria. But as I haven't corresponded with Schilling since 2010 perhaps I shouldn't be so quick as to jump to conclusions about how he goes about his work and maybe my presumptions as aforementioned are way wide of the mark.

I hear your concerns about aerophobia and cost, and maybe the guy in Ireland is good, but operator experience is KING where AF ablations are concerned (although arguably less so for paroxysmal AF PROVIDING there aren't any other non-PVI triggers) and Pierre Jais must have done at least 6000 AF ablations by now. Whilst putting some sort of arbitrary figure on it is a bit silly in some ways, I'd want whoever does my imminent ablation to have done at least 2000 AF ablations rather than a few hundred.

Do keep us posted as to what you learn and decide to do!

Cheers,

Mike F.

Sam, after visiting Bordeaux 3 times I very much doubt that Professors Haissaguerre, Jais and Hocini would just do a PVI and say that's your lot. They actively go looking for other trigger spots and ablate them as well. They then speed your heart up to something like 300BPM to test their work and if no afib is induced they consider the ablation to be complete. They do as little burning/damage as possible but in my last ablationc they finally decided they needed a flame thrower and my ticker probably looks like a cinder now. Still hiking and jogging the hills where I live but don't red line it any more at 68 years of age. Resting HR 55 BMP, Blood pressure 130/76 and I believe my hearts ejection fraction ( volume of blood pushed each beat) will be much the same as one month after the ablation seven years ago.

Go for it.

Barry G..

Barry G.
Loved your response very funny. My heart also by now is prob a cinder block within!

Sam, after re-reading my earlier post it may appear that my 3 visits to Bordeaux are not what you would want to hear as like every one else you want a once and for all procedure to eliminate the afib. I think I must just explain my afib history so as not to discredit Bordeaux.

My first ablation was in New Dehli India at Escorts hospital, the top place in India for heart operations etc. It was far cheaper than anywhere else and more importantly they could do the ablation at a weeks notice as against Bordeaux being up to 12 months notice at the time. The hospital was spotless and the staff as good as you could find anywhere. The procedure took 6 hours and I was back in AF within 3 hours or so. I asked the doc how many procedure he had done and he said between 5 and 10 annually so I knew then that Bordeaux would be my next stop. I would expect that Escorts will have dramatically advanced its skills since my visit in 2007 Note: many of the doctors there where returning Indian doctors from the UK NHS because the money was much better at Escorts. The inside the Catheter Lab looked like a spaceship with state of the art equipment, very impressive.

The Escorts ablation kept me in NSR as long as I didn't try to run or take part in any sports which was not good enough for me so I booked my ticket to Bordeaux, the first of 3 visits. My long stories on my afib journey are in the archives somewhere around 2007 to 2010, my first visit story can be found under the heading Bordeaux Diary or similar which I believe gave a very descriptive view on attending Bordeaux, hopefully with a bit of dry humour thrown in. If I remember correctly Hans even said it was a page turner.

Not to go over everything again my first ablation in Bordeaux was by Dr Jais and I think it was about 2.5 hours after which he said he thought he has got it all but I could tell he was not definitely sure. Later he told me I was possibly in the worst 3 cases he had ever come across and if not definitely in the most difficult 10 - had already done over 4000 since 1997. I was in NSR but with plenty of PAC activity, a few days latter I had another ablation - free of charge - by Professor Haissagurre because the PACs had turned into afib and then to Left Atrial Flutter. I left Bordeaux in AF two days after leaving the hospital

Maybe 8 moths later I was back in Bordeaux again because although the afib burden was dramatically reduced I could not live my life as I wished i.e. running through the hills and joining in with sports etc. I think that ablation was by Professor Haissagurre and all went well for the next few weeks until Left Atrial Flutter started up and which was 24/7 and just as bad as AF if not worse as it never stopped until my next visit to Bordeaux maybe 3 months later - Bordeaux pushed me to the front of the queue as I said I could fly at 24 hours notice.

On that 3rd visit to Bordeaux the ablation was carried of by Dr Hocini a very nice attractive French lady. As I was someone who had probably damaged the hospitals success rates somewhat she did everything that could be possibly done in the ablation process as far as I know, the full works whether needed or not. I have been clear of AF ever since with just the very occasional run of PACs in the year after that ablation.

So as you can see I could have been AF free after that first visit to Bordeaux if my life revolved around train spotting, collecting stamps or playing darts down the pub.

A bit long Sam but I hope this helps others who are thinking of taking the ablation route.

Barry G.

Barry,

I'm glad you are doing well! I clearly remember all your ablations stories as i read them at the time.

Cheers,

George

Hi George, thanks for your comment and yes touch wood I am still doing great after that last ablation in 2010. Good to see you are still supporting the BB with the knowledge of your successful fight against AF without having to go the way of ablation. I did tell some long stories back then with hopefully a bit of humour in them to help try to lift the gloom of this hideous affliction adding to the fact that my story finally had an happy ending. I am always mindful that once an afibber always an afibber as Mr Schumann used to say on the BB....you have walked through a door to a world of AFib and that door has slammed shut behind you. Never one to raise false hope Mr Schu.but a very interesting poster back then.

My main message is that apparently I was a very serious case but I eventually came out at the other end so it would appear that many others will have a far greater chance of NSR than I did.

Barry G.

Good stuff Barry and a good read as always! Great to hear you're doing well. If one of the worst 10 cases Pierre Jais had encountered when he already had 4500 AF ablations under his belt there's hope for us all if you can come out of the ablation process AF-free! Long may it continue (-:
Best,
Mike F.

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Barry G.
Hi George, thanks for your comment and yes touch wood I am still doing great after that last ablation in 2010. Good to see you are still supporting the BB with the knowledge of your successful fight against AF without having to go the way of ablation. I did tell some long stories back then with hopefully a bit of humour in them to help try to lift the gloom of this hideous affliction adding to the fact that my story finally had an happy ending. I am always mindful that once an afibber always an afibber as Mr Schumann used to say on the BB....you have walked through a door to a world of AFib and that door has slammed shut behind you. Never one to raise false hope Mr Schu.but a very interesting poster back then.

Ah yes, Wil Schuemann, hadn't thought of him in a while. He's an interesting fellow and very bright. For those who are new here, Mr. Schuemann purchased his own Holter monitor to try and figure out his situation. Prior to that, he purchased a medical office grade ECG for sampling and testing. As I recall he did have a successful Natale ablation. He also experimented with a Cardymeter - an agricultural meter that can measure saliva potassium which can be correlated with serum potassium <[www.afibbers.org]. Here is a search on his posts: <[www.afibbers.org] He was a vocal advocate for not waiting too long for ablation. For example: <[www.afibbers.org] dealing with the risks of cardiomyopathy caused by afib and the risks of ablation.

Good to hear from you Barry, pleased that all is well. My "cringe" ablation is still working, I’m happy to say. Those Bordeaux people know their stuff!

Gill

Hi Gill, good to see you are still posting and passing on your experiences to help others especially the continuous inflow of newbies. I had to smile with you mentioning your cringe ablation at Bordeaux back in pre-2005. To explain your cringe ablation I would have to go back to my 3rd visit to Bordeaux in 2010 when I had my 4th ablation there, this time with Professor Hocini who had obviously been fore warned by Professors. Haissaguerre/Jais of this English guy who never stops asking difficult questions about AF and ablations etc. On meeting Ms Hocini for the post ablation chat the first thing she said was please don't ask me any technical questions which took me back a bit, her being one of the top ablators in the world, but then again she probably can drive a car but has no idea what a zenodiode is.

Her main thrust was "you must understand you have been a very difficult case here in Bordeaux, possibly unique", fame I really didn't want to be burdened with pun intended. She went on to say that she had done everything they could possibly do to end my Afib using all the latest technology and advances in the actual procedure and that she cringes - facial expression - when she thinks how they did ablations only 5 years previous but didn't mention Gill personally :-)

No doubt things have moved on dramatically since my 2010 visit to Bordeaux.

Barry G.