What symptoms do patients have after successful ablation.

After one year has passed since a successful 1st ablation, what AF symptoms and procedure-related symptoms persist?

In other words, suppose an ablation goes smoothly with no mistakes/complications, and suppose that one year afterwards the patient does not have episodes, nor any other arrhythmia. What other symptoms of their AF might exist 1 year later? Similarly, what iatrogenic symptoms might exist 1 year later?

The reason I ask is because today I came across, MAFSI, the Mayo AF-Specific Symptom Inventory.

Apparently MAFSI is used to score all ablation patients, even those with successful ablations.

So even with zero episodes/arrhythmias at 1 year, patients still might experience any of: Slow heart beat, Lightheadedness/dizziness, Fainting/blackouts/loss-of-consciousness, Chest pain, Shortness of breath, Inability to exercise, Tired/lack-of-energy, Weakness, Feeling warm/flushed?

Questionnaire: Mayo AF-Specific Symptom Inventory

Abstract 633: Unique AF-Specific Symptom Score Assesses Long-Term Symptom Relief After Ablation



Edited 1 time(s). Last edit at 10/11/2022 05:09PM by Kwilk.

You find really great articles and studies.

I've never experienced any of those symptoms after an ablation, successful or not. I can only recall two people from 3 separate forums who've reported stuff like that a year out, and they both had significant procedural complications. I would expect almost all those symptoms to be associated with a failed ablation, comorbidities, or drugs.

I'm well under a year from my own procedure, but I have had a few of those symptoms, most of them fleeting, not all recurring.

PACs - yes

Light-headedness/dizzy/fainting - only the former, two events, all on the same evening after five weeks so - yes

Inability to exercise - yes. I used to run competitively, and have always been a cyclist, snowshoer, hiker, and wood chopper. I got on my e-bike at six weeks and took my time to start out, with lots of 'assist' in the drive mechanism. It wasn't four minutes before I was at 135 and on the way up. Fortunately, it wasn't so bad and I reverted after about three hours. More recently, when I go for walks, I do the same careful slow stride until I have been walking for at least five minutes, and then naturally speed up...some. Within four minutes my HR goes from 95 to 115, and I know (now) to sit for a minute, and my HR precipitously plunges to 75. Literally 30 seconds to a minute, and I suddenly lose 40+ BPM.

Flush/warmth and sweating (not mentioned above) from mostly my scalp - yes, again one or two short episodes the past 10 days, and I correct myself.

I went off Amiodarone four days early last week, after discussing my case with the outreach nurse at the Island's AF Clinic. She couldn't see any AF in my last two ECGs, and said all she could see was PACs. Odd contradiction between her and the two ER internists. She also opined that I shouldn't have been on Amiodarone more than about a week to get stable, and then they use metoprolol or another drug whose name I can't recall. Since that conversation, I have had to resort to a 12.5mg dose of metoprolol, only three nights ago, and it worked well. Have had great days since then, no issues.

I mention this last subject because I have had terrible sleep and I believe some constipation, and I'm blaming it on the Amiodarone. Also, some iffy coordination when walking around the house or my garden. That was never a problem prior to Amiodarone.

I'll stop at this point, but it's an interesting topic. Thanks for the post.

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gloaming
I'm well under a year from my own procedure
<big snip>
but it's an interesting topic.

Thanks for sharing your experiences. It's hard to sit still. The papers I looked at this morning found many ablatees were still struggling at 6 months and longer, so you are not alone. So I used "1-year" in my top post to take most if not all of the recovery phase out of the equation.

@gloaming ... I happened to still have a pubmed window open with one of the papers:

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pubmed

2017 Symptom Challenges after Atrial Fibrillation Ablation

Fatigue, pre-syncope, palpitations, and trouble sleeping were the most prevalent symptom challenges during the first one to three months post-ablation.

At six months, the most prevalent symptoms were palpitations and trouble sleeping

That abstract is 14 years old and ablation techniques and experience have changed a lot in that time, so I doubt if those results still stand.

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Daisy
That abstract is 14 years old

Correct, the MAFSI score was created 14 years ago, and is still being used today.



Edited 1 time(s). Last edit at 10/11/2022 07:24PM by Kwilk.

PAC's would be the big 1 for most i am guessing....for me it has been absol. 0 other things but the Pac's are now under control (a few dozen or so weak 1's a day) since my successful 2018 procedure.

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vanlith
PAC's would be the big 1 for most i am guessing....for me it has been absol. 0 other things but the Pac's are now under control (a few dozen or so weak 1's a day) since my successful 2018 procedure.

So no other symptoms other than PACs (now under control)? What type of AF did you have when you were first diagnosed? If you've summarized your AF journey somewhere, I'd be interested in reading it. Thanks for posting.

But the scoring doesn't differentiate between failed ablations, drug-induced symptoms, and successful ablations. Can you find data on that scoring system that only includes successful ablations with no antiarrhythmic or rate control drugs? That's your question, after all.

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Carey
But the scoring doesn't differentiate between failed ablations, drug-induced symptoms, and successful ablations. Can you find data on that scoring system that only includes successful ablations with no antiarrhythmic or rate control drugs? That's your question, after all.

Also, some of those symptoms are not going to be related to the ablation at all. For instance, before my ablation I have pre-syncope, light headedness, shortness of breath, fatigue and limited ability to exercise. For me, these are not caused by cardiac problems and I will most likely still have them after the ablation.

One year after my 2 ablations, I was back to 100% normal as if I never had a fib.

I think your criteria might be conflated. Failed vs not-failed. Drug vs no-drug explanation.

Regarding MAFSI:
Score N patients before and after treatment.
Histogram the scores.
Is the distribution multimodal?
If so, look for reasons/correlations.
You suggested 2, AF burden reduction and RX matrix.
Others might be treatment type (drug vs surgery), type of surgery, ablation technology, abalation extent, age, pre-treatment comorbidities, EP # cases, EP training, and on and and on and on.

MAFSI is used to score all AF ablation patients regardless of outcome. If, as you maintain, all patients at 1-year are free of MAFSI symptoms if they no longer have AF episodes nor other arrhythmia, then investigators wouldn't waste their funding to survey that majority subset of patients.

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Daisy
before my ablation I have pre-syncope, light headedness, shortness of breath, fatigue and limited ability to exercise.

Patients are scored before and after.

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Ken
One year after my 2 ablations, I was back to 100% normal as if I never had a fib.

Thanks for sharing your experience. If you've summarized your AF history here, I'd be interested in reading it. Thanks for posting.

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Kwilk
MAFSI is used to score all AF ablation patients regardless of outcome. If, as you maintain, all patients at 1-year are free of MAFSI symptoms if they no longer have AF episodes nor other arrhythmia, then investigators wouldn't waste their funding to survey that majority subset of patients.

That's not what I said. My complaint with the scoring is they don't account for comorbidities, failed ablations and drugs. So the results make it appear that a large number of successful ablations leave lingering symptoms, many rather severe, when that's not the case in my experience both as an ablatee and as someone who knows the outcomes of hundreds of ablations.

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Carey
So the results

Do you have a link?

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Kwilk
Do you have a link?

I was referring to the study you linked to in your first post on this thread. Those results paint a grim picture for ablation patients that I don't think matches reality. I speculate that the reason is we're looking at an entire group of patients as if they're a homogeneous group, and I'm sure they're not. There are undoubtedly many patients in that data that are elderly, have varying degrees of comorbidities, and are taking a myriad of drugs. The paper did separate out those on antiarrhythmics, but rate control drugs are often a bigger culprit when it comes to fatigue, exercise intolerance, etc. And lord knows what other non-cardiac drugs many of them are taking. I think their assessment system is okay for their internal use because they have access to patient records, but as a study I think it's pretty weak and misleading.

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Carey
I was referring to the study you linked to in your first post on this thread.

In my top post, link to a MAFSI questionnaire. To substantiate it, I linked to the origin of MAFSI. The origin link was only meant to be that, a citation of the origin. The only point of mentioning anything MAFSI was to substantiate my question.

Given the title is prefixed with "Abstract 633" the abstract appears to me to be a conference poster or talk, not a paper, and not likely a study. In fact "Meeting Report" appears above the title.

It's not uncommon for conference presentations to report work-in-progress, or have the purpose of testing an idea on the wider community. Sometimes organizers will make room at the conference for all submissions, sometimes they'll select a portion of those submitted. That is as close at it gets to being peer reviewed. As such, attendees don't weight them very heavily, and instead 'wait for the paper to come out'. More often than not, it never does.

I don't know what the ablation world looked like in 2008, but I can't imagine outcomes have not improved dramatically sionce then in both burden reduction and second tier measures.

It's a conference paper published in a major peer reviewed journal, and it presents data collected as part of a study, so it's a study. I agree it wasn't published independently outside of a conference proceeding, but I don't understand why that matters. I simply responded to the data you presented and explained why find it flawed and misleading. A large part of my motivation is to speak to the audience, which is bigger than most people realize. For every person you see post here there are at least a hundred more reading who never post, and many of them are scared and not medically sophisticated.

With a better breakdown of patient characteristics I could see MAFSI being more useful, but at least as it was in 2008 I find it not so much. It just comingles too many different possible causes. Has it been refined since and published?

you don't get it
and your derailing this this thread, as you do so often
and your conflating MAFSI with the spurious data that you're hyping as a 'study'
the data may have just been from a beta test of the author's initial draft of the questionnaire

why don't you get the thread back on topic and just post a link to a paper that supports your opinion that (zero burden post ablation) = (zero symptoms at 1 year)?



Edited 1 time(s). Last edit at 10/13/2022 10:56AM by Kwilk.

How about you cool down and stop putting words in my mouth? I don't understand why you post data and then turn around and poo poo it. It's published in a reputable journal, so that says the authors expect the data to be taken seriously.