To have an ablation or not..that is the question

hi guys my name is Sanjay Gupta I'm a consultant cardiologist in New York and today I wanted to do a video on the subject of ablation a lot of people who suffer from atrial fibrillation have asked me about ablation I it's a question I get faced with every day and I thought I'd do a little video just to try and explain ablation to patients and what are the kind of things you should think about before deciding whether to go ahead with it or not it is true to say that there are lots of people doing ablation and sometimes some enthusiasts may sort of you know try and tell patients that this is the way forward and people can be left quite confused because there's a lot of conflicting advice out there on Google so the first thing to say is this video is really about impatient for those patients who have atrial fibrillation okay the second thing to say is that it's important to remember that there did whenever whenever the first thing to say is an ablation is not a there are two types of ablation that patients with atrial fibrillation can have and I'll talk you through them but it is true to say that whatever ablation you're having an ablation is not a natural process it's an invasive procedure okay and therefore it involves and doing something to your body it involves putting things inside your body it involves burning around the heart and that is not natural and that is not what the heart rooms get or so a it carries with it a degree of risk during the procedure and secondly it may have long-term consequences and because it is a procedure that has not been around very long it's very difficult to be sure that in the long term there are no long-term consequences of the burning that is done around the heart so it's always important to bear that in my it's not as straightforward as oh it's a simple thing it has it's harmless you know it isn't it carries with it risk during the procedure and possibly also long-term consequences although there is no evidence to say that yet but you know it's important to be a little bit skeptical because it's not a natural thing you know the body wasn't designed for someone to poke things into the into the heart and burn bits off so whenever you're faced with a question like this particularly one that can carry a degree of risk and you're contemplating as to whether to have this procedure or not it's important to try and work out whether you really where what benefit you're going to derive from the procedure okay and for me it's very simple with any procedure there's only two things you're hoping to achieve okay the first is that you're hoping that the procedure could potentially prolong your life secondly you're hoping that the procedure would in some way improve your quality of life and there are two separate things length of life and quality of life are two completely separate things and they don't really bear any connection to each other so um so when you're faced with the question of should I have an ablation the first question to say is is this condition is the condition I'm suffering from likely to be shorten my lifespan and if it is would an ablation prolong my lifespan or you know stop my lifespan from being shortened and with atrial fibrillation the thing is that it does expose patients to the risk of stroke and that risk of stroke is generally treated or reduced by anticoagulation blood thinning medication it is also important to realize that once you have developed atrial fibrillation then it doesn't really matter whether you are in atrial fibrillation or not your risk of stroke remains that is to say there are some people who have for example atrial fibrillation and you have a stroke treatment to the heart and they come out of atrial fibrillation but actually just because they're out of atrial fibrillation does not mean their stroke risk has gone away okay so if you're having and if you're contemplating an ablation because it'll take you out of atrial fibrillation and therefore you think you will no longer be exposed to the risk of stroke then you would be wrong okay just because you've had an ablation and the age of the relation has been taken away does not mean that your risk of stroke has gotten less and therefore you will still require blood thinning medications even if you have a successful ablation so you should not really have an ablation because you think it will prolong your life you should not really have an ablation because you think the atrial fibrillation will shorten your lifespan and by having ablation you're going to prolong life that is not the reason to have an ablation okay the second thing then to say is should you have an ablation for quality of life by quality of life I mean symptoms for some people and ablation for some people atrial fibrillation can be very troublesome some people get recurrence so there are people who have paroxysmal atrial fibrillation where the atrial fibrillation comes and goes and that can be incredibly troublesome for the patient because there's a sudden unexpected change from a regular heart rhythm to atrial fibrillation and the patient is then symptomatic during the Age of fibrillation the heart is going fast they feel tired they feel yucky they feel dizzy and they don't know when they're going to come out of it and that can happen more and more frequently so for those people the atrial fibrillation is affecting their quality of life similarly people who have persistent atrial fibrillation aye atrial fibrillation all the time can also feel tired and generally breathless and yucky and and for them the atrial fibrillation affecting their quality of life - okay it is important to bear in mind that there are two ways in which well there are actually three ways in which atrial fibrillation affects a person's quality of life remember atrial fibrillation is a disorder both of rhythm I the heart is beating irregularly and rate I the heart can beat very fast biking so both these things the irregularity as well as the rate can cause symptoms so for example when you are beating irregularly the heart is beating less efficiently because you've lost the atrial cake so you've lost 15 to 20 percent of the filling of the left ventricle and therefore there's less blood going around so just losing that can make people feel tired and generally a bit yucky however for some people it is because of course they've lost that kick because they're in atrial fibrillation but also they're going very fast or they're they've lost that control over their heart rate so they could be sitting and their heart could be going at a hundred beats per minute they could start walking and their heart rate could go to 160 beats per minute contrast this with a normal person is not an atrial fibrillation their heart rate will probably be 70 beats per minute when they're sitting and will go up to 90 bits per minute when they're walking so the person who has atrial fibrillation where the rate is not adequately controlled will become much more symptomatic because their heart will be working much harder than they needs to so if they're walking gently and their heart is rate is going up to 160 beats per minute they will feel like they're doing an activity to make the heart rate go at 160 beats per minute so when you have symptoms from your atrial fibrillation the first question to ask yourself is are my symptoms because of my rate not being adequately controlled or are they simply because of my rhythm okay and the way you can do that is you can ask your doctor to put you on the treadmill and when you go on the treadmill of course your irregular but you will see how quickly the heart rate rises if you find that the heart rate is going very fast when you're on the treadmill then it's a rate problem and the rate needs to be controlled and that is generally controlled with tablets such as beta blockers digoxin calcium antagonists okay and in some people when you put them on the treadmill you realize that actually the rate is completely normal it's behaving normally it's not going too fast in those people if they're feeling yucky then you have to assume that is it is just the irregularity okay and a lot of these patients then end up having to have a cardioversion where they have a shock treatment to the heart to try and get them back into a regular rhythm so it's very important if you are getting symptoms from your atrial fibrillation to try and work out whether it's just the irregularity or whether it's the irregularity and the rate okay because this will help you work out why you're getting the symptoms and how best to treat your symptoms now let's assume it's the rate okay if it's the rate then the best thing is to try and control the rate and stop the heart rate from going very fast when you're exerting yourself and we do that with the tablets now in some people despite all the tablets in the world the heart rate is still going very fast okay so they walk and their heart rate shoots up and you've given them all the tablets and despite that you can't do anything those people could be considered for something called a B node ablation alright that is one form of the glacier AV node ablation and basically what you're doing there is you're saying that okay the top chambers are fibrillating the bottom chambers are listening to the top chambers and therefore the bottom chambers are going very fast and very irregularly now what you can do is you can break the connection between the top chambers and the bottom chambers so there's no communication between the two and now that there's no communication between the two there is nothing for the bottom chambers to listen to so you have to put in a pacemaker to keep the bottom chambers going so you're breaking the connection between the two but then your consigning the patient to a pacemaker for life which will control the bottom chambers the bottom chambers will therefore beat regularly and will beat at a rate which is decided by the pacemaker the top chambers will continue to fibrillate and therefore you still need blood thinning medication but with with this you don't necessarily need as much in the way of you don't need a heart rate lowering medication because your bottom chamber is going to be controlled by your pacemaker it's not the it's not a I don't recommend it unless there is absolutely no other option and the patient is symptomatic you know the patient is really struggling with symptoms of breathlessness of tiredness otherwise I wouldn't recommend it but if they are then that would be an option in those people in whom the symptoms are being caused by a rate issue i the heart rate is not adequately controlled and remember again it is not ideal this is not what the body was designed for it was not designed for a pacemaker it was not designed for someone to break the connection between the top chambers in the bottom chambers so I don't recommend it lightheartedly you know I think it's important that you try everything before you consider consider that the important thing also to bear in mind is that in some people there are those conditions which led to the atrial fibrillation happening in the first place and unless you try and control those conditions I wouldn't push them forwards for this if what for an AV node ablation for example if a person is very overweight if a person has sleep apnea you know those things I would like to control those first because if I can control those maybe that will bring the heart rate down and therefore maybe the patient will not need this AV node ablation okay so those are the people - that's one type of ablation then there are those patients in whom it's not a rate issue it is just that they are irregular and they don't like being irregular they they've lost 15 or 20 percent efficiency of the heart and that just makes them clean yuck no right in those people what you can do is you can shock the heart under electrical cardioversion and that often restores the heart rhythm but unfortunately often that doesn't last very long and most people go back into atrial fibrillation and sometimes if that doesn't work sometimes doctors recommend that they cook the patient goes on something called amiodarone and then they try and shock the heart again because the amiodarone can hold the patient in a regular rhythm for longer but again Mei Jian is a quite a toxic drugs I don't really like using it a lot and once everything else has failed you can offer the patient something called and AF ablation again the idea behind this is that there is this suggestion that the pulmonary veins which are the veins that are around the heart and connect the heart and the lungs they become irritable and they start fibrillating and those impulses go to the atria and make the atrial fibrillation those patients you can burn the area around the pulmonary vein and that therefore allows the pulmonary vein to continue fibrillating but the impulses don't go to the atria and thereby you don't get the atrial fibrillation however it is important to realize that this is a invasive procedure again and the risks are and sorry not the risk and the success rates are very very variable you know they're between 40 to 70% okay 40 to 70% and a lot of people require more than one procedure and a lot of people actually after they have had this procedure then start complaining of things like a topic beats they become very conscious of their heartbeat etc so it does have a place but only if you have terrible symptoms which which are not because your rate is going very fast because of no other reason again I would say that unless you sweet what has caused your atrial fibrillation first place there is no marriage and having the ablation because if you continue doing those things that led to the atrial fibrillation the first place then even after the ablation you'll go into atrial fibrillation again so those things are things like you know if your diet is bad if you're very overweight if you have sleep apnea and those are really important things to try and tackle first because if you can tackle those in general your quality of life will improve anyway if you if you're overweight and you lose weight your quality of life will improve anyway and remember the only reason to have an ablation is simply because your quality of life is made unbearable by the presence of atrial fibrillation the atrial fibrillation is a byproduct of inflammation within the body if you treat the inflammation then that is the better thing the ablation sorts out the atrial fibrillation a it will not take away your stroke risk B if those things that led to the atrial fibrillation continue in the background then the atrial fibrillation will simply come back so in essence what I'm trying to say is an ablation does have a row but only if you have very bad symptoms which are unbearable and affecting your quality of life in a bad way now quality of life means different things to different people you know if you like running and you can't do it because you have atrial fibrillation sure that's that's important on the other hand if you're a sedentary person and you know you're breathless all the time that's another reason so what I'm not saying is that you I'm saying that each person has their own subjective notion of what their quality of life should be and it really depends on you the individual to decide whether your symptoms are bad enough to warrant this having said that please don't take it lightly it is an invasive procedure it does carry with it some risk and it is not unnatural it's not a natural treatment by any chance and of course whatever you do the most important thing is treat your leister tree those things that led to this happening in the first place because undoubtedly you feel better and in some cases it may make your quality of life so much so much better just by losing the weight or treating the sleep apnea that the atrial fibrillation doesn't bother you anymore another thing I wanted to say is that atrial fibrillation baguettes atrial fibrillation so the more atrial fibrillation you have the more you will have the more you've had the more difficult it's going to be to get you out of it and that is why ablation are more successful in patients who have paroxysmal atrial fibrillation ivh a population that's coming and going then patients who have long established je trouve fibrillation so if you're a young person who gets paroxysms you're likely to do better provided you treat everything else like the weight and you know diet and exercise and mind search and all that I provided you do that you will do better from a narration that someone who has established air all right so I hope this was helpful she keep giving me thank you so much I'd be really grateful if you'd consider sharing these videos and if you need to talk to me this is me okay and this is my website and this is my Facebook page and this is my secretary Jeanette's number so thank you very much and if you enjoyed this please consider sharing it thank you so much bye

Channel: York Cardiology

Views: 244,986

Keywords: #hangoutsonair, Hangouts On Air, #hoa, ablation, atrial fibrillation, Afib, AF, RFA, pacemaker

Id: 3VOq9BL7Y1U

Length: 19min 25sec (1165 seconds)

Published: Fri Feb 26 2016