To ablate or not to ablate, that is the question.
There are approximately 1.4 million people with Atrial Fibrillation which is a major risk factor for strokes, and contributes to one in five strokes in the UK.
Atrial Fibrillation (AF) is the most common arrhythmia (heart rhythm disorder), and occurs when chaotic electrical activity fires off from different places in the atria causing the heart rhythm to be irregular, too fast or too slow.
AF can have a considerable impact on an individual’s quality of life. It can be an unpredictable and stressful condition, with potentially serious complications. Some people cope well but for others it can be debilitating and disabling with significant symptoms of palpitations, dizziness, breathlessness and fainting.
The heart’s pumping action is controlled by tiny electrical messages produced by the sinus node which is sometimes referred to as the heart’s ‘natural pacemaker’. These regular electrical messages tell the heart to contract and pump blood around the body. AF occurs when in addition to the regular electrical impulses sent by the sinus node, the atria produces irregular electrical messages. These irregular messages cause the atria to twitch, which is known as fibrillation and felt as an irregular and sometimes fast heartbeat, or pulse.
Ablation or, pulmonary vein isolation, means that attempts are made to ablate the areas within the atrium which are causing the fibrillation.
With one Atrial Flutter ablation procedure behind me, a condition similar to AF, which had made no difference to my worsening Atrial Fibrillation condition, I was left uncertain what to do next. My heart was beating regularly at over 170 bps, at random times day or night, breathlessness was a normal state of being and driving was becoming out of the question. Severe bouts of AF can cause fainting (syncope) episodes, which in my case resulted in concussion and hospitalisation.
There were only two real alternatives; face another ablation or stay on heavy doses of medication permanently.
My second ablation procedure, this time for AF, was carried out in London’s Royal Brompton Hospital, also on the NHS. Several technicians and participants are required for this procedure and it is not surprising costs for this privately range from £9k to £30k.Well out of the remit of most people’s purses and certainly this journalist’s one.
With fatalities of 1in 1000 and risk of stroke 1 in 300 it is not a decision to be taken lightly. The Royal Brompton took every care to ensure the risks are understood before proceeding.
Catheter ablation procedures are carried out as day cases or require a short stay. They take place in an electrophysiology laboratory similar to an operating theatre and take between 1 and 4 hours depending on the condition being treated.
Once ‘wheeled into the lab’ I jokingly mentioned to the technicians and nurses that there were more people, wires, leads, and equipment than backstage at a Carnegie Hall Rock concert.Luckily, I had a pre-med at this time and was not too alarmed at the number of participants required for this procedure or the wall-to-wall monitors.
Catheter ablation is used to treat a variety of heart rhythm disturbances. Targeted areas of the heart’s electrical tissue are ablated, to prevent the abnormal electrical circuits responsible for the condition. The tissue is ablated by being heated (radio-frequency ablation, RF) or frozen (cryo-ablation).Long wires, called catheters, are placed in the heart via the bloodstream.An X-ray camera, moves around the chest to help position the catheters correctly inside the heart. The catheters sense electrical activity in the heart and deliver electrical energy to make the heart beat (‘pace the heart’) in a combination of ways. These ‘pacing manoeuvres’ can be used to identify the abnormal electrical pathways.
Once the team are satisfied that they have all the anatomical and electrical information needed they begin the ablation itself.
Ablation works by creating scar tissue on the inside surface of the heart which blocks the rogue electrical impulses causing AF. The scars can can take up to three months or more to form and heal and that period is often referred to as the blanking period. Rest is essential part of the recovery as the heart has suffered some trauma and will take time to recover.
Success rates vary but are generally high and may prevent the need for long-term medication and can result in a cure, or, cessation of the AF for several years. The heart may still find other pathways resulting in the AFbreaking through again. Further ablations or in some cases pace makers may be needed.
Post procedure I received constant care and attention, remained overnight andwas seen twice by the registrar and the Consultant Cardiologist and Electrophysiologist, Dr Julian Jarman, who admitted me originally. This attention to my well-being remained until I was discharged with follow up medication and contact details of nurses and departments to ring with queries or worries. The pre and post medical care at every level at the Royal Brompton was exemplary. Even the paperwork was first-class, the content accurate, the arrival timely, and the administration at all ports swift and professional.
The previous experience for my Atrial Flutter ablation, also treated in another NHS London hospital, was very different. The registrar carrying out the procedure introduced himself to me for first time minutes before I was taken into the ‘lab’ and I was discharged without details of the results or follow up from anyone who had attended the procedure. No information on medication or advice on what to expect was given. In the ensuing weeks following the procedure my condition deteriorated and the EP in charge of my case was not available to talk to in spite of several callsabout my condition. In Correspondence relating to my case took over 3 months to arrive at my address and also my GP’s medical centre.
The outcome from AF ablation, as with other procedures, differ for many reasons and origins of the AF are also contributing factors. Before proceeding with ablation, you should ask the electrophysiologist about his / her personal level of experience and the results and risk factors. Cardiologists who specialise in heart rhythm disorders are usually referred to as an electrophysiologist (EP) and manage all aspects of heart rhythm diagnosis and treatment, including ablation procedures.There can be many reasons and circumstances that affect individuals’ treatment and experiences; a supportive EP, correct diagnosis, understanding of the condition and its treatments, will help with managing these.
I chose to write this article to share useful information and forums (below) about AFand to highlight the hard work and treatment at the Royal Brompton Hospital which inspired me to do so.This hospital, like many others, was under threat of closure. Thousands of people campaigned long and hard to keep this specialist Heart and Lung London Centre open. NHS England has now reversed plans to close three of the country’s heart surgery units, including that of the Royal Brompton Hospital.
Professional advice should be sought before making any decisions. Below is a guide to related AF organisations, charities and forums.
The Royal Brompton Hospital has an evening Rapid Access Arrhythmia Clinic to establish whether a patient’s symptoms are caused by an important arrhythmia and consultant cardiologist and electro-physiologists suggest appropriate treatment plans.
Clinic appointments:Wednesday 5.30-9.00pm; Outpatients 0207351 8011
Atrial Fibrillation Association / Tel: 01789 451837
Arrhythmia Alliance / Tel: 01789 450787
- Waiting time on the NHS is approximately 6 months.
- Private costs vary from £9k – £30k
- Travel insurance premiums may rise, several companiesprovide cover for this.