The skeptical cardiologist previously shared reader Mark Goldstein’s experience with atrial fibrillation which led him to choose to have an ablation.
Mark has subsequently undergone the ablation procedure and has kindly shared his thoughts and observations on the process. I’ve included a few comments (in green).
The Mystery of Afib and An Ablation
Everyone associated with afib knows how mysterious it seems to be. What triggers it? Why does it stop? Why does it affect marathoners, cross-country skiers, and NBA players more than other groups? Why is everyone’s experience as unique as popcorn granules? Recently Dr. Pearson invited me to talk about my accidental discover of afib, my unsuccessful cardioversions, and my decision to have an ablation.
In the last post, afib was affecting me every day when exercising. Moderate exercise would cause my heart to, as my electrocardiologist would say, “act like a drunken sailor.” It became hard. Exercise is important to me. Medication was not working for me. An ablation was the next step.
Choosing A Doctor
Before you decide on the cardiologist or electrophysiologist (EP) to perform an ablation, do research. Ablations are not particularly dangerous. No one is opening your chest. The doctor is “redecorating” your heart…OK, killing tiny parts of your heart. People occasionally die. There can be complications like infections. How long has your doctor been doing ablations? How many a year? I asked my EP where he learned the technique. Turned out that he learned it from the French doctor who invented it. Peer recognition is good. My EP leads the Atrial Fibrillation Center at the big regional hospital where I had the work. Find out if they are involved in research since this suggests they keep up on the latest developments. I saw that my EP was doing research via the U.S. government’s Medline Plus clinical trial website (https://medlineplus.gov/clinicaltrials.html). And if you are reading about the latest research on the Internet, you can see if your doctor is keeping up with the latest. I asked my EC about a study that appeared days before our appointment. He read it and talked about it. He passed my tests.
(I’ve been meaning to write about a recent study which looked at the early mortality rate (<30 days after procedure) from catheter ablation for atrial fibrillation which was 0.46% among more than 60,000 patients treated for A-fib ablation between 2010 and 2015. These real-world rates are higher than those reported in randomized trials. This doesn’t necessarily make ablation a “dangerous” procedure but patients should know that there is a 1 in 200 chance of dying from it.)
Interestingly, and relevant to Mark’s point about choosing an EP who does a lot of ablations per year, mortality rate was higher in low volume hospital (<21 ablations per year). These data support choosing a high volume operator in a high volume hospital.
Once you choose a doctor, the remainder is scheduling and insurance paperwork. My experience is that you should assume at least a day in the hospital and a day to recover.
I arrived early the day of the procedure. After my previous cardioversions I was experienced with the registration and prep process. A few hours later I was on a gurney entering “mission control.” The procedure room was full of large TV’s, reminding me of launching a rocket. It can be a bit intimidating, but I thought of it as a sports bar. Instead of watching games people were watching my heart. It wasn’t a long time in the room before I was told I’d be sleeping soon.
They were right because I “woke up” about four hours later in a recovery room. I immediately saw my heart rate was in the 70’s and steady. That was good. I put on my Apple Watch and started the ECG test. Without waiting for the watch to decide, I could see my beats were rhythmic. YEAH! I saw “normal sinus rhythm” on the watch and celebrated. Later I found out that I had almost four hours of a successful ablation. Apparently, that is a lot of work however the afib, aflutter, was gone.
After the procedure I felt pressure around my heart. Not surprising considering the “redecorating” that was done. It was more of an annoyance than painful. That lasted for a few days. The area around my groin was also sore from the insertion of the ablation instruments. Certainly not unbearable but not fun. A couple of hours after the procedure I asked if I could go for a walk. The staff accompanied me for a walk and saw that I was fine. I asked if I continue walking. After a mile of moderate walking around the hospital (thanks to the Apple Watch’s measurements), my groin felt much better. When my watch showed I walked three miles, I went to bed. The following morning before breakfast, I walked another three miles. After ablation, start walking as soon as you can. It helped me physically and probably more important mentally showing that I was OK.
My groin area was purple for about a week so the worst part of the ablation was I couldn’t wear a Speedo (nor did I want to wear one). It was ugly and a minor nuisance but didn’t affect my activities. Oddly the second day after the procedure I woke up feeling the aftermath of cramps in both of my calves. This was bothersome walking stairs especially. I hadn’t heard of cramps associated with an ablation so it may just have been coincidence. The next day I could walk fine.
Post-Ablation Early Recurrence
My heart was fine after the ablation. I checked it regularly with my Apple Watch and Kardia Mobile EKG. Life was good until 1:55AM a couple of weeks after the ablation. I was sleeping. Without explanation my heart rate jumped from 53 beats per minute to 110 in five minutes. When I woke hours later, I knew my heart was racing. The Kardia Mobile showed I had a “uncategorized” problem. It stayed around 110 beats no matter what I was doing. A few hours later my EP saw my EKG chart and said I needed another cardioversion. He reminded me that he told me the first time we discussed ablation that during the first three or four months I might have more rhythm problems as the heart returns to normal. He was right.
A few days later I had my third cardioversion. My heart immediately went from 110 back to 60/70 beats per minute after the procedure. Yeah! I was beating normally again.
One Month After Ablation
Today is a month after the last cardioversion. My Apple Watch, Kardia Mobile, and body tell me I am fine. The other metric I check regularly is my heart rate while sleeping since it should reflect my heart rate without activity. I’m averaging 54 beats per minute at night which is fine. I can now exercise moderately or intensely. I am celebrating by writing this article.
I continue to take a blood thinner because of my CHADS₂ score. Hopefully my afib adventure is over…but I will not be surprised if it returns.
So far, so good.
Hopefully, Mark will remain free of afib for many years if not a lifetime but given that he is empowered with both a Kardia 6L device and an Apple Watch for monitoring his rhythm I feel confident he will know when and if it returns.
N.B. Here are the charges for the ablation procedure.
Hospital – 86,350
EC/EP – 7,365
Anesthesia – 4,550
Blood test – 120
Misc charge – 22
Mark ended up paying $200 out of pocket.
Mark Goldstein works in the field of cybersecurity in the Washington, DC area and can be contacted at https://www.linkedin.com
13 thoughts on “Ablation For Atrial Fibrillation: One Patient’s Experience”
My ablation was about five weeks ago. For the last week when I lay down at night my pulse rate goes up. My throat kinda burns, like when you run and are not in shape. I don’t feel well at all. Tried taking extra bata blocker. This does help some. I am not able to sleep. Now the virus epidemic is ramping up, and I am afraid to go to the doctor. My ablation surely was not what I hoped for.
Very interesting to hear in such detail about your experience. Thanks for taking the trouble to record it.
Concerning this “atrial kick”:
Using cryo-ablation generally damages ganglia that are in close proximity to the pulmonary vein ablation sites. RF less so.
Does anyone really know what specific functions these ganglia perform and what the consequences of damage might be?
I’ve noticed two unfortunate changes following my cryo:
My resting heart rate before was in the high 50s. Immediately after and through the following five years it’s been in the mid to high 70s. This phenomenon is recognized, but not widely warned of or addressed.
More subtle is a quite slow cardiovascular response to an increased stimulus since the ablation. I find myself panting and my legs aching the first several passes with my push lawn mower. My pulse stays at mid-to-high 70s for more than five minutes, then slowly increases so that the next twenty minutes or more make for comfortable mowing.
I must plan carefully for extended warm-up periods to attempt any ordinarily reasonable physical activity.
Anyone else? Is this the “kick” spoken of?
Perhaps it’s due to missing ganglia?
You asked for ablation costs. I’ve had 2 in 2019. Charges to my insurance for each one included about $125k for the hospital services (1 night stay) and $7600 for the EP and $6000 for the anesthesiologist. Negotiated rates dropped these to a little over half.
I’m in the greater Seattle WA area.
Dear Dr. Anthony and Mark,
Thanks for your review of your afib ablation experience. I had similar experience with a successful ablation 15 months ago.
After a wonderful year of sinus rhythm- hiking/backpacking, swimming, and traveling, I went into afib last week on a New Year’s backpacking trip. I was shocked (or should I say “surprised”?).
I had hoped to get 5 years out of this procedure (I am 71) so only one year free of afib seems short.
What are your thoughts on the longevity of a successful ablation?
Sinus rhythm is a wonderful thing!
ps. For several months after my ablation I too felt like I had lost my atrial kick.
Shortness of breathe on a hill climb feels distinctly different when I was out of shape than when in afib.
Excellent review of this one man’s experience. I had a young woman (perhaps mid-30s) co-worker some years ago who, after ablation, chronically complained that the procedure destroyed her “atrial kick”.
Thanks. What your co-worker said fascinates me. I do feel that atrial function is impaired after surgical procedures for atrial fibrillation. But typically with surgery they also obliterate in some way the atrial appendage which provides most of the oomph in the atrial kick. With catheter ablation the burns and damage are around the pulmonary veins predominantly although some EPs might be going after the atrial appendage.
Thank you Dr. P. for posting this. I think it helps. My AFib has been getting worse. I believe I’m ready to begin with my own procedure. I’m concerned about surviving the the Ablation, but I don’t feel like staying so tired all the time as I do now. Thank you. Gladys Addington
Seems crazy expensive on the hospital.
The quicker the time to re-occurrence the more likely that it will continue down the road, if you will. Why blood thinner? Why not isolate LAA. That also may help reduce arrhythmia,
Why blood thinner? There is no evidence that ablation reduces the risk of stroke in patients with atrial fibrillation so blood thinners should be continued if the CHADS2 VA2SC score is high and there are no contradincations.
Why not isolate LAA? LAA isolation is not a standard part of an ablation procedure. There are recent reports on adding it on with the idea that the LAA could be a trigger but my concerns would be over damaging the lAA and making it more thrombogenic.
Are the prices cited for all three ablations?
There was only one ablation so that apparently is what the costs were for. It seemed quite high to me. If other readers can provide the cost of theier ablations that would be interesting.
Mark had 3 cardioversions, electrical shocks to convert the heart back to normal. I don’t have the price the hospital charged for those.