October 20, 2017

Should Patients and Doctors Consider Radio-frequency Catheter Ablation for Atrial Fibrillation to Be Ready for Prime Time — Share Your Opinion

A study of radio-frequency catheter ablation by the Agency for Healthcare Research and Quality (AHRQ) was one of the first government-mandated Comparative Effectiveness Research (CER) studies released. The report found that catheter ablation appears effective up to one year after the procedure, but more research is needed into longer-term success as well as the impact on stroke and with certain populations. In addition, we need to know whether patients can have catheter ablation for afib as their first treatment rather than waiting for medications to fail before considering it. If you’re thinking about getting a catheter ablation, this report holds a wealth of information for you.

Read:  Is Radio-frequency Catheter Ablation for Atrial Fibrillation Ready for Prime Time with Patients and Doctors — Share Your Opinion

After you have read the article, please come back here and add your comments below for our discussion at the AHRQ conference on 9/14/09.

Comments

  1. I’m a 35 year old athletic male and have had Lone A-fib episodes for 5 years now. My first afib episode was in 2007 after having too much caffeine (Lasted about 5-6 hrs). I didn’t have another episode until 2010 but now it’s coming more often. My triggers are caffeine, alcohol-dehydration, drinking anything cold during exercise, adrenaline, stress and exercise. I am now on Flecainide 50 mg 2x daily and I am back to Exercising after 3 months off. It seems to be helping me stay in Normal Sinus Rhythm but I’ve only been on the med for less than 2 months and have gone into Afib once after exercise while I drank a cold drink. I think we, in order to better relate our experiences with one another, should categorize ourseleves as having Lone A-fib, or Afib caused by underlying heart issues. Personally, knowing now that there is little evidence on the effect of the procedure on Stroke I’m leaning towards not having an ablation done.The procedure is expensive and is not a guarantee fix. If my doctors could help me figure out my success rate and if it’s fairly high, then I’m likely to do the procedure. I thought by now there would be a formula for assessing the success rate of a patient considering cardiac Radio Frequency Cather Ablation.

  2. Goodness me Marsha, how are you now??

  3. July 10, 2011
    Hi: I am so sorry to hear about everybody’s problems with their heart. I started to have my problems about 2000 when my heart would go into beating too fast. I was told by a doctor to take T3 along with my T4 for my thyroid to lose weight. Evidentally it was not approved by the FDA to take both together. The doctor also did not lower the T4 enough to possibly let it work. I went to the emergency room because of chest aches and had my levels of thyroid levels checked and it was at 7.5 on the TSH when it should have been 2 or 3. They told me to cut it back but a week later my heart started to feel like I was having a heart attack. I ended up having a lot of tests and it turned out I did not have a heart attack. I also didn’t have any plaque or blocks either. After I went home I started having a lot of irregular heart beats. In about 2000 I went for an electrophysiology study and thought the doctor would fix the AFIB that kept coming back. Although the charge was almost $100,000. for it he said he couldn’t get it to stay enough to tell where the problem was. It seemed to get worse when I was upset. I also had fibromyalgia and was taking skellaxin for it. It seemed if I took it my arrithmias didn’t start up. I wasn’t too bad until 2006 when it started bad again. This time it would go from a flutter to AFIB. I went for what I thought was radio frequency ablation to fix it. However after the same doctor finished he said I fixed the flutter but I didn’t have a tool that could go deep enough to fix the AFIB. I was shocked, if I had known he didn’t have the tool I’d never have had it done the second time. The first time he tried to fix it he lead me to believe he was a specialist in AFIB. He then sent me to several doctors near Plano. One said if I got thin he could go in through the side and not have to do open heart surgery to fix it and I’d have an 85% chance of it being fixed. The next doctor towards Dallas said where he worked they had the right tools but their imaging was not as good as where I had gone to the last hospital and he didn’t think I’d have a 50% chance of it being fixed. I also visited a doctor in Houston and he said the only way to fix it was really to open the chest up in open heart surgery. He said he wouldn’t do that unless I needed a valve replaced. Finally I found another doctor that was supposed to know how to do the radio frequency ablation. This was a mistake, the hospital overdosed me on the anesthesia, I needed a celiac diet and until the day I left they either didn’t bring me anything to eat or brought a sandwich I couldn’t eat because I am allergic to wheat. The nurse in the recovery room wouldn’t bring me anything I needed and told my husband I didn’t need a call light. I could not talk because she had left the breathing tube in for 2 days. She told my husband that she wouldn’t take it out at night as no doctors were there to help and she didn’t want the responsibility to take it out. I finally waved people passing by down and got a pen to write a not saying to fire the nurse and call the doctor. Immediately she moved to a regular room where the nurses were great. One went to get me some food as I had not eaten in three days and it was 4:30 in the afternoon. I realized my metropolol was 25 mg 2 times a day. My lung doctor said my lungs were not that bad and they had to have over dosed me with the anesthesia. When I was able to I went for a brain test that showed very little alpha waves on it. I was being over dosed on the dosage I was on and evidentally the surgery doctors didn’t check the brain waves to know. I very slowly cut the dosages to 121/2 with an extended release metropolol one time a day and I was good for 3 months or so with my heart beating regular even on that lower dose. When I woke up I asked my husband to look at my back as it was hurting very badly. He couldn’t believe it, evidently I was burnt by the grounding board with 3rd degree burns. It will be 2 years this August and it’s still not healed right. It still peels and bleeds and has very deep scaring down in the tissue for maybe 3 inches. I could walk before this burn but from the day I left the hospital I couldn’t do good as my legs seemed weak like they had nerve damage or something. When I couldn’t get any answers from the doctor about how I got burned, all he said is I was the worst case he’d seen being burned by the grounding board. I slowly have lost the ability to walk and can’t stand more than a minute because of all over pain, not just in my knees that have been affected with degenerative joint disease but the whole legs and the back. When I went to a new doctor he said he believed the burn was a radiation burn. I hadn’t been treated for a radiation burn even at the burn unit of the hospital where I was burnt. I’m also trying to level off my diabetes because after I was put on a beta blocker they put me on insulin. Now I have to take 4 shots of insulin a day. I’m too heavy for safe knee replacements and I’m at my wits end. I finally tried atenolol to see if my memory would get a bit better as since this all happened I have to struggle with some short term memory problems and feelings of depression I never had before. My current heart doctor thinks I might get the heart arrithmia fixed but he doesn’t think I’ll ever be able to stop taking beta blocks to keep it beating right. They seem to affect me feeling tired all the time and other problems. Maybe it’s really the radiation that’s caused some of these problems. I’ve had to spend nearly $2,000.00 on fixing my teeth even though before this I’d not had a cavity in 25 years. It seems something is making my mouth dry and causing decay. I have to use special flouride tooth paste every day to try to fix this problem. I can no longer even carry a gallon of milk in so I have to have help all of the time. I thought I had a lawyer to help win something from the hospital and I did all the paper work for months he wanted done. When he found out a Senator was not elected again he then withdrew from helping me. Their office had helped me to find a lawyer becuase of the tort laws no lawyer will now take a mal practice case in Texas because they say paying for an expert witness can cost $100,000.00 and the law doesn’t allow them to make any money so they turn down 30 or 40 cases a week because it’s not profitable enough to them. The lawyer thought maybe the senator could help change the law. I even tried to report it to the better business bureau but they won’t even list a malpractice problem in their office. I only have 3 weeks left to find a lawyer because of the 2 year limit on a law suit.
    Does anyone have any information on how I can collect something for damages for this burn some other way? The hospital wouldn’t even give me tape for the bandages which had to be changed 3 and 4 times a day for months, and the nurses who came to help couldn’t get any I could use until the very end of their coming to visit.I feel my life is a real mess because I can’t stand to do anything hardly at all although I won’t give up trying and believing God will help me.
    I don’t want everyone to give up on doctors but try to find a really good doctor that you can trust and that cares more about people than the money he’ll get for the surgery. I have many other doctor issues and so forth I could write about but feel I’ve taken up to much space no. God Bless you all.
    Marsha

  4. OK, I had a crazy fast palpitation when I was about 19 years old after slamming 2 mountain dews when I had a hangover from alcohol. I didn’t know what the heck was going on, my heart was beating so fast and so hard.

    I panicked, which fed it, and it lasted about 7 minutes. You never forget your first one.

    Then, 5 years ago, I started getting them directly out of sleep. Of course I panicked, I woke up twice with a HR of probably over 220 bpm. The second time I went to the ER.

    I have, in general, slowing and raising of heartrate throughout the day. Last night, I woke up with palpitations of (I assuming) around 160 bpm. I did not let my panick get out of hand and I just let it pass. It took 10 minutes.

    I’m reconsidering ablation, but the truth is that alcohol and dehydration was probably the cause for each out of sleep attack. Caffeine also seems to make it worse, even 1 cup of coffee is probably too much.

    I don’t think I’m going to go ahead with anything at the time. I can still exercise, and in my case, the stronger my heart, the less problems I have.
    This has been a scary thing, but I may be able to get through life without ablation.

    This condition is said to very rarely be fatal.

    Is there anyone else who is in my shoes and doesn’t have it quite bad enough to take the risk of complications and ineffective procedures?

  5. cathy wassmann says:

    i was diagnosed with atrial flutter… i am 43 yr old healthy female… i am on metatoporol 12mgs i get constant flutters which i thought was anxiety with having 4 kids and a crazy life… the doctor wants to do catheter ablation.. what should i do?

  6. Pamela Hunter says:

    Thanks for all the posts here. I have been dealing with episodes of AFIB for 12 years. I was cardio-verted once and placed on Rythmol which helped for a while until the AFIB returned about twice a year. I started to experience body aches after being on the Rythmol for several years and requested a change in meds. The doctor placed me on Fleccainade and immediately the body aches went away. I have been on the Fleccainade for 4 years and still have AFIB occurances, the latest were 3 times within 2 months. Yesterday I went to the doctor and we discussed ablation. I am worried about the risks as well as the AFIB returning. Any words of wisdom are appreciated.

  7. Loren,
    Thanks for sharing your experieince. I’m 48 and been dealing with Afib since a heart attack in 2008. I’ve tried several medications, failed the Sotalol and currently take Multaq. I’ve been cardioverted 5 times and had 1 ablation two months ago. I still go into Afib about once per week, but convert on my own after an hour or two. My question is whether of not to do the second ablation??

  8. Well after reading this thread i just thought I would share my expeirence with A-Fib. Well in 2004 i was diagnosed with a fib. we went though all the meds and was on warfrin for years. then i had a cardio version wich was a waste of time.. Then it was ablation time. The abalation was successfull in fixing the a fib but in the middle of the procedure my Dr nicked the back of my heart. So i started bleeding from my heart into the paracadial sac wich constricts the heart from beating. basically i was dying quick. the only way to fix this issues was to crack me open and stich the hole .. went from one week recovey time to three months. My abation was performed on 10-7-07 and i went back into a fib 11-14-10. so it lasted 3 years.. im scheduled for the next one in two months and yes im willing to risk it all to be rid of all the meds and dr visits.. especially getting INR checked weekly. Oh and BTW im on a new replacement for warfrin called Pradaxa which doesnt require the insessant finger prics just two pills a day..

  9. I am so upset and don’t want to live like this. I am 10 years of torture. In 2001 I was diagnosed with SVT and lost down to 98 pounds and the doctor had no idea why. I had surgery for the SVT and it stopped the SVT but I continued to have what I call “speed ups”. For 10 years I experienced a lot of heart irregularities hitting the emergency room after the initial ablation and steadily it got better. However, I would have speed ups during the night and I would pop a pill or call the emergency room if it got too high. Now 10 years later I start experiencing AFIB after a lot of stress and overworking in my life. In and out of the emergency room every week and a 1 day stay in the hospital. I had the AFIB ablation and the doctor does not tell you all the after symptoms that you will experience from tightness in chest and feeling of burning in chest for close to 2 months. Very uncomfortable. Now to top it off 3 1/2 months later post ablation, I am having accelerated heart beats where they will get as high as 120 and mostly waking me up out of a deep sleep. I find that I am snoring more as well. I did not do that as much. I at times feel uncomfortable feelings in my chest as well. I don’t know what to do. Please can someone tell if they experienced anything like this. I don’t know what to do. I am so over this. My husband has lost his job and I am the sole supporter of us right now and I just can’t take anymore of this. I need some relief and so far it seems to be turning in another direction.

  10. Bradley,

    It’s definitely important to get enough water – soda, coffee, tea, and juices, aren’t a substitute for water.

    The most important thing you can do to achieve success at catheter ablation is to make sure you have the most experienced electrophysiologist you can, one who does hundreds of ablations each year with good success rates and low complications rates.

    Good luck.

    Mellanie

  11. Wow, now I don’t know! I am a 58 year old male, with A-FIB, and have scheduled ablation for January 25th, 2011, since the medication does not seem to work, I will go into A-FIB about once every 12-16 days. After reading these comments, I don’t know about this procedure. I sometimes think it is a mineral deficiency and dehydration. I do not drink a lot of water on a daily basis, I do not drink much alcohol or coffee either. Maye one soda a day. Heck I don;t want to make this worse.

  12. My husband was diagnosed with A-fib back in 2002 when he was 23 years old. He is 6’1 and very athletic. Now 8 years later still dealing with it back n forth and finally a doctor said this is too much for your age and decided to refer us to a doctor in Abbot, Mn. We are still awaiting the phone call for appointment which we will be talkin about the ablation procedure. His first episode came upon pretty strong but we mostly blamed it on the drinking because he did like to party. So then they told us he had to be strict with his diet and pretty much quite drinking. So he worked on it and 6 months later it happened again. Well, he wasn’t drinking this time so now the doctors said stress and caffeine. Okay so then 2 years later it happens again, and this time they do the cardioversion on him. Put him on some more meds, had an angiagram done, and all the lab work. Again it happened in 2007, and cardioversion was done. Now this year it happened 3 times in less then 6 months and that’s when they finally said, lets do something about this. I was so angry because I had done research and I knew what options he had but noone would recommend it, or say anything besides keep taking his meds. Now this last doctor we’d seen in Thief River Falls, Mn said there was a good doctor in the cities that can help us out because aparently all these other doctors keep saying the same thing. But by the sounds of an ablation being done, I am concerned? Many on here make it sound like its a bad idea. What should we bring up to the doctor’s when we do see him? Any questions you guys think I should ask or suggest?

  13. foin morrison says:

    i’m 30 years old, 6’3″ and 225lbs. i had a low heart rate of 38 bpm and 40 premature ventricular contractions per minute. i had my first oblesion surgery in january of 2010. for the next three months after that, i didn’t do much but lay around the house, and go for short walks. exactly three months later, i went back to the cardiologist for a follow up, and the EKG showed i was bigeminy. he set me up for another surgery about 2 weeks later. i just got out of the hospital last week. i’m constantly having chest pains now, and i keep telling my wife, as far as my chest pains and fatigue, i feel worse now then i did before the second surgery. i keep telling the cardiologist this, but he says it’s just because of the surgery. i did talk to a VA cardiologist at the VA hospital, and he told me that a second abletion surgery that quick is highly risky, cause my heart hasn
    t had the full time to recover. so now, i’m second guessing my cardiolgist. i have talked with my family doctor about it, and he’s just floored why they don’t do a pacemaker. i’m 30 years old with a 10 year old and 4 year old at home. i’m tired of being tired and in pain and able to do the things i used to do. i’m wondering if anyone has any opinions on the problem, as in should there have been a second surgery within three months, and if the surgery is sucessful, is it sucessful permantly?

  14. I was diagnosed with Afib back in Late November 2009. Had it regularly. Occassional high heart rate and definite irregular heartbeats. I personnaly believe it came about due to heavy racquetball workouts and possible dehydration. In any case, I was put on Metropolol at 25mg to control the rate and Rythmol 325mg twice a day. It worked but not the whole 24 hour period. I discussed a different approach with my Cardiologist and I asked if I could go with Rythmol 225mg three times a day or every 8 hours. Granted the dose would now be slightly higher at 675mg vs 650mg but it didn’t seem like the 325mg extended release version was getting me through the day.

    The end result is that I am pretty stable the full 24 hour period now. I had a very irregular heartbeat before and occassionally the rate would go to 120. Now my heartbeat is typically in the 60 to 65 beats/second range and the irregularities are minimal and controllable. By going to the regular Ryhtmol vs the extended release, my cost also went down from $83/ prescription refill to $5.00.
    What was a fairly scary situation is now under control but having said that, I know if I stopped the medication, I would go back into Afib fairly quickly. I have gone to U of M and they say I am a good candidate for Radio Ablation. Sounds good on the surface to think that one could get rid of this problem possibly for good. I must say I am a little discouraged regarding the lack of success experienced by some of the folks who commented here. The choice is to stay on the medicine regime that works for me or take a chance on a potential fix. I am leaning towards the ablation as the chances of the meds working for the rest of my life are probably not good.(I’m 55).

    I will say that I do believe taking a good one a day vitamin that has magnesium in it has helped me as well as staying well hydrated. Magnesium seems to help with the electrical conductivity. This has been my experience.

  15. George,

    I’m glad your father’s mini maze was successful. Mine was as well, having been afib-free for over 4 years now.

    Good luck to him.

    Mellanie

  16. My father had atrial fibrillation ablated surgically in Chicago area by Dr. Piluiko. He had additional afib after surgery for 1 month. Since then he has no afib and now is off coumadin and all drugs. It seems that mini Maze procedure is more painfull, but it also more effective. he has small incisions on his chest and doctor applied burns on his lung veins. We went through whole lot of research before we decided to go for it.We heard a lot of stories about safety of percutaneous ablation through groin, but it has a lot of complications- stroke, death and low success rate.

  17. Joseph Reitmeyer says:

    I am 58 years old and I’ve had A-Fib since 2003. I’ve had 13 cardioversions and 4 ablations. My last ablation was September 2009. My A-Fib has become progressively worse after the last ablation. My heart rate has increased and now go in and out of A-Fib regularly. Medication had controlled my A-Fib before this last ablation. My family doctor advised me to not to go through with it. He told me to wait for new and better procedures that will offer better success rates. I did not listen and will now suffer for the rest of my life.

  18. Marie Ennis says:

    I am 50 years old and in generally good health, regular excercise, but high stress work/life (NYC); no family history of heart problems. I went to the emergency room in December 2007 with Afib. Initially I had night time Afib, mostly while sleeping. I tried Metropolol; then Atenolol and Lanoxin; then Multaq and Lanoxin; at this point I am having Afib and Aflutter twice a day for 15 minutes to four hours at a time and it is taking its toll. Today I picked up a new prescription for Sotalol but I am not overly optimistic and I really don’t want to be on meds forever. A friend had ablation at the University of Pennsylvania several years ago (he had persistent Afib) and he feels satisfied with the improvement, but the benefits seem to diminish over time as the heart “heals.” I have mentioned ablation to my cardiologist but he wants to try the Sotalol first. I feel like no one really knows what is best; I wish I could contribute something more positive!

  19. Sandy in Denver says:

    I had a valve replacement in Dec 2006. The following july, I began going into Afib and Aflutter and would have to be cardioconverted out. This happened 7 times in a 6 month period. I tried every kind of rhythm medication and finally got on sotolol…which I hated. that and the coumadin…nasty. I am too young for amiodarone. I finally had an ablation from Dr. Andrea Natale formerly of the Cleveland Clinic…now out of St David’s in Austin. I had to stay on all meds for another 4 months until the heart healed…then off the sotalol. After another 4 months, I got off the coumadin. That was January of this year. About July 4 of this year, I got into Aflutter and need cardioconversion. I truly believe that being dehydrated brings it on. I make sure I am hydrated and hope that it does not happen again.

  20. marvin resnick says:

    Age 81 soon to be 82. Heart medicine makes me weak – cardizem and digoxin. Considering ablation.
    A bit afraid. Have friend says “do no harm”. Gives me articles “complications of catheter ablation: incidence and predictors”. From eClips Consult. http://www.eclips.consult.com/eclips/article/Cardiology/S0145-414.
    What should I do?

  21. I’ve had this procedure twice, about six months apart, and neither of them helped. In fact, the first one made things worse. I was in uncontrolled A-Fib for two months until I had a cardioversion, which didn’t return me to regular rhythm for more than about two hours but at least I was in controlled A-Fib and felt a lot better.
    I’ve had chronic persistent A-Fib for I guess about 5 years now and am still looking for something better. I know I won’t go through another ablation. I might be willing to try the Convergent Ex-Maze sometime down the road, but I think it’s still too early to tell if it is really effective.

  22. I am 56, very physically active, weigh 106 lbs, and feel great, but I have AFIB. My attacks use to occur about every 4 months. About 8 weeks ago, I had an ablation. The first 3 weeks I was doing great. Then the doctor told me that I could come off of the Toprol. About a week later, I started having little episodes lasting just a few seconds( acouple of times it lasted about 15 seconds). I am wondering if I should go back on the Toprol. Also, originally the doctor said that I could come off of the Coumadin after 3 months, but now I am not sure that he is still going to recommend that. My CHAD score is 0, so maybe. I am getting a little discouraged, b/c I am afraid that the ablation did not work. Maybe is is too early to tell though. Does anyone know if what is happening is normal? Is this common to have some of this 8 wks after an ablation? Any advice, comments or suggestions would be appreciated. Vicki

  23. I am 63, 6’1″and 193lbs.
    I am very active in racket sports and play in
    senior games in Arizona & California

    Before my ablation I could not tell when
    I went into afib or flutter.
    I also had stress test and nuclear stress tests
    where during that time I did not go into afib or flutter.

    I had an ablation for afib/flutter on July2/09.
    During the ablation everything sounded like
    it was going fine and then the doctor’s voice
    changed and he rushed out of the room to
    get a portable ultra sound machine and then
    he pressed hard below my chest, I guess to try and see my heart.

    Has anyone heard of a Dr.doing this ?

    It has been 2 months since my ablation.
    I had a stress tests and my heart went into afib & flutter

    I work out at the gym and it seems if I get my heart rate above 85 it will go into afib or flutter.

    At this point I am not very pleased with the results of the proceedure.

    I am trying to be patient and waiting to see whats happening a month from now.

    The only meds I am on is :
    sotalol 40mg twice a day
    aspirin

  24. Jay,

    I have not had an ablation myself because my episodes have been two years apart. I have been in contact with two individuals one has had one ablation and the other one has had two. Both of them are in their second to third year without another episode so you should be fine.

  25. Jay,

    I’m sorry for what you’re going through. Yes, it does take several months for the heart to totally heal after ablation, so it’s not unusual to be on medications for a few months afterwards to make it easier for the heart to heal.

    This report, from the Agency for Healthcare Research and Quality, is not saying that an ablation is only good for a year – it wouldn’t be worth it for just that. What the report is saying is that for many of the studies there is only data out for 12 months following the procedure and that we need more long-term data. Newer studies are capturing longer time frames, which will be reflected in future reports. Ablations are still so new that we don’t know how long they can last.

    Mellanie

  26. Jay Markstrom says:

    I have just had my second ablation. The first one was two years ago and did not work. I have been assured there is a 90% chance of success on the second ablation. This is the success rate at Abbott Heart Hospital in Minneapolis, MN.
    I was out of options on drug therapy. I was on Amiodarone for 10 years, which worked, however one cannot stay on it without serious consequences. Other drugs were tried early on but were not effective.(I also have had an atrial induced stroke.) I am told it will take 3 to 4 months for the heart to heal thoroughly so I will not have a determination on success of the ablation until then. I have had breakthroughs since the ablation 10 days ago so I am now back on Amiodarone just to get through the healing process. I am disappointed to read on this web site that
    an ablation, if successful, is only effective for about one year according to some reports. If that is really the case,RF cather ablation is not worth it.

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