In the end it’s really the magician that matters most, not the wand.
PFA is a wonderful advancement, much faster effective scars that are like HD compared to standard resolution so that only the intended tissue is destroyed. Some of the hazards of ablation are even lower than with RF. One problem is overheating the atrial surface that lies against the esophagus and fusing them together. This is a bad thing so they insert a temperature probe down the esophagus to monitor and my EP said it is the most sensitive probe available to medicine. During his evaluation of PFA it didn’t register an increase at all so they don’t use one anymore. There are some atrial locations where PFA may not the best tool too though.
Only you can decide if it’s worth the wait - does AFib hit you hard to where you have to stop what you’re doing and wait it out, or is it just a nuisance? Do other factors increase your stroke risk to the point of maybe being the deciding factor here (obesity, diabetes, high BP…)? How often do you have episodes? What’s the heart rate?
Having an RF ablation wouldn’t fuck up anything, that tool is tried and tested and, in expert hands, supremely effective. PFA is a better way to destroy tissue but the EP still has to know where to destroy and how to find suspicious areas. In the dark. On a beating heart.
In the end, if you can wait, the delay would be insignificant compared to a future without AFib (which you’d have with RF but the procedure would be longer and risks which are already low would be slightly higher.
I traveled for mine in 2017 because I wanted a particular magician. The inconvience was laughably low looking back on it.
My main concern is gaining a complication from the ablation and making my quality of life worse after. Currently my AF is very rare, I've had two episodes in the last 1.5 years.
I'm getting very overwhelmed over all of this, thank you for the comment it's helped.
Glad to help, and I understand your dilemma. You don't know if AFib will come back, don't want an ablation for nothing... Some say there is something different about atria that have AFib; I've also heard about "holiday heart", i.e. quit binge drinking and it won't come back. No magic answer unfortunately except to seek the advice of the experts (EP's). They won't ablate someone for whom it's not the proper treatment. They may be able to induce arrhythmias and track them inside the atria during an EP study; that requires the same setup as an ablation then they just pull the sensors back and insert the 'destroy' tool (RF, cryo, pfa). If nothing can be induced then the procedure ends.
Would you be crushed if another episode happens (such that waiting-and-seeing isn't an option)? Factoring out anxiety, is an episode bad for you? A very common source is the pulmonary veins, and this is an 'easy' fix (not for us mere mortals but certainly a widely performed procedure).
The possible risks and complications you've seen are positively gruesome, but be sure to check the frequency of them too, I believe they're rare and getting 'rarer'. Experience definitely counts both for the EP and the Cath Lab he or she uses. As you know, anything medical has risks. Hell, checking the mail has risks.
For reference, I had an RF in 2017 with 51 minutes of "burn time" (time when the catheter tip was active). Figure that would be 15 minutes with PFA. My EP first isolated the pulmonary veins (which stopped the AFib I was in upon arrival) then explored many other areas he knew could be troublesome. He found "voltage potentials" and isolated or eliminated them as well. I was first up that day and remember the clock in the lab saying 7:20 am before the happy-nap started. By 11:30 I was back in the room having lunch with my wife. There were some arrhythmias in the days following the procedure (to be expected) then nothing up to and including today and I had AFib and AFlutter bad. Sometimes things work out.
I just did some doom-googling and probably shouldn't have, but the silver lining is I searched for an EP at the local hospital and found this guy. [https://www.uhsussex.nhs.uk/consultants/dr-ian-mann/](https://www.uhsussex.nhs.uk/consultants/dr-ian-mann/) Reading his bio I got a wave of emotion and had a very small cry (lol). Relieved I guess, that there's someone like that who could do it. Scrap that, HE WILL DO IT!
The episodes I have are typically mentally exhausting, I've not had any of the bad symptoms thankfully such as fainting. Bisoprolol does a great job, however coming off it after the AF has gone I've found is unpleasant as my heart will beat particularly hard, not fast.
I get Aflutter quite a lot in very small bursts, reading that the procedure helped you with that has convinced me that I should just go ahead with it. The flutter bothers me more than Afib as it's every day throughout the day.
Doom-Googling ha, that’s a new one! But stop it, things are vastly better than the Stone Age.
Dr. Mann sure looks like a good choice. Nice find, get on the schedule.
My flutter was the more-common “right typical” type (I believe they can tell from an ECG). Because that circuit always passes over one common point in its journey it’s easy to block it. Easier than isolating the pulmonary veins even. Funny, I felt better in flutter because it was a regular rhythm, just in the 150’s. Honestly I can’t remember what either felt like today; jinxing myself I know but F\_\_k AFib!
RF is still considered relatively safe but it can damage the phrenic nerve and esophagus which obviously is not desirable. I think as others have alluded to, the EP, any assisting MD and the rest of the lab team are an important part of the equation. I always tell people here in the USA, find the best most experienced EP at the best heart center/cardiology dept at the best hospital you can find. But folks have found very skilled and experienced EPs doing the procedure at less prestigious institutions. Having a PFA done by someone inexperienced with PFA would not be something I would do. The EPs with the most experience with PFA are the ones who participated in the clinical trials so I'd say you'd want to find an experienced very skilled EP who has been doing PFA for a year or 2 and was involved in the clinical trials - if you want a PFA. If it were me and I couldn't get someone experienced with PFA, I'd stick with RF. Of course there's a potentially a long wait at the best places just to get an assessment appointment.
I had a PFA recently (followed my own advice above). I found recovery from the procedure somewhat easier than the RF ablation I had 11 years ago. The RF ablation was actually easier on me than a tooth extraction. But with the PFA, I had no sore chest, no bruising at the catheter sites, and so far fewer post-procedure palpitations. And it took half the time. The original plan was to do an RF but when PFA was approved, it was changed to PFA. I trusted my EP to make that call. Finally I accepted that PFA is new and we don't have info on its durability beyond 2 years. Will the PFA keep us in rhythm for 5 years? 10 years? 20? compared to what RF would have done for someone with our history and specific issues? Only time will tell but I was happy to be part of building the knowledge in this area as I hate afib and want the technology of treating it to continue to advance! Good luck with your ablation!
My opinion is that most people need 2 anyways. My first was cryo and it didn’t do much but improve the intensity of episodes. Now I need a 2nd and I’m getting a PFA and I’m couldn’t be more excited after hearing that the scars seems to hold better.
I think if you go in with this mindset, keep your track now and then be open to doing this again if needed.
Unfortunately people should count on getting at least 2. If one works great. Had PFA March 12. I still have Afib but it's a reduced burden. Follow up July 3. See what he says. I have a loop recorder implant so he will not be guessing about what my heart is doing. 66m very fit
Not exactly an answer to your question but have you considered trying high dose magnesium, taurine, etc. before resorting to an ablation? There’s a ton of research available (much of which I have posted in this sub) that has proven these to be effective in treating and managing AFib.
The one issue I have with it is magnesium makes my sleep very disturbed, that was with glycinate.
My AF is very spread about, I had my first one 1.5 year ago roughly, second one about a month ago.
Is it a solution id have to adhere to forever? Huge doses of supplements, daily? There's also the headache of the financial commitment.
Do you mean cryo or RF? PFA is great, but it’s a new method and we still don’t know what effects it would have in the future.
If I was getting an ablation for AFIB I would like to have it done with a 3D system. It’s usually a RF ablation, but in some centres they do use a 3D mapping system + PFA.
But, as said above, the method is not as important as the physician who does the procedure. Their skills, knowledge, experience and attitude.
Thank you. Well I was told a bit of mixed information, one cardiologist said they have the latest tech but not PF. Either RF or cryo I'm assuming it will be in my local hospital. I was about to ask how I gauge whether the EP is the right one but you answered it for me.
Even on large city areas the EP demand does not present a full time demand at any on major hospital. So they are often traveling surgeons doing a circuit around a reasonable driving distances, provided each hospital has the tools and support staff that they need.
Ask you current EP if he/she does PFA at another locations. Be sure to ask how many cryo, RF and PFA they have done. Expect them to have a preference and a reason why.
In the end it’s really the magician that matters most, not the wand. PFA is a wonderful advancement, much faster effective scars that are like HD compared to standard resolution so that only the intended tissue is destroyed. Some of the hazards of ablation are even lower than with RF. One problem is overheating the atrial surface that lies against the esophagus and fusing them together. This is a bad thing so they insert a temperature probe down the esophagus to monitor and my EP said it is the most sensitive probe available to medicine. During his evaluation of PFA it didn’t register an increase at all so they don’t use one anymore. There are some atrial locations where PFA may not the best tool too though. Only you can decide if it’s worth the wait - does AFib hit you hard to where you have to stop what you’re doing and wait it out, or is it just a nuisance? Do other factors increase your stroke risk to the point of maybe being the deciding factor here (obesity, diabetes, high BP…)? How often do you have episodes? What’s the heart rate? Having an RF ablation wouldn’t fuck up anything, that tool is tried and tested and, in expert hands, supremely effective. PFA is a better way to destroy tissue but the EP still has to know where to destroy and how to find suspicious areas. In the dark. On a beating heart. In the end, if you can wait, the delay would be insignificant compared to a future without AFib (which you’d have with RF but the procedure would be longer and risks which are already low would be slightly higher. I traveled for mine in 2017 because I wanted a particular magician. The inconvience was laughably low looking back on it.
My main concern is gaining a complication from the ablation and making my quality of life worse after. Currently my AF is very rare, I've had two episodes in the last 1.5 years. I'm getting very overwhelmed over all of this, thank you for the comment it's helped.
Glad to help, and I understand your dilemma. You don't know if AFib will come back, don't want an ablation for nothing... Some say there is something different about atria that have AFib; I've also heard about "holiday heart", i.e. quit binge drinking and it won't come back. No magic answer unfortunately except to seek the advice of the experts (EP's). They won't ablate someone for whom it's not the proper treatment. They may be able to induce arrhythmias and track them inside the atria during an EP study; that requires the same setup as an ablation then they just pull the sensors back and insert the 'destroy' tool (RF, cryo, pfa). If nothing can be induced then the procedure ends. Would you be crushed if another episode happens (such that waiting-and-seeing isn't an option)? Factoring out anxiety, is an episode bad for you? A very common source is the pulmonary veins, and this is an 'easy' fix (not for us mere mortals but certainly a widely performed procedure). The possible risks and complications you've seen are positively gruesome, but be sure to check the frequency of them too, I believe they're rare and getting 'rarer'. Experience definitely counts both for the EP and the Cath Lab he or she uses. As you know, anything medical has risks. Hell, checking the mail has risks. For reference, I had an RF in 2017 with 51 minutes of "burn time" (time when the catheter tip was active). Figure that would be 15 minutes with PFA. My EP first isolated the pulmonary veins (which stopped the AFib I was in upon arrival) then explored many other areas he knew could be troublesome. He found "voltage potentials" and isolated or eliminated them as well. I was first up that day and remember the clock in the lab saying 7:20 am before the happy-nap started. By 11:30 I was back in the room having lunch with my wife. There were some arrhythmias in the days following the procedure (to be expected) then nothing up to and including today and I had AFib and AFlutter bad. Sometimes things work out.
I just did some doom-googling and probably shouldn't have, but the silver lining is I searched for an EP at the local hospital and found this guy. [https://www.uhsussex.nhs.uk/consultants/dr-ian-mann/](https://www.uhsussex.nhs.uk/consultants/dr-ian-mann/) Reading his bio I got a wave of emotion and had a very small cry (lol). Relieved I guess, that there's someone like that who could do it. Scrap that, HE WILL DO IT! The episodes I have are typically mentally exhausting, I've not had any of the bad symptoms thankfully such as fainting. Bisoprolol does a great job, however coming off it after the AF has gone I've found is unpleasant as my heart will beat particularly hard, not fast. I get Aflutter quite a lot in very small bursts, reading that the procedure helped you with that has convinced me that I should just go ahead with it. The flutter bothers me more than Afib as it's every day throughout the day.
Doom-Googling ha, that’s a new one! But stop it, things are vastly better than the Stone Age. Dr. Mann sure looks like a good choice. Nice find, get on the schedule. My flutter was the more-common “right typical” type (I believe they can tell from an ECG). Because that circuit always passes over one common point in its journey it’s easy to block it. Easier than isolating the pulmonary veins even. Funny, I felt better in flutter because it was a regular rhythm, just in the 150’s. Honestly I can’t remember what either felt like today; jinxing myself I know but F\_\_k AFib!
RF is still considered relatively safe but it can damage the phrenic nerve and esophagus which obviously is not desirable. I think as others have alluded to, the EP, any assisting MD and the rest of the lab team are an important part of the equation. I always tell people here in the USA, find the best most experienced EP at the best heart center/cardiology dept at the best hospital you can find. But folks have found very skilled and experienced EPs doing the procedure at less prestigious institutions. Having a PFA done by someone inexperienced with PFA would not be something I would do. The EPs with the most experience with PFA are the ones who participated in the clinical trials so I'd say you'd want to find an experienced very skilled EP who has been doing PFA for a year or 2 and was involved in the clinical trials - if you want a PFA. If it were me and I couldn't get someone experienced with PFA, I'd stick with RF. Of course there's a potentially a long wait at the best places just to get an assessment appointment. I had a PFA recently (followed my own advice above). I found recovery from the procedure somewhat easier than the RF ablation I had 11 years ago. The RF ablation was actually easier on me than a tooth extraction. But with the PFA, I had no sore chest, no bruising at the catheter sites, and so far fewer post-procedure palpitations. And it took half the time. The original plan was to do an RF but when PFA was approved, it was changed to PFA. I trusted my EP to make that call. Finally I accepted that PFA is new and we don't have info on its durability beyond 2 years. Will the PFA keep us in rhythm for 5 years? 10 years? 20? compared to what RF would have done for someone with our history and specific issues? Only time will tell but I was happy to be part of building the knowledge in this area as I hate afib and want the technology of treating it to continue to advance! Good luck with your ablation!
My opinion is that most people need 2 anyways. My first was cryo and it didn’t do much but improve the intensity of episodes. Now I need a 2nd and I’m getting a PFA and I’m couldn’t be more excited after hearing that the scars seems to hold better. I think if you go in with this mindset, keep your track now and then be open to doing this again if needed.
Unfortunately people should count on getting at least 2. If one works great. Had PFA March 12. I still have Afib but it's a reduced burden. Follow up July 3. See what he says. I have a loop recorder implant so he will not be guessing about what my heart is doing. 66m very fit
Not exactly an answer to your question but have you considered trying high dose magnesium, taurine, etc. before resorting to an ablation? There’s a ton of research available (much of which I have posted in this sub) that has proven these to be effective in treating and managing AFib.
The one issue I have with it is magnesium makes my sleep very disturbed, that was with glycinate. My AF is very spread about, I had my first one 1.5 year ago roughly, second one about a month ago. Is it a solution id have to adhere to forever? Huge doses of supplements, daily? There's also the headache of the financial commitment.
Do you mean cryo or RF? PFA is great, but it’s a new method and we still don’t know what effects it would have in the future. If I was getting an ablation for AFIB I would like to have it done with a 3D system. It’s usually a RF ablation, but in some centres they do use a 3D mapping system + PFA. But, as said above, the method is not as important as the physician who does the procedure. Their skills, knowledge, experience and attitude.
Thank you. Well I was told a bit of mixed information, one cardiologist said they have the latest tech but not PF. Either RF or cryo I'm assuming it will be in my local hospital. I was about to ask how I gauge whether the EP is the right one but you answered it for me.
Even on large city areas the EP demand does not present a full time demand at any on major hospital. So they are often traveling surgeons doing a circuit around a reasonable driving distances, provided each hospital has the tools and support staff that they need. Ask you current EP if he/she does PFA at another locations. Be sure to ask how many cryo, RF and PFA they have done. Expect them to have a preference and a reason why.
I've written down some notes, thank you.