Post Ablation questions

Just a question for those either considering an ablation or have had one. Has anyone experienced a worse condtion than before the ablation? I have heard some comments about aflutter. I would like to hear especially from those who have researhed the post ablation and or those that have had an ablation. Is your life truly better after an ablation (PVI)?


Thanks, as I am seriously considering having one done in January at the CCF with Dr. Tchou.

I had read somewhere in an archive that HANS would have one if Dr. Natale or some other world reknowned Electro Cardio Doctor would perform it. Hans if you read this, have you changed your mind about this or am I misquoting you?

Joe

Joe,
I had my ablation 7 months ago. Prior to the procedure I was in afib 90% of the time. I was on medications that I hated and had side effects. Other than the first week after the procedure I am afib free, off medications, and am living my active lifestyle like nothing happened.

Is my life truly better? You better believe it.

BTW, I was supposed to have Natale, but ended up with another doc that had done 150 procedures with Natale checking his work 2 or 3 times during the procedure (he was doing a procedure in the next room). the success rates for the doc that did me were comparable to Natale's.

Larry,
Thanks so much for your reply. I still would like to hear from some more.
Questions, before your ablation, did you feel tired before actually going into afib. We're you tired when you came out?
Did they tell you how much mapping they did of the heart area when you went in.
I know you say you feel great now, how much better is great. Are you back to where you we're before you starting having afib? How did you get afib in the first place...........I could go on and on Thanks for your post!
Joe

Larry,
Maybe you can also help Buster out, he is asking about other Doctors from CCF. Do you know the name?

Thanks,
Joe

Had mine a little more than 2 months ago.Life is better in many ways but I`m dissapointed in other ways.It`s a bit harder excercising and there are more than a few very weird sensations I`m having.Overall I`m still happy I had the procedure.I cant seem to wean off of the beta blockers.Anytime I`ve tried it`s been an uncomfortable experience..Good luck with your decision Joe.

Joe,

I am afraid you are really putting me on the spot here. However, I will try to outline my current thoughts on ablation.

- Whether or not I want to undergo an ablation is highly dependent on the frequency, duration and intensity of my episodes. When I am in the middle of a prolonged, intense episode hard on the heels of another one after only a 4 or 5-day respite believe me – I want an ablation – badly!!! When, on the other hand, I have gone 3 weeks without an episode and then experience one that I am lucky enough to terminate in 2 hours with the “on demand” approach, then I say, “Oh well, I can live with this”.

- I am not in a position to pick and choose who performs my ablation as I live in Canada. We certainly have excellent electrophysiologists here, but their equipment is no match for that used at the Cleveland Clinic or in Bordeaux.

- I have just completed the evaluation of the results of the September ablation survey of 59 afibbers who had undergone ablation. The overall success rate (no drugs, no episodes) was 54% with pulmonary vein ablation having a success rate of 62%. I noticed a very strong correlation between success rate and how recent the ablation was performed. Ablations performed in the period 2002-2003 had an overall success rate of 66% with PVA having a success rate of 68%, so there is no question that we still are on a fairly steep portion of the learning curve. Nevertheless, some EPs clearly have higher success rates than others. I will be discussing this further in the upcoming November issue of The AFIB Report.

- I am sure very few experiences can compare with that of being “given your life back” after a successful ablation. However, are people worse off after a failed ablation? 80% of the 15 unsuccessful afibbers who commented on this in the survey thought that their episode duration and frequency were the same or less than before the ablation. However, the average (median) episode frequency over a 6-month period in this group was actually 4 times higher than the median in our main database so this is a difficult question to answer.

- Yes, left atrial flutter can develop after an otherwise successful PVA, and so can stenosis of the pulmonary veins. Pam’s experience, of course, speaks for itself. Thanks to a generous fellow-afibber I now have a personal subscription to the 2 main journals for atrial fibrillation, “Journal of Cardiovascular Electrophysiology” and “Pacing and Clinical Electrophysiology”. Reading these journals makes it clear that there is still a lot of work to be done before ablation becomes a routine procedure with a 90-95% success rate and no side or after effects. As one EP put it, “We only have 4 or 5 years experience with PV ablation for atrial fibrillation so we really don’t know what the long term effects are”.

- There is a considerable amount of research going on in the medical community regarding ablation for AF. Cryoablation, for example, looks very promising as there is no problem with stenosis. New, very accurate mapping systems and miniature cameras are also being introduced and greatly facilitate the accuracy of the ablation.

- There is a considerable amount of serious research going on among contributors to this Bulletin Board. We are pursuing several different avenues that may eventually lead to a nutritional solution. At the moment I am increasingly convinced that a serious copper deficiency of long standing is my main problem and am already seeing remarkable improvements in my heart rhythm after less than 2 weeks of supplementation. Who knows? But than again, I distinctly remember being very optimistic about a possible solution before! Anyway, one thing is clear, lone AF is not caused by a lack of flecainide nor by the absence of strategically placed scar tissue in the left atrium.

- To make a long story short – if you can live with your afib, and this, of course, is a highly individual decision, then you might wait a bit longer before hitting the ablation table. If, on the other hand, you find your episodes intolerable, interfering with your work and career, and your quality of life is greatly diminished then I would say “Go for it!”, especially if you are able to arrange for your procedure to be done by a first rate EP

Hope this helps,
Hans

Hans,

I think your post on this subject is excellent. It parallels my own opinions regarding ablation for Lone A-fib. I very much would like to have all these problems behind me but will continue to wait awhile for further technology and history. Of course, if I start having problems on a weekly basis instead of a monthly or bi-monthly basis my decision would be up for reconsideration.

Hans,

Thank you for your straight forward answer. I am sorry if I "put you on the spot", but after reading your book and evaluating all of the material you have put out- plus reading this board for almost a year, I consider you to be the foremost authority on afib in this hemisphere.
Your scholarly approach to this malady is certainly more than enough to count as a disseratation in any academic environment and certailny would count as doctoral level work, perhaps you should consider it.... I know, I'm working on my disseration now, although it's in music and technology.
I did talk to Dr. Tchou about the cryoablation process. He told me that it would not be available at the CCF to use on humans for about 2 years. He also told me that the ultrasound ablations don't look to promising at this point. The Cryoablation process does seem promising. Dr. Tchou certainly calmed some of my fears about the ablation process, but I guess I'm looking for a guarantee that just can't be given.
My afib definetly is becoming bothersome in my career and more frequent, it is impacting my ability to teach effectively. I have scheduled an ablation with Dr. Tchou for sometime in January, but they haven't given me the exact date yet.
For now, like most here, I struggle with this decision, I am not so sure that I might change my mind. Thank you for the great work you have started here and your continued excellence with it.

Joe

Amen to that Joe,

Mike F.

I just want to add what Hans has mentioned about PVA's here in Canada. I read all the posts regarding CCF and Dr. Natale and all the other great EP's doing very successful PVI's there in the states. We can only wish for a Dr. Natale to be here in Canada doing so many ablations. Dr. Natale did his internship here in Ontario and its a shame he left as so many other great Dr.s do once they have completed their training here. Still we do have some great Ep's doing abaltions here in Canada and feel they can be pretty comparable in success rates has CC,just don't do as many PVI's due to our health care system. I'm on a waiting list now for a PVI in London, Ontario where they are doing great work by Dr. Skanes,only thing waiting list is about 1-1/2 years long. So to all our American friends you are very fortunate to have such great facilities such as the C.C. Thouh in a few years I feel most countries will be up to par with CC. All the best to all !

Frank
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