Atrial fibrillation: what they never tell you about your ablation procedure
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- เผยแพร่เมื่อ 1 ส.ค. 2024
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Video description:
Dr.Kneller talks about the risks of fluoroscopy for doctors and patients.
Atrial fibrillation (AFIB) is the most common sustained cardiac arrhythmia encountered in clinical practice. The burden of AFIB as well as awareness of this condition has increased dramatically in recent years. AFIB can be effectively treated with a procedure known as catheter ablation. This procedure is usually performed under general anesthesia - meaning the first thing the patient knows is that the procedure is over! Patients usually spend one night over night in hospital and go home on the day following the procedure.
While the patient is asleep, catheters are advanced through the large veins to the heart, arriving in the right atrium (RA). The majority of AFIB arises from the left atrium (LA). To access the LA, transseptal puncture must be performed, so catheter can be advanced across the very thin wall separating the RA from LA. Within the LA, the priority is then to perform pulmonary vein isolation (PVI). The PVs can produces bursts of abnormal electrical activity, inducing episodes of AFIB. Catheter ablation is therefore performed around each of the four PVs, to achieve electrical isolation from the remainder of the LA. Durable PVI is the backbone of all ablation procedures for AFIB.
When the pattern of AFIB is paroxysmal (short episodes of AFIB that come and go), only PVI is performed. When the pattern of AFIB becomes persistent (episodes Lasting weeks to months), additional ablation targets may be addressed in addition to PVI. Tremendous progress in catheter technology and the evolution of electroanatomic mapping systems have made AFIB ablations far more safe and successful. In this video, we are using the CARTO mapping systems and catheters from Biosense Webster.
For additional information:
Atrial Fibrillation For Patients & Families - Full Presentation:
• Atrial Fibrillation Fo...
Patient-specific ablation for atrial fibrillation using rotors, CFAEs, pulmonary veins, and lines:
• Customized ablation fo...
Iv had 3 ablations but my AFIB has returned unfortunately. But it’s nothing like it was. I still work full time and life is good.👍
I just came upon this video and noticed it was actually produced approximately five years ago. I had an ablation procedure at North Shore University Hospital Manhasset, NY in March 2024. I myself happen to be a licensed x-ray technologist, and fluoroscopy exposure was one of the questions I posed to my electrophysiologist, Dr. Mitra. I was astounded when his response was that I would be exposed to zero fluoroscopy time. He explained to me that he is now able to do the procedure without x-ray/fluoroscopy. Personally, I was elated at hearing this. So it appears that advances in this procedure have come quite a ways in the last five years. As a radiologic technologist, I can confirm what Dr. Kneller is saying. Significant fluoroscopy exposure can be quite harmful to the patient. Ablation procedures can often run long, sometimes up to four hours. Although the doctor is not stepping on the fluoroscopy pedal the entire four hours, he could be exposing you to significant radiation. The effects of this radiation exposure are not immediately seen, so people have a tendency to marginalize this. This is definitely a question that the patient should be asking his/her electrophysiologist prior to the procedure.
I had an ablation in 1991 at Stanford University Hospital. I had suffered with arrhythmia and tachycardia that could not be controlled with medication. 30 years of no symptoms :)
What does it do?
My wife has suffered SVT all her life, she's been offered the ablation option; but she's apprehensive.
She'd rather stay with her meds and suffer.
@@James-bv4nu it’s scary! I have battled tachycardia my whole life. Now I have SVT. I have my ablation on Tuesday & I’m terrified.
I am here to tell you to stop being terrified regarding your ablation! You will be absolutely fine, I promise you! They now do those ablation routinely now days. You'll feel way less problem than anything you ever had. So take a deep breath and just calm down.
68 yr old female had ABLATION
Thank you for making us A-Fib patients aware of this!
Thanks so much my mom is in surgery now as i type need all the prayers i could get
Thanks a lot Dr. Kneller.
I’ve had 3 heart ablations and no one mentioned a word about the risks with fluoroscopy exposure.
I’ve had 3 “successful” heart ablations. 1st catheter ablation worked great for 2 1/2 years then my heart suddenly went back into persistent AF. 2nd ablation (mini-maze) worked great for 6 years then my heart went back into persistent AF. 3rd ablation (catheter) worked great for 3 1/2 years then my heart suddenly went back into persistent AF.
I’m scheduled to have a 4th ablation (another catheter) in 2 weeks. Again no one (RN’s, MD’s, EP’s have mentioned anything about fluoroscopy exposure.
Thank you doctor! Why can't there be more doctors like you!
Had it done over two years ago and I feel GREAT !
I'm scheduled to have mine done in two weeks. I'm so glad that TH-cam recommended this video! Thank you Doc!
Mr williams can you tell me how the procedure have you done it ? what do you feel i am planning to do it too
Thank you Dr. Kneller for this enlightening video.
Your advice is an eye-opener. Thank you. I had no idea that there was a radiation risk to the patient.
Dr Kneller performed an ablation procedure on my wife on 9/23/20. So far, so good
Im going for one soon but the risks worry me. How did she find the procedure?
I wish I would have seen this video 3 years ago when I had my ablation. Very informative. Thanks.
What a wonderful human being..
I happily had 3 ablations. Before all of them I could hardly stand up and goto the toilet. Any drugs slowed my heart and lowered my blood pressure to the extent I ended up in hospital. I think it’s the surgeons who take more risks than I do. I am very grateful they take this risk
Thank you doctor for this great information.
Thanks Dr. Kneller for the excellent video and all those who responded in the comments. I will undergo an ablation in 2 weeks and you all helped me calm my fears. I am a colorectal cancer patient just finished my chemo 3.5 months ago
Hi doc my question is I have structured heart dease COPD and had a total of 3 ablations 2 AFib 1 ventricular ablation all failed my electrophysiologists stated he has no clue what me heart problem is
Excellent video thank you, James. I love your way.
Brilliant & explicit presentation
condensed I a few mnts, a gift of wisdom knowledge & life♥️
Thanks for this invaluable information! You rock!!!
Thank you!
Thank you! I will ask these questions!
Wonderful information.Thank you so much. Fix 1 problem and inherent another.
Thanks so much for the tip. About to have this procedure in a few weeks.
That’s for that important information . I will ask him that question. Very informative . Thanks
Thank you! This was a great concern of mine and I am thankful for your explanation.
Great information. Thank You.
Thank you for the great explanation and education! 🤔😊🤗
Very useful info! thanks
Had ablation about year ago, felt great for a while, have hypo thyroid and I have having episodes of fast beats everyday. Going to my cardiologist this month. I just won't go away.
Thanks Doc! Didn’t know about this!
Thank you Dr. Kneller. You had the courage to admit one of the downsides of having the procedure done. The average patient is not always told the risks that are involved. Who wants to find out afterwards about a risk that should have been discussed upfront?
I got AFib want ablation
Thank for this info, very much appreciate knowledge of fluoro exposure and cancer & other complications.
Uhh, I didn’t know this was part of the procedure I had done 12/7/2023. I did as my doctor tons of questions, but a few questions I didn’t know I should ask.
She probably thoroughly explained everything, but it’s a lot to take in and try to understand.
I’ll add this question to the list for my svt ablation follow up appointment next week.
Thank You for taking the time to educate and explain! ❤
Thank you for that info- they never talk about there procedures - - leaving out very important for me to say NO OR YES
Thanks for telling me about this, I wasn't aware.
Thank You...!
Thank you for information
My dad is 67 and has a surgery appointment and i’m so nervous! Hoping for the best🙏🏽
No you for this information.
Thanks for that information doctor as I am looking into ablation for myself
I'll be getting this done the 28th of this month and I did as you said and asked my doctor and he said 10 min. at the most.
Many thanks Dr. Most useful.
This is awesome Dr. Kneller, from a retired cath lab/electrophysiology RN. Finally someone is giving informed consent to patients about prolonged radiation. Patients should be required to sign consents for this but my facility didn't have one. I've had to initiate sentinel event reports for patients who were overexposed. No one would call them post procedure and tell them either to watch for manifestations of radiation burn or future cancers. Repeat accumulated exposures add up the exposure. At least in the cardiac cath lab the camera eye is moving about but not the electrophysiology lab. Thank you for this important public service announcement.
I had an ablation 13 years ago and the surgeon burst my aorta.
I nearly bled out, as he decided to go in to my heart using a new method. I was in intensive care for two weeks, and have never forgotten it.
This procedure was carried out in St Mary’s London.
Hopefully new ways of ablating are now general practice, as I may have to have another one at a top hospital here in London.
I am full of trepidation.
That's terrifying I'm surprised you would get another one
Great advice that I didn't know about!
Thanks a lot for the insights!!
Had an ablation 6 years ago. A life changer for me. However Afib episodes have returned this year with a vengeance. With Covid slowing scheduled appointments, I did some research and have altered my daily regiment with positive results so far. Gave up drinking alcohol (ugh! I live in wine country), drinking more water and monitoring my magnesium, thyroid and other levels. So far I am six weeks episode free and really like it.
Yes. i had afib until i had my ablation, but i also found that magnesium is of benefit. Also. sound healing meditation for relaxation, because for sure afib causes anxiety and probably vice versa.
@@plantluvr2917 That magnesium is a no no for those who are on beta blockers 😩
@@TBONE82 Google it. I think only if it causes blood pressure to go too low. I had to discontinue beta blockers because of low blood pressure. That was b4 I was taking magnesium.
@@plantluvr2917 You are right!
I found that regular exercise like walking really helps too.
I’m glad I s saw this.
Dr. Kneller, thank you! Of all the videos I've watched, NOBODY mentioned the radiation hazard.
My ablation was life changing. It gave me my sleep back and my functional level back. Absolutely wonderful! It does take time after the procedure for it to finish going away, but it gets better every day.
same here brother
Unfortunately it only lasts a few years:/
@@Yash-rv3rp 111111
Doctor said AFIB should be gone completely in 3 months after ablation but mine took 5 months. So don’t get discouraged if you’re still getting it after the ablation.
@@winkstorm It took me several months. More than the cardiologist thought. But it did eventually go completely away.
Thank you I will be asking about flouroscopy time
Thank you doctor, EPS coder
I suffered from Afib and had an ablation three years ago and no more Afib. Always a danger but sometimes better than nothing.
Hello Doctor James, I will have an atrial fibrillation ablation procedure on Friday, December 10/2021. (next week). Thanks a lot for your Video!
Thank you so much. I had my ablation done yesterday and I did ask about the fluoroscopy time. And it was under 5 minutes. Thank you for educating everyone. You are awesome. Gob bless
Did you have cryoablation? I am in the middle of consults for cryoablation for afib.
@@michaelmccormick2890 no, mine was with radio frequency. I’ve read that for afin though. It is not uncommon to use cryo. I had avnrt.
good for you .good luck
Really interesting. My question is should I ask for leaded shields on my head, eyes, and thyroid?
Had an Ablation two years ago. The Afib was stopped, thank God but the problem I had was two weeks later my heart beat dropped from 62 to only 40 beats a minute. I then had to get a Pace Maker.
I am going for ablation. Thank you Doc.
I’m 28 having a fib episodes when I have glasses of wine or notice when I wear heels. Having my ablation in May and looking forward to going back to my normal life. I’m also a post transplant recipient so praying that my Procedure goes very well.
I’m going in next week. How did it go? I hope you’re feeling much better!?
Thank Sir
Thank you for the very serious information...this is why I like youtube people helping people...beautiful!
Skip the cardiology. You should be on Saturday Night Live. I loved the glasses bit
Thank you fro the heads up on flouro time!!!
Im currently scheduling and ablation at Froedert and the medical college of wisconsin
Thank you! I kept looking and found a doctor that does fluoroless ablation. I don't even get mammograms so this was important information to take in.
My ablasion lasted less than a year, but till then I had great energy!
Same here...I had 3 ablations and now 6 years later problems are back. They told me it would eventually come back.
What about me, as a Respiratory Therapist who for 35 years bagged patients in Cat scan right next to the torrid with lead vest only . Only in the last few years of working did I get a neck cover radio opaque goggles and a dosimeter. Since I've retired, I've had cataract surgery.
WOW well I will be checking on this as my ablation procedure is going to be scheduled in 7-10 bus days. I'm glad I watched this video. I'm positive my Dr will keep it minimal but will ask for sure. I do have cancer risk on father's side. I sure don't need any of that. AFib has been enough for me.
Worked for me!
Hello Dr!! I had an ablation process for Wolff Parkinson White (WPW) about 20 years ago in London at the Wellington Hospital. A Dr Nathan did my ablation which took many hours, I had 9 accessory pathways and one in the coronary sinus. His first words to me as I removed the 6 hour procedure was that he never wanted to see me again, my case the hardest he’d ever encountered. After your video, I’m now wondering how much radiation I was exposed to in a process, 20 years ago, that took 6 hours. The ablation was a total success and the WPW was eliminated and I’ve never had an event since, a few tachycardia events but that all. Previously I’d black out if I suddenly sat down, be t over in the shower, or even stepped off a sidewalk. Once I suddenly raised my arms and that triggered a WPW event. It was terrifying for sure. God Bless you for working in a more modern system and keeping us folks informed and up to date. Adrian in Bermuda 💕❤️💕
Omg. Just got diagnosed w fibrillation after mixing sleeping pills one nite. On meds. Fear of future.
Sad to say but I fear that no matter what improvement we have received or corrective surgery we received..our heart defects that we had have been training our hearts for far too long that there will be a few milliseconds where you're going to feel those beats trying to or successfully releasing those funky beats hear and their. Not because your procedure didn't work, by all means it did, but because its going against a muscle that has memorized a new beat for who knows how many years and now that a NEW BEAT is in town...of course its gonna put a fight up here n there. Just remember to breath slowly. Dont get excited or over excited meaning dont panic. This wont hurt you unless you have symptoms of a heart attack or stroke. They can start to or turn into panic attacks if you don't control these. I'm sure you got the best information ever on this from your dr on this..
I have a rare condition to which my heart did actually fight this and procedure was a fail. I was disappointed. The said it was my nerves...because I was young n woull not check in the er..even though i mentioned i just had surgery. Then my next visit I was having psvts...up in the 150s. Definitely not normal. However my bp was crashing. However er said I was having a panic attack n needed to calm down. When I finally got through all that mess. That's when we found out my procedure didn't work for me.
Anyway..sorry for a boring story lol...that was 16 years ago from now though..see still alive. 😊😁
Worry not. Not a big deal.
Had 2 ablations. Both failed to cure my AFib. On medication now. First one in 2012 lasted over 3 hours, nearly killed me. Second one in 2014 by another doctor was about 30 minutes.
Thanks for your encouragement and information my husband has AFib he is given Elquish for three months and we not know what they will do in future
Eliquist is expensive… I think is fr life, I had a mini stroke cause I have A-fib, I am on 10 mg a day
*
I was on the table at the SF VA twice for Ablation's. Felt better each time , and a tad bit more noticeable energy. Hey...at 76, I am not worried ,
However, I will address the issues Dr Kneller brought up with my Cardio Dr.
Age 73 and tried everything for my Atrial Flutter over 2 years. 150 pulse often. . Cardio-versions too. Doc put me on Flecainide even though WE AGREED it was dangerous. 4 hours later I was in ICU with heart failure. 1 hour later...VENTILATOR ! Doc felt bad and did and an immediate Ablation the next day..took 5 hours ! That was June 2020. Doing great Immediately I woke up, but a few ectopics(PACs) recently... NO AFIB.. Feel great in general and do heavy sawing etc no problem....pulse 69 and my Kardia-mobile ($80 amazon) says no AFIB.... NORMAL !
IM 49 and they put me on Flecainide. Thought I was just feeling crap...luckily was in for an appt when my pule shot up to 197!! Cardioverted twice then in for the ablation....hoping this is all behind me... to your health.
@@blakemoss7305 Flecainide had a homicidal effect on me but it can't be the same for everyone surely ? I usually have mild derision for people who claim weird reactions and allergies etc, and I take much aspirin etc etc with no bad effects. I took Eliquis with zero side effects. I was surprised to be almost killed by flecainide and I would urge a check with Emergency that they have flecainide blocker before taking any... It disrupts and jazzes up the heart rhythms so it goes into heart failure
Flexainide felt like it was killing me!! I stopped it then finally after finding the right heart doctor, he put me on Betapace AF…. Beta blockers helped my Afib!!
Very helpful. I’m seeing an electro cardiologist in two days. Was just diagnosed with a fib last week in the hospital and my first cardiologist appointment was a couple days ago. He discussed my options. There’s a big learning curve for this and these details are helpful. Also the comments are really helpful as I consider whether to go with ablation.
If it bothers you a lot you should consider it. No medication worked for me. Messed up my stomach after awhile. I had to do it twice (ablation) but much better today. I’ve heard of some people having 3 procedures. Everyone is different and every electro physiologist can vary on experience as well. Better then taking meds for the rest of your life. Blood thinners can be dangerous. 💖🙏🏻Wishing you the best. 🌴😎🌈Along 🤙🏼
@@youtubeguy1 thank you for sharing. It sounds like you could quit the blood thinners. Thinners are a big concern for me.
Fix it yourself. Stop all alcohol, take magnesium taurine, eat lots of fruit, do a sleep apnea study and limit stress.
Magnesium Taurate
@@nancybrown3885 Thanks for the advice. I'm doing all except have to get the magnesium taurate. I was taking calcium but my blood test showed high calcium. I stopped and actually I feel much better.
What are you doing to protect the patient.?.
What they never tell you about the procedure.......the level of involvement of trainees during this high risk procedure.
I totally agree.. there was another person that was being trained by my cardiologist during my operation. The rookie did the work. I suffered a tear, which cause a bleed, and an night in the CCU
Catheter ablation is not something to undertake lightly. It doesn’t necessarily reduce stroke risk, though many think it does - current thinking is to continue with anticoagulants. What it can do is to give you your life back if your condition is severe enough to restrict your lifestyle unacceptably. I’ve had two catheter ablations, and my surgeon is my hero. Thank you for giving me my life back, Dr Martin Lowe, I am for ever in your debt. Everything else is meaningless.
You don’t know what you are talking about. If you are going into an arrhythmia then you are at high risk of stroke. By having that ablation you take care of the arrhythmi then the stroke risk is gone. Do your homework before you talk non sense.
@@irvincasanueva3423 - I’m not a medical professional, and considering the tone of your response, I’m guessing neither are you. My understanding, gleaned from the homework I have done, is that at best the jury is out on this topic. If you personally have had an ablation (catheter, surgical or hybrid) and have been taken off anticoagulants, you might wish to revisit the issue. One reference is at th-cam.com/video/3VOq9BL7Y1U/w-d-xo.html (go straight to 4.45 if you wish to cut to the chase). I don’t think anything further can be achieved by continuing this thread unless a qualified professional would like to contribute.
@@neildesperandum6114 everyone here is a doctor from Google medical school. You are literally giving an statement in your comment that is not accurate. You are misleading people. I am a healthcare worker by the way. I’m happy your procedure went well.
@@irvincasanueva3423 Yes thank you..ridiculous
@@irvincasanueva3423 Yes exactly.
if your in an arythmia your at risk..what then is it? When did that fact ever change?
No one mentioned this to me I had two oblations scheduled for another but got a pacemaker instead!
Did any of your past patients who had 60 Minutes of exposure develop cancer?
What kinds of protection is offered to the patients during the procedure? Are they given partial lead covering over parts of their bodies, i.e., leaded thyroid cover, leaded head cover, leaded glasses? Wouldn’t these types of precautions lower heir radiation risks too?
Friday March 19, 2021 I escorting an ablation 7 min. fluoroscopy long at the SFVAMC. How does one verify that the Procedure was a full success? Could a surgeon miss the target preforming this procedure? What does one do if this has happened?
I have had 3 ablations, the last was 6 years ago. Having issues again...how many ablations can a person have safely?
Had mine done at Texas Clinic for Cardiac Arrhythmia by Dr. Natale. Great result. Life changing.
Late to the party but me too, 5 years ago. Excellent experience.
My husband had one two weeks ago and the doctor accidentally put a hole in his heart. He had to have open heart surgery to save his life. The doctor called his procedure-The One Percent, make sure you do your research so this doesn’t happen to you.
Thats horrendous. Hope he's ok? Did it fix it afib though afterwards. Poor guy.
I was warned this was a risk by my cardiologist along with possible damage to the oesophagus and lungs. I went ahead with it because being hit by 7 hour long episodes of aggressive afibs with greater frequency was wrecking my life.
No regrets. The first ablation only lasted a week. The second, called a redo, has so far lasted about 18 months. I’ve had occasional breakthrough symptoms, but otherwise the procedures gave me normality back, and it’s been wonderful.
Would I have an ablation again ? Show me the way to the lab !
@@Chipchase780 That's great news. So did they get to your heart through your thigh? I have persistent afib and cardioversion only last a week. I'm thinking cryoablation may be the best for me after the research I've done myself. How would ones esophagus get damaged 🤔 do they put tubes down there with the way you had it done?
@@PS-en7wn The esophagus is directly behind the left atrium. If the energy delivered to the the LA is too high or if the LA wall is thin, it can heat the esophagus enough to cause an ulcer, which can lead to a deadly condition called a fistula where an opening from the esophagus into the heart develops several weeks after the ablation. This is rare but if it occurs the chances for recovery are not good. It's more likely to happen if the patient has a bad esophagus already due to reflux or other conditions.The main point is that it's rare and usually requires an already weakened esophagus.
@@CT-if2tt Nice to know. I'm hoping to get cryoablation so I believe that's safer and less chance of such complications like that...if I'm reading the right information. Thanks.
@JamesKnellerMD
I got Atrial fibrillation after a Mitral Valve replacement in 1996. Around 2000 I was put to sleep had my heart stopped and restarted, but the effect of it only lasted about a week. I had read at the time about this procedure and at the time asked my cardiologist he told me it would not be any good in my case. As I said that was in 2000. Does this hold true today? I have very little energy, and my sleep pattern is very bad. I was 75 in March of 2021.
I have a question. I have had 2 cardiac ablations and fortunately my afib has been in control for about 5 years. I recently had an ablation on my legs for Chronic Venous Insufficiency. Is flouroscopy used for this ablation?
Having mine on Friday
Do you have any experience with PFA (Pulsed Field Ablation) please and if so, what's been your observation in terms of rate of a fib recurrence. Thank you!
Thanks so much for this info...I had no idea..I will be asking about this for my procedure in 2 weeks..🙏🙏
I have to get this done and already having issues with potential doctors...the first doctor that I was referred to cannot provide insight in terms of how much of fluoroscopy will be used...
My electrophysiologist said if we do the rf procedure, the fluoroscopy will be 5 to 10 minutes. Double that if we do the cryo. Does that sound ok? Thanks!
Thank you so much!!! This is great information
I've had 4 ablations. I was honestly the lab rat for my first2 but donated all my medical history to the hospital to hopefully help others with certain conditions. I have a pacemaker..but now I'll be going to get my 5th. Honestly..I wish I was as fortunate like everyone here to say I was back at 100% however..my two natural pacemakers are not working any long..and now this will be on my av node. My last natural pacemaker. I ended up have a heart attack a year after my 4th child. However..my condition is rare...I do hope ablations help you all and your quality of life. I am so grateful for every day I've been given.
Grrrrl 4 kids congratulations!
@@MrsPaulaTorres thank you 😊😍
I was just diagnosed with A-fib. I have had a pacemaker since i was 54 (I'm now 71) The pacemaker was installed to keep my heart rate at 60 bpm. It was running around 34 bpm. My whole life I've had a low pulse rate. How come the pace maker can detect the a fib, but it doesn't stop the episode? Thanks!
Does the hospital have the lead vest
I had an ablation this week and my doctor said he used 0 fluoroscopy. I guess the new technology is really getting good.
Never would I have ever had my ablation. I had 2 the second one my left atrium was punctured. I only got worse. I presently have a pacemaker which I am totally dependent on.
I need it but have been skeptic about but I hate the eliquis I am on. I bruise like a banana. Thanks for the info!
Since when did Thomas Dolby qualify as a cardiologist ?
I am looking at an ablation procedure for AFib & Atrial Flutter. What is a normal exposure time for the dual procedure?