RF ablation for atrial fibrillation

[Siamic]

I am wondering how many people here have had radio-frequency ablation to fix atrial fibrillation? Where did you have it done? What did it cost? Was it successful?

I have just had my second electrical cardioversion in 15 months and it lasted just a few days. Days with no alcohol, caffeine or MSG. The first one lasted a few months but when AF returned I was able to get back into sinus rhythm with propafenone. Currently on warfarin, amlopine 10mg and propafenone 150mg twice a day.  A single shot of 300mg of flecainide didn't reverse the AF.

[Sheryl]

The overall success rate is around 75% and it often  takes more than one attempt.

 

Cost will vary greatly depending on hospital.

 

Whether it is worth it depends a lot on your age. More worthwhile for younger people as they are otherwise looking at a longer period on anticoagulants and also more curtailment of life style (AF decreases cardiac output by around 15% - older less active people will often not even notice the difference but a younger, active person will).

 

Bets to consult a good cardiologists for expert opinion on pros and cons specific to your situation.Where do you live?

[rak sa_ngop]

I went to the Bangkok Heart Hospital Bangkok in December last year. The price estimate for the ablation AFib procedure with 2 nights stay, came within the range of 538,000 to 728,000 baht with some additional costs not included.

 

So far I have managed to control my short lived AFib episodes and I have decided not to proceed.

 

The surgeon's name is Dr Koonlawee Nademanee and I was told that he has trained/performed the procedure in the US where it cost 3 times as much.

 

I also read recently in the British "Daily Mail" about a new procedure that uses 'cold' to freeze tissue to produce the same benefits as RF burning. Title of the article was "Icy balloon to help calm a racing heart". This article appeared about 2 weeks ago, I read it in a pub.

 

Hope this helps.

[churchill]

I had the procedure at Piyavate Hospital Bangkok last July ..

 

Total 162,000 Baht .. including 1 night stay .

 

Successful so far although I still get very occasional palpitations during the night .. cause unknown .

 

 

[Siamic]

Thanks for adding you valuable input Sheryl. I am 61 and live in Phuket. Seeing a cardiologist at Bangkok Phuket who as far as I can tell, is very good. Last visit he decided that rhythm control with propafenone wasn't working so went for rate control with metoprolol (beta blocker) which has made my BP normal and bpm around 80, instead of 115+. Still arrhythmic so get tired with the slightest exercise. He suggested that the long term outcomes of RF ablation compared with simple rate control with beta blockers was not much different - according to one major study.

Churchill, one thing that may trigger palpitations is sleeping on your left side! I noticed this and a Google search brought up a huge number of anecdotes from other sufferers. Does your RF ablation enable you to exercise, drink beer etc normally? Thanks!

[NancyL]

I had radio-frequency ablation done in the U.S. but it was to correct atrial flutter, not a. fibrillation.  I was 45 at the time.  It worked and was a real god-send for me because I could stop taking blood thinner and worrying about going out of rhythm, something that had happened three times before and could only be fixed with cardioversion, not with meds.

 

Each time I'd go out of rhythm it was during periods when I was under much stress, doing physical work and not getting enough sleep.  It was difficult to avoid these times since we we had a greenhouse/nursery business and had to work 18+ hour days during our short selling season.  The ablation solved the problem permanently and I was able to stop taking blood thinners, with the need for testing and worrying about clotting when I cut or scratched myself, something that happened often in my line of work.

 

Now, nearly age 65, I do have periods of atrial fibrillation from time-to-time, again when I'm not well-rested and have had too much to drink.  I find metoprolol helps when I feel I'm in a. fib, but I don't take it routinely because it creates too low a resting heart rate and I feel sluggish.   I do take amlopine and lisinpril which do a great job of keeping my BP normal.  The metroprolol doesn't seem to affect the BP reading, just lowers the heart rate, which normally is in the low sixties to mid sixties anyway.   

 

Yes, I find it better to sleep on my right side and with the head of the bed elevated about six inches.  When we stay in a hotel for more than a night or two, I wake up with my face very puffy.  Sometimes, I'll use lasik diuretic when we travel because of this and also because it's difficult to find low sodium foods when traveling and eating out.   

[churchill]

2 hours ago, Siamic said:

 

Churchill, one thing that may trigger palpitations is sleeping on your left side! I noticed this and a Google search brought up a huge number of anecdotes from other sufferers. Does your RF ablation enable you to exercise, drink beer etc normally? Thanks!

 

Yes if i notice palpitations whilst sleeping on my left .. just turning over and I can return to normal rhythm in seconds ..

 

I do regular exercise and I am sure this helps ... .. I think one of the causes in the 1st place was over exercise .. I started crossfit but pushed a bit too hard .. now am into a regular daily exercise class but not as tough as crossfit ..

 

I like my wine and have cut back a bit .. Stress does not help and that is not so easy to manage ...I recently took up yoga and this can help ...It seems to be a matter of cutting out any possible causes as much as possible and trying to manage ..

 

Exercise though is a definite benefit as well as yoga and I think my condition would be worse if I did not keep those up .

[Siamic]

Just an update on what eventuated. 

An echocardiogram showed that my mitral valve was prolapsed and regurgitating ie there was blowback through the valve reducing my cardiac output.

By chance (the friend of an acquaintance worked there) I discovered Central Chest Institute of Thailand, a state hospital in Bangkok. I went there and it was confronting; no signs in English and almost no staff spoke English. After several visits, EKG, echocardiogram, transoesophageal echocardiogram, angiogram, I went there for mitral valve repair and a Maze-type radiofrequency ablation to fix the atrial fibrillation. The surgeon was Soochak Kasemsarn. I had a private room, but that meant my mother in law had to spend all the time with me for just over a month. She was an angel. The food was bad but she brought in salads and fruit so I could survive. But everything else was very good. I am in regular rhythm currently but it will be  6 months before any concrete conclusions about the success of my surgery will be drawn.. At 354000 baht for everything I thought it very reasonable. So I am back home, feeling a little better each day. The last stitches came out a couple of days ago (part of the wound from opening the chest was slow to heal).

[rak sa_ngop]

On 6/9/2018 at 7:10 PM, churchill said:

 

I do regular exercise and I am sure this helps ... .. I think one of the causes in the 1st place was over exercise .. I started crossfit but pushed a bit too hard .. now am into a regular daily exercise class but not as tough as crossfit ..

 

I like my wine and have cut back a bit .. Stress does not help and that is not so easy to manage ...I recently took up yoga and this can help ...It seems to be a matter of cutting out any possible causes as much as possible and trying to manage ..

 

Exercise though is a definite benefit as well as yoga and I think my condition would be worse if I did not keep those up .

This tends to mirror my own experience...too much exercise or physical stress and my heart starts to beat irregularly, generally when I sit down or lie down hours after completion of my exercise.

 

It's a bit of a Catch-22 situation, one needs to exercise to keep the heart strong, but this results it irregular heart rhythms some hours later.  My resting heart rate is 50 or lower so I do not take beta-blockers. I just take Edoxaban (Lixiana in Thailand) to mitigate strokes.

 

One way I have of regaining a normal sinuous rhythm is to get up and about and do some exercise, or go for a run!

 

The alcohol does not help so I try and avoid drinking after running or gym work. But as my cardio says: keep exercising and learn to live with it!