Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)
1. Heart Function: “Does this burning and scarring during the ablation procedure affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?”
Related question: “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.”
2. Radiation: “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I’m worried about radiation exposure.”
3. Condition of Heart: “What is an enlarged heart? Does it cause A-Fib? I was told I can’t have a catheter ablation because I have an enlarged heart. Why is that?”
Related question: “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?”
Related question: “I have a defective Mitral Valve. Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?”
4. Age: “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?”
Related question: “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?“
5. Blanking Period: “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”
Related question: “Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?”
6. O.R. Report: “I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?”
7. Procedure Length: “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?”
8. Clots/Blood Thinners: “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin, an NOAC or aspirin?”
Related question: “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. Afterwards shouldn’t there be even less need for a prescription anticoagulant rather than more?”
Related question: “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?”
9. Exercise: “I’m having a PVA and I love to exercise. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?”
10. Non-PV Triggers: “Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib?
11. Heart Rate: “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”
12. The Bordeaux Group: “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?”
13. Cure? “I have Chronic Atrial Fibrillation. Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?”
Related question: “I’ve read that an ablation only treats A-Fib symptoms, that it isn’t a ‘cure’. If I take meds like flecainide which stop all A-Fib symptoms and have no significant side effects, isn’t that a ‘cure?’”
14. Tech Advances: “I’m getting by with my Atrial Fibrillation. With the recent improvements in Pulmonary Vein ablation techniques, should I wait until a better technique is developed?”
“I’m 80 and been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?”
With Chronic A-Fib of long duration, perhaps not. Although a few centers get very good results when treating Chronic A-Fib even of long duration (the French Bordeaux group achieves an acceptable success rate after 2 ablations), most centers have a success rate of only around 50% for Chronic A-Fib. And although catheter ablation is a low risk procedure, there are still risks.
Many centers won’t ablate patients who are over 80 years old or in Chronic A-Fib for over a year. There is a higher risk of complications in older people, and it is more difficult to ablate Chronic A-Fib. (In Chronic A-Fib there are often multiple spots in the heart producing A-Fib signals. It’s hard to identify and ablate [isolate] them all.)
The Positive Side of being in Chronic A-Fib: Sometimes people feel relieved to be in permanent A-Fib. There’s no longer the fear, uncertainty, and shock of an A-Fib attack. You can adjust your lifestyle to how your heart behaves, because it doesn’t change much. You may be short of breath, somewhat light headed, tired, and unable to work or exercise hard. But you get used to it. You may even feel better than when you had Paroxysmal A-Fib. In addition, an ablation may be only partially successful and have the unwanted consequence of putting you back into Paroxysmal A-Fib.
You still need to take blood thinners to prevent an A-Fib stroke. But if you get the Watchman or Lariat device installed (very low risk), it closes off your Left Atrial Appendage where 95% of A-Fib clots originate. It’s then possible to go off of Coumadin baring other risk factors for stroke.
The Negative Side of being in Chronic A-Fib: The down side of being in Chronic A-Fib is your heart forever and always will not pump properly. Blood flow to your brain and other organs is reduced by about 15%-30%. This can lead to conditions like dementia and Alzheimer’s. (If you are a superior athlete like a bicyclist or runner, your exercise may overcome this reduced blood flow.)
A-Fib is a progressive disease. It tends to get worse even in Chronic A-Fib. Your atria expand and stretch. Your ejection fraction diminishes. Chronic A-Fib produces fibrosis and collagen deposits which stiffen the heart and make it less flexible. All this leads to conditions such as Congestive Heart Failure and Cardiomyopathy
But please weigh the above statements carefully (the author is concerned that they may create unwarranted fear). How do you feel? If you don’t feel any symptoms and your doctor says your heart isn’t enlarging and/or developing poor ejection fraction, etc., then there’s no need to rush out to get a Pulmonary Vein Ablation which does involve real risk.
The Bottom Line: You can be cured of Chronic A-Fib, even at your age. But it will take at least 2 ablations. And it won’t be easy finding a doctor to do it. (There is a short list of doctors at Specialists In Persistent/Chronic A-Fib. You need someone with a proven track record in ablating Chronic A-Fib.) However, an ablation is more risky at your age.
On the other hand, you can live in Chronic A-Fib. Many people do. The key to living a satisfying life in Chronic A-Fib may be good rate control. For example, a resting heart rate of around 80 beats per minute with an exercise rate of 110 is very close to that of a normal person. People with good rate control of their Chronic A-Fib report a good quality of life and seem less prone to develop other heart or mental problems.
What this Means to You: Are you happy or content with your quality of life in Chronic A-Fib? If so, then the added hassles and risks of an ablation are probably not worth it for you. Only you (and your doctor) can decide if it’s better to spend your twilight years in a perhaps reduced but satisfactory quality of life.
• Haines, D. “Atrial Fibrillation: New Approaches in Management.” Un. of Virginia multi-media presentation, 1999, p.6.
• The Link Between Infections in Heart Disease. Life Extension Vitamins. Last accessed Feb. 16, 2013. URL: http://www.lifeextensionvitamins.com/cadico6otco.html
• Peykar, S. Atrial Fibrillation, Cardiac Arrhythmia Institute. Last accessed Feb 16, 2013. URL: http://caifl.com/arrhythmia-information/atrial-fibrillation/
• Heartscape: The Heart’s Structure. Last accessed Feb. 16, 2013. URL: http://www.skillstat.com/tools/heart-scape.↵
• Elias, MF, et al. Atrial Fibrillation Is Associated With Lower Cognitive Performance in the Framingham Offspring Men. Journal of Stroke and Cerebrovascular Diseases, Vol. 15, No. 5 (September-October), 2006: pp. 214-222. http://www.ncbi.nlm.nih.gov/pubmed/17904078
• Bunch, J. J., Weiss, P. P., & Crandall, B. G. et al. Atrial fibrillation is independently associated with senile, vascular, and alzheimer’s dementia. Heart rhythm, 2010:7 (4), 433-437. URL http://dx.doi.org/10.1016/j.hrthm.2009.12.004
• Camm, “Clinical Relevance of Silent Atrial Fibrillation: Prevalence, Prognosis, Quality of Life, and Management.” Journal of Interventional Cardiac Electrophysiology 4, 369-382, 2000, p. 373-376. http://www.ncbi.nlm.nih.gov/pubmed/10936003
• Un. of Utah Health Sciences, Atrial Fibrillation FAQ, What is Atrial Fibrillation, Risks. http://healthsciences.utah.edu/carma/forthepatient/faqs.html, heart weakness, heart attacks, etc.
• Benjamin EJ, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998 Sep 8;98(10):946-52. Last accessed Nov 22, 2014. URL: http://circ.ahajournals.org/content/98/10/946.full.
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FAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues
Coping with your Atrial Fibrillation means a patient and their family have many and varied questions. Here are answers to the most frequently asked questions about dealing with the day-to-day issues of having Atrial Fibrillation. (Click on the question to jump to the answer.)
1. Specialist: “I like my cardiologist, but he has not talked about me seeing an Electrophysiologist [heart rhythm specialist]. Should I ask for a second opinion?”
2. Forewarning? “Is there any way to predict when I’m going to have an A-Fib attack?”
4. Progression of A-Fib: “How long do I have before my A-Fib goes into chronic or permanent A-Fib? I know it’s harder to cure. My A-Fib episodes seem to be getting longer and more frequent.”
6. Medical Marijuana: “Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?
7. Action Plan: “During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. I need a plan.”
Related Question: “When my husband has an Atrial Fibrillation episode, what can I do for him? How can I be supportive?”
Related Question: “In case I have a stroke, what does my family need to know to help me? (I’m already on a blood thinner.) What can I do to improve my odds of surviving it?”
8. PVC/PACs: “I have a lot of extra beats and palpitations (PVCs or PACs) They seem to proceed an A-Fib attack. What can or should I do about them?”
9. DIY Monitors: “What kind of monitors are available for atrial fibrillation? Is there any way to tell how often I get A-Fib or how long the episodes last?”
Related Question: “My mom is 94 with A-Fib. Are there consumer heart rate monitors she can wear to alert me at work if her heart rate exceeds a certain number?”
10. Heart Rate: “Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib, but I don’t always have a rapid heart rate.”
Related Question: “My doctor says I need a pacemaker because my heart rate is too slow. I’m an athlete with A-Fib and have a naturally slow heart rate.”
11. Circulation: “Is there any way I can improve my circulation? I feel tired and a little light-headed, probably because my atria aren’t pumping properly. Is there a way without having to undergo a Catheter Ablation (poor success rate and risky at my age) or Surgery (even more risky)? I am in Chronic A-Fib. “”
12. Hereditary A-Fib: “Both my uncles and my Dad have Atrial Fibrillation. I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”
13. Treatment choices: “How do I know which is the best A-Fib treatment option for me?”
Related Question: “In one of your articles it said that having an ablation was better than living in A-Fib. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.”