Atrial Fibrillation...Should We Worry

[brianleach]

You may be right Jonathan.

I just read on the GCN+ website "Sagan subsequently underwent an ablation procedure to correct arrhythmias in his heart"

Perhaps I put 2 and 2 together and got 5 but I still think 2 ablations isn't a good sign.

[axel_knutt]

lying on my left side makes it a lot worse

Very common.

In the days when I could shrug off my AF I didn't take much notice, but since my AF got much worse in 2020 I've had to sleep on my right side only for about the last two years because it's completely intolerable otherwise.

I still think 2 ablations isn't a good sign.

It's fairly common to need 2 or even 3 for AF, and then a PVI is only about 70% successful IIRC. On the other hand, a CTI for atrial flutter is much quicker, simpler, and higher success rate though.

[brianleach]

Perhaps I am basing this too much on my own experience. I was only offered 1 ablation and my cardiologist expressed some surprise that I had stayed in SR for longer than he expected after that ablation.

Hopefully Mr S will be able to compete again but I think we are talking about a completely different level of stress on the heart for that but again I may be wrong.

[axel_knutt]

I was only offered 1 ablation and my cardiologist expressed some surprise that I had stayed in SR for longer than he expected after that ablation.

I was offered an ablation for my AF ten years ago, and I'm still waiting for it.

[brianleach]

I was offered an ablation for my AF ten years ago, and I'm still waiting for it

I believe it is a very expensive procedure so with the present state of the NHS that does not come as any surprise sadly.

[Jdsk]

I believe it is a very expensive procedure so with the present state of the NHS that does not come as any surprise sadly.

The current (!) cost-effectiveness analysis from NICE:
https://www.nice.org.uk/guidance/ng196/ ... 6949243734

Jonathan

[brianleach]

Thank you but far too complicated for me Jonathan!

[Jdsk]

It's not an easy calculation because of the number of options and the ignorance about many outcomes, including avoidance of stroke.

Here's the bottom line:
The committee acknowledged that the NHS reference cost used for the catheter ablation procedures may not fully capture differences in resource use between the different techniques. However, despite further analysis to adjust costs and account for this, radiofrequency point‑by‑point ablation remained the most cost‑effective option, and other catheter ablation techniques are therefore unlikely to provide a cost‑effective use of NHS resources. Based on the economic model results the committee agreed that radiofrequency point‑by‑point ablation should be considered in people with symptomatic paroxysmal atrial fibrillation if drug treatment is unsuccessful, unsuitable or not tolerated.
https://www.nice.org.uk/guidance/ng196/ ... l-ablation

Jonathan

[brianleach]

Thank you for highlighting the salient part. I see they refer to radiofrequency ablations. I thought they used a laser. Perhaps that is the same thing as I am not a scientist. As I said I think it is unlikely I will ever be offered another one so I suppose it is academic.

[Jdsk]

Thank you for highlighting the salient part. I see they refer to radiofrequency ablations. I thought they used a laser.
...

No, that's a different technology. And that range of options makes decisions much harder. In this analysis they included:

2.1.1 Comparators
Twelve comparators were selected for the model:
• Antiarrhythmic drugs (AADs) (split into six comparators to allow for cross over to each
ablation technique outlined below if AF symptoms recur within first year)
• Radiofrequency point by point (RF PP) catheter ablation
• Radiofrequency multi-electrode (RF ME) catheter ablation
• Cryoballoon catheter ablation
• Laser catheter ablation
• Thoracoscopy
• Hybrid ablation (thoracoscopy and radiofrequency point by point catheter ablation)

Jonathan

[brianleach]

I didn't realise there were so many choices! I definitely had the laser catheter ablation option. It took me about a month to fully recover from the anesthetic!

[axel_knutt]

radiofrequency point‑by‑point ablation should be considered in people with symptomatic paroxysmal atrial fibrillation if drug treatment is unsuccessful, unsuitable or not tolerated

I can do nothing but sit in this chair all day and every day, it's ruining my life. That wasn't the case when they offered it to me in July 2013.

[brianleach]

I can do nothing but sit in this chair all day and every day, it's ruining my life

Sorry to hear this. Obviously your condition is far worse than mine as at least I can still do some local rides although I cannot go out with even the easy rides group locally as I need to go at my own pace.