Ablation to treat arrhythmias

[pem]

Hi. A family member has a persistent arrhythmia. It might be tachycardia. They tried cardioversion three times. The first two times it didn't stick and the third time it just wouldn't take.

So they are recommending ablation. Has anyone had good or bad outcomes with this? Also, how important is the facility or person doing the ablation to the outcome?

Thanks,
pem

 

[Terry45]

Hey Pem, I have had two cardioversions and an ablation. The first cardioversion was done while in the hospital to reset my rhythm and lasted about a month. I woke up the Saturday before Labor Day with a heart rate of about 145bpm. I went to the ER and ended up staying in the hospital for four days while waiting for another cardioversion procedure. My cardio doc was pretty sure that the flutter and heart rate would return and advised me to get the ablation done. He had me wait another 60 days to allow my heart to recover and get a little stronger. I had the ablation done on 27 Oct and have had no real problems since. I have had some pvc's and a few skipped beats here and there but no real flutters or afib episodes. The ablation appears to have worked well.

The procedure wasn’t painful and I had no issues. The prep in the OR was a little scary, it is very cold in the room and you are pretty much naked. They did put body warmers around most of my body but the center was very cold. They prep you for the worse in case your heart stops "just in case". My cardio doc and the hospital staff were great. The OR staff and I joked, cut up and laughed all the way up until they knocked me out which really helped ease my mind. I had to lay fairly still in recovery for three hours after while the arteries healed up. I had talked with my cardio guy a good bit about the procedure and was very comfortable with him and ablations are his specialty. He specializes in the electrical part of the heart. I think the person and the facility are very important. Every bit as important ant as your surgeon and you should be comfortable with him. I hope this helps and good luck!

 

[kfay]

Pem, I've had 3 ablations. The first one was a very, very long time ago when they still had to do them through OHS and actually cut the area that needed to be ablated. That ablation actually worked extremely well and stopped that particular arrhythmia to this day. I then had two more ablations about 4 years ago after my second OHS, with somewhat mixed results. The first ablation wasn't successful at all, hence the need for the second one. That one was more successful that the first one, however, it wasn't 100%. Having said that, my rhythm issues were very complex and difficult to track down, so that outcome would not probably be the norm for a first timer with no scar tissue in their heart, etc. I wouldn't hesitate to go back for another ablation if a situation arose that called for it.

I definitely wouldn't let just anyone do an ablation on me. It's just like heart surgeons, some EP's are used to doing more of a certain type of procedure than others, so I would make sure that they have experience treating this type of issue that your relative has. At my local clinic, there are several EP's, but my congenital cardio won't let any of them near me because he says they just don't have the experience to take care of my issues, that they mostly only deal with elderly people who need pacemakers or who have a-fib, so I traveled for my ablations just like I did for my surgery. Luckily, this clinic just recently hired the EP from the Mayo clinic who did my last two ablations, so he is now here so I don't have to travel if I need another.

Kim

 

[Madsometimes]

I had an ablation for typical flutter, which has been fully successful.

My cardiologist had already put a pacemaker in my heart, so he was confident that the procedure would be quick and easy because he had already treated me. My ablation was done under local anaesthetic, and was over from start to finish in less than one hour. The wires were in my heart for about 10 minutes only. I had been pre-warned that I may feel a burning sensation during the treatment, but I felt nothing at all. The only uncomfortable part was the when the local anaesthetic was injected into my groin. I was observed for about five hours on the day ward, and then went home. Since I had been in flutter for over 6 months, I felt marvellous straight away. I found resting for a few days quite difficult because I just wanted to run about.

The flutter that I had responded particularly well to ablation therapy. I know that other conditions, such as a-fib are less easy to treat by ablation.

 

[pem]

ablations are his specialty. He specializes in the electrical part of the heart. I think the person and the facility are very important. Every bit as important ant as your surgeon and you should be comfortable with him.

Hi Terry,

This is great information - thanks. Glad the ablation solved your problem!

Best,
pem

 

[pem]

I then had two more ablations about 4 years ago after my second OHS, with somewhat mixed results.

At my local clinic, there are several EP's, but my congenital cardio won't let any of them near me because he says they just don't have the experience to take care of my issues, that they mostly only deal with elderly people who need pacemakers or who have a-fib,
Kim

Hi Kim,

Thanks for sharing your experiences. In what way were your results mixed? Have you done anything else to address the mixed results over the last four years, or just lived with them?

I think the purpose of this one is to address a-fib, so I wonder if that means it isn't quite so critical to go to a place like Mayo or Cleveland-? What do you think?

Thanks again,
pem

 

[pem]

I had an ablation for typical flutter, which has been fully successful.

I know that other conditions, such as a-fib are less easy to treat by ablation.

Hi Madsometimes,

Thanks for your feedback on this. So glad it worked out for you!

From what you wrote it sounds like the ablation was done using a catheter - is that right? If so, do you happen to know if it was venous or by artery?

Also, do you think an ablation procedure to treat a-fib would be done as an outpatient or inpatient procedure?

Thanks again,
pem

 

[kfay]

Pem, The second ablation just decreased the frequency of my rhythm issues, not stop them. I lived with them for another 2 years after that last ablation without doing anything, but then finally went on Flecainide for about a year which completely controlled them and then when I went off of it, it was like magic, they didn't really come back!

Ablations are done using a catheter, they can go in through the groin, neck, or wrist. In my case, they needed both sides of my groin and my neck. Although technically considered "outpatient", I did spend the night in the hospital each time I had it done. I don't think that a trip to Mayo or CC is warranted for an ablation, but I would want to make sure the person doing it had done quite a few, what their success rates were for a-fib, and if their clinic had the latest 3-D equipment that is supposed to make it more precise (see the article below).

I do know that ablations for a-fib are less successful that ablations for other types of rhythms issues. My own local cardio has had his mitral valve repaired and is in and out of a-fib a couple of times every day. He has tried several meds for it, and when I asked why he didn't have it ablated, he said because it wasn't very successful.

Here is a good article you might want to read that talks about ablating a-fib and the issues with it: http://heartdisease.about.com/cs/arrhythmias/a/ablateafib.htm

Kim

 

[Madsometimes]

My ablation was venous, accessed through the femoral vein.

The cardiologist I see specialises in ablation, and the hospital I had it done at is known for its electrophysiology. Success rates for flutter are about 97%, but for a-fib it tends to be in the 80-85% region even for experienced operators. So worth a go, but harder to get a good result, and the treatment can take several hours.